Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - August 2018

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of August 2018. This month there are two guidelines that impact upon primary care.

The Flu vaccination: Increasing uptake guideline has been published. It covers how to increase uptake of the free flu vaccination among people who are eligible. It describes ways to increase awareness and how to use all opportunities in primary and secondary care to identify people who should be encouraged to have the vaccination.

The Community pharmacies: promoting health and wellbeing guideline has been published. It covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It may be relevant for people working in related services, for example GP practices and out-of-hours services.

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

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Alzheimer's disease treatments delisted in France

According the Prescrire, a French medical journal, drug treatments for Alzheimer's disease have been delisted in France and will no longer be reimbursed by the national health insurance system.

According to the article, the National Authority for Health (HAS) has previously issued guidance recommended treatments including donepezil, galantamine, rivastigmine and memantine. A review in 2016 of the harm-benefit balance of these treatments by France's Pharmacoeconomic Committee resulted in HAS acknowledging that these drugs have no place in the management of Alzheimer's disease.

Current guidance from NICE still recommends these treatments as options along with a range of other interventions to promote wellbeing and functional ability.

Action: Clinicians should continue to follow current NICE guidance however this move represents an interesting move away from medication in favour of supportive strategies for daily living that includes assistance for caregivers and family members.

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CKS Updates - July 2018

During July 2018 Clinical Knowledge Summaries were published or updated in the following areas.

New topics were published for:

The following topics were all reviewed:

The majority of topics have undergone reviews and minor restructures.

The most significant changes were to the Fungal skin infection - body and groin topic which has had new nodes on Definition, Risk factors, Prevalence, Complications, and Prognosis added to the Background information section. The Prescribing Information section has also been updated and expanded in line with current CKS style for this topic and the Osteoarthritis topic.

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

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Drug Safety Update - July 2018

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for July 2018 (PDF).

This issue advises of the risk of airway obstruction from aspiration of loose objects when using pressurised metered dose inhalers (pMDI). There have been 22 reports in the UK of accidental inhalation of the mouthpiece cover or objects that have become trapped in the inhaler since 1987 with a further 36 cases reported outside of the UK. It is suggested that patients using pMDI inhalers are advised to:

  • store the inhaler with the mouthpiece cover correctly in place
  • remove the mouthpiece fully before using the inhaler
  • shake the inhaler to remove loose objects that may not be visible before use
  • check the inside and outside of the mouthpiece are clear before inhaling a dose
  • not use damaged inhalers

Yellow Cards should be submitted to report adverse incidents during use of inhalers and are also invited in this issue for suspected adverse reactions associated with medicines taken during pregnancy experienced by women or the baby or child.

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

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NICE Guidance - July 2018

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of July 2018. This month there is one guideline that impacts upon primary care.

The Rheumatoid arthritis in adults guideline has been published, it updates and replaces existing guidance. It covers diagnosing and managing rheumatoid arthritis. It aims to improve quality of life by ensuring that people with rheumatoid arthritis have the right treatment to slow the progression of their condition and control their symptoms. People should also have rapid access to specialist care if their condition suddenly worsens.

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

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