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Statin
prescribing
Changes/additions to materials:
MeReC Stop Press on NICE Clinical Guideline 67.
NICE issued guidance on CV risk assessment and lipid modification in June 2008. The important changes are discussed in the MeReC Stop Press, which should be read in conjunction with the materials in this room of NPCi.
MHRA advice re fibrates - Drug Safety Update Vol 1, Issue 4. 4th. November 2007
The MHRA has issued revised advice to prescribers concerning the place in therapy of fibrates:
"Fibrates should be used as first-line therapy only in patients with isolated severe hypertriglyceridaemia. In patients who also have raised cholesterol, fibrates may be considered only when a statin or other effective treatments are contraindicated or not tolerated".
This is discussed in a MeReC Stop Press, which should be read in conjunction with the materials in this room of NPCi.
Note that some of the materials apply the black triangle () to rosuvastatin. This was correct at their time of publication but the black triangle was removed by the MHRA in June 2007
Increasing low cost
statin prescribing
Increasing low cost statin prescribing (prescription items
for simvastatin and pravastatin as a percentage of the total number of prescriptions
for all statins) is one of the "better value, better care" indicators
of efficiency published by the NHS Institute in October 2006. These indicators
identify areas for potential improvements in efficiency and will form part
of a portfolio of NHS performance measures.
http://www.institute.nhs.uk/PriorityProgrammes/DeliveringQualityAndValue/better_value_better_care_indicators.htm
The volume of statin prescribing has increased several-fold
during recent years and there are large differences in cost between the different
drugs. By ensuring that clinicians initiate patients on one of the lower cost
drugs, PCTs can keep statin prescribing costs down. In addition, many will
wish to review prescribing of these drugs for patients prescribed one of the
more costly versions.
The National Prescribing Centre has collated and published
a range of resources to support organisations and individuals that are undertaking
their own local statin switching initiatives.
Here is a list of the materials that are currently available
through our websites www.npc.co.uk and www.npc.nhs.uk.
Check back regularly as we will be adding new materials on an ongoing basis.
Please note that some of the resources are intended to be
templates from which you can produce local versions, adapted to your own local
needs. The remainder are not intended to be changed. The materials have been
split into the four following directories:
Policy and
guidance
GMS
contract QOF targets for cholesterol 2006-07
Summary of GMS quality and outcome framework targets including points available
in clinical areas.
Summary
of NICE guidance
An extract of NICE technology appraisal 94 —Statins for the prevention
of cardiovascular events
National
policy on statin prescribing
Copy of the statement issued by Professor Roger Boyle, National Director for
Heart Disease and Stroke, DH to clarify NHS policy for statin prescribing subsequent
to the publication of JBS2 and NICE guidelines.
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Therapeutics
Lipid
evidence PowerPoint presentation
Download a PowerPoint presentation to use in your discussions with prescribers
around statin use. Extensive teaching notes are also available below.
Lipid evidence
PowerPoint presentation notes
Teaching notes to support the lipid evidence PowerPoint presentation.
Lipids
data-focused commentary
Statin prescribing in the UK is increasing every month. Download this commentary
to read about just how much is being prescribed and which ones are the ones
being prescribed most often in your area. It also examines the evidence around
the prescribing of rosuvastatin and ezetimibe and relates this to the prescribing
data around the use of these agents.
Lipids
quiz
Test your knowledge of the evidence-base around statins with this quiz. Simply
download the quiz, complete it, and then download the quiz and answers below
to see how many you answered correctly.
Lipids
quiz and answers
Quiz and answers.
Lipids
case study
Paul and Fiona have both seen an advert on TV about their cholesterol levels
and come and ask your advice as to whether they should take a statin. Test
how much you know about statin prescribing using these 'real world' examples.
Download the case study first and then answer the questions contained within
it. Then download the suggested answers and check to see if your choices are
in line with the evidence-base.
Lipids
case study and answers
Case study and answers.
Summary of potentially hazardous drug interactions –statins
A summary of the most important and common interactions with statins, published by the CHM/MHRA in Drug Safety Update 1(6) January 2008
Statins –a
guide for patients
A guide to help prescribers discuss the risks and benefits of taking a statin
with patients during a consultation. Presented in a simple pictorial format.
ELearning in less than 60 minutes
Five multimedia workshops each of 10 minutes duration looking at the evidence-base
for the management of cardiovascular risk and lipids. Each workshop consists
of a PowerPoint presentation accompanied by an pre-recorded audio commentary
by one of the NPC team.
Instructions: You will need to download Interwise
application software version 6 to play the workshops. Install this
software by clicking
here. If you are experiencing problems downloading this application software click
here or alternatively contact your local IT helpdesk. The NPC
cannot provide technical support to enable you to access these files. Once
you have downloaded the application click
here for further instructions on how to use the software.
Then choose the workshop you wish to view from the list below. The files have been zipped but once unzipped
double click on the file name to start the presentation. You can stop the workshop
at any time by clicking the pause button and then clicking play again to restart
it. Requires use of Interwise application software.
Workshop 1 —Introduction
and background
Workshop 2 —The evidence
for different statins and different doses
Workshop 3 —High dose
statin vs. ‘standard’doses
Workshop 4 —Choice of
statin in individuals
Workshop 5 —Implementing
the NICE guidance in practice
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Implementation resources
5
Minute Guide —High impact statin switching
A brief summary of approaches that have worked in other organisations
that have made statin switches. Intended to provide some basic ideas for changes
that lead to improvements. Designed for double-sided printing on A4 paper and
to be folded into a small booklet.
5
Minute Guide —Principles of change management
A short introduction to key principles for managing change such as statin switching
policies. Designed for double-sided printing on A4 paper and to be folded into
a small booklet.
Template
for a practice-based audit —Low-cost statin prescribing
A template for practices to enable them audit their statin prescribing before,
during or after a switching campaign. Can be used as a tool to monitor progress.
Intended for adaptation according to local circumstances or preferences.
Template
for Standing Operating Procedure —Switching patients from high cost
to low cost statin
A template SOP for use by practices or PCTs switching from high cost to low
cost statins. Contains basic framework that is suitable for local adaptation.
Statin
switch letter
Sample of a letter that could be used to inform patients of a change to their
medicines. Template for local adaptation.
Template
information leaflet for patients
Template for an information leaflet containing basic information to support
a local statin switching campaign.
Practice
switch recording form
Template form to record patients switched from high cost to low cost statin.
Includes columns for documenting follow up blood results and LFTs etc. Fully
customisable to suit local policies.
Template
for discussion points on statin switching
A template containing some possible discussion points for consideration as
part of a local statin switching campaign. Intended for use in discussions
with prescribers.
Statin
prescribing points
A summary of points for consideration when prescribing a statin. Intended for
use in discussions with prescribers.
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Monitoring tools
Statin
switch tracker and impact assessment tool
A simple-to-use tool for monitoring progress of a local statin switching campaigns.
Enables practices or PCTs to set switching targets for individual drugs and
dose forms. Produces charts of progress and can be used to give feedback to
individual prescribers or practices. Detailed instructions for use are contained
in the associated file Statin
review tool.
Statin
review tool
A user guide to accompany file Statin
switch track.
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Acknowledgements
The National Prescribing Centre would like to acknowledge
the support of all of the individuals and organisations that have shared their
ideas, documents and other materials to enable us to create the resources for
statin switching initiatives.
In particular, we would like to acknowledge the significant
contribution made by the following organisations (click
here), who have shared materials and ideas from their own statin
switching campaigns with us.
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