Background
Low-value prescribing practice nomination
Low-value prescribing practice quantification
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Cataloguing nominated low-value prescribing practices from low-value lists published internationally. This process is ongoing and will be updated to incorporate additional practices appearing on international lists.
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Translating low-value prescribing practices into indicators that can be applied to Australian routine data collections.
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Quantifying the extent of low-value prescribing practices in Australia.
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Quantifying the downstream consequences of low-value prescribing practices in Australia.
Methods
Cataloguing low-value prescribing practices
List | Total number practices within lista
| Number (%) prescribing practices within lista
|
---|---|---|
Choosing Wisely USA [64] | 421 | 86 (20%) |
Choosing Wisely Canada [65] | 176 | 41 (23%) |
Choosing Wisely Italy [66] | 111 | 20 (18%) |
Choosing Wisely Australia [67] | 93 | 33 (35%) |
Choosing Wisely International top 10 list [54] | 10 | 5 (50%) |
Choosing Wisely Netherlands [68] | 35 | 2 (6%) |
Choosing Wisely Switzerland [69] | 10 | 2 (20%) |
Duplication of practices within and between lists
Defining broader and narrower definitions of low-value practices
Translating low-value prescribing practices into indicators applied to Australian routine data collections
Australia’s health care setting
Australia’s routine data collections
Dataset | Variables of interest |
---|---|
Medicines prescribed in the community | |
Dispensing Dataset: Pharmaceutical Benefits Scheme (PBS) dispensing claims. Available 2005 to current Custodian: Australian Government Department of Human Services | Item number, date of prescribing and dispensing service, patient co-payment, cost to government, patient demographics (age, gender, location of residence mapped to Socioeconomic Index and Remoteness classifications), provider location (also mapped), fact of death |
Prescribing Dataset: MedicineInsight. Available 2010 to current Custodian: NPS MedicineWise | Prescribed medicines (date of prescribing; prescribed daily dose; indication for prescribing), test ordering (date of request, results), patient demographics (age, gender, location of residence mapped to Socioeconomic Index and Remoteness classifications), patient past medical and family history, referrals, management plans, immunisations, provider location (also mapped) |
Datasets to which PBS dispensing data will be linked | |
Tests, procedures and outpatient consultations Dataset: Medical Benefits Schedule (MBS) service claims. Available 2004 to 2013 Custodian: Australian Government Department of Veterans Affairs | Item number, date of service, scheduled fee, provider charge, benefits paid, patient co-payment, patient demographics (age, gender, location of residence mapped to Socioeconomic Index and Remoteness classifications), provider location (also mapped) |
Hospitalisations Dataset: NSW Admitted Patient Data Collection Available July 2000 to current Custodian: Director, Demand and Performance Evaluation Branch, NSW Department of Health | Diagnostic and procedure codes, diagnosis-related groups (admission costs), hospital type, separation date and status, geographic location of patient residence and hospital; patient demographics (age, gender, place of residence) |
Emergency department visits Dataset: NSW Emergency Department Data Collection. Available 2005 to current Custodian: Director, Demand and Performance Evaluation Branch, NSW Department of Health | Triage category, diagnostic codes; mode of arrival; hospital type, geographic location of patient residence and hospital, separation date and status, patient demographics (age, gender, place of residence) |
Cancer notifications Dataset: NSW Central Cancer Registry. Available 1994 to current Custodian: Central Cancer Registry NSW | Date of new cancer diagnosis, type of cancer, stage at diagnosis |
Death data Dataset: Registry of Births, Deaths and Marriages NSW. Available 1994 to current Custodian: Registrar of Births, Deaths and Marriages NSW | Cause of death, place of death, date of death, decedent demographics (age, gender, place of usual residence) |
Pharmaceutical Benefits Scheme data
Prescribing data
Prescribed medicine data linked to other routinely collected datasets
Indicator development and application
Prescribing practice example number | Practice | Choosing Wisely list |
---|---|---|
1 | Avoid prescribing antibiotics for upper respiratory infections | USA |
2 | Don’t use benzodiazepines in the elderly | International |
3 | Avoid long-term PPI therapy for GI symptoms | International |
4 | Avoid antipsychotics for dementia | International |
5 | Do not use antibiotics in asymptomatic bacteriuria | Australia |
6 | Don’t recommend the regular use of oral non-steroidal anti-inflammatory medicines (NSAIDs) in older people | Australia |
7 | Don’t prescribe testosterone therapy unless there is evidence of proven testosterone deficiency | Australia |
8 | Don’t initiate and continue medicines for primary prevention in individuals who have a limited life expectancy | Australia |
9 | Don’t routinely prescribe two or more antipsychotic medications concurrently | USA |
Indicator components | Prescribing practice | ||||||||
---|---|---|---|---|---|---|---|---|---|
1. Antibiotics in URTIs | 2. Benzodiazepines in elderly | 3. Long-term PPIs | 4. Antipsychotics in dementia | 5. Antibiotics in bacteriuria | 6. NSAIDs in elderly | 7. Testosterone | 8. Primary prevention in limited life | 9. Antipsychotic polypharmacy | |
Dispensing data | |||||||||
Patient demographicsa
| X | X | X | X | |||||
Initiation (date of dispensing) | X | X | X | X | X | X | X | X | X |
Discontinuationb
| X | ||||||||
Concomitant useb
| X | ||||||||
Switchingb
| |||||||||
Comorbidityb
| X | X | |||||||
Fact of death | X | ||||||||
Prescribing data | |||||||||
Patient demographicsa
| X | X | |||||||
Initiation | X | X | X | X | X | X | X | X | X |
Discontinuation | X | ||||||||
Concomitant use | X | ||||||||
Switching | |||||||||
Indication stated by prescriber | X | X | X | X | X | X | |||
Test ordering | X | X | |||||||
Comorbidities | X | X | |||||||
Hospitalisation data | |||||||||
Co-morbidity (ICD-10 code) | X | X | X | ||||||
Pathology data | |||||||||
Test results | X | X | |||||||
Death data | |||||||||
Date of death | X | ||||||||
Cancer data | |||||||||
Cancer diagnosis | X |