Benjamin Ramasubbu & Rian O'Regan
Dr Benjamin Ramasubbu – currently working as a GPST2 in South Glasgow within NHS Greater Glasgow and Clyde. A keen interest in Addictions Psychiatry and hoping to complete further audit and QI work at the interface of primary care and addictions psychiatry.
Dr Rian O’Regan – works within NHS Greater Glasgow and Clyde as a General Adult Psychiatry ST6 Trainee. Currently working in Dykebar Hospital General Adult Services Paisley, having completed a year endorsement in Addictions Psychiatry from 2019-2020 in South Glasgow. Following completion of training next year, aiming to work within the Addictions service in Glasgow.
Thiamine prescription practices in primary care
The prophylactic prescription of thiamine has long been recognised as key in the management of alcohol use disorders. We audited the use of thiamine in GP to ensure that those at risk of WE are receiving appropriate preventive treatment and investigated whether individuals with a historical diagnosis of alcoholism were still prescribed thiamine unnecessarily meaning we could safely reduce NHS spending (predicted £60 per annum).
Using EMIS keyword searches we identified those who would potentially require thiamine treatment. Additionally, a search using the ‘general prescribing support tool’ was carried out using ‘thiamine’ as a drug name search to show those patients currently on thiamine. Consultation information and prescription data was also interrogated. If a recent alcohol usage was not apparent patients would be contacted by phone to ascertain a current alcohol consumption measure.
Cycle 1 Of those with alcohol related codes (89), six patients (6/89, 7%) had thiamine commenced who warranted treatment. Twelve patients had thiamine stopped due to a historical diagnosis and no longer mandating treatment (12/89, 13%). Of those patients with a current thiamine prescription (48), 22 patients had no alcohol related code. Of these, 1 had an alternative code applied (in part related to alcohol on detailed review, ARBD), 9 had their thiamine stopped. 10 were newly coded. 2 outstanding codes. In total, 27 changes were made to thiamine treatment plans (27/111, 24%).
Cycle 2 Two outstanding codes rectified. 38 in cycle two on thiamine – all had a code attached and treatment was appropriate.
We have brought thiamine prescription in our practice in line with NICE guidelines. This will improve the quality of the care delivered and optimise cost effectiveness.
Poster link: Thiamine prescription practices in primary care