Pharmacist and Data Driven Quality Improvement in Primary Care

Denominator definition: No. of patients aged 75 years or older meeting one or more denominator definitions as specified under 'Other Pre-specified Outcomes' P001 to P011; Numerator definition: No. of denominator patients meeting one or more numerator definitions as specified under 'Other Pre-specified Outcomes' P001 to P011

Denominator definition: No. of patients aged 75 years or older meeting one or more denominator definitions as specified under 'Other Pre-specified Outcomes' P001 to P046; Numerator definition: No. of denominator patients meeting one or more numerator definitions as specified under 'Other Pre-specified Outcomes' P001 to P046

Denominator definition: No. of patients aged 75 years or older meeting one or more denominator definitions as specified under 'Other Pre-specified Outcomes' P001 to P046; Numerator definition: No. of indicators specified under 'Other Pre-specified Outcomes' P001 to P046 triggered by denominator patients

Denominator definition: No. of patients aged <75 years meeting one or more denominator definitions as specified under 'Other Pre-specified Outcomes' P001 to P011; Numerator definition: No. of denominator patients meeting one or more numerator definitions as specified under 'Other Pre-specified Outcomes' P001 to P011;

Denominator definition: No. of patients aged <75 years meeting one or more denominator definitions as specified under 'Other Pre-specified Outcomes' P001 to P046; Numerator definition: No. of denominator patients meeting one or more numerator definitions as specified under 'Other Pre-specified Outcomes' P001 to P046

Denominator definition: No. of patients aged <75 years meeting one or more denominator definitions as specified under 'Other Pre-specified Outcomes' P001 to P046; Numerator definition: No. of indicators specified under 'Other Pre-specified Outcomes' P001 to P046 triggered by denominator patients

Denominator definition: No. of patients aged 75 years or older meeting one or more denominator definitions specified under 'Other Pre-specified Outcomes' P001 to P011, who have met one or more numerator definitions specified under 'Other Pre-specified Outcomes' P001 to P011 in the previous 57 to 364 days; Numerator definition (Old): No. of denominator patients meeting one or more numerator definitions specified under 'Other Pre-specified Outcomes' P001 to P011

Denominator definition: No. of patients aged 75 years or older meeting one or more denominator definitions specified under 'Other Pre-specified Outcomes' P001 to P011, who have NOT met any numerator definitions specified under 'Other Pre-specified Outcomes' P001 to P011 in the previous 57 to 364 days; Numerator definition: No. of denominator patients meeting one or more numerator definitions specified under 'Other Pre-specified Outcomes' P001 to P011

Denominator definition: No. of patients aged <75 years meeting one or more denominator definitions as specified under 'Other Pre-specified Outcomes' P047 to P050; Numerator definition: No. of indicators specified under 'Other Pre-specified Outcomes' P047 to P050 triggered by denominator patients

Denominator definition: No. of patients aged 75 years or older; Numerator definition: No. of denominator patients who had an unscheduled care event with bleeding in the previous 84 days

Denominator definition: No. of patients aged 75 years or older; Numerator definition: No. of denominator patients who had an unscheduled care event with hypoglycaemia, a fall or a fracture in the previous 84 days

Denominator definition: No. of patients aged 75 years or older; Numerator definition: No. of denominator patients who had an unscheduled care event in the previous 84 days with any of the following: Hypoglycaemia, fall, fracture, bleeding, heart failure, bradycardia, acute kidney injury, constipation, dehydration, hyperkalaemia, hyponatraemia, urinary retention, delirium) in the previous 84 days

Denominator definition: No. of patients aged 75 years or older; Numerator definition: No. of denominator patients who had an unscheduled care event in the previous 84 days with an unrelated ambulatory care sensitive admission (Appendicitis, pancreatitis, cholecystitis, cancer, cellulitis)

P001 - Denominator definition: No. of patients aged 75 and older; Numerator definition: No. of denominator patients with any non-topical non-steroidal anti-inflammatory drug (NSAID) issued in last 56d and NO gastro-protection issued in last 84d

P002 - Denominator definition: No. of patients aged 65 to 74 and gastrointestinal ulcer or issued an antiplatelet, oral anticoagulant or oral corticosteroid in last 56d; Numerator definition: No. of denominator patients with any non-topical NSAID issued in last 56d and NO gastro-protection issued in last 84d

P003 - Denominator definition: No. of patients aged 65 or older and aspirin issued in last 84d; Numerator definition: No. of denominator patients with clopidogrel issued in last 56d and NO gastro-protection issued in last 84d

P004 - Denominator definition: No. of patients with previous gastrointestinal ulcer; Numerator definition: No. of denominator patients with antiplatelet issued in last 56d and NO gastro-protection issued in last 84d

P005 - Denominator definition: No. of patients with an oral anticoagulant issued in last 84d; Numerator definition: No. of denominator patients with an antiplatelet issued in last 56d and NO gastro-protection issued in last 84d

