Data can be a powerful thing. It can help to tell a story, provide evidence to put forward an argument, or shed light on an unknown area. We’re living in an increasingly digitalised world, with data being generated or collected by many of the devices we interact with in our lives and in our work. Despite being awash with data, one area where it is somewhat lacking is how we, as a country, use medicines. Certainly, within a pharmacy, one can get a view of the most common medicines, but we can’t get a sense of how this might compare to other pharmacies, or the overall national picture. 

RxTrends 

To try to address this, our team based at RCSI University of Medicine and Health Sciences has developed a new digital tool to provide real-time insights into prescribing trends in Ireland. The interactive platform, known as RxTrends, enables anyone who might be interested — healthcare professionals, policymakers, researchers or the public — to analyse national prescribing patterns over time.  

The RxTrends application is the first of-its-kind in Ireland, using publicly available data from the HSE’s Primary Care Reimbursement Service (PCRS). The PCRS releases monthly data relating to the community drug schemes, covering aspects like numbers of eligibile individuals, reimbursement claims, and prescribing of medicines. Currently, the data RxTrends covers relates to the General Medical Services (GMS, or ‘medical card’) Scheme. Its functionality is linked to the level of data available from PCRS, and so it allows users to visualise and compare prescribing rates and costs over time, giving a clearer picture of medicine usage across the country. This can be done at the level of medications (that feature among the top 100 each month by frequency and/or cost), therapeutic groups (based on a medications classification, for example Drugs for Acid Related Disorders and Analgesics) or body system (for example, Cardiovascular System and Nervous System).  

RxTrends was developed as part of the CDRx project funded by the Health Research Board, which aims to use data to understand policies and practices for safe use of controlled drugs, and more specifically, sedative and analgesic medicines. The tool is available on the project website (cdrx-project.eu > RXTrends tool) and it was developed with collaborators in University College Cork and the HSE.   

We feel this tool offers a valuable resource for decision-making and policy development, as understanding how medicines are prescribed and how costs evolve over time is crucial for improving healthcare policy and practice. RxTrends provides a user-friendly way to analyse prescribing data, which can help us to ensure more efficient use of medicines, to understand how prescribing aligns with national recommendations, how generic medicines can save costs for the health service and the impact of new policies. Without data being easily accessible and usable, it can’t answer the questions we want to ask. 

The application was developed by our team using the R-based Shiny framework and incorporates prescribing and cost data from 2016 to the most recent available data, covering the 100 most frequently prescribed medicines and all therapeutic groups. Users can track trends by selecting specific medicines or broader therapeutic categories, making the tool highly flexible and informative. The approach for developing the tool has been documented in a newly published paper (‘RxTrends: An R-based Shiny Application for Visualising Open Data on Prescribed Medications in Ireland’, available at hrbopenresearch.org), which details its methodology and potential applications.  

Key functions 

Key functionality of the tool includes:  

• Graphs and trend analyses of medication use and costs over time;  

• Download data for the timeframe and medications of interest;  

• The ability to assess the proportion of prescribing for a medication within a therapeutic group or a body system; and  

• Using the data to explore how medication use changes based on seasonal trends or policies like Ireland’s Preferred Drug Initiative, and the introduction of generic medicines and new reference prices. 

While RxTrends represents an important step forward in evaluating medication use in Ireland, further improvements could be made with access to more detailed prescribing data. This data and tool are a new development in Ireland, but looking to our nearest neighbour, we are still some ways behind. NHS England has a long history of sharing data and statistics about the delivery of healthcare across a range of settings, many of these relating to medicines. The extent of transparency is noteworthy; the English Prescribing Dataset publishes data for each month after six to eight weeks that includes for every GP practice in the country the number of prescriptions issued and overall quantity prescribed for every item (for example, a drug or appliance), and associated costs. As you might expect, such detailed data is fairly unwieldy if you only want to check how much atorvastatin GP practices in the area are prescribing. The OpenPrescribing.net platform, launched in December 2015 by a team at the University of Oxford, solves this issue, providing an extensive range of analytics to explore prescribing of products, drugs, or drug classes over time and across GP practices, and small and large regions. The platform has also GP practice dashboards where practices can benchmark their prescribing against all other practices across a range of quality indicators, to help stimulate quality improvement initiatives.  

Future considerations 

This provides an example of what the future could hold for medicines prescribing data in Ireland. The status quo that PCRS data does not cover private prescriptions is a limitation inherent in our health system, but which could be addressed with developments of the national ePrescribing system. In the meantime, the utility of RxTrends could be greatly enhanced by expanding the depth of data made available by the PCRS. Our interest in prescribing should extend beyond just 100 medications and so release of data on further common medicines would be an important first step. Further expansion that would increase insight from the data would be to cover details at the product level, or to report data across health regions, local health office areas, or even GP practices. Practice-level would provide substantial opportunities for clinical audit and feedback, which could result in benefits in prescribing safety, appropriateness, and cost effectiveness. 

So, while RxTrends is a first step in harnessing open prescribing data in Ireland, making more extensive information available would truly unlock the power of data to understand and enhance medication use to achieve high-quality healthcare and patient safety.