Pharmacists and chronic pain prescribing: first RCT
May 17, 2013 by admin
In what they say is the first UK randomised controlled trial of pharmacist prescribing, UK researchers have concluded that there may be benefits for people with chronic pain from pharmacist prescribing, and that larger trials are now needed. The authors comment that despite the increasing number of pharmacists and other non-medical prescribers, rigorous outcome comparisons are lacking.
The trial assigned 196 patients from six practices with prescribing pharmacists in England and Scotland, all of whom used repeat prescriptions for pain medication (excluding certain groups such as those serious mental illness), to three groups at random - two groups received pharmacist medication review, with and without pharmacist prescribing (the former with a face to face consultation; the lattter with feedback to the GP), and one group received treatment as usual. One of the reasons for this exploratory trial was to select the best outcome measures for a larger multi-centre trial - four were used here, including both pain and generic health outcome measures.
The authors highlight the paucity of the evidence base for pharmacist prescribing using validated outcome measures, rather than the reported experiences of healthcare professionals and patients. The results suggest that pharmacist prescribing, and perhaps pharmacist medication review alone, is “feasible, acceptable and may lead to improvements in pain and other measures”, conclude the authors.
Bruhn H et al. Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial. BMJ Open 2013;3:e002361
http://dx.doi.org/10.1136/bmjopen-2012-002361
Comparing nurse prescribing and PGD use in a UK emergency department
May 17, 2013 by admin
Nurses in a London emergency department were providing appropriate medication under the different mechanisms of independent nurse prescribing and Patient Group Directions (PGDs), with some notable differences, according to this cross-sectional review.
The researchers reviewed notes from 617 episodes of care, 382 using independent nurse prescribing and 235 using PGDs. Analysis of the results revealed more frequent prescribing by the prescribing nurses, with appropriate medication given in all but one case (where penicillin was prescribed for an allergic patient, highlighting the importance of history-taking). All medications received by patients in the PGD group were appropriate, although documented less consistently, but over 10% were not covered within the PGD - it was not clear how a prescription was obtained for these from the patient notes. This highlights the limitations of PGDs. The nurses in this department managed a wide range of conditions, with pain relief being the most common type of medication supplied.
Black A and Dawood M. A comparison in independent nurse prescribing and patient group directions by nurse practitioners in the emergency department: A cross sectional review. Int. Emerg Nurs 2013; published online 6 May.
http:dx.doi.org/10.1016/j.ienj.2013.03.009
Antibiotics for lower back pain study hits headlines
May 17, 2013 by admin
Some rather ‘overexcited’ media coverage followed publication of a study in which antibiotic treatment of one particular type of chronic lower back pain was found to be more effective at one year than placebo in reducing back pain and disability, according to NHS Choices, which cautions that further research is needed and that the research certainly does not mean that everyone with lower back pain should be offered antibiotics.
All the patients in the trial had ‘Modic type 1 changes’ - signs of bone swelling in the lower back confimed with MRI scans - and had been in pain for six months or more after a slipped disc. The possibility that the swelling could be caused by bacterial infection and therefore treatable with antibiotics was tested in this randomised controlled trial. The NHS Choices commentary also highlights some limitations in the research.
PGD good practice guidance expected in June
May 17, 2013 by admin
NICE now expects to publish the new good practice guidance for patient group directions (PGDs) in June, it has announced, and some organisations have published information about their responses to the consultation, which closed at the end of April.
The Guild of Healthcare Pharmacists is recommending that pharmacy technicians be added to the list of professionals who can use PGDs, arguing that their clinical roles in the NHS have developed in recent years and that this would improve patients’ access to medicines. The Guild is clear that PGDs should only be used for “distinct patient episodes”, as otherwise they may end up being used for rare indications “as cover” by some providers that do not have a doctor or referral mechanism. This use of PGDs as a substitute for non-medical prescribing in these situations is not in patients’ interests.
Pharmacy Voice highlights what it sees as the benefits of PGDs, for example how community pharmacy NHS ‘flu vaccination services may help reach under-65 at risk groups. It argues that there have been only limited opportunities for community pharmacists to become independent prescribers, although service redesign does offer further potential.
Latest NICE guidance and evidence summaries
May 17, 2013 by admin
NICE has issued several updates recently, including an update to the guidance on omalizumab, recommended as an additional treatment for severe persistent allergic asthma in adults and children over 6 who need continuous or frequent treatment with oral corticosteroids.
In the ‘Evidence summaries: new medicines’ series, there are summaries on the use of lisdexamfetamine dimesylate in children and young people with attention deficit hyperactivity disorder, linaclotide for irritable bowel syndrome with constipation in adults, and lurasidone for schizophrenia, among others.
