Greener Inhaler Prescribing reports

Greener Inhaler Prescribing reports

In clinical reporting within SystmOne, you will see a new sub-folder called ‘Greener Practice’.  This contains sub folders relevant to each improvement area – these can then be run when required.


 

InfoPrimary Care IT has collaborated with Greener Practice to produce supporting searches for their asthma toolkit.

Accessing the reports

The reports are freely available to all healthcare organisations, and are available for both EMIS Web and SystmOne. SystmOne organisations can submit a ticket to PCIT to request to join the free share group. PCIT Subscribers will already find the reports on their systems.
 

Reports overview

The screenshot below shows the following folders of reports which mirror the tasks in the asthma toolkit. TPP sorts these folders alphabetically, but the remainder of this article will follow the order shown in the toolkit.



Idea
The projects have been written with a view to focusing on patients with asthma. These reports take a slightly different approach by ignoring patients with a COPD diagnosis; we recognised that there are a significant number of patients who do not have an asthma diagnosis, but receive prescriptions for inhalers on a regular basis. The Reports Outputs include a column to help distinguish between those who already have an asthma diagnosis and anybody who has no respiratory diagnosis.

All of the projects below can be used with a selection of customised Output Reports which have been designed to extract additional relevant information about the patient without the need to immediately access each record for the purposes of data gathering.

Every report begins with some patient details, including telephone contact details in case the report is used to contact patients.

Diagnosis

GIP-110) SABA without asthma diagnosis

The details of this project can be found here.



The top report has been designed to identify patients who have received SABA prescriptions in the past 12 months, who are not currently diagnosed with asthma or COPD. This report is sub-divided into those patients who have had a spirometry or FeNO test, and those who have not. The GIP-111 and GIP-112 reports have been designed to refine the results and pull out additional information which will save time checking various parts of the medical record. 

A Report Output has been defined when viewing patients, called Greener Practice 2. This shows details of the most recent SABA issue, plus the most recent spirometry and/or FeNO codes. If any patients have previously been diagnosed, it will be seen as Asthma resolved. 

We recommend exporting the entire results from this report and use the Sort or Filter options in Excel. This will enable you to prioritise patients who have had multiple SABA issues for review.

 

Disease Control 1: Identifying poor asthma control


The details of this project can be found here.



This folder contains a number of different reports designed to review asthma control. Patients appearing in this folder do not have a current diagnosis of COPD, but are likely to have a current diagnosis of asthma; patients with no formal diagnosis will also appear.


Idea

A Report Output has been defined when viewing patients, called Greener Practice 1. This shows details of the earliest asthma diagnosis, most recent SABA issue, most recent prednisolone issue, latest acute exacerbation, and if recorded in the last 12 months - the number of exacerbations in the previous 12 months.  

We recommend exporting the entire results from this report and use the Sort or Filter options in Excel. This will enable you to prioritise patients who have had multiple SABA issues for review.

GIP-122) 6 or more SABA in last 12 months
A high number of issues of a SABA inhaler may suggest suboptimal asthma control. This report is similar but not the same as the old PCN DES IIF indicator RESP-02 as it includes patients with no respiratory diagnosis as well as those with an asthma diagnosis, but nobody with a diagnosis of COPD. A shortcoming of the report is that it does not pick up patients who had 3 separate issues of 2 devices, or 2 issues of 3 devices in the last 12 months. 

GIP-124) 2 or more courses of oral steroids in last 12 months
This report looks at patients who had at least 2 issues of oral steroids (prednisolone) in the past 12 months. Oral steroid issues in asthma are suggestive of exacerbations. Patients with COPD are not shown in this report as they may also be issued oral steroids in the form of a rescue pack, but patients with no respiratory diagnosis are shown.

From the original report output it will be necessary to refine the patients by removing patients who have Polymyalgia rheumatica and various other conditions which require regular oral steroids. 

GIP-126) Asthma exacerbation coded in last 12 months
This report looks at coded asthma exacerbations from the past 12 months. The report has been built as wide as possible and looks at codes with a SNOMED CT attribute of a disorder (eg: Acute asthma) as well as the observation attribute of 'Number of asthma exacerbations in past year'. This latter code will have a value corresponding to the number of exacerbations. The caveat to this number of asthma exacerbations in past year is that if this code had been added 360 days ago, a single episode of exacerbation could have been nearly 24 months ago.

Use the report to distinguish between those who have a current asthma diagnosis and those who do not. The report also shows how many exacerbations have been recorded and when they occurred.

Disease Control 4: Identifying patients on SABA alone


GIP-140) On SABA, no other asthma therapy, no COPD
Anybody who has SABA but no other inhaled therapy such as ICS.

Device Choice

The details of this project can be found here.



GIP-150) Ventolin Evohaler or generic salbutamol pMDI on repeat

This report has been designed to identify patients over the age of 5 who have Ventolin Evohaler on their current medication list. The idea of the project is to change patients to a lower carbon dioxide emitting alternative. This was part of the ES-02 indicator for PCN DES IIF, which focused on reducing the number of inhalers prescribed which have a high CO2 emissions value per device by switching to a device with a lower CO2 emissions value. Much like ES-02, the generic Salbutamol CFC free inhaler 100 microgram is not recommended as it has a similar CO2 emissions value to the Evohaler.

Idea

The Report Output Greener Practice 1 can be used to view the dose instructions any current Ventolin Evohaler medication.


Disposal

The details of this project can be found here.

Info

Info
Disposal projects 1&2 focus on informing and educating patients on how to dispose of or recycle their empty inhalers. 
Unlike the previous folders, this folder identifies all patients with inhaler issues regardless of diagnosis.



Unlike the previous projects the GIP-160 search only takes into account repeat inhaler issues, meaning that patients with asthma or COPD diagnoses are included as well as patients with no coded respiratory diagnosis.

The Output Report Greener Practice 1 will help to list which inhalers each patient has been issued in the past 12 months. SystmOne does not yet offer an appropriate code to document education about inhaler disposal.

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