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Prescribing

Prescribing. Jo swallow ST1 group 15/7. Free Px or £7.20 per item?. List the groups who are entitled to free px. The main groups. <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

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Prescribing

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  1. Prescribing Jo swallow ST1 group 15/7

  2. Free Px or £7.20 per item? • List the groups who are entitled to free px

  3. The main groups • <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).

  4. Discussion • Free Prescriptions for all?

  5. http://www.youtube.com/watch?v=JlmEc8rd_Nw&feature=related

  6. Consider • 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?

  7. BMA support the notion of free px for all • http://www.telegraph.co.uk/health/healthnews/4938070/Make-all-prescriptions-free-in-England-doctors-argue.html

  8. Medicine Adherence • Recent focus of NICE guidance • Main points: • 30-50% of px for long term medications are not used properly • Don’t want to use vs. practical difficulties

  9. Doctor Role play scenario • 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

  10. Patient role play scenario • 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.

  11. Feedback • What went well • What effective strategies were used?

  12. Case • 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?

  13. Principles • 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!

  14. Licence to kill? • 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.

  15. Side Effects • 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

  16. Polypharmacy • 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

  17. Renal Excretion • Many drugs are excreted renally • Therefore in renal failure they can accumulate • A raised creatinine is a late sign, use GFR

  18. Pregnancy/Breast Feeding • 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

  19. Common things you might px in pregnancy

  20. Consider • 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

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