Denis Naughten (Roscommon-South Leitrim, Independent)
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620. To ask the Minister for Health further to Parliamentary Question No. 906 of 11 June 2013, if he will provide an answer to the question; if he will make available the information provided to his Department by the Health Service Executive on 27 June; the reason for the delay in making this information available; and if he will make a statement on the matter. [41127/13]

James Reilly (Dublin North, Fine Gael)
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Snapshots of the level of prescribing of benzodiazepines and z-drugs were taken In November 2011, March 2012 and November 2012, and provided to all GMS GPs in February 2012, July 2012 and April 2013 respectively. Three pieces of information were provided to them: the prescribing frequency standardised for gender/panel profile of benzodiazepines and z-drugs; the number of patients who were presenting prescriptions for periods of more than 3, 6 and 12 months; and a pictorial representation of their individual prescribing against the national profile.

Where a GP asked for further information on receipt of details in February 2012, the HSE provided to that GP a “pharmacist reported” dispensing history over six months. Some 74 GPs were over two standard deviations from the mean. Separate communication was dispatched in May 2012 to four GPs who had not reverted previously to the HSE and who were over four standard deviations above the mean. In relation to the snapshot of March 2012 provided to all GMS GPs by letter in early July 2012, the HSE also wrote separately to 16 GPs whose prescribing rate was over 3 standard deviations from the mean enclosing the dispensing records for the four months up to the end of May 2012.

In its most recent communication to GPs in April 2013, the HSE drew attention of the GPs to the value of comparing the November 2012 and 2011 snapshots, anticipating that this would allow individual GPs to self-audit their practice effectively in the coming months and, where appropriate, make practise adjustments. The HSE also drew attention to the number of patients who were newly initiated and who should be closely monitored to avoid inadvertent dependence. The HSE is considering now whether it is appropriate to engage in more targeted “face to face intervention” and how such primary care intervention can be effectively introduced within the Medicines Management Programme

Since the initiative undertaken by the HSE, both the mean and standard deviation have reduced meaning that prescribers are coming increasingly in line with each other. While there is a small increase in the number of individual outliers, this is possibly because a reduced mean and standard deviation tend to highlight individual outliers. It is also important to note that some of these GPs have communicated to the HSE valid and reasonable rationales for their higher prescribing than their peers.

A comparison of the level of prescribing of benzodiazepines and z-drugs between November 2011 (when GPs were first written to) and November 2012 shows a reduction in items dispensed by community pharmacists of 1,427 items per quarter million patients, from 15,970 to 14,543 items. While it is important to remember that this is a quality prescribing initiative rather than a cost cutting measure, estimated savings per annum of €1.57 million were achieved.