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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

MTRAC Reviews

The Midlands Therapeutic Review and Advisory Committee (MTRAC) has published reviews covering ropinirole (Adartrel®) and pramipexole (Mirapexin®) for restless leg syndrome.

Ropinirole
has been assessed as a Q3 drug having stronger evidence but a lower place in therapy. Pramipexole has been assessed as a Q4 drug having weaker evidence and a lower place in therapy. Both drugs have a lower place in therapy as use is recommended only after potential causes of secondary restless leg syndrome such as iron deficiency anaemia and peripheral neuropathy had been excluded.

Both treatments are licensed for the treatment of moderate to severe restless leg syndrome (RLS). Assessment of the severity of RLS is possible using the Restless Leg Syndrome Rating Scale. This scale rates a patients assessment of their symptoms over 10 questions and allows examiners to rate RLS severity to guide treatment decisions.

Action: Clinicians should use the RLS rating scale to guide treatment decisions. In patients with moderate to severe RLS ropinirole appears to be the most effective treatment option but patients should be warned about potential side effects (nausea and vomiting occur in more than 10% of cases) and there is also a possibility for paradoxical worsening of symptoms with treatment.

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Controlled Drug Guide updated

The National Prescribing Centre (NPC) has updated the Guide to Good Practice in the Management of Controlled Drugs in Primary Care.

The Guide incorporates changes that have been announced since the first edition of the guide was published in December 2005. It covers many aspects of the management of controlled drugs including:

  • Purchase and Supply
  • Storage
  • Records
  • Destruction
  • Prescribing
  • Possession

The NPC also recommend that, since the legal and regulatory framework governing CDs is continuing to change significantly, the following sites may be useful in obtaining the most up-to-date information:

Action: All healthcare professionals who prescribe, supply or administer controlled drugs should obtain a copy of this guide and familiarise themselves with the changes in legislation and good practice.

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Competencies for shared decision making

The National Prescribing Centre has published a competency framework for shared decision-making with patients. This document is intended support healthcare professionals in their consultations with patients to ensure that patients can make informed decisions about their health.

This document summarises the shared decision-making process into three distinct areas each of which has further competency considerations as detailed below:

  • Building a relationship - Listening and Communicating
  • Managing a shared consultation - Context and Knowledge
  • Sharing a decision - Understanding, Exploring, Deciding and Monitoring

The document then goes on to discuss the key skills and behaviours required for each competency, for example clinicians should make patients feel at ease, allow then to express their views and concerns and give the opportunity to ask questions while listening.

Action: All clinicians, but especially those who are new to the consultation or concordance process, will find this document to be a useful resource. It will allow individuals to reflect upon their own consultation skills and identify areas that can be improved.

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New SIGN Guidelines

The Scottish Intercollegiate Guideline Network (SIGN) has published five new guidelines covering several different aspects of cardiovascular disease.

The guidelines cover:

Action: Clinicians involved in the diagnosis and management of cardiovascular disease will find these guidelines to be a useful reference. They should be read in conjunction with any published NICE guidance on the same topic.

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New Clinical Knowledge Summaries site

The new Clinical Knowledge Summaries (CKS) website has published several new and updated Prodigy Guidelines. The guidelines include angina, asthma, atrial fibrillation, diabetes- glycaemic control and hypertension.

As reported previously the Department of Health ended an agreement with BJM Publishing to provide Clinical Evidence in September 2006.

This new website links to Prodigy guidance (full and quick reference guides), patient information leaflets and PRODIGY Drugs. PRODIGY Drugs is consistent with the Prodigy guidelines and has been developed to support formulary development.

Action: Further developments are planned on the CKS website. Clinicians should add this website resource to their regular reading list and ensure ready access by creating an Internet bookmark.

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