An evaluation into the refusal of essential shared care agreements: Aripiprazole

Tolley, L.; Azar, M.; Singh, G.; Gunnell, K.A.; Campbell, A.; White, S.

Abstract

Introduction: Essential Shared Care Agreements (ESCAs) are written agreements which allow for coherent transfer of prescribing between primary and secondary care services. This study focuses on one UK NHS Trust which uses ESCAs for atypical antipsychotics, including those used for medicines classified as ‘amber’ in local guidelines1,2. Amber classification means that responsibility for prescribing may be transferred from secondary to primary care once the patient is stabilised. This trust recorded an increasing number of ESCA refusals from primary care for atypical antipsychotics, despite local guidelines deeming them suitable for shared care1. Quetiapine was selected as it appeared most frequently on a list of antipsychotic ESCA refusals recorded by the Trust. Quetiapine is indicated in the ESCA for schizophrenia and the treatment / prevention of bipolar disorder1. As the study was a service evaluation, ethics approval was not needed.

Aim: To evaluate the documented reasons for primary care refusal of prescribing quetiapine under ESCAs in one UK NHS Trust.

Method: A convenience sample from a pre-determined list of refusals in the last three months was drawn up. These were investigated for reasons for refusal as well as adherence to the Trust's ESCA requirements and free-typed into an Excel spreadsheet. Results were analysed using descriptive statistics.

Results: 10 refusals were studied. The main reason (60%) reported for refusal of ESCAs was the ‘amber classification’ of quetiapine. In 10% of cases the primary care prescriber felt the patient was no longer suitable for shared care and in 30% no reason was documented. Only 20% of patients were prescribed quetiapine for indications outlined in the ESCA. Other conditions that it was prescribed for included: cyclothymia, emotionally unstable personality disorder and anxiety. None of the records studied had all monitoring requirements completed and there was little evidence documented of communication across the interface.

Conclusion: This study provides initial insight into the reasons behind ESCA refusal. Prescribing for indications outside the ESCA occurred in the majority of cases, which may have influenced refusal. Data collection revealed gaps in patients' records for monitoring and communication, in line with the themes highlighted in previous studies. However, as this was a small scale project, further study is needed to explain the nature of the challenge in prescribing ‘amber’-classified medicines as well as the issues with record keeping.

References
NHS Shropshire CCG, Midland Partnership NHS Foundation Trust, Telford and Wrekin CCG 2018. Prescribing information for quetiapine for the treatment of schizophrenia/bipolar disorder and adjunctive treatment in major depressive disorder. [Online]. https://www.mpft.nhs.uk/application/files/7515/5248/6146/PID02_Quetiapine_PID_v2.pdf. Accessed August 12, 2020.
North Staffordshire CCG, Stoke-on-Trent CCG, University Hospitals of North Midlands NHS Trust and North Staffordshire Combined Healthcare NHS Trust. 2018. North Staffordshire Joint Formulary. Guidance to Prescribers in Primary and Secondary care. [Online]. https://www.stokeccg.nhs.uk/your-ccg/ns-publications/generic-publications/medicinesoptimisation-2/joint-formulary/1386-formulary-introduction-2018/file. Accessed August 10, 2020.

Citation

Tolley, L., Azar, M., Singh, G., Gunnell, K., Campbell, A., & White, S. (2021). An evaluation into the refusal of essential shared care agreements: Aripiprazole. Pharmacoepidemiology and Drug Safety, 30(S2), 4

• Journal Article Type: Meeting Abstract
• Acceptance Date: Jun 1, 2021
• Online Publication Date: Aug 4, 2021
• Publication Date: 2021-08
• Deposit Date: Jul 22, 2024
• Journal: Pharmacoepidemiology & Drug Safety
• Print ISSN: 1053-8569
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 30
• Issue: S2
• Pages: 4
• Public URL: https://keele-repository.worktribe.com/output/878917
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1002/pds.5315
• Additional Information: Published: 2021-08-04