Prescribing Advice for GPs

Hypertension Meta-Analysis

May 16, 2008 on 11:29 am | In Prescribing Extra - Drugs |  Print | No Comments

The British Medical Journal has published the results of a meta-analysis of hypertension trials that aimed to quantify the relative risk reductions achieved with different regimens in younger and older adults.

The study reviewed 31 trials, including 190,606 participants. The primary outcome was major cardiovascular events compared in two age groups, those under 65 and those over 65 years old. The data were analysed in several different ways to compare active treatments with placebo or alternative active comparators.

The study found no difference in the primary outcome when comparing different drug regimens (P≥0.24 in all cases) and there was no clear difference in blood pressure lowering effects in the different age groups. An accompanying editorial discusses some of the limitations in the study including the arbitrary age cut-off and also attempts to integrate the results of this analysis into the existing evidence base and current guidelines.

The authors conclude that, “Reduction of blood pressure produces benefits in younger and older adults, with no strong evidence that protection against major vascular events afforded by different drug classes varies substantially with age“.

Action: Clinicians should continue to implement the existing national guidelines for hypertension irrespective of age. Effective control of hypertension is key in the management of overall cardiovascular risk.

May CKS Update

May 15, 2008 on 9:41 am | In Prescribing Extra - Other |  Print | No Comments

Clinical Knowledge Summaries (CKS) has been updated in May for the following clinical areas:

• Anal fissure
• Corneal superficial injury
• Dyspepsia - pregnancy associated
• Haemorrhoids
• Nausea/vomiting in pregnancy

Action: Clinicians who see patients with any of these conditions may find the updated information useful when reviewing current clinical practice.

Immunisation website adds HPV information

May 14, 2008 on 9:21 am | In Prescribing Extra - Other |  Print | No Comments

The NHS immunisations website has been updated with information about the human papillomavirus vaccine (HPV) and the vaccination programme due to start this autumn. A recent study highlighted that lack of information was a common reason for refusing the vaccination.

This new website contains:

• Information about the vaccine
• Information about the disease the vaccine can prevent
• A list of frequently asked questions (FAQs)
• Links to other resources

The information currently available is intended for healthcare professionals but it may also prove helpful to patients. The information will continue to be updated with a changing focus to patient orientated information.

Action: Clinicians who want more information about the HPV vaccine and vaccination programme will find this site useful. Patients can also be directed to this resource, especially as the information updates are added.

SMC May Update

May 13, 2008 on 9:09 am | In Prescribing Extra - Other |  Print | No Comments

The Scottish Medicines Consortium has issued its monthly advice on new medicines.

Aliskiren (Rasilez^®) has been rejected for the treatment of essential hypertension. Escitalopram (Cipralex^®) has been rejected for the treatment of social anxiety disorder. Both rejections we made because the manufacturers failed to make a submission.

Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected medicines should be avoided.

Debate on NHS top-up fees

May 12, 2008 on 2:13 pm | In Prescribing Extra - Other |  Print | No Comments

The British Medical Journal has published a head to head debate asking if patients should be able to pay top-up fees to get the treatment they want.

James Gubb, director of health unit, argues in favour of top-up fees stating that this practice already happens but is in need of some standardisation in terms of cost and availability. He sites the current situation with hearing aids and also how decisions over funding of NICE rejected anti-cancer drugs differ with location.

Karen Bloor, a researcher at the University of York, argues against top-up fees stating the treatment should be based on clinical need and not on ability to pay. It is also argued that allowing top-up fees could have a significant effect on market prices with emergence of top-up fee insurance and increasing drug costs due to the weaker price negotiating position of multiple purchasers.

This debate serves to highlight the continued tension of providing an enormous range of treatments with a limited resource. This debate is likely to continue, especially while individual patients, pharmaceutical companies and patient groups continue to contest national policy decisions to not fund treatment based upon want rather than need.

Action: Clinicians must ensure that they make optimal use of their allocated NHS resource by prescribing with due regard for cost-efficacy and clinical need.