The National Prescribing Service (NPS)is a valued independent resource for good and unbiased prescribing information and education.
Given the marketing pressures applied by global drug companies, Australia is blessed to have such a resource.
Pharmacists are moving closer to a prescribing role within the health system and it is appropriate that i2P promote the message of the NPS.
* Prescribers urged to use accurate, independent information sources
* NPS urges judicious use of Proton Pump Inhibitors
* Discuss pramipexole for restless leg syndrome with patients
* Feedback sought on medicines issues in palliative care paper
Prescribers urged to use accurate, independent information sources
The National Prescribing Service Ltd (NPS) has welcomed recommendations in the latest Professional Services Review (PSR) report for prescribers to refer to evidence-based sources of information when making decisions about medicines.
The PSR Scheme was established by Medicare Australia and provides a peer review mechanism to deal with possible inappropriate practices in relation to the Medicare benefits and pharmaceutical benefits programs. In 2007-08 the PSR was asked to investigate 50 cases of possible inappropriate practices.
A common feature in referrals to the PSR was apparent inappropriate prescribing, mostly relating to the prescribing of narcotic analgesics and benzodiazepines, which PSR Director, Dr Tony Webber has labeled ‘concerning’. In the report, Dr Webber reminds practitioners that ‘there are many readily available sources of information that detail evidence-based prescribing information’, and ‘practitioners should not base their prescribing decisions solely on the recommendations of drug company representatives’.
Funded by the Department of Health and Ageing, NPS is an independent organisation that provides evidence-based information, services and activities to help support prescribing decisions.
“NPS has no commercial interests so health professionals can be confident our information is independent, accurate and balanced,” NPS CEO, Dr Lynn Weekes said.
“Our evidence-based information is drawn from world-class sources, making NPS a unique but highly valued service in the Australian health sector.”
Since its inception in 1998, the breadth and reach of NPS educational activities for health professionals has grown significantly, while participation by GPs, pharmacists and nurses has increased year-on-year.
NPS offers a range of activities for health professionals to review their prescribing practices against best practice and optimal use guidelines. This includes self audits and drug use evaluations available in hard copy and electronic formats. Some provide instant feedback and all are easy to use.
“Participating in NPS activities can help prescribers identify how they compare against best practice standards. Self audits can highlight if there are discrepancies and the feedback includes behavior change solutions. Participation in our activities could ultimately prevent a prescriber being investigated by the PSR,” Dr Weekes said.
NPS is currently running activities for health professionals on topics including:
· Anti-platelet and anticoagulant therapy in stroke prevention
· Proton pump inhibitors
· Treating the symptoms of dementia
· Early use of insulin and oral anti-diabetic drugs
NPS will offer activities around antibiotic use in respiratory infection from June 2009 and Benzodiazepines and hypnotics from February 2010.
NPS urges judicious use of Proton Pump Inhibitors
In line with the latest NPS therapeutic program, health professionals are advised to step-down proton pump inhibitor (PPI) therapy and cease when appropriate.
PPIs are widely regarded as safe medicines, but evidence suggests they can cause serious adverse effects. For example, acute interstitial nephritis, a rare hypersensitivity reaction, has been reported following the use of all PPIs. Recent studies have also indicated that PPI use may increase the risk of Clostridium difficile infection and community-acquired pneumonia.
“Many patients with gastroesophageal reflux disease will not need continuous, long-term PPI therapy, so when patients present for review or request a repeat prescription, best practice would be to assess if ongoing therapy is still necessary,” NPS clinical expert, Education and Quality Assurance Program Manager, Ms Judith Mackson said.
“Patients on long-term PPI therapy may be reluctant to reduce or stop their medication because their reflux symptoms appear to be well controlled. They may not be aware that when less medicine is used, there is less risk of unwanted side effects and prescription costs could be lower.”
“By using a step-down approach, the beneficial effects of PPI therapy are retained and the risk of adverse effects is reduced. Patient symptoms can be controlled using a lower dose, either daily or when symptoms occur,” Ms Mackson said.
