Dashboards to reduce inappropriate prescribing of metformin and aspirin: A quality assurance programme in a primary care sentinel network

Simon de Lusignan; William Hinton; Samuel Seidu; Mekha Mathew; Michael D Feher; Neil Munro; Mark Joy; Fabrizio Carinci; F D Richard Hobbs; Kamlesh Khunti

doi:10.1016/j.pcd.2021.06.003

Dashboards to reduce inappropriate prescribing of metformin and aspirin: A quality assurance programme in a primary care sentinel network

Prim Care Diabetes. 2021 Dec;15(6):1075-1079. doi: 10.1016/j.pcd.2021.06.003. Epub 2021 Jun 17.

Authors

Affiliations

¹ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London, UK. Electronic address: simon.delusignan@phc.ox.ac.uk.
² Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK.
³ Diabetes Research Centre, University of Leicester, Leicester, UK.
⁴ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
⁵ Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK.
⁶ Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK; Department of Statistical Sciences, University of Bologna, Italy.

PMID: 34147402
DOI: 10.1016/j.pcd.2021.06.003

Abstract

Aims: To pilot two dashboards to monitor prescribing of metformin and aspirin according to the National Institute for Health and Care Excellence (NICE) 'Do-Not-Do' recommendations.

Methods: This quality assurance programme was conducted in twelve general practices of the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network. We developed dashboards to flag inappropriate prescribing of metformin and aspirin to people with type 2 diabetes mellitus (T2DM). In Phase 1, six practices (Group A) received a dashboard flagging suboptimal metformin prescriptions in people with reduced renal function. The other six practices (Group B) were controls. In Phase 2, Group B were provided a dashboard to flag inappropriate aspirin prescribing and Group A were controls. We used logistic regression to explore associations between dashboard exposure and inappropriate prescribing.

Results: The cohort comprised 5644 individuals (Group A, n = 2656; Group B, n = 2988). Half (51.6%, n = 2991) were prescribed metformin of which 15 (0.5%) were inappropriate (Group A, n = 10; Group B, n = 5). A fifth (17.6%, n = 986) were prescribed aspirin of which 828 (84.0%) were inappropriate. During Phase 1, metformin was stopped in 50% (n = 5) of people in Group A, compared with 20% (n = 1) in the control group (Group B); in Phase 2, the odds ratio of inappropriate aspirin prescribing was significantly lower in practices that received the dashboard versus control (0.44, 95%CI 0.27-0.72).

Conclusions: It was feasible to use a dashboard to flag inappropriate prescribing. Whilst underpowered to report a change in metformin, we demonstrated a reduction in inappropriate aspirin prescribing.

Keywords: Aspirin; Metformin; Primary health care; Type 2 diabetes mellitus.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aspirin / adverse effects
Diabetes Mellitus, Type 2* / diagnosis
Diabetes Mellitus, Type 2* / drug therapy
Humans
Inappropriate Prescribing / prevention & control
Metformin* / adverse effects
Primary Health Care

Substances

Metformin
Aspirin