Adjusted antibiotic prescribing in primary care by the NHS - WMCA

Annual total number of prescribed antibiotic items per STAR PU (Specific Therapeutic group Age sex weightings Related Prescribing Unit)RationaleReductions in antibiotic consumption is a well-recognised target in AMR policies across UKHSA, the NHS, DHSC and internationally, including WHO. This can be used as an overall metric for benchmarking across Local Authorities, bringing together a whole health economy approach with NHS prescriptions from all types of hospitals (including Acute, Mental Health, Community etc), General Practices, other Community Locations (Urgent care, Walk in Centres). Data from Dentists is only available at NHS area team at present but will be added to this metric when available.In order to fully appreciate antimicrobial prescribing, it is necessary to take into consideration demographic characteristics of the population as it may influence levels of prescribing. For that reason STAR PU data is adjusted for both age and sex.STAR PU is an adjusted rate that removes confounding effects of age and sex in the comparison of prescribing between different geographical areas. This method allows for more accurate comparison of prescribing. In this specific indicator, a higher value is associated with increased prescribing.Definition of numerator"Total number of antibiotic items prescribed in practices located within the area. An item is an antibiotic (from British National Formulary Section 5.1) that is prescribed in a primary care setting.A prescription item refers to a single item prescribed by a prescriber on a prescription form (known as an FP10). If a prescription form includes three medicines it is counted as three prescription items. The number of items is a measure of how often a prescriber has decided to write a prescription. It is often used when we wish to look at prescriber behaviour as every prescription is an opportunity to change treatment. For vaccinations and acute treatment (for example, a short course of antibiotics) the item is also a reasonable measure of the number of courses of treatment.GP practice counts of items are aggregated to Local Authorities based on the postcode of location of the GP practice."Definition of denominatorTotal of STAR PU units for practices located within the area. STAR PU are weighted units to allow comparisons adjusting for the age and sex of patients distribution of each practice. These variables vary significantly and it is important to make necessary adjustments.There are differences in the age and sex profiles of patients who are prescribed drugs in specific therapeutic groups. For example: drugs for dementia are generally prescribed for older people. STAR PUs (Specific Therapeutic Group Age sex weightings Related Prescribing Units) allow more accurate and meaningful comparisons within a specific therapeutic group by taking into account the types of people who will be receiving that treatment. These have been developed to weight individual practice or organisation populations for age and sex to allow for better comparison of prescribing patterns. These figures are based on the cost or volume of prescribing within therapeutic groups rather than all prescribing. The STAR PU weightings for anti bacterials are item based, as this is more appropriate for such prescribing. These weightings should be used only for the specific therapeutic area. STAR PU values are available for BNF sections from the  https://digital.nhs.uk/data-and-information/areas-of-interest/prescribing  NHS Digital websiteCaveatsAll antibiotic items that are administered orally, which are prescribed in a primary care setting are recorded by NHS Digital. There are no concerns about incomplete or inaccurate data.STAR PU data is inappropriate to use at any smaller level than total prescribing. I.e. individual drug class level. STAR PU data only includes antibiotics that are administered orally. Orally administered derivative of BNF 5.1 codes account for more than 99.8 percent of all prescribed items.Drugs are only included in the numerator if they have a British National Formulae (BNF) 5.1 code consistant with an anti bacterial item.Figures will vary if compared to similar indicators at different geographical levels for example GP, as they are separate indicators and have different criteria for inclusion and exclusion.

年度STAR PU（特定治疗组年龄性别权重相关处方单位）所指定抗生素项目的总数量。STAR PU旨在消除年龄和性别在比较不同地区间处方差异时的混杂效应，从而实现更准确的处方比较。本指标中，数值越高，表示处方量越大。分子定义为：区域内位于实践场所的处方抗生素项目总数。一个项目是指在英国国家处方形式手册第5.1节中指定的，在初级保健环境中处方的抗生素。处方项目指的是处方单上由处方者开具的单个项目（称为FP10）。如果处方单包含三种药物，则计为三个处方项目。项目数量是衡量处方者决定开具处方频率的指标。在分析处方者行为时，通常使用此指标，因为每一张处方都是一个改变治疗的机会。对于疫苗接种和急性治疗（例如，短期的抗生素疗程），项目数量也是衡量治疗疗程数量的合理指标。GP实践场所的项目数量根据GP实践场所的邮政编码汇总至地方当局。分母定义为：区域内位于该区域的STAR PU实践单位总数。STAR PU是加权单位，旨在调整每个实践或组织人群的年龄和性别分布，以便更好地比较处方模式。这些数据基于治疗组的处方成本或数量，而非所有处方的总和。抗生素的STAR PU加权基于项目，这更适用于此类处方。这些加权应仅用于特定治疗领域。STAR PU值可通过NHS数字网站https://digital.nhs.uk/data-and-information/areas-of-interest/prescribing获取。注意事项：所有在初级保健环境中处方的口服抗生素项目均由NHS数字记录，不存在数据不完整或不准确的问题。STAR PU数据不适用于比总处方更小的级别，例如个体药物类别水平。STAR PU数据仅包括口服抗生素。BNF 5.1代码的口服衍生品占所有处方项目的99.8%以上。只有具有与抗菌项目一致的英国国家处方形式（BNF）5.1代码的药物才包括在分子中。与不同地理级别（例如GP）的类似指标相比，数据可能会有所不同，因为它们是独立的指标，具有不同的纳入和排除标准。