Malcolm Qualie, Pharmacy Lead for Specialised Commissioning NHS England, spoke to ‘the Way Forward’ event on Blueteq’s potential contribution to reducing variance. Outlining the landscape for pharmacological interventions in the UK, the room was reminded that, due to people living longer, more complex and innovative medicines are being developed, and more specialist medicines being used. For multiple sclerosis (MS) this is especially true of disease-modifying therapies, and we later heard from Rachel Dorsey-Campbell regarding some of the monitoring and safety challenges associated with this broadening of available treatments.

Malcolm Qualie at ‘MS Service Provision in the UK; the Way Forward’, Birmingham November 2018

Malcolm noted that overall medicines spend in the UK for 2016/17 was £17.4 billion, an increase of 33.7% from the £13 billion spend in 2010/11. £300 million of this is being spent on MS drugs at present. However, he also noted that a staggering 50% of medicines are not taken properly by patients, with between five and eight percent of patients admitted for acute care due to inappropriate use of a medicine, highlighting the necessity of appropriate prescribing accompanied by clear and correct information. It is in this picture of medicines prescribing and management that Blueteq’s role sits.

 

Blueteq’s role

Blueteq is essentially a web-based prior approval system that notifies the NHS that a person is going to be put onto a given medicine, and it has been used since before the new NHS England was established, with some primary care trusts (PCTs) having utilised the tool.

Fig 1: Screenshot of the Blueteq tool

Fig 1: Screenshot of the Blueteq tool

It requires set information to be completed and submitted via an online form. The data that Blueteq gathers can be hugely meaningful, and a wide variety of information can be extracted, including variation, demographics by patient population, individual drugs being used (fig 2), EDSS scores, and patient progression. However, Blueteq understand the demand on clinical staff time and so Malcolm explained that their team continue to try and make the Bueteq forms

‘as simple, logical and meaningful as possible’.

Fig 2: The individual drugs being used for MS treatment across the UK

Fig 2: The individual drugs being used for MS treatment across the UK

The information can be drilled down into, able to recount an individual patient and their data gathered over time, showing the history of treatments they have received. This data can then be displayed alongside their EDSS score as a form of measurement to someone’s MS progression, which over time could give a powerful picture of the efficacy of treatment and the impact on a person’s health outcomes.

Discussions from the floor centred around the challenges with the Expanded Disability Status Scale, or ‘EDSS’, its impact on clinical time in itself, and its usefulness as a means of measuring someone’s disease progression. Malcolm agreed that there are limitations to any form of measurement of disease progression, but that the mechanisms within the Blueteq system allow for a parallel comparison of a person’s overall condition over time against the medicines they have received, and that is a highly insightful set of data to gather over time.

 

Core concerns with EDSS

Blueteq’s potential role in providing meaningful data was undisputed in the room, but concerns over the EDSS as a core element of that data gathered, and as the means of measuring a person with MS’s level disability, were vocally shared.

By a show of hands in a room full of clinicians, the majority felt that the time constraints in completing an EDSS form for every patient being prescribed a DMT would adversely affect the care given to patients, as most people would have difficulty in giving the appropriate level of care alongside completing the form. One delegate suggested that the Blueteq form allow for an estimated EDSS score instead to save on time but still include the score as a means of monitoring progression. Some of their colleagues, however, pointed out that whilst estimating scores up to 3.5 and from 6.5-7 onwards is quite straightforward, the gap in between is difficult to judge.

Other delegates felt that to use the EDSS in isolation was an arbitrary measure.

‘EDSS is only one part of decision-making’, explained one attendee, ‘I look at their cognition, their emotional state, their MRI scan – I don’t feel it’s the most important set of information.’

Malcolm noted that Blueteq had added the EDSS score in at stakeholder behest – both clinical and patient – through feedback during beta-testing.

Despite this widespread discussion on the usefulness of the EDSS score, something which continued throughout the day in discussions around other databases and forms of data gathering, there was general agreement, continued later in Professor Jeremy Hobart and Professor Neil Robertson’s talks on databases and auditing tools, that gathering a consistent set of meaningful data throughout the UK would enable improved understanding of equity and service delivery, as well as a means of benchmarking quality. There is no question that Blueteq is an important element to this consistent form of data collation.

 

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