What are the different Monitoring Invite sections?

The different sections of the monitoring invites folder can be confusing. You may wonder why we have different sections at all, why not just group them all together?!

Even accounting for different approaches between practices, all practices experience variability in their capacity and have times when they need to focus on higher-priority invites first.

The sections can be summarised like this:

1. HIGH RISK DRUG (HRD) MONITORING - includes Shared Care, other High Risk Drugs that require frequent monitoring, Overdue Critical Annual Monitoring & Critical tests after starting new medication
2. ROUTINE MONITORING - includes frequent monitoring (i.e. more frequent than annual) and one-off requests. Essentially any patients who need either one-off or frequent monitoring and who aren't in section 1. This includes things like 6 monthly HbA1cs for Diabetics, any regular monitoring that's been configured on individual patients, any one-off requests using our request test template. 
3. HIGH RISK DRUG (HRD) MONITORING - Shared Care Only [this is the highest priority of section 1]
4. ROUTINE MONITORING - High Priority Only (PSA, Ad Hoc Requests, DM Diagnoses) [this is the highest priority of section 2]
5. MONITORING - Ad Hoc Requests, Shared Care Drugs, Med changes requested to monitor and Any Localised Priorities [see options below]

This Venn diagram displays the way they overlap / relate:

If a practice has sufficient capacity, sections 1 and 2 cover all the patients who need monitoring invites and ideally, both of these sections should be sent each week. If capacity is limited, sections 3 and 4 should be used.

Section 5 was developed later as a way to let a practice choose their priorities. It always includes ad hoc requests, requests to monitor new medication and shared care drugs that require frequent monitoring. Other items to be included can be configured for each practice.

Here's more detailed information about what we mean by the terms in the list above:

Shared Care Drugs:

Any of these medications on repeat and not coded as monitored by Secondary Care:

• ADHD/CNS Stimulants (<18y)
• Antiproliferative immunosuppressants
• Azathioprine
• Ciclosporin
• Cinacalcet
• Dapsone
• Intuniv (guanfacine)
• Leflunomide
• Mercaptopurine
• Methotrexate
• Midodrine
• Rifaximin
• Sirolimus
• Sulfasalazine
• Tacrolimus

Other High Risk Drugs 

Any of these medications that are on repeat and that require monitoring more frequently than annual:

• Alfacalcidol
• Amiodarone
• Antimetabolites
• Apomorphine
• Azithromycin
• Carbimazole
• Denosumab
• DOACs
• Dronedarone
• Gold salts
• Lithium
• Loop diuretics
• Minocycline
• Mirabegron
• Modafinil
• Nitrofurantion / Trimethoprim on more than 6m
• Oral Retinoids
• Penicillamine
• Potassium-sparing diuretics and aldosterone antagonists (Eplerenone / Spironolactone)
• Sulfasalazine
• Ursodeoxycholic acid

Overdue Critical Monitoring

These are medications that are very important to monitor annually and become high risk when that monitoring is overdue. These medications on repeat, without appropriate monitoring in the last 14 months are included in section 1:

• ACE/ARB              
• Antipsychotics   
• Digoxin 
• DOACS  
• Loop Diuretics
• NSAIDS 
• Olsalazine, Balsalazide, Mesalazine           
• Sodium Valporate
• Thyroid hormones

Critical tests after starting new medication

Historically, our systems identified these by looking at repeat medication. Now this is based on the pop-ups you see when starting or changing medication. Time frames depend on the medication and options selected on the pop-ups.

• Allopurinol / Febuxostat with no UE & Urate after starting / changing
• Anti-Hypertensives with no UE after starting / changing
• Statins or other Lipid Regulating agents with no ALT / LFT after starting
• Testosterone Replacement with no Testerone levels after starting
• Thyroid Hormones with no TFT after starting / changing

Local Priorities

These are practice dependent. These are the current options available:

• Bloods to repeat following abnormal results from pathology system
• Carbimazole Monitoring
• Diabetes Diagnosis (i.e. repeating one-off raised HbA1c)
• Diabetes Monitoring
• DOAC Monitoring
• PSA Monitoring (patient specific)

Just let us know if you'd like any of these enabling for your practice, or if there's another priority you'd like to request.