You may have seen the launch of an evaluation of the Medicines Optimisation Dashboard produced by NHS England in yesterdays CCG Bulletin.

We would appreciate you taking the time to both complete the survey and also forward information about the survey to colleagues who would like to share their views too.

From the CCG Bulletin:

Medicines Optimisation: Have your say

Building on the principles of medicines optimisation, and developed in collaboration with CCGs, trusts and the pharmaceutical industry, NHS England launched the medicines optimisation dashboard on 12 June.

This prototype dashboard brings together a range of medicines-related data in a way never done before. NHS England hopes that it will help CCGs explore how well their local populations are supported to optimise medicines use.

NHS England would like to explore how the dashboard is being used locally and use this evaluation to shape future versions of the dashboard. Please complete this short survey to have your say. 

Thank you for your time,

Keele Centre for Medicines Optimisation

An update on Keele's Monthly Script newsletter

One of the resources that team here at Keele delivers as part of our Medicines Optimisation service is the 'Monthly Script' newsletter, which provides readers with a quick update and comment on key developments over the past month that may have an impact on primary care prescribing.

In the past, we used to make our Monthly Script newsletters freely available on-line. However, a decision was taken a few months ago to start restricting access to this newsletter (and to some of our other materials) to only our subscriber CCGs, i.e. those CCGs that currently commission our medicines optimisation services.

Consequently, our blog has been a bit quiet recently!!!!!!

To address this, we have decided that we will start sharing a list of items that we have included in the most recent Monthly Script, which, we hope, may still be of interest to some readers. This list includes links to new guidance, safety updates, news items and evidence that the team at Keele has decided to highlight to our CCGs.

Below is the list for the June Monthly Script newsletter (The eagle-eyed may spot that the new atrial fibrillation guidance from NICE is not included, as this came out after we put this list together!). 

We hope you find it useful!

Best wishes,
The Keele Medicines Optimisation Team

Keele’s June Monthly Script content

Update from NICE:

• ·         Medicines and Prescribing Centre’s evidence summary of dapoxetine for erectile dysfunction
• ·         New NICE public health guideline: Overweight and obese adults - lifestyle weight management (PH53)

Safety Update:

• ·         MHRA update: Adrenaline auto-injector advice for patients: after every use, an ambulance should be called even if symptoms are improving, the individual should lie down with legs raised and, if at all possible, should not be left alone
• ·         MHRA update: Domperidone: risks of cardiac side effects— indication restricted to nausea and vomiting, new contraindications, and reduced dose and duration of use (also  link to Trent MI publication)
• ·         MHRA’s review of Statins -  benefits and risks
• ·         MHRA’s final advice on Zolpidem: risk of drowsiness and reduced driving ability
• ·         FDA’s drug safety communication on Pradaxa (dabigatran): Lower Risk for Stroke and Death, but Higher Risk for GI Bleeding Compared to Warfarin
• ·         EU starts review of hydroxyzine-containing medicines
• ·         EU starts review of ivabradine (Procoralan)

National policy and guidance:

• ·         Question and Answer document for the NHS on the Pharmaceutical Price Regulation Scheme (PPRS)
• 
  

Update on UKMI publications:

• ·         Is melatonin effective for preventing cluster headache?
• ·         Is there an interaction between erythromycin and statins?
• ·         What is the available evidence for the use of statins in patients with renal impairment?
• ·         Which medicines can be used to treat intermittent allergic rhinitis during pregnancy?
• ·         Chondroitin – what are the adverse effects?
• ·         Does St John’s Wort interact with Emergency Hormonal Contraception?
• ·         Is there an interaction between St John’s Wort and combined and progestogen only hormonal contraceptives?
• ·         NICE Bites on Managing Meds in Care Homes

New resources:

• ·         New Public Health England resources for CCGs: ‘Commissioning for value packs’ to improve cardiovascular services –

Other news:

• ·         Changes to the legal classifications of tramadol, lisdexamfetamine, zopiclone and zaleplon
• ·         Report: Why asthma still kills

Drug Update:

Launched

• ·         New product: Vitaros (alprostadil) 3 mg/g cream for ED

On