Prescribing Advice for GPs

NICE Guidance - January 2012

January 30, 2012 at 12:06 pm | In Prescribing Extra - Other |  Print | No Comments

The National Institute of Health and Clinical Excellence (NICE) has published new guidance for the month of January 2012. This month there is one clinical guideline and two technology appraisals that impact upon primary care.

The updated Epilepsy clinical guideline now includes several newer anti-epileptic drugs that have been introduced since the original guideline. New recommendations include:

• Basing therapeutic choice on the presenting epilepsy syndrome or presenting seizure type(s) where the syndrome type is unclear.
• Advising women and girls of the possible risk of malformation and neuro-developmental impairment in an unborn child when sodium valproate is used.
• Only prescribe buccal midazolam or rectal diazepam for use in the community for individuals who have had a previous episode of prolonged or serial convulsive seizures.

Roflumilast has been reviewed in a technology appraisal for the management of severe chronic obstructive pulmonary disease. The drug is only recommended as part of a research study (clinical trial) that is investigating using roflumilast at the same time as a bronchodilator.

Apixaban has also been reviewed in a technology appraisal for the prevention of venous thromboembolism after total hip or knee replacement in adults. The treatment has been recommended as an option based on greater efficacy and lower acquisition costs than some alternatives. Primary care may be asked to issue treatment completions.

Action: Clinicians should be aware of this new guidance and implement any necessary changes to practice.

Vitamin D importance highlighted

January 30, 2012 at 9:06 am | In Prescribing Extra - Other |  Print | 4 Comments

The Chief Medical Officer for England has been reported to be contacting healthcare professionals about vitamin D deficiency after recent research found that many healthcare professionals were unaware of current recommendations. According to NHS choices, several newspapers and other news outlets carried this story (BBC).

Current advice (PDF) highlights which groups are at risk of vitamin D deficiency, sources of vitamin D in the diet as well as from skin exposure to sunlight and recommends daily intake levels of vitamin D in those at risk of deficiency.

It also describes access to supplements, via Healthy Start if eligible or the alternatives depending on local arrangements if individuals are not eligible. Healthy Start Vitamins are allowed on NHS prescription.

Action: Clinicians should be aware of these recent reports and current recommendations.

MeReC Bulletin - Implementing key therapeutic topics: 1

January 27, 2012 at 9:47 am | In Prescribing Extra - Other |  Print | No Comments

The National Prescribing Centre has published a MeReC Bulletin (PDF), the first in a series of three, that focuses on the therapeutic areas of the QIPP agenda.

The topics covered in this bulletin are:

• Non-steroidal anti-inflammatory drugs
• Antibiotic prescribing - especially quinolones and cephalosporins
• High dose inhaled corticosteroids in asthma

For each of the therapeutic topic areas the evidence base is summarised and current prescribing data are reviewed.

Action: Clinicians who prescribe in any of the areas above and who are striving to deliver value for money while maintaining or improving the quality of care will find this information is useful and informative.

Prodigy update - January 2012

January 12, 2012 at 10:23 am | In Prescribing Extra - Other |  Print | No Comments

Prodigy
has been updated in January 2012 for the following clinical areas:

• Adverse drug reactions
• Angio-oedema and anaphylaxis
• Ankylosing spondylitis
• Bipolar disorder
• Bites - human and animal
• Dementia
• Depression
• Depression - antenatal and postnatal
• Diabetes - type 2
• Dyspepsia - proven GORD
• Dyspepsia - proven non-ulcer
• Dyspepsia - proven peptic ulcer
• Dyspepsia - unidentified cause
• Heart failure - chronic
• HIV infection and AIDS
• LUTS in men, age-related (prostatism)
• Menopause
• Obsessive-compulsive disorder
• Osteoarthritis
• Schizophrenia
• Stroke and TIA
• Tamoxifen - managing adverse effects
• Urticaria

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

MeReC Bulletin - Supporting adoption of evidence

December 23, 2011 at 11:37 am | In Prescribing Extra - Other |  Print | No Comments

The National Prescribing Centre has published a MeReC Bulletin (PDF) that focuses on the adoption of evidence into practice.

This bulletin takes evidence and ideas from educational theory, decision-making theory, information management and implementation science and brings them together in one place. It notes that directives issued 'from above' may be resisted and that there are no fool-proof solutions.

However, it is suggested that a strategic approach that is adaptable and flexible may prove more useful in addressing the concerns of potential adopters. Deploying a wide range of interventions in a sensitive and appropriate manner can then lead to important improvements in care.

Finally, this bulletin lists some key principles for more successful implementation of evidence into practice:

• Aim for adoption of the change in practice, not its imposition
• Consider the concerns and questions of potential adopters
• Make it easier for people to do the right thing
• Support effective foraging, hunting and hot-synching
• Recognise and support the communities of practice in which potential adopters work
• Allow potential adopters to experiment with and adapt the change in practice to their situation
• Plan carefully but be flexible and adaptable

Action: This MeReC Bulletin will be a worthwhile read for any clinicians who are also involved in encouraging evidence-based, clinically effective practice.