Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Which? Pharmacy Investigation

Which? has published a report detailing findings of an investigation that sent undercover investigators into 101 pharmacies across the UK.

This study has been reported in the general media (BBC) because advice was described as unsatisfactory in a third of all encounters.

The Royal Pharmaceutical Society of Great Britain has responded noting that improvements have been made since the last Which? investigation in 2004, in particular the availability of private consultation areas, the supply of Emergency Hormonal Contraception and provision of Medicine Use Reviews. It is also stated that the full report will be analysed and the Society will work with the profession to address areas for improvement.

Action: Clinicians and the general public can be assured that pharmacies still offer high quality advice and are committed to continually improving standards and training.

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NPCi discusses Anticholinergics in COPD

The National Prescribing Centre (NPC) has published a Rapid Review discussing in detail the current concerns about inhaled anticholinergics in people with COPD and an increase in cardiovascular events.

The article details the background to the current concerns, provides a detailed interpretation of the latest information and highlights the limitations in the current data.

Action: Clinicians will find this article useful in reassuring patients. It is thorough and of the usual high standard expected of the NPC.

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COPD study in the news

The study linking COPD treatment with an increased risk of death is now being reported in the wider media (BBC). As reported last week, the study found an increased risk of all-cause and cardiovascular mortality in patients using anti-muscarinic drugs like ipratropium.

It has already been noted that this study did not correct for smoking status. Smokers are already at heightened risk of heart attacks and the cause of the observed difference in death rates may be due to factors other that drug treatment.

[UPDATE]
A second study published in the Journal of the American Medical Association has also linked inhaled anticholinergics to an increased risk of cardiovascular outcomes including cardiovascular death, myocardial infarction (MI) and stroke. The authors acknowledge that there are insufficient data to correct for other risk factors, including hypertension and pre-existing heart disease

Action: Worried patients should be reassured and encouraged to continue using their treatment.

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September NICE Guidance

The National Institute of Health and Clinical Excellence has published new guidance for the month of September.

There are two new Clinical Guidelines that impact on primary care. Attention deficit hyperactivity disorder (ADHD) (PDF) covers the diagnosis and management of ADHD in children, young people and adults. It discusses care, treatment and support that can be offered by health services and family members.

Chronic kidney disease (PDF) covers the early identification and management of adults with chronic kidney disease. It discusses diagnosis, treatment and referral to specialist renal services. Recommendations are also made about management of diabetes, blood pressure and cardiovascular risk in people with chronic kidney disease.

Action: Primary care clinicians should be aware of these new guidelines. They provide useful information regarding diagnosis, management, drug treatment and referral for patients with these conditions.

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Targeted HIV Testing

A new guideline issued by the British HIV Association (BHIVA), the British Association for Sexual Health and HIV (BASHH) and the British Infection Society (BIS) has recommended more targeted testing for infection with human immunodeficiency virus (HIV).

The Health Protection Agency (HPA) has supported this recommendation. According to HPA estimates around 73,000 people in the UK are infected with HIV with one third of these cases being unaware that they are infected.

To assist with local planning and delivery the HPA have also released prevalence data by Primary Care Trust (PCT). Thirty four PCTs have infections rates greater than 2 cases per 1,000 population. 25 of these are in London with the remaining nine as follows: Blackpool, Bournemouth & Poole, Brighton And Hove City, Heart Of Birmingham, Leicester City, Luton, Manchester, Nottingham City and Salford.

The guideline also recommends universal testing for HIV through sexual health clinics, antenatal services, pregnancy termination services, drug dependency programmes and services for those diagnosed with tuberculosis, hepatitis B, hepatitis C and lymphoma.

Action: Clinicians should be aware of these recommendations and be able to sign post patients to local HIV testing services.

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