Walker Alex J, Curtis Helen J, Croker Richard, Bacon Seb, Goldacre Ben
Evidence Based Medicine DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
J Med Internet Res. 2019 Jan 16;21(1):e10929. doi: 10.2196/10929.
OpenPrescribing is a freely accessible service that enables any user to view and analyze the National Health Service (NHS) primary care prescribing data at the level of individual practices. This tool is intended to improve the quality, safety, and cost-effectiveness of prescribing.
We aimed to measure the impact of OpenPrescribing being viewed on subsequent prescribing.
Having preregistered our protocol and code, we measured three different metrics of prescribing quality (mean percentile across 34 existing OpenPrescribing quality measures, available "price-per-unit" savings, and total "low-priority prescribing" spend) to see whether they changed after the viewing of Clinical Commissioning Group (CCG) and practice pages. We also measured whether practices whose data were viewed on OpenPrescribing differed in prescribing, prior to viewing, compared with those who were not. We used fixed-effects and between-effects linear panel regression to isolate change over time and differences between practices, respectively. We adjusted for the month of prescribing in the fixed-effects model to remove underlying trends in outcome measures.
We found a reduction in available price-per-unit savings for both practices and CCGs after their pages were viewed. The saving was greater at practice level (-£40.42 per thousand patients per month; 95% CI -54.04 to -26.81) than at CCG level (-£14.70 per thousand patients per month; 95% CI -25.56 to -3.84). We estimate a total saving since launch of £243 thosand at practice level and £1.47 million at CCG level between the feature launch and end of follow-up (August to November 2017) among practices viewed. If the observed savings from practices viewed were extrapolated to all practices, this would generate £26.8 million in annual savings for the NHS, approximately 20% of the total possible savings from this method. The other two measures were not different after CCGs or practices were viewed. Practices that were viewed had worse prescribing quality scores overall prior to viewing.
We found a positive impact from the use of OpenPrescribing, specifically for the class of savings opportunities that can only be identified by using this tool. Furthermore, we show that it is possible to conduct a robust analysis of the impact of such a Web-based service on clinical practice.
OpenPrescribing是一项免费获取的服务，可让任何用户在个体医疗机构层面查看和分析国民医疗服务体系（NHS）的基层医疗处方数据。该工具旨在提高处方的质量、安全性和成本效益。
我们旨在衡量查看OpenPrescribing对后续处方的影响。
在预先注册我们的方案和代码后，我们测量了三种不同的处方质量指标（34项现有OpenPrescribing质量指标的平均百分位数、可用的“单位价格”节省以及“低优先级处方”总支出），以观察在查看临床委托小组（CCG）和医疗机构页面后这些指标是否发生变化。我们还测量了在OpenPrescribing上其数据被查看的医疗机构与未被查看的医疗机构在查看之前的处方是否存在差异。我们分别使用固定效应和组间效应线性面板回归来分离随时间的变化和医疗机构之间的差异。我们在固定效应模型中对处方月份进行了调整，以消除结果指标中的潜在趋势。
我们发现，在查看了医疗机构和CCG的页面后，两者的可用单位价格节省都有所减少。在医疗机构层面的节省幅度更大（每月每千名患者减少40.42英镑；95%置信区间为-54.04至-26.81），高于CCG层面（每月每千名患者减少14.70英镑；95%置信区间为-25.56至-3.84）。我们估计，自该功能推出至随访结束（2017年8月至11月），在被查看的医疗机构中，医疗机构层面的总节省为24.3万英镑，CCG层面为147万英镑。如果将从被查看的医疗机构中观察到的数据节省推广到所有医疗机构，这将为NHS带来每年2680万英镑的节省，约占该方法可能节省总额的20%。在查看CCG或医疗机构后，另外两项指标没有差异。被查看的医疗机构在查看之前总体处方质量得分更差。
我们发现使用OpenPrescribing有积极影响，特别是对于只能通过使用此工具才能识别的节省机会类别。此外，我们表明可以对这种基于网络的服务对临床实践的影响进行有力分析。
