We were called into a large surgery in West Yorkshire with nearly 12,000 registered patients. The practice had sixteen doctors in total and were supported by over twenty-five allied staff members.
I ran the Bone Health Osteoporosis and Vitamin D Audits at the practice as a medicines optimisation exercise to make better use of bone health treatments and cost-effective use of medicines.
The audit was split into five parts as follows:
Part 1 – Identifying patients who fall under high risk fragility fracture risk groups based under NICE and SIGN Osteoporosis guidelines. These 5 categories are;
• Patients who suffer from osteoporosis
• Patients prescribed bisphosphonates
• Patients who are housebound or lives in nursing/residential home
• Patients who are taking long term and/or high dose corticosteroid
• Patients who are over 75 years with a history of one or more fragility fracture(s) after 50 years
Patients in these five groups were narrowed down to those who are eligible to receive some sort of Calcium and Vitamin D supplement – Calcium and Vitamin D is to help replenish bones and reduce the risk of bone fractures thus acting as preventative medicine from fractures from occurring or reoccurring – patients would then be prescribed a Calcium and Vitamin D supplement and reviewed to see their progress.
Part 2 – Identifying patients on higher costing Calcium and Vitamin D supplements and calculating the cost saving if patients were to be switched to a more cost effective Calcium and Vitamin D supplement – this would help in saving on the medicines prescribing budget GP surgeries are allocated and make better use of resources, particularly to where they are more urgently needed not just in the surgery but also wider health economy – the switching exercise would be authorised by the surgery and patients informed of change.
Part 3 – Improving QOF (Quality Outcome Framework) prevalence for Osteoporosis in the surgery where potential patients who can go onto the Osteoporosis QOF register are identified and appropriately coded thus helping surgery reach their prevalence targets and appropriately treat newly identified Osteoporosis patients.
Part 4 – Identify patients who are over 65 years of age and are taking either antipsychotics and antihypertensives and to ensure they have minimal chance of falls whilst on these medications particularly if they feel dizziness and light headedness – this is by providing the surgery with a list with these patients and reviewing their falls risk status normally through a falls risk assessment.
Part 5 – Reviewing bisphosphonate prescribing for patients particularly those who have been taking bisphosphonates for over five years and take appropriate action according to guidelines in terms of how to take their treatment forward.
An audit completion report would then be written for the practice to display the results and also for the practice to present their clinical audit findings for CQC inspection.
A small Vitamin D prescribing audit would also be carried out to go hand in hand with the Osteoporosis audit as a predominantly cost saving exercise especially as Vitamin D is a “top 10 dispensed drug” in the UK with over 24 million units dispensed in 2020/21 (https://nhsbsa-opendata.s3.eu-west-2.amazonaws.com/pca/pca_summary_narrative_2020_21_v001.html)
In this surgery’s scenario we helped directly save over £10,000 in prescribing costs over just one day’s worth of work by optimising and making use of more cost-effective forms of Calcium and Vitamin D as well as helping boost the Osteoporosis QOF prevalence through appropriate and correct coding and putting a review plan in place to assess patients who are in high fracture risk groups to take adequate Calcium and Vitamin D so helping reduce fracture rates and costly hospital admissions.
The GP partners and management were very pleased of the results and a re-audit date was penciled in for 12 months time to ensure standards are maintained and patients are appropriately treated.
