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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Prescription charge changes delayed

The Department of Health has announced that any further changes to the way prescriptions are charged or exempted will have to await the next Spending Review due in the Autumn. This decision has been reported in the general media (BBC).

Since the 1st April 2009 patients on active cancer treatments have qualified for a medical exemption certificate. Current proposals include a phased introduction of exemptions for people with long terms conditions and a gradual reduction in the price of a prepayment certificate.

Action: Clinicians should be aware of current exemption classes and be able to advise patients how they could better fund access medicines, for example with a prepayment certificate.

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Falls prevented by single vision glasses

The British Medical Journal has published the results of a study that aimed to assess whether the provision of single lens distance glasses to older wearers of multifocal glasses reduces falls. The results have been reported in the general media (BBC).

The study was conducted in New South Wales, Australia and recruited 606 participants who were regular wearers of multifocal glasses with a mean age of 80 years old. Inclusion criteria included an increased risk of falling and regular use of multifocal glasses while outdoors. Follow up was planned after 13 months with 90% of the intervention group being provided with their new glasses within 2 months.

Participants were randomly assigned to usual care or an intervention group who were provided with single lens distance glasses and advised to use them when walking and undertaking outdoor activities. Assessors were blinded to group allocation.

Use of single lens distance glasses was associated with an 8% reduction in falls (non-significant) in the study population. In a pre-specified sub-analysis, a significant reduction in all falls was identified in participants who undertook higher levels of outdoor activities. This reduction was also observed for outdoor falls and injurious falls. However, there was an increase in the number of outdoor falls among participants who had lower levels of outdoor activity.

The authors conclude that, "provision of single lens glasses for older wearers of multifocal glasses who take part in regular outdoor activities is an effective falls prevention strategy".

Action: Clinicians should be aware of this study. Patients who wear varifocal glasses and who also undertake regular outdoor activities may benefit from obtaining single vision glasses for use outdoors as an intervention to reduce the risk of falls.

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SMC Update - May 2010

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

Telmisartan (Micardis®) has been rejected for use in cardiovascular prevention and in type 2 diabetes with documented target organ damage. The manufacturer failed to make a submission.

Sitagliption / Metformin (Janumet®) has been accepted for restricted use as an adjunct to diet and exercise to improve glycaemic control in patients with type 2 diabetes mellitus. It is restricted to use in patients for whom a combination of sitagliptin and metformin is an appropriate choice of therapy and only when the addition of sulphonylureas to metformin monotherapy is not appropriate.

Extended release nicotinic acid / laropiprant (Tredaptive®) has bee accepted for restricted use in the treatment of dyslipidaemia, particularly in patients with combined mixed dyslipidaemia and in patients with primary hypercholesterolaemia as monotherapy in patients in whom HMG-CoA reductase inhibitors [statins] are considered inappropriate or not tolerated.

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

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MeReC Extra 45

The National Prescribing Centre has published MeReC Extra 45 (PDF) which contains information regarding recent study results that identified blood pressure variability as an independent risk factor for stroke and the relationship between blood glucose lowering and mortality in type 2 diabetes.

The first section discusses the results of a recent study published in the Lancet that identified variability in systolic blood pressure as an independent risk factor for stroke even after correction for mean systolic blood pressure. Additional studies have identified that some antihypertensive classes may offer advantages however there are limitations in the analyses and it is therefore recommended that clinicians continue to follow current guidelines until they can be formally reviewed.

The second section discusses the results of another study published in the Lancet that reviewed the association between HbA1c and all-cause mortality in patients with type 2 diabetes. This study found that the lowest risk of mortality was associated with an HbA1c of 7.5% (59mmol/mol). These findings are consistent with the results of several randomised controlled studies. Clinicians should take these findings into consideration when thinking about intensifying hypoglycaemic treatment.

Action: Clinicians who see patients with hypertension or type 2 diabetes will find this information useful and informative.

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NICE Guidance - May 2010

The National Institute of Health and Clinical Excellence has published new guidance for the month of May 2010.

This month there is one clinical guideline that has an impact on primary care. The management of lower urinary tract symptoms in men (QRG) gives clear recommendations on assessing, monitoring and treating lower urinary tract symptoms. The guideline covers:

  • Management of acute and chronic retention
  • Conservative, pharmacological and surgical treatment of voiding symptoms
  • Conservative, pharmacological and surgical treatment of storage symptoms

Action: Clinicians should be aware of these guidelines. They will be a useful resource for clinicians who see men with urinary symptoms.

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