Clinical Pharmacist's monthly news round-up: the top 10
What has been happening in the world of pharmacy? The team at Clinical Pharmacist summarises the month's top 10 clinical pharmacy and NHS stories.
1. Scottish Government responds to Wilson
All pharmacists who provide NHS pharmaceutical care to patients in Scotland should be independent prescribers by 2023, according to the Scottish Government.
“Prescription for excellence”, published last month in response to the so-called Wilson review, describes the vision for delivering pharmaceutical care over the next 10 years and includes an action plan that explains what needs to happen to make the vision a reality.
“We want to make optimal use of the pharmacists we train and educate so that they can contribute fully and clinically, along with the rest of the healthcare team, to providing the best treatment for patients,” said Bill Scott, chief pharmaceutical officer for Scotland.
Working in partnerships with medical practitioners, pharmacists will be involved in the initial choice of medicine, as well as being responsible for longer-term monitoring and making adjustments to the dose, the report says. The vision also includes patients having a named pharmacist, with NHS boards maintaining lists of NHS accredited pharmacists.Full story
2. Wider role for clinical pharmacists heralded
Specialist clinical pharmacists could have wider involvement outside hospitals if the Future Hospital Commission’s vision for patient care becomes reality.
The independent Future Hospital Commission, established by the Royal College of Physicians in March 2012, published its report “Future hospital: caring for medical patients” this month. The report outlines 50 recommendations for achieving a vision for hospitals in which all patients receive consistently safe, high-quality care.
Developing effective relationships between medical and other health and social care teams will enable realistic transfer-of-care arrangements when patients move from one care setting to another, the report says.
The Royal Pharmaceutical Society commented: “We are keen to see how the expectation that the hospital retains an aspect of follow-up care and that the specialists spend a proportion of their time in the community would impact on hospital, community and primary care pharmacists.”
3. Workforce consultation
Pharmacists have been asked to put forward their views on controlling pharmacist numbers by responding to a public consultation from the Higher Education Funding Council for England and Health Education England.
Three options out for consultation are: to let the market continue to determine the number of pharmacy graduate places; to restrict the number of students enrolled at each university; or to introduce a “break-point” on the degree course — where pharmacy students would have the option to leave with a science degree after three or four years.
The consultation closes on 15 November 2013.
4. Discharge communication
Community pharmacists should receive copies of hospital discharge letters for patients under their care, the Scottish Government has advised in a new set of standards that aim to improve medicines reconciliation for patients in Scotland.
The standards, published in a letter last month, advise that discharge information for patients who leave hospital should be sent to their GP and named community pharmacist as soon as possible.
The guidance suggests that verification of medicines reconciliation by pharmacists is an important part of the medicines reconciliation process.
5. Automatic stop dates reduce antibiotic use
Writing automatic stop dates when antibiotics are prescribed for patients admitted to hospital with lower respiratory tract infections can reduce antibiotic duration and related side effects, a Scottish study has found (Journal of Antimicrobial Chemotherapy, online 10 September 2013).
The study, which was presented at the European Respiratory Society’s annual congress in Barcelona last month, found the intervention reduced antibiotic treatment from 8.3 to 6.8 days (P<0.001) and led to a reduction in antibiotic side effects from 31% to 19% (P=0.03).
Conor Jamieson, pharmacy team leader for antimicrobial therapy at Sandwell and West Birmingham Hospitals NHS Trust, said: “The study showed that a simple and low-cost intervention can result in a marked reduction in antibiotic use. This shows pharmacists can play a role in ensuring the duration of the antibiotic is specified.”
Also last month, the Government published its five-year strategy to counter antimicrobial resistance. The plan aims to improve understanding around the problem, conserve existing treatments and stimulate the development of new antibiotics and diagnostics.
6. Homecare standards offer added support
Chief pharmacists should be an integral part of homecare medicines management and take a lead role in the multidisciplinary homecare team, according to new professional standards published by the Royal Pharmaceutical Society.
