prescribing and qipp 2011 n.
Skip this Video
Loading SlideShow in 5 Seconds..
Prescribing and QiPP 2011 PowerPoint Presentation
Download Presentation
Prescribing and QiPP 2011

Loading in 2 Seconds...

play fullscreen
1 / 31

Prescribing and QiPP 2011 - PowerPoint PPT Presentation

  • Uploaded on

Prescribing and QiPP 2011. Anne-Marie Bailey Associate Lead for Medicines Management NHS south of Tyne & Wear . QiPP. Q uality I nnovation P roductivity P revention. How will this be achieved?. 4 key regional programmes: Efficient use of medicines

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Prescribing and QiPP 2011' - naava

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
prescribing and qipp 2011

Prescribing and QiPP 2011

Anne-Marie Bailey

Associate Lead for Medicines ManagementNHS south of Tyne & Wear

  • Quality
  • Innovation
  • Productivity
  • Prevention
how will this be achieved
How will this be achieved?

4 key regional programmes:

  • Efficient use of medicines
  • Repeat medication management – supporting patients
  • Procurement
  • Local Decision-Making – Effective Commissioning
local decision making
Local Decision Making
  • Area Prescribing Committee
  • Joint committee between PCT and FT
  • Regional decision making
  • NETAG (North East Treatment Approvals Group)
  • NECDAG (North East Cancer Drugs Approval Group)
  • Formulary development
formulary development
Formulary Development
  • Seamless care
  • Familiarity with drugs
  • Cost-effective prescribing
    • Safety
    • Tolerability
    • Effectiveness
    • Price
traffic light system
Traffic Light System
  • RED = hospital prescribing only
  • AMBER = shared care
    • Should be started in hospital
    • Can be handed over to primary care with appropriate documentation
  • GREEN PLUS = started in secondary care, less specialised monitoring etc needed
  • GREEN = can be started in primary care
dabigitran and non valvular atrial fibrillation
Dabigitran and Non-valvular Atrial Fibrillation
  • NETAG review in June 2011
  • Warfarin will remain first line treatment for AF
  • Dabigatran can be considered for patients with an allergy or absolute contra-indication to warfarin
  • Cost impact currently being evaluated to extend Dabigitran to patients who are not adequately treated on warfarin or whose INR is unstable
  • A bleeding risk that would lead to a contra-indication to warfarin would also contra-indicate to Dabigatran
  • Dabigatran should be specialist initiated at present
qipp current work
Gaviscon Advance

Doxazosin MR

Prednisolone EC


Diclofenac (oral)

Diclofenac (topical)

Venlafaxine MR

Famciclovir 750mg 1 daily




Citalopram (or sertraline)



Venlafaxine standard

Aciclovir 800mg 5x daily

QIPP – current work
prescribing terminology
Prescribing Terminology


Age Sex Temporary Resident Originated Prescribing Units


Specific Therapeutic Group Age-Sex Related Prescribing Units


Average Daily Quantity


Net Ingredient Cost

ppi prescribing prices for 28 doses from drug tariff september 2011

20mg tablets £18.50

40mg tablets £25.19


15mg capsules £1.22

30mg capsules £1.89

15mg FasTabsTM £2.99

30mg FasTabsTM £5.50


20mg tablets £1.34

40mg tablets £2.08


10mg tablets £11.56

20mg tablets £19.55


10mg capsules £1.57

20mg capsules £1.62

40mg capsules £6.68

10mg MUPSTM tablets £7.75

20mg MUPSTM tablets £11.60

40mg MUPSTM tablets £23.20

10mg tablets £5.63

20mg tablets £5.17

40mg tablets £25.12

56 = £3.24

<half cost

PPI PrescribingPrices for 28 doses fromDrug Tariff, September 2011
statins summary
Statins summary
  • Simvastatin = first-line
  • Simvastatin or pravastatin ONLY in primary prevention
  • No targets for primary prevention
  • Atorvastatin 80mg is being used in ACS
  • Ezetimibe – only if all statins not tolerated
  • Familial Hypercholesterolaemia – specialist referral

NICE guidance: ACE inhibitors first-lineNICE CG34 Hypertension, 2006; NICE CG5 Heart Failure, 2003; NICE CG48 MI: secondary prevention, 2007; NICE CG87 Type 2 diabetes, 2009; NICE CG73 Chronic kidney disease, 2008

  • No evidence that A2RAs are superior to ACE inhibitors
  • No evidence that A2RAs are safer than ACE inhibitors
  • A2RAs do not reduce risk of MI vs. placebo
  • A2RAs cause less cough than ACE inhibitors but difference is small (absolute difference in discontinuation due to cough 3% in ONTARGET)
  • Generic ACE inhibitors are less expensive than A2RAs
  • Possible increase in fatal CV events with Olmesartan
clopidogrel generic prescribing
Clopidogrel 75mg

