The Pharmaceutical Journal
Vol 274 No 7336 p179
12 February 2005

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Drug Utilisation Research Group

Patients need more NPfIT information

It is important to consider the National Programme for IT from a patient perspective, Sue Benn, manager of the Patient Advice and Liaison Service (PALS) at University College London Hospitals, reminded delegates. The problem is, she explained, that most patients do not actually have a perspective because they are not well enough informed.

For example, she described how in a straw poll of visitors to PALS in a recent week, 100 per cent of patients responded positively when the benefits of electronic transfer of prescriptions (ETP) were described to them. However, when asked if they would mind pharmacists having access to their personal records 48 per cent of patients said they would not be happy with that arrangement. Although this was not an official survey, it is an indication that patients need more balanced information about such services, beyond what they may read in the national papers and going further than a few leaflets scattered in GP surgeries, she said.

Will patients understand how ETP works and will they know whether to contact their GP or pharmacist for a repeat prescription, she asked.

Ms Benn acknowledged the vast opportunities that NPfIT will bring, but also raised some questions about areas of concern. For example, what would be the implications for the stored data if companies were to fold, and what would happen to the audit trail?

Mrs Benn also voiced her concern about the capacities for increasing workload and the implications for independent pharmacies.

“I’m sure a lot of the answers to these questions are out there,” she said, “but I do not know them and patients will not know them.”

Secondary users

Tom MacDonald, professor of clinical pharmacology at the division of medicine and therapeutics, University of Dundee, described how NPfIT will benefit pharmacoepidemiology studies, many of which are conducted in the NHS environment. He explained that although large GP databases have been available for some time, limitations exist in the form of missing data, transcription errors and an inability to link to complete hospital, laboratory or dispensed prescribing data. “NPfIT promises to create the world’s largest high quality and truly population-based dataset,” he says. “This will enable research to be done quickly that will improve the safety, efficacy and quality of care provided by the NHS.”

Professor MacDonald also said that ETP could revolutionise drug safety surveillance.

Practicalities and safety issues

Mike Bainbridge, senior clinical architect for NPfIT, told delegates that although concerns have been raised about patient confidentiality with electronic records, NPfIT will enable patients to know exactly who has been looking at their records, by means of an access trail, which is not possible with paper records.

Dr Bainbridge mentioned that more computer terminals being installed in hospitals with multiple users could pose an infection hazard, such as the transfer of bacteria from people’s hands. He explained that infection- resistant keyboards were being explored as a hardware solution to this potential problem.

Another factor to consider, he said, is that because different systems are being installed for different area clusters, safety mechanisms will need to be put in place for clinicians who work across the border areas and will therefore need to learn how to use more than one system.

Tony Avery, chairman of DURG asked if patients’ existing records would be entered into the new database or if data would only be available for records made from now onwards. Dr Bainbridge replied that they were looking into the risk of rapidly transferring existing data to the electronic record with the risk of transcription errors, and the risk of data not being uploaded at all.

When asked how the new patient records would affect confidential reporting of medication errors, Dr Bainbridge said that there will always be the need for the anonymised data that the National Patient Safety Agency currently collects, but that over the next 18 months to two years the benefits of being able to see what is going on right across a patient’s record will be seen.

“As long as we keep a keep a clear head about the architecture [of NPfIT] and when it is going to happen the safety will flow out of it,” he said.

PSU joins new centre

Dave Roberts, manager of the Prescribing Support Unit (PSU) explained how the PSU will form part of a new health and social care information centre, based in Leeds, in April. He explained that the centre has been created to improve the quality and use of information and knowledge for the benefit of patients and service users, and it will work with all parts of the health and social care system and the NPfIT.

PPI research awarded McGavock bursary

The McGavock bursary of £500 was awarded to Kathleen Bennett and her team from the department of pharmacology and therapeutics at St James’s Hospital, Dublin, and the department of gastroenterology, Adelaide and Meath Hospital, Dublin, for their research into the use of proton pump inhibitor (PPI) maintenance therapy after triple therapy regimens.

They followed a cohort of 2,239 patients receiving triple therapy and after one year they assessed whether patients were asymptomatic, required second line triple therapy or were on maintenance PPI therapy. They found that nearly 55 per cent of patients remained on maintenance PPI, the majority of these at a high dose, suggesting that GPs in Ireland are continuing to prescribe these drugs at a high dose after triple therapy eradication, contrary to prescribing recommendations and the cost implications of this.

DURG also awarded a £50 prize for the best poster presentation to Alan Wade, director of CPS research in Glasgow, for his poster on “A holistic evaluation of attitudes to depression.”