Stoma Appliance Service in the Community: Stoma Care Quality and Cost Effectiveness Review 2015

Appendix 1: Ostomy Community Data Review

Introduction

This paper provides analysis for one NHS Board for the financial year 2014-15 based on anonymised patient prescribing data to try to assess the value for money for the products dispensed to patients in the Board area.

The local usage information was compared to the published guidance developed by stoma nurse specialist staff in Trusts from NHS England. This guidance covers the prescribing of accessories and also indicative appliance usage based on the clinical indication and associated products. The analysis looks as the potential effect of applying these protocols.

The analysis looked at three specific triggers (or alerts) that would suggest the patient's needs are reviewed to ensure the product demand is in alignment to stoma ostomy prescribing guidelines which meet the actual demand and clinical requirements of the patient.

Trigger One: Potential Over Prescribing of stoma appliance (Bags)

There may be many reasons why bags are being prescribed in excess of the indicative volumes indicated below. An annual alert level was set at 25% more than the indicated volumes from NHS England information and then checked against prescribed items per patient identifier.

Table 1 - Usage Indications

Trigger Two: Prescribing of Non-Recommend Accessories

The guidelines from NHS England indicated a variety of items deemed as accessories (such as deodorants) that should not be prescribed and this was analysed against the usage of these items from the data set.

Trigger Three: Annual Cost of prescribed Items

Based on the usage indications in Table 1 an annual spend of £3,000 should trigger a review to ensure the prescribed items are meeting the requirements of the patient.

Based on these three triggers the following findings have been made that may warrant further review and follow up.

Trigger One: Potential Over Prescribing of Bags

Colostomy - 8% of patients would appear to be oversubscribed colostomy bags

Ileostomy - 40% of patients would appear to be oversubscribed Ileostomy bags

Two Piece - 9% of patients would appear to be oversubscribed Two Piece bags

Urostomy - 1% of patients would appear to be oversubscribed Urostomy bags

Trigger Two: Prescribing of Non-Recommend Accessories

5% of the total Health Board spend was assessed as products that are not recommended in the guidance from England and therefore may benefit of a review with the patients to determine the clinical requirements and how these products are being used.

Trigger Three: Annual Cost of prescribed Items

It was determined that 8% of patients equated to 21% of the Health Board costs (some of which would be the potential oversubscribing as indicated above). Some patients had accessories between 30% and 50% of the total annual cost and may benefit of a review with the patients to determine the clinical requirements and how these products are being used.

Conclusions

This initial analysis has indicated that a review of approximately 10% of an identified group of patients may lead to a significant opportunity in reviewing prescribed products and adopt the effective prescribing guidance currently being implemented across NHSScotland. Some of this identified group may already be under regular review of a clinical specialist and therefore this identified group may be reduced.

Based on the data provided and indicative guidelines used, implementation of specific patient reviews based on the prescribed item alerts indicated above would reduce the national spend across NHSScotland from between £2.0M and £2.5M from an annual spend of £21M.