Transcript Adult Obesity and Prescribing in Wiltshire

Compliance with Orlistat Prescribing
Guidelines – An Assessment Amongst
Wiltshire General Practitioners
Dr. Daz (Karoline) Harding
GP in Public Health
NHS Wiltshire
The ‘scale’ of the problem
• 13% of adult men
• 16% of adult women
were obese in 1993
• 22% of adult men
• 24% of adult women
were obese in 2009
The future?
Foresight study (2009)
By 2050
60% of males and
50% females
will be obese
Orlistat
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NICE recommended
3 months treatment - £94.89
In 2008 total cost to the NHS was £44.8 million
Tenfold rise in cost since 1998
Wiltshire costs
• 2009-2010 total cost of Orlistat £239,287.63
• Further £76,916.10 on Sibutramine
• Prescribing costs vary from £0 to £5012.33
2006 NICE Obesity Guidelines
• Orlistat can be started
‘only after dietary, exercise and
behavioural approaches have been
started and evaluated’ in patients with a
BMI >28kg/m2 plus co-morbidities or
>30kg/m2
And continued
‘For longer than three months only if
the person has lost 5% of their initial
body weight since starting drug
treatment, less strict in type II Diabetes’
Method
• Questionnaire sent to all 63 practices
• 39 were returned (62%)
• Audit of ten adult patients started on Orlistat at
the ten highest prescribing practices.
• Nine of the ten practices participated
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12% had no BMI documented before prescription
7% had a waist circumference taken
46% had no supervised period of lifestyle change
52% had no referral to weight/exercise scheme
72% had no goal weight discussed
15% achieved a 5% weight loss over 3 months
50% did not complete three months of treatment
70% of those who did not achieve 5% weight loss at 3
months were continued on the medication
• One in ten was not compliant
• Several had Orlistat on their repeat prescription list
Questionnaire
• 69% always trialled
lifestyle change
• 28% always enforced
a 5% weight reduction
or cessation
• 7.5 out of 10 –
difficulty rating
managing obesity
• Hurdles and
suggestions
Discussion
• Documentation
• Higher v lower
prescribers
• Not always following
guidance
• Local guidance
• Lifestyle and
Prescription contracts
• Lifestyle leaflets
widely available with
‘Ten Top Tips for
weight loss’
• Physical Activity on
Referral
• Fund independent
slimming clubs on the
NHS
• Expected reduction in prescribing for
2011-2012 £73,244
• Disseminate information amongst local
GPs