Cow's Milk Protein Allergy (CMPA/CMA) is an immune mediated response to one or more proteins found in cow's milk. The form seen most often in primary care is 'non-IgE mediated', symptoms of which include itching skin, vomiting, and loose stools. It is delayed onset, and children usually outgrow it by the time they are 18 months old. Prescribing for cow's milk protein allergy is above National levels in Tees Valley. Working alongside a local paediatric consultant an updated guideline was developed, and the goal was to implement this guideline, educate prescribers and create helpful resources, to ultimately allow more uniform and appropriate management of children presenting with a possible allergy to cow's milk.
Using OpenPrescribing local trends were analysed, and the highest prescribing practice was found, in order to use them as a trial. The new guideline and the practice data was then discussed with the GP clinical lead and the practice pharmacist. To help implement the guideline, OptimiseRx messages were created, Ardens templates checked that they were up to date and being used, and videos created by the local trust to educate patients on milk free weaning and the milk ladder were shared.
A pharmacist education session was conducted with all the local PCN pharmacists, with positive feedback being received that it has already spurred on work to improve prescribing in this area. It was also discussed at local GP meetings and will be part of this year's medicines optimisation workplan for the area.
Already there has been impact from the project, with a £745 (20.4%) reduction in spend and a 23% reduction in items for allergy milks in the trial practice. The trial practice is also no longer the highest spend, having moved two places to be the third highest in the area, this is still above the national average, but is certainly a positive step.
