1. What Is Your Main Professional Role?

Introduction

NICE Bitesisa monthly bulletin for healthcare professionals. The purpose of this publication is to provide a clear and succinct summary of key prescribing points taken from NICE guidance. It emerged from collaboration with colleagues in primary care in response to a need for information which is easily accessible. To assess the impact of this publication by seeking the views of the readers asurvey was undertaken using Zoomerang web based software. The survey was launched on 21st September 2010 and was active for six weeks. Readers were signposted to the survey via the NICE Bitesemail and bulletin in September and October, and could also access it via the National electronic Library for Medicines at

Survey Results

Over the six week period of the survey,160 completed responses were received. The following is a summary of the data responses from each question:

1. What is your main professional role?

There were 14 health professional categories listed in this question. Data from these have been collated into ten main professional groups (see Figure1). 160 respondentsgave 165 responses reflecting the fact that some people have responsibilities within different specialities. Two respondents worked in both primary and secondary care, one worked as a primary care nurse and NHS Direct staff member, one worked as a public health professional and a manager. Figure 1 shows the proportion of respondents for each category. 58% of respondents were pharmacists, and 7% pharmacy technicians. NICE Bites is sent directly viaemail primarily to pharmacists and so this result is as expected. 16% (n=27) of respondents were GPs or GP trainees and 7% were nurses.

2. Which sector do you work in most of your time?

Figure 2 shows the proportion of respondents within the NHS working in primary and secondary care and any non-NHS personnel.

72% of respondents work in primary care. Only 26% of respondents work in secondary care. These results highlight that there may be a need to promote this publication more widely within secondary care.

3. Where do you work most of the time?

NICE Bites was produced to support NICE implementation within the North West SHA. Following its introduction however, requests were received for this bulletin from further afield. Our survey results show that 46% of respondents (n=75) work in the North West SHA. The proportion of respondents from each SHA in England is shown in Figure 3. 10% of respondents work in Wales, 7% in Northern Ireland and 1% in Scotland. One respondent was from the Isle of Man. Some respondents were from outside the UK: Spain (n=1), Germany (n=1) and Saudi Arabia (n=1).

Country / Percentage of respondents
England / 79%
Wales / 10%
Northern Ireland / 7%
Scotland / 1%
Isle of Man / <1%
Spain / <1%
Germany / <1%
Saudi Arabia / <1%

4. Are you a prescriber?

62% of respondents were not prescribers, 38% were; Figure 4 shows the proportion of prescribersby professional group. NICE Bites focuses on the main prescribing recommendations from NICE guidance.Although not all respondents are prescribers some may provide prescribing support (see Question 13). These results highlight that there may be an opportunity to raise awareness of this publication and increase uptake by prescribers. However, it is also recognised that there may be a low response to the online survey from this group.

5. How do you access NICE Bites?

NICE Bites is sent to over 500 people each month directly via an email distribution list and is also accessible online. Each month it is published onthe National electronic Library for Medicines at and is also available via the East Lancashire Health Economy Medicines Management Board website at .

There were 182 responses to this question. 75% of respondents received NICE Bites via email and 29 % access it online; see Figure 5.

* Total percentages exceed 100 as multiple responses were allowed for this question.

6. Have you accessed NICE Bites online at any of the following sites?

Survey respondents were asked which websites they used to access NICE Bites. Multiple responses were allowed.There were 180 responses. Figure 6 shows the proportion of respondents that accessed NICE Bitesonline and at which site, if any.

* Total percentages exceed 100 as multiple responses were allowed for this question.

40% of respondents do not access NICE Bites online. Of these 14% are not aware it is available online. This highlights the need to increase awareness of online access and signpost readers to available websites.

7. How often do you access NICE Bites?

52% of respondents access NICE Bites once a month which is likely to be when the bulletin is published. 8% (n=13) of respondents selected ‘other’; ten of these stated that they accessed NICE Bites upon receipt.

8. Do you send NICE Bites to anyone?

42% (n=67) of respondents forward NICE Bites onto other people (see Questions 9 and 10 for further details).

9. How do you distribute NICE Bites?

Multiple responses were allowed for this question.There were 86 responses from 67 respondents; 80% of respondents used email to distribute NICE Bites, 15% inserted a hyperlink in an electronic bulletin and 8% upload it onto an intranet. Distribution of paper copies is used by 21% of respondents.One respondent discusses NICE Bites with GPs at a monthly meeting.

* Total percentages exceed 100 as multiple responses were allowed for this question.

10. How many people do you send it to?

Figure 9 shows how many people are included in distribution cascades within the following bands; 0-10, 11-50, 51-100, other.