The standards were unveiled at the RPS conference last month by England’s chief pharmaceutical officer Keith Ridge, who stressed the need to ensure there are appropriate safeguards in place to support the growing homecare market.
The 10 standards are designed to offer a support framework for pharmacy teams that provide homecare services. They apply to the whole pharmacy team, but lay particular emphasis on the duties of the senior pharmacist responsible for providing the homecare pharmacy service.
One of the standards highlighted by Ray Fitzpatrick, chairman of the homecare standards workgroup, is that patients should have their medicines history and proposed medicines pathway reviewed by a homecare pharmacist and, where appropriate, a specialist clinical pharmacist, to optimise patient outcomes.
7. Preventing spina bifida
Reducing the dose of valproate in early pregnancy appears to reduce the risk of fetal spina bifida more than the risk of other types of fetal malformation, according to an analysis of 13 years of data from the Australian Register of Antiepileptic Drugs in Pregnancy (Neurology 2013;81:999). A decline in mean maternal valproate dosage in the first trimester was associated with a significant decrease in incidence of spina bifida.
The findings suggest that using valproate in the lowest effective dose may reduce the hazard of one of the most devastating fetal malformations, the researchers say.
8. Tuberculosis management
Virtual observation of patients taking antituberculosis medicines could encourage adherence and free healthcare resources, according to research presented at the European Respiratory Society annual congress last month.
Researchers tested the effectiveness of the virtually observed treatment method as an alternative to directly observed treatment. Patients videoed themselves taking their medicines and sent the video to their healthcare provider using a mobile telephone.
Lead author Sara Hemming said that virtually monitoring patients can ensure effective medicines use without requiring a one-to-one session.
9. Cancer drug regimen suitable in old age
The combination of bevacizumab and capecitabine is an effective and tolerable regimen for elderly patients with metastatic colorectal cancer, according to the results of an international randomised trial published in Lancet Oncology (online, 10 September 2013).
The AVEX trial involved 280 patients aged 70 years or older with previously untreated metastatic cancer for whom oxaliplatin or irinotecan regimens were not suitable. They received a combination of bevacizumab plus capecitabine, or capecitabine alone.
Progression-free survival was significantly longer with the combination treatment: median 9.1 months versus 5.1 months (hazard ratio 0.53; 95% confidence interval 0.41–0.69).
In a separate development, the Medicines and Healthcare products Regulatory Agency’s latest Drug Safety Update says that healthcare professionals should establish evidence of wildtype RAS status in adult patients with metastatic colorectal cancer before initiating panitumumab, either alone or with other chemotherapy, because this may affect survival.
10. Data reassuring on saxagliptin CV safety
Diabetes medicine saxagliptin is not associated with an increased risk of ischaemic cardiovascular events, according to a postmarketing study reported last month at the European Society of Cardiology annual congress (New England Journal of Medicine, 2 September 2013).
The 26-country trial involved 16,492 patients with type 2 diabetes who had a history or high risk of cardiovascular events. They were given saxagliptin or placebo, plus standard care, and followed up for two years.
Saxagliptin neither increased nor reduced the risk of the primary composite endpoint of cardiovascular death, myocardial infarction or ischaemic stroke.
Analysis of secondary endpoints showed increased hospital admissions for heart failure with saxagliptin (hazard ratio 1.27, 95% confidence interval 1.07–1.51). The authors say this was unexpected and needs further investigation.
According to first author Benjamin Scirica, the trial’s neutral results, in contrast with earlier findings, highlight the importance of adequately powered outcome studies for assessing cardiovascular effects.Full Story
In these pages we summarise the 10 news items from the past month that we believe will be of greatest interest or relevance for your practice. The full stories, accessible on PJ Online (www.pjonline.com), usually contain more detailed information, data and expert comments.
We work closely with the PJ Online daily news team to get clinical and healthcare news out as soon as possible after the stories break. And so if you want to keep up to date throughout the month, the best way of doing so is to visit our landing page (www.clinicalpharmacist.com) regularly, where you can also sign up to our clinical news RSS feed.
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