In the ‘Evidence summaries, unlicensed/off-label medicines‘, series, new entries include modafinil for fatigue in multiple sclerosis, and oral desmopressin for nocturia and nocturnal polyuria in men with lower urinary tract symptoms.
NICE launches PGD consultation
April 12, 2013 by admin
NICE has launched a consultation of new good practice guidance for patient group directions, with a closing date of 29 April. Only registered stakeholders can comment, so see if your organisation is registered if you would like to be involved.
New medicines awareness service from NICE
March 22, 2013 by admin
NICE is to launch new, personalised medicines awareness services - both daily and weekly - to replace the current offerings from the Medicines and Prescribing Centre. In April, existing subscribers will automatically be transferred.
NICE says it is working with UK Medicines Information (UKMi) to develop the new service and to bring together medicines information into one place, so that it ca be found more easily by prescribers and others with medicines responsibilities.
Clinical Knowledge Summaries are back!
March 22, 2013 by admin
A “new and improved” Clinical Knowledge Summaries (CKS) service has been commissioned by NICE and will be going live early in April, according to the company that provides the service.
Existing content is available now and more information about the new service is expected soon, but it will include up to 10 new primary care topics each year.
Should professional indemnity insurance be compulsory?
March 22, 2013 by admin
Should all members of regulated healthcare professions have an appropriate indemnity or insurance, as a condition of their registration with the relevant regulator? The Department of Health has launched a consultation on indemnity insurance for healthcare professionals, with a closing date of 17 May 2013.
The consultation is UK-wide. The proposed change would implement part of an EU Directive about patients’ rights in cross-border healthcare, which requires that systems of professional liability insurance or similar are in place by 25 October 2013. The Government also wants to implement the recommendations of a 2010 review.
So, the consultation says that these aims can be achieved by, “requiring statutorily regulated healthcare professionals to hold insurance or indemnity cover as a condition of their registration”. It adds that indemnity arrangements provided by employers will be sufficient to meet the requirement. The four health departments believe that it is not acceptable that individuals who have suffered harm because of negligence by a member of a regulated profession may not have access to compensation.
There are eight statutory healthcare professional regulatory bodies covered by the UK Parliament: six already have a statutory requirement in place or on its way. Two do not have a requirement or guidance, of which the Nursing and Midwifery Council (NMC) is one - although it does recommend registrants have indemnity cover. So the new provisions would include an enabling framework for these two bodies to give them the power to make the relevant rules.
GMC issues updated prescribing guidance
March 22, 2013 by admin
The General Medical Council has updated its prescribing guidance for doctors, in Good practice in prescribing and managing medicines and devices (2013).
Some of the information is relevant for non-medical prescribers:
- The guidance sets out the information sources that doctors should use to improve prescribing safety: the Medicines and Healthcare products Regulatory Agency’s (MHRA) Drug Safety Update; the the National Prescribing Centre, now part of NICE Medicines and Prescribing Centre and the electronic Medicines Compendium (eMC). It also sets out the sources of clinical guidelines that doctors should take account of. See here and here for ways in which medicines information is changing (Bill please add links to articles 3 and 4 for “here” and “here”)
- It includes the updated GMC stance on remote prescribing of Botox and other injectable cosmetic products. The Nursing and Midwifery Council (NMC) advice is here.
- A section on raising concerns, very interesting in the light of recent news saying, “You must protect patients from risks of harm posed by colleagues’ prescribing, administration and other medicines-related errors. You should question any decision or action that you consider might be unsafe. You should also respond constructively to concerns raised by colleagues, patients and carers about your own practice.”
- The section on unlicensed medicines says that some medicines are routinely used outside their licenses, and that in some situations, “it may not be practical or necessary to draw attention to the licence” - for example in emergencies or if realistically there is no alternative and the information is likely to be distressing. The NMC circular on nurse and midwife prescribing of unlicensed medicines from 2010 says that one of the conditions for prescribing is that, “The patient or client agrees to the prescription in the knowledge that the medicine is unlicensed and understands the implications of this.” The GMC points out two useful sources, if explaining about unlicensed medicines: the Medicines for Children leaflets including one on unlicensed medicines; and a British Pain Society leaflet on using medicines beyond their license.
- A section on sports medicine that deals with performance enhancement.
The NMC standards of proficiency for nurse and midwife prescribers were issued in 2006, with several circulars addressing prescribing issues and changes issued since.
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Recent Posts
- Pharmacists and chronic pain prescribing: first RCT
- Comparing nurse prescribing and PGD use in a UK emergency department
- Antibiotics for lower back pain study hits headlines
- PGD good practice guidance expected in June
- Latest NICE guidance and evidence summaries
- NICE launches PGD consultation
- New medicines awareness service from NICE
- Clinical Knowledge Summaries are back!
- Should professional indemnity insurance be compulsory?
- GMC issues updated prescribing guidance
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