Prescribing generically: how to decide
February 25, 2011 by admin
Which medicines should not be prescribed generically and what are biosimilar medicines? These are some of the questions considered in a useful new bulletin from the MeReC on prescribing generically in primary care. It explains about generics, branding, costs and reimbursement, and the now-abandoned proposals for generic substitution in primary care in England (see here). Generic medicines given a licence have been deemed by the regulator to be as safe as the branded medicine and clinically equivalent, when used at the same dose for the same condition. There is little evidence to back concerns that switching has adverse effects.
There are some circumstances in which a specific product, branded or generic, should be prescribed and these include: drugs with a narrow therapeutic index such as phenytoin (although there is little good quality evidence to support concerns about these medicines, the concerns remain and the consequences are potentially serious); some modified-release or extended-release drugs (because of the differences resulting from different manufacturers’ formulations); certain administration devices such as some CFC-free beclometasone inhalers; multiple ingredient products such as oral contraceptives and emollient creams; ‘biosimilar’ medicines; if differences in appearance might lead to confusion or anxiety, reducing adherence to long–term medications; to avoid specific inactive formulation ingredients where they are not tolerated.
NICE updates guidance on anxiety
February 25, 2011 by admin
Nice has updated its guidance on managing generalised anxiety disorder. Benzodiazepines should not be offered as treatment for generalised anxiety disorder (except as short term crisis help), and nor should antipsychotics in primary care. It says sertraline can be considered, but that as of January 2011, it did not have UK marketing authorisation for this indication so documented informed consent is needed.
The guidance stresses the importance of considering each person’s needs and preferences, and on good communication. The first step should be education about the disorder and active monitoring, followed by low-intensity psychological intervention such as guided self-help. After that, the choice is between more intensive psychological intervention or drug treatment. A final layer consists of more complex and intensive specialist interventions. Recommendations for panic disorder, also included in this guideline, have not changed.
Managing constipation: MeReC bulletin
February 25, 2011 by admin
A MeReC bulletin has pulled together useful information and guidelines about the management of constipation in children and adults using three case studies. It comments on how the wide variation in normal bowel function can make diagnosis of constipation subjective and on how public perceptions have changed. Because there is not enough clinical evidence to compare the efficacy of some laxatives, prescribers consider cost, symptoms and acceptability to patients.
CKS: new topics published
February 25, 2011 by admin
Several new topics were added to the NHS Clinical Knowledge Summaries website in February: male and female androgenetic alopecia; benign paroxysmal positional vertigo; breastfeeding problems; delirium; pulmonary embolism; and vestibular neuronitis. The topics on hypothyroidism and pruritus vulvae have been updated as well.
Potential of nurse prescribing in dermatology
February 3, 2011 by admin
This commentary on a recent article (see here) argues that nurse prescribing has an important contribution to make to the development of dermatology services given its scale and its potential to improve treatment outcomes and access to care. As ways of improving treatment effectiveness develop and are evaluated, it is important that they take account of nursing activity.
Ersser SJ. Nurse prescribing, concordance and the therapeutic consultation. BJD 2011; 164(2): 236-237.
Pharmacist independent prescribing: a community-based mental health clinic
February 3, 2011 by admin
A pharmacist independent prescriber describes his experiences in a community-based clinic for secondary care patients, mostly with affective disorders. A nurse prescriber and a consultant psychiatrist run clinics in tandem: he says there is a niche for pharmacist prescribers to see more complicated cases where people are taking multiple medicines and that more pharmacists could do this kind of work - although seeing patients like this and being responsible for them as a prescriber is outside the traditional comfort zone for many pharmacists.
Kirk S. Independent prescribing for secondary care patients in a community-based clinic. Br J Clin Pharmacy 2010; 2(11): 347-348.
http://www.clinicalpharmacy.org.uk/2010/december.html
Evaluating nurse prescribing in acute care: a case study
February 3, 2011 by admin
Nurse prescribers and doctors were found to provide equivalent care in this small case study in an acute hospital. This is interesting because much research so far has focussed on community settings and also because this study sought views from a range of levels within the organisation, including managers and patients from a range of ethnic groups.
The researchers used semi-structured interviews with nurse prescribers, medical, nursing and pharmacy colleagues and senior hospital staff, observations of nurse and doctor consultations, and patient questionnaires.
Nurse prescribing was seen as a positive development: there were benefits for patients through better use of staff skills and improved service delivery and both the prescribers and their colleagues were positive about the changes and their impact. Patients were more likely to be satisfied with the medication information they had received if they had seen a nurse rather than a doctor. Patients from different ethnic groups appeared to have similar views about their experience and medication. The prescribing practice of the doctors and nurses were found to be similar. Shared vision, local championship, action learning and team, peer and buddy support were all identified as factors that actively enabled implementation.
Jones K, Edwards M and While A. Nurse prescribing roles in acute care: an evaluative case study. J Advanced Nursing 2010; 67(1): 117-126.
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