On 2017 I signed our practice, Lockside Medical Centre to CPRD, a research initiative, funded by MHRA/NIHR, that routinely collects anonymised patient data from practices to support innovative public health research. Extracted data enables drug/vaccine safety studies, helps develop clinical guidelines ensuring better care for patients.
I have often been irritated (and I’m sure I’m not the only one) with ‘Evidence-based medicine’. It’s a great idea isn’t it, to only base our therapy decisions on what has been proven to work in clinical trials. But when you get down to the detail, pretty much all of my patients would have been excluded from the trial… too old… too ill… on too many other medicines. So what we really need to guide our clinical decisions is real life research based on tens, if not hundreds, of thousands of patients. Though my motives were initially altruistic, signing up turned out to bring other benefits.
A few years ago CPRD linked up with the Clinical innovation and Research Centre of RCGP to create Quality Improvement reports for practices who had signed up to CPRD. Currently 100 practices are signed up in Greater Manchester, and nearly 1,400 across the UK. This means, a couple of times a year, they are able to extract data related to particular issues, which might be a concern for our patients, particularly related to prescribing safety.
We receive medicines safety alerts so often, that it is sometimes hard to see the wood for the trees. Whilst some are very high profile, such as the danger of valproate in pregnancy, some are less so, like the importance of avoiding glitazones in patients with heart failure or anti-psychotics in people with learning disability or autism.
The CPRD/RCGP QI Reports are so helpful. They look at some of these ‘hard to remember’ issues, and send us an easy to read report, benchmarking our practice’ prescribing against other CPRD practices, and also giving us a trend line over time, so we can see if changes we have introduced have made a difference. They also provide us with the patient’s unique identifier number from our medical records systems so we can quickly identify people who may benefit from a GP or pharmacist review.
As well as the safety aspect, they have also chosen to focus on looking at patients with AF who are on aspirin monotherapy. This is particularly helpful as, when guidance changes, practice is often slow to follow.
I was pleased to see our figures on all of the indicators had improved on the second report, and that we were doing well compared to others.