P006 - Denominator definition: No. of patients with any of the following: Chronic kidney disease (CKD) stage 4 or 5 or latest estimated glomerular filtration rate (eGFR)<30ml/min (in previous 364 days); Numerator definition: No. of denominator patients with direct thrombin inhibitor issued in last 56d

P007 - Denominator: One of the following: CKD stage 5 or latest eGFR showing eGFR<15ml/min (in previous 364d); Numerator: Factor Xa inhibitor issued in last 56d

P008 - Denominator definition: No. of patients with an oral anticoagulant issued in last 84d; Numerator definition: No. of denominator patients with latest SBP>160 or latest DBP>100 BP (in previous 364 days)

P009 - Denominator definition: No. of patients with insulin issued in last 84d; Numerator definition: No. of denominator patients with no glucose test strips issued in last 56d

P010 - Denominator definition: No. of patients with diabetes type 2 and aged 75 or older or dementia; Numerator definition: No. of denominator patients with insulin or an oral hypoglycaemic drug other than metformin issued in last 56d and last glycated haemoglobin (HbA1c)<53 (7.0%) (in previous 364d)

P011 - Denominator definition: No. of patients Diabetes type 2 and aged 65 to 74 without dementia; Numerator definition: No. of denominator patients with insulin or an oral hypoglycaemic drug other than metformin issued in last 56d and last HbA1c<48 (6.5%) (in previous 364d)

P012- Denominator definition: No. of patients with an oral nitrate or nicorandil issued in last 84d; Numerator definition: No. of denominator patients with phosphodiesterase type-5 inhibitor issued in last 56d

P013- Denominator definition: No. of patients with heart failure; Numerator definition: No. of denominator patients with a glitazone issued in last 56d

P014- Denominator definition: No. of patients heart failure; Numerator definition: No. of denominator patients with any non-topical NSAID issued in last 56d

P015- Denominator definition: No. of patients with heart failure or issued a beta blocker in the previous 84d; Numerator definition: No. of denominator patients with verapamil or diltiazem issued in last 56d

P016- Denominator definition: No. of patients with heart failure without atrial fibrillation, CKD stage ≥3, latest eGFR<60ml/min (in previous 365 days) or verapamil issued in last 84d; Numerator definition: No. of denominator patients with digoxin tablets >125mcg strength issued in last 56d

P017- Denominator definition: No. of patients with beta blocker, acetylcholine esterase inhibitor or digoxin issued in last 84d; Numerator definition: No. of denominator patients with last pulse <60bpm

P018- Denominator definition: No. of patients with CKD stage 5 or latest eGFR<10ml/min (in previous 365d); Numerator definition: No. of denominator patients with colchicine issued in last 56d

P019- Denominator definition: No. of patients with methotrexate issued in last 84d; Numerator definition: No. of denominator patients with methotrexate 2.5mg strength issued and methotrexate 10mg strength issued in last 56d

P020- Denominator definition: No. of patients with methotrexate issued in last 84d; Numerator definition: No. of denominator patients with trimethoprim issued in last 56d and trimethoprim issued in last 57 to 112 days

P021- Denominator definition: No. of patients with one or more of the following risk factors for Acute Kidney Injury (AKI):

• diuretic issued in last 84d and ACEI or ARB issued in last 84d
• CKD stage 4 or 5 or latest eGFR<30ml/min (in previous 364d)
• ACEI or ARB issued in last 84d and CKD stage 3 or latest eGFR 30 to 59ml/min (in previous 364d) in last 84d
• diuretic issued in last 84d and CKD stage 3 or latest eGFR 30 to 59ml/min (in previous 364d) in last 84d; Numerator definition: No. of denominator patients with Any non-topical NSAID issued in last 56d

P022- Denominator definition: No. of patients with CKD stage 4 or 5 or latest eGFR <30 ml/min (in previous 365 days) or ACEI or ARB issued in last 84d; Numerator definition: No. of denominator patients with potassium salt issued in last 56d

P023- Denominator definition: No. of patients with angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) issued in last 84d; Numerator definition: No. of denominator patients with ACEI and ARB issued in previous 56d

P024- Denominator definition: No. of patients with ACEI or ARB issued in last 84d and no history of CKD stage 4 or 5 and latest eGFR >=30 ml/min or unknown (in previous 364d); Numerator definition: No. of denominator patients with potassium sparing diuretic and aliskiren issued in last 56d

P025- Denominator definition: No. of patients CKD stage 4 or 5 or latest eGFR <30 ml/min (in previous 364d); Numerator definition: No. of denominator patients with potassium sparing diuretic or aliskiren issued in last 56d

P026- Denominator definition: No. of patients with CKD stage 4 or 5 or latest eGFR <30 ml/min (in previous 364d); Numerator definition: No. of denominator patients with trimethoprim issued in last 56d

P027- Denominator definition: No. of patients with digoxin issued in the last 84d; Numerator definition: No. of denominator patients with latest potassium <3.0 mmol/L (in previous 364 d)

