Transcript Prescribing - My Surgery Website

Prescribing
Jo swallow
ST1 group 15/7
Free Px or £7.20 per item?
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List the groups who are entitled to
free px
The main groups
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<16/>60
Or-18 in full time education
Students>18 if eligible >completing form (HC2)
Pregnant/delivered in last 1yr (FW8)
Income support
Epilepsy on meds
Diabetes on meds
Hypothyroidism/Hypoparathyroidism
Physical diability (DLA)
PPC -three items in three months or 14 items in
12 months, may find it cheaper to buy a
prescription prepayment certificate (PPC).
Discussion
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Free Prescriptions for all?
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http://www.youtube.com/watch?v=Jl
mEc8rd_Nw&feature=related
Consider
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Only 11% of people pay for their
prescriptions currently, ie you and I
Free prescriptions for all in Wales and
Northern Ireland
Free prescriptions for all cancer patients
Principles of the NHS free healthcare for
all at the point of delivery
Economics, ? Is it viable
Why should a pt with heart failure but not
diabetes have to pay?
BMA support the notion of free px
for all
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http://www.telegraph.co.uk/health/h
ealthnews/4938070/Make-allprescriptions-free-in-Englanddoctors-argue.html
Medicine Adherence
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Recent focus of NICE guidance
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Main points:
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30-50% of px for long term
medications are not used properly
Don’t want to use vs. practical
difficulties
Doctor Role play scenario
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Albert 74 attends your surgery for his annual
medication review.
PMHX: CVA 02/08, Hypertension, Ex-smoker.
BP 170/92 last week with nurse.
Aspirin 75mg od
Dipyridamole MR 200mg bd
Ramipril 10mg od
Simvastatin 40mg nocte
Indapamide 2.5mg od
Patient role play scenario
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You are Albert 74.
Until last feb you were ‘fit as a fiddle’ now suddenly
you have been given 5 different medications
You don’t know what they are for
You do take some of them, sometimes when you remember
Some are difficult to swallow and the aspirin doesn’t taste very
nice
Your memory is failing you and you think sometimes you might
take them twice by mistake
If the doctor explains clearly which medication is for what purpose
and the risks of not taking them you agree to try
You agree to a dosette box if offered.
You are terrified of having another stroke and didn’t know that the
medications were for that purpose
If the doctor insists you take them without adequate explanation
you refuse to take any.
Feedback
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What went well
What effective strategies were used?
Case
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You attend your GP surgery for your
asthma check. They offer you a new on
the market inhaler in place of your qvar.
What would you want to know?
What would make you likely to take this?
What might inhibit you from taking it?
Principles
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Patient involvement in decision making
Increase understanding of how to take
Listen to problems which may be occuring
Reminders re directions at consultations,
med reviews and opportunistically
Many patients with short term medical
conditions do not even collect the script
you issue!
Licence to kill?
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Medications although intended to aid,
usually
Can be harmful
Especially in the elderly, the young,
or those with renal/liver failure/on
other medications
Before px, look up the renal function,
the other meds, and the back bit of
the bnf.
Side Effects
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If a pt has side effects think…
?need to report – yellow card?
?listed
?alternative
?real/incidental/anxious pt?
Good practice!
Apologise to the patient that the
medication hasn’t agreed with them and
that it is unusual, regain their trust and
confidence to try again or to try an
alternative
Polypharmacy
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UK NSF recommends
>75yrs >risk of falls, s/effects
Is it essential, can it be cut down?
Avoid BZs increase falls,
Annual review of meds
6 monthly if on 4/>meds
Renal Excretion
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Many drugs are excreted renally
Therefore in renal failure they can
accumulate
A raised creatinine is a late sign, use
GFR
Pregnancy/Breast Feeding
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Just don’t do it unless you’ve looked it up/know!
Common BNF advice:
Avoid teratogenic
No evidence of harm
Less useful
Manufacturer advises caution
Manufacturer advises use only if potential benefits outweigh
risks.
Safety not established but not known to be harmful
Toxicity in animal studies
Common things you might px in
pregnancy
Consider
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Abx for UTI
Hay fever or Asthma treatment
Thrush treatment, not fluconazole
Anti-emetics
Acid reflux tretments
Tamiflu ? Relenza….
Analgesia, for backpain/labour
Antidepressants
Supplements, vits/herbal etc…
Anticoagulants