The NPS therapeutic program on PPIs reinforces the following:
· A 4–8 week course of standard-dose PPI therapy should be used to control symptoms of gastro-oesophageal reflux disease (GORD)
· A step-down approach should be adopted to reach the lowest dose and frequency of PPIs
· Serious PPI side effects can occur
· Lifestyle changes can help reduce the need for PPI therapy
“Lifestyle changes should also be encouraged at the same time as PPI therapy. If patients can avoid foods and drinks that exacerbate their dyspeptic symptoms, this will reduce reliance on PPIs,” Ms Mackson said.
As part of the therapeutic program, NPS also provides health professionals with:
· A hypothetical case to refine your skills: Case study (57): Proton pump inhibitors – appropriate and safe use
· GP Clinical Audit toolkit to Review proton pump inhibitor (PPI) prescribing (Enrol by 12 June)
· A desktop GP Clinical e-Audit: Review of proton pump inhibitor (PPI) prescribing (Enrol from Sept)
· A counselling resource kit for pharmacists: Pharmacy Practice Review: Quality use of prescription PPIs (Enrol by 26 June)
· Up-to-date information in Prescribing Practice Review (45): Proton pump inhibitors: step-down to symptom control
For more information visit www.nps.org.au, phone (02) 8217 8700 or email email@example.com.
Discuss pramipexole for restless leg syndrome with patients
Health professionals discussing a new treatment for restless legs syndrome with patients can refer to the latest edition of NPS RADAR for important counselling points.
Pramipexole (Sifrol) should be reserved for patients with severe primary cases of restless legs syndrome as the benefits of use are relatively modest, NPS recommends in the latest edition of NPS RADAR. The review of the recently listed PBS item includes an ‘information for patients’ section to assist with counselling patients.
According to NPS Deputy CEO, Karen Kaye, restless legs can be severe and distressing for some patients who may benefit from drug treatment for their symptoms, but for others the risk of adverse events outweigh the benefits of use.
“Health professionals can suggest non-drug measures for managing restless legs, such as stretching, massage and relaxation techniques. Though these lack strong evidence, patients may benefit from these low risk and low cost interventions,” Ms Kaye said.
“If treatment with pramipexole is an option, it’s important that patients are aware of the possible side effects as well as the potential benefits.”
Pramipexole is not well tolerated by some patients. Sudden-onset daytime sleep (sleep attacks) can occur with pramipexole use and rare cases of compulsive behaviour, such as gambling, have been reported. Nausea and somnolence are common with use of pramipexole but are generally mild and transient.
Evidence for efficacy of pramipexole beyond three months is limited and observations suggest that it declines over time
NPS RADAR recommends that prescribers diagnose restless legs syndrome by confirming that the patient meets all four clinical criteria and that severity is graded using the International Restless Leg Syndrome Study Group rating scale. Links to the criteria and the rating scale are provided in full review at www.npsradar.com.au.
Possible causes of secondary restless legs syndrome should also be considered at the point of diagnosis.
To view all NPS RADAR reviews or register for free email alerts go to www.npsradar.com.au.
Feedback sought on medicines issues in palliative care paper
National Prescribing Service Ltd (NPS) invites health professionals and interested health organisations to provide feedback on a consultation report about medicines issues in palliative care and end of life, which will guide future NPS programs in this area.
In mid 2008, NPS consulted key health organisations and individuals on the perceived gaps in achieving quality use of medicines (QUM) in palliative or end of life care.
Following these consultations, the report titled ‘Understanding the issues and exploring the strategies to achieve quality use of medicines in palliative care and end of life’ was developed in collaboration with Palliative Care Australia (PCA).
The report describes the key factors affecting the achievement of QUM in palliative care and proposes strategies to improve QUM in these areas. The key factors are based on QUM principles:
1. the judicious choice of management options
2. the appropriate choice of medicines, where a medicine is considered necessary
3. safe and effective use.
The recommendations for action have been framed around the National Strategy for Quality Use of Medicines. The report details areas where QUM may be improved including:
1. policy development and implementation
2. facilitation and co-ordination of QUM activities
3. provision of objective information and assurance of ethical promotion of medicines
4. education and training
5. provision of services and appropriate interventions
6. strategic research, evaluation and routine data collection.
NPS is seeking responses and comments from a wide range of health professionals and interest groups by Wednesday 20 May 2009. The consultation report is available for download at http://www.nps.org.au/members_and_stakeholders.
Please email the report containing your feedback in the boxes provided to: firstname.lastname@example.org