P028- Denominator definition: No. of patients with CKD stage 4 or 5 or latest eGFR <30 ml/min (in previous 364d); Numerator definition: No. of denominator patients with metformin issued in last 84d

P029- Denominator definition: No. of patients Aged 75 or older without heart failure; Numerator definition: No. of denominator patients with last systolic blood pressure (SBP) <110 and last diastolic blood pressure (DBP)<65 and any of the following issued in last 56d: ACEI, ARB, beta blocker, thiazide, calcium channel blocker, alpha blocker, oral nitrate, centrally acting antihypertensive drug

P030- Denominator definition: No. of patients with dementia and hypertension; Numerator definition: No. of denominator patients with Last SBP <130 and last DBP<75 and two or more of the following issued in last 56d: ACEI, ARB, beta blocker, thiazide, calcium channel blocker, alpha blocker, oral nitrate, centrally acting antihypertensive drug

P031- Denominator definition: No. of patients aged 65 years or older with dementia; Numerator definition: No. of denominator patients with antipsychotic issued in last 56d

P032- Denominator definition: No. of patients who are female and have previous venous thromboembolism; Numerator definition: No. of denominator patients with Oestrogen issued in last 56d

P033- Denominator definition: No. of patients with atrial fibrillation (AF) and C(ardiac failure)H(ypertension)A(ge)D(iabetes)S(troke/TIA)VASc(ular disease history) score >=3; Numerator definition: No. of denominator patients with NO oral anticoagulant issued in last 56d

P034- Denominator definition: No. of patients with asthma without chronic obstructive pulmonary disease (COPD) and a short acting beta agonist (SABA) issued in last 84d; Numerator definition: No. of denominator patients with non-cardio-selective beta blocker issued in last 56d

P035- Denominator definition: No. of patients aged 75 years and older and an oral steroid issued in last 84d and in the last 85 to 168 days; Numerator definition: No. of denominator patients with no bisphosphate, vitamin D or calcium issued in last 56d

P036- Denominator definition: No. of patients with dementia; Numerator definition: No. of denominator patients with two or more drugs with significant sedating or anticholinergic effects issued in previous 56d (excluding drugs only used for epilepsy)

P037- Denominator definition: No. of patients with no dementia and aged 65 to 74 years; Numerator definition: No. of denominator patients with THREE or more drugs with significant sedating or anticholinergic effects issued in previous 56d (excluding drugs only used for epilepsy)

P038- Denominator definition: No. of patients with no dementia and aged 75 years or older; Numerator definition: No. of denominator patients with two or more drugs with significant sedating or anticholinergic effects (excluding drugs only used for epilepsy)

P039- Denominator definition: No. of patients with opioid issued in last 84d; Numerator definition: No. of denominator patients issued an opioid in last 56d and issued opioids at an average daily dose equivalent to >180mg morphine per day over the previous 182d

P040- Denominator definition: No. of patients with gabapentin or pregabalin issued in last 84d; Numerator definition: No. of denominator patients issued gabapentin or pregabalin in the last 56d and issued gabapentin or pregabalin at an average daily dose of >4800mg gabapentin per day over the previous 182d

P041- Denominator definition: No. of patients with lithium issued in last 84d; Numerator definition: No. of denominator patients with an NSAID issued in the last 56d

P042- Denominator definition: No. of patients with lithium issued in last 84d; Numerator definition: No. of denominator patients with thiazide diuretic issued in previous 56d and no thiazide diuretic issued in previous 57 to 112 days

P043- Denominator definition: No. of patients with levodopa issued in last 84d; Numerator definition: No. of denominator patients with prochlorperazine issued in last 56d and previous 57 to 112d or metoclopramide issued in last 56d and previous 57 to 112d

P044- Denominator definition: No. of patients aged 65 years or older; Numerator definition: No. of denominator patients with metoclopramide issued in last 56 and in the previous 57 to 112d

P045- Denominator definition: No. of patients with a history of breast cancer; Numerator definition: No. of denominator patients with oestrogen issued in last 56d

P046- Denominator definition: No. of female patients aged 60 years or older; Numerator definition: No. of denominator patients with estrogen issued in last 56d

P047- Denominator definition: No. of patients with thiazide or a loop diuretic issued in the last 84d; Numerator definition: No. of denominator patients with latest potassium <3.0 mmol/L (in previous 364 d)

P048- Denominator definition: No. of patients with selective serotonin reuptake inhibitor (SSRI), thiazide or loop diuretic issued in last 84d; Numerator definition: No. of denominator patients with latest sodium <130 mmol/l (in previous 364 days)

P049- Denominator definition: No. of patients with a thiazide issued in last 84d; Numerator definition: No. of denominator patients with latest calcium >2.65 mmol/L (in previous 364 days)

P050- Denominator definition: No. of patients with ACEI or ARB, potassium sparing diuretic, aldosterone antagonist, aliskiren or potassium supplement issued in previous 84d; Numerator definition: No. of denominator patients with latest potassium >5.5mmol/L (in previous 364 days)