Evaluating the National rollout of a pharmacist-led information technology intervention (PINCER) in English general practice, using a Clinical Practice Data link ‘non standard linkage’

Problem

PINCER is a pharmacist-led information technology intervention targeting hazardous prescribing in general practice. We previously reported the effectiveness and cost-effectiveness of PINCER at reducing hazardous prescribing in the East Midlands by 18%, 23% and 22% at 6-, -12 and 24-months post-intervention. The PINCER intervention searches GP clinical systems to identify patients at risk of hazardous prescribing, identified by prescribing safety indicators, and with pharmacist support the practice acts to correct the prescribing to minimise future risk.Between 1st July 2018 and 30 June 2021, PINCER was implemented in over 2,800 (41%) GP practices practices across England. An updated set of indicators were used including both prescribing and monitoring indicators were used. This new study aimed to evaluate the effectiveness of the national roll out of PINCER at reducing patient exposure to hazardous prescribing and suboptimal monitoring, and investigated whether PINCER also reduces the incidence of serious harm in patients at risk of hazardous prescribing using secondary care data.

Approach

The intervention was implemented over a 3 year period, therefore to evaluate the effectiveness of the intervention, we needed to link retrospective general practice data, death data, deprivation data and secondary care data to separately held practice level implementation dates. We worked with the Clinical Practice Data Link (CPRD) to use a non-standard linkage to pseudonymously link to GP practice implementation dates.

Findings

This process has enabled data from 715 practices to be linked and extracted. These include the practices who implemented PINCER as part of the national roll out and who were included in CPRD with HES linkage. Using the PINCER indicators we identified patients with potentially hazardous prescribing and associated serious harm outcomes, collecting data over a maximum of 26 quarterly time periods between Jun 2015 and Dec 2021.A CPRD non-standard linkage is a valuable tool to enable the effectiveness of interventions, where the intervention is not recorded within the routinely collected clinical data, to be evaluated.We hypothesise that the intervention when rolled out within England will support our previous findings that PINCER is effective at reducing patient exposure to hazardous prescribing. This study will provide further evidence to support whether PINCER also reduces the incidence of serious avoidable harm.

Consequences

The results from this study will further support the use of PINCER in England to improve prescribing safety and patient outcomes, via their inclusion in clinical decision support tools and in national policy.