Plavix 75mg

Clopidogrel Hydrogen Sulphate 75mg

Cost for 30 tablets




Clopidogrel generic prescribing
hypoglycaemic agents 1 st line metformin 2 nd line sulphonylureas
Hypoglycaemic Agents1st line Metformin: 2nd line Sulphonylureas
  • Metformin – only hypoglycemic agent to reduce total mortality, diabetes related deaths and CV events (Mortality NNT 14 over 10.7yrs UKPDS)
  • Sulphonylureas can be used first line if significant osmotic symptoms and a rapid response is needed.
  • Small increased risk of bladder cancer with Pioglitazone (ARI 0.08% NNH 1250)
  • Increase risk of heart failure (NNH 62 over 3 years) and fractures with glitazones (NNH 55 for 1 yr in women average age of 56)
  • No long term safety data for gliptins or GLP-1s
  • Reports of pancreatitis and acute renal failure with GLP-1s
insulin analogues nice cg 87 may 2009
Insulin analoguesNICE CG 87 May 2009
  • Long acting Insulin analogues should be reserved for patients with:-
    • Problematic hypoglycaemia
    • Require assistance to administer and monitor their injections
  • NPH insulins are preferred insulin (Insulatard, Insuman basal and Insulin I)
  • Reviews of studies comparing insulin analogues with standard non analogue insulins found no major clinical differences
  • Long term safety of insulin analogues is unknown
  • Analogues are 1.7-1.8 times more expensive than standard insulin
cephalosporin quinolone prescribing
Cephalosporin & Quinolone Prescribing
  • Regionally, second and third generation cephalosporins and clindamycin are restricted to reduce the risk of MRSA and C.difficile
  • Quinolones and cephalosporins should be reserved to treat resistant disease
  • Avoid cephalosporins or quinolones in patients at high risk of HCAIs – over 65’s, LTCs requiring recurrent antibiotics, recent hospital admission, institutionalised
  • Quinolones are recommended first line by the HPA only in limited situations (e.g. acute pyelonephritis or acute prostatitis)
safer nsaids
“Safer NSAIDs”
  • Naproxen
  • Ibuprofen ≤ 1200mg daily

Review patients:

  • Over 65 years of age
  • With CVD, PVD, Heart failure and diabetes
  • With hypertension
  • Active or history of Peptic Ulcer Disease
generic alendronate and alendronate as a proportion of bisphosphonates
1st line

Alendronic Acid 10mg

Alendronic Acid 70mg

2nd line

Risedronate 5mg

Risedronate 35mg

3rd line

Strontium Ranelate

Denosumab Inj

Cost for 28 days


£1.16 (Branded £22.80)


£2.20 (Branded £19.12)


£28.47 (not inc. admin costs)

Generic Alendronate and % Alendronate as a proportion of bisphosphonates
NICE Guidance: Bisphosphonates first lineNICE TA 160: October 2008. NICE TA 161: October 2008:NICE TA 204: June 2011
  • First line Alendronic Acid
  • Second line Risedronate
  • Third line Strontium Ranelate or Denosumab
  • No difference in the risk of serious upper GI reactions has been demonstrated between alendronic acid and risedronate
benzodiazepines prescribing
Benzodiazepines prescribing
  • If prescriptions are issued, they are short term, small quantities and controlled
  • Newly registered patients are not issued with prescription until reviewed by GP they are then strongly encouraged to withdraw
  • Practice policy for “troublesome patients” – lost prescriptions, lost medication, left at relatives, eaten by the dog……
  • Blanket no prescribing of z drugs
  • Avoid dual prescribing of benzodiazepines e.g. Diazepam and Temazepam’
  • Consider using other alternative drugs for anxiety, depression, chronic pain
street prices 2010
Diazepam 2mg (whites)

Diazepam 5mg (yellows)

Diazepam 10mg (blues)

Temazepam 10mg (wobbly)

Zopiclone 7.5mg

Amitriptyline 1 sm strip (tripline)







Street prices (2010)
other drugs associated with diversion
Other drugs associated with diversion
  • Dihydrocodeine
  • Tramadol
  • Codeine
  • Gabapentin
  • Pregabalin
  • Methadone & Buprenorphine
  • Methylphenidate
  • Dexamfetamine
wound management and sip feeds
Wound management and sip feeds
  • Formularies have been developed in most PCOs across the SHA region
  • Exploring option of procurement of dressings and sip feeds on contract and other “off prescription” routes of supply
  • Department of health are looking to devolve budgets to provider services
  • Prescribe a licensed medicine first-line
    • ALWAYS
  • Licensed liquid may be more expensive than crushing tablet option
  • Crushing tablet is unlicensed BUT
  • So is a special (unlicensed liquid)
  • RPS guidance available
  • Quetiapine 12.5mg/5ml for swallowing difficulties
    • £299.32 for 1120ml
    • OR tablets can be crushed and mixed with water (£33.83 for 60 x 25mg)
      • or alternative drugs have liquid options: amisulpiride, risperidone, olanzapine (oro-disp) and aripiprazole (oro-disp)
anti dementia drugs off patent formulations
Anti-Dementia Drugs – Off Patent Formulations
  • Rivastigmine is now off patent, Donepezil in January 2012 and Galantamine in Summer 2012
  • New novel formulations now being introduced which are more costly – Galantamine MR, Rivastigmine patches and Donepezil orodispersible tablets
  • Regionally, MMTs are working with Acute and Mental Health Trusts to ensure cost growth is contained by remaining with the older formulations
cd e learning http www npc nhs uk controlled drugs less than sixty php
CD e-learning
  • Controlled drugs e-learning available for practices (25 min PowerPoint presentation)
  • Presentation covers all aspects of controlled drugs management from ordering through to destruction and prescribing
  • Useful for:-
    • practices who store CDs
    • individual GPs holding CDs in doctors bag
    • GP registrars or new GPs to the practice
safety issues
Safety issues
  • Aspirin and reduction in cancer risk
  • Implanon and contraceptive failure
  • NPSA safer use of insulin alert
  • Inhaled corticosteroids and risk of diabetes
  • Olmesartan and possible increased risk of CV death
  • Mixing of medicines (syringe drivers and nebules)
  • NPSA patient passports – Lithium, insulin and warfarin
useful links
Useful links
  • Gateshead Information Network (GIN)
  • National Prescribing Centre (NPC)
    • (Therapeutics)
  • Electronic Medicines Compendium