Update lpherbal.json

openprescribing/measure_definitions/lpherbal.json

@@ -1,13 +1,31 @@
 {
-  "name": "NHS England Low Priority Treatment - herbal medicines",
+  "name": "Items which should not routinely be prescribed in primary care - herbal medicines",
   "title": "Herbal medicines cost per 1000 patients",
   "description": "Cost of herbal medicines per 1000 patients",
   "numerator_short": "Herbal medicines cost (£)",
   "denominator_short": "1000 patients",
   "why_it_matters": [
-    "Under a Traditional Herbal Registration there is no requirement to prove scientifically that a product works, ",
-    "the registration is based on longstanding use of the product as a traditional medicine, and therefore there is ",
-    "a lack of robust evidence of clinical effectiveness for these products."
+
+    "<p><a href='https://www.england.nhs.uk/long-read/items-which-should-not-routinely-be-prescribed-in-primary-care-policy-guidance/#herbal-treatments-and-other-natural-products-updated-2023' target='_blank'>",
+    "NHS England guidance states</a>:</p>",
+    "<p><i>Under a traditional herbal registration (THR) there is no requirement to prove scientifically that a product works; the registration is based on longstanding use of the product as a traditional medicine.</p>",
+    "<p>Due to the lack of scientific evidence required to register these products with the MHRA, the joint clinical working group felt that they were suitable for inclusion in this guidance.</p>",
+    "<p>In addition to herbal treatments with a THR, other natural products without robust evidence of clinical effectiveness should not be prescribed at NHS expense and fall within these recommendations. ",
+    "These products do not have a THR, are not recognised as supplements in the NHS Drug Tariff and do not appear as medicines in the BNF. ",
+    "These include:",
+    "<ul>",
+    "<li>natural oils, eg eucalyptus and almond</li>",
+    "<li>coenzyme Q10 (ubiquinone and ubidecarenone)</li>",
+    "<li>evening primrose (gamolenic acid).</li>",
+    "</ul>",
+    "</p>",
+    "<p>MHRA withdrew the licence for 2-gamolenic acid preparations in 2002 due to a lack of evidence of efficacy.</i></p>",
+    "NHS England recommend that GPs</a>:",
+    "<ul>",
+    "<li>Do not initiate.</li>",
+    "<li>Deprescribe in patients currently prescribed this medicine.</li>",
+    "</ul></p>",
+    "<p><b>Please note: this measure does not currently include natural oil preparations.</b>"
   ],
   "tags": [
     "cost",
@@ -19,13 +37,30 @@
   "is_cost_based": true,
   "low_is_good": true,
   "numerator_type": "bnf_cost",
-  "numerator_bnf_codes_query": "SELECT DISTINCT bnf_code FROM {dmd}.amp WHERE lic_auth = 4 AND bnf_code NOT LIKE '190203%'",
+  "numerator_bnf_codes_query": [ 
+    "SELECT DISTINCT v.bnf_code FROM dmd.vmp v", 
+    "INNER JOIN dmd.vtm t", 
+    "ON t.id = v.vtm",
+    "WHERE (LOWER(t.nm) LIKE '%gamolenic%' OR LOWER(t.nm) LIKE '%ubidecarenone%') ",
+    "AND v.bnf_code IS NOT NULL",
+    "UNION ALL",
+    "SELECT DISTINCT a.bnf_code FROM dmd.amp a",  
+    "INNER JOIN dmd.vmp v ON a.vmp = v.id",
+    "INNER JOIN dmd.vtm t ON t.id = v.vtm",
+    "WHERE (LOWER(t.nm) LIKE '%gamolenic%' OR LOWER(t.nm) LIKE '%ubidecarenone%') ",
+    "AND a.bnf_code IS NOT NULL",
+    "UNION ALL",
+    "SELECT DISTINCT bnf_code FROM dmd.amp",
+    "WHERE lic_auth = 4",
+    "AND bnf_code NOT LIKE '190203%'"
+  ],
   "denominator_type": "list_size",
   "authored_by": "[email protected]",
-  "checked_by": "[email protected]",
-  "date_reviewed": "2023-04-18",
-  "next_review": "2024-04-18",
-  "measure_complexity": "low",
-  "measure_type": "bnf_code"
+  "checked_by": "",
+  "date_reviewed": "2023-11-20",
+  "next_review": "2024-11-20",
+  "measure_complexity": "medium",
+  "measure_type": "dmd",
+  "radar_exclude": false
 }