Alerts feedback

[sebbacon]

Feedback originating from alerts users:

Things that are done now:

• "Top or bottom 10%" is confusing for some. Perhaps "deviated a long way from the median practice"? (#979)

Things to consider:

• Deal with noisy practices. Possibly 3 month smoothed average? (#999) Related to this:

  Monthly is too frequent - quarterly data would be better - time to respond to info and long time period so less variation

• Mention how many measures in total to give context to the highlights mentioned

• quantify "massively" "considerably" or "slightly".

• make sure measures are explained clearly, e.g. make it more clear which measures are proportions or totals or capitations (easier to interpret for practices undergoing e.g. mergers).

  Kamal suggestion: "You prescribed XXXX Keppra items out of XXXX total for leviteracetam. If you could reduce this to XX%, you could save £XXXX over the next six months."

  (Resolved with new legend/titles) ~Anna: The GPs in particular weren't actually sure what the measures were, because the descriptions we tested were a bit cryptic. We just need to be a bit clearer.~

  your feedback would make more sense if it was contextualised by giving comparative regional & national data (Demographically weighted or equivalised ASTROPU-style)

• Give a demographic summary of registered population?

  Provide further context with data on the profile of patients (age and gender being the obvious ones) and how it differs from the average?

• Make it clearer that "slipping" relates to your ranking, not absolute performance:

  With the statement High Cost prescribing slipping on ED - surely that is a good thing we are not prescribing high cost drugs?

Things we can't do (possibly address in FAQ)

• Prescriber-level data

  ...data by practice is not really representative as prescribing differences are in practice by GP with few practice-wide policies

[HelenCEBM]

I think we should use some of the feedback to make an FAQ we can link to in the email. "Need help interpreting this information? See our FAQ[link]"

[HelenCEBM]

also see old issue #155

[HelenCEBM]

Could we say how many percentiles they've slipped by, particularly when saying "slipped massively" which sometimes doesn't appear to be a large change, i.e. when the deciles are closely bunched together

[brianmackenna]

User feedback

Thank you for sending an update on our prescribing, which I find helpful. However, what I do not find helpful is you lexicon. Patients are on medication for many individual reasons. I have looked up a couple of our patients and are on “expensive” treatment for their particular illness and on the advice of a consultant or dietician. The use of “ getting worse”,” could do better” and “worst prescribing measures”, I feel is inappropriate and indicates your only purpose is to reduce prescribing costs_ _and not in treating the patient. I would appreciate it and it would be more truthful if you could use phrases and words, which are not inflammatory and are not open to misinterpretation by the general public. E.g. INCREASING COST for” getting worse” * COULD REDUCE THE COST* IN for “could do better” COULD REVIEW YOUR PRESCRIBING for “worst prescribing measures”

[HelenCEBM]

More feedback, similar to above

I'm happy to get the info but could we tone down the emotive language used or use descriptions which are more objective?

For example "this practice slipped massively" when checked one trainee GP had prescribed for one patient out of our 10,000 a brand following a hospital discharge letter which we have gratefully corrected but hardly felt a "massive slip" although a cost impact of £38 per month. I'm also not sure what the significance of "considerably" v "moderately" v "slightly" is when viewed against the above example - it may be a slight slip is actually more important in terms of the number of patents involved than the massive one because of the cost element in the latter?