Five respondents chose’other’. These responses are as follows;

for distribution further,
all GPs in the PCT (>100),
all GPs, practice managers and NMPs,
500 people,
everybody in the organisation has access.

From these figures it is estimated that NICE Bites is distributed to over 2,000 people from the 67 respondents. Higher figures would be expected if these results are replicated across the wider readership of NICE Bites.

Questions 11, 12 and 15 to 17:Which format do you prefer?

Of 160 respondents 49% preferred PDF format and 36% stated no preference. Only 17% preferred Word format.25% of respondents copy and paste sections of NICE Bites into their own formulary/publications. This percentage is much less than the percentage of respondents that distribute NICE Bites to others. These results suggest that most respondents use NICE Bites in its entirety.

Of 160 respondents;

97% thought that two sides of A4 was an appropriate length for NICE Bites.
96% thought that there was enough detail in the content of the bulletin.
88% of respondents thought that NICE Bites should be published monthly as it is currently.

These results suggest that no change is needed to the format and content of the bulletin.

13. How do you use NICE Bites?

Multiple responses were allowed for this question. There were 482 responses from 160 respondents. See Figure 10.

* Total percentages exceed 100 as multiple responses were allowed for this question.

NICE Bites is used in a variety of ways.These results show that respondents primarily used NICE Bites as a reference source. 46% of respondents use NICE Bites in implementation of NICE guidance. From the ‘other’ responses NICE Bites is also used in newsletters (n=3), formularies (n=2), for discussion with GPs (n=3) and in answering medicines information enquiries (n=1).

14. Do you find NICE Bites easy to read?

18. Which NICE publications should be included in NICE Bites?

Multiple responses were allowed for this question. There were 229 responses from 160 respondents.

* Total percentages exceed 100 as multiple responses were allowed for this question.

Currently NICE Technology appraisals are not included in NICE Bites but as 44% of respondents would like these to be included this needs to be reconsidered.

19. Is the timescale of guidance included in NICE Bites appropriate?

NICE Bites aims to include new guidance within one month of publication by NICE.

99% of respondents thought that this timescale was appropriate.

20. Is it helpful to include NICE guidance published prior to 2009?

76% of respondents would find it helpful to include NICE Guidance published prior to 2009.

21. Is NICE Bites relevant to your practice?

22. Have you ever been prompted to change your practice after reading NICE Bites?

54% of respondents were prompted to change their practice. 24 respondents gave examples. A sample of these answers is as follows;

Increased warfarin prescription for AF. Awareness of CHAD2

NICE Clinical Guideline on heart failure (HF) – switch to licensed beta blocker

Use beta blocker in HF in patient with COPD

Refer HF patients for rehab

Reduce use of ezetimibe with statin

UseNICE Bites as a training tool within practice on a regular basis

Review of practice guidelines and audit of prescribing

We have changed our prescribing to accommodate NICE guidelines

23. Would you recommend NICE Bites to your colleagues?

100% of respondents would recommend this publication to others.

24. Any further comments?

35% (n= 57) of respondents also provided further positive comments. A sample of these are included on the final page of this document.

Summary

The results from the NICE BitesUser survey have been very encouraging and show that this publicationisrecognised as a useful resource.160 completed responses were received. Pharmacists are the main professional group that completed the survey (58% of respondents), followed by GPs (16%) and nurses (7%). 72% of respondents work in primary care. 38% of respondents are prescribers.

75% of respondents accessNICE Bites via email and 29% access it online. NICE Bites is published onthe National electronic Library for Medicines website at of respondents accessNICE Bites at this site. 40% of respondents do not access NICE Bites online and of these 14% are not aware it is available online. In the words of one respondent, “it needs to be more easily accessible. Difficult to find on the internet – I only heard by word of mouth. RSS feed isn’t clear and I have no idea how to get it delivered by email.”This highlights the need to increase awareness of online access.

Results from the survey confirm that NICE Bites includes information which is relevant to prescribers, in a format which is easy to read and of an appropriate length.

It is an adaptable resource which is used in a variety of ways. 25% of respondents copy and paste sections into their own formularies. 46% of respondents use NICE Bites in the implementation of NICE guidance.

As a result of this survey the following actions need to be considered:

extend the email distribution list. This will be a considerable administrative burden and will need allocation of additional resources.

include NICE technology appraisals in future editions of NICE Bites.

give consideration to new ways of access as technology advances

signpost readers to online access in the NICE Bites monthly email and bulletin:

valuable refer

December 2010Lindsay Banks

North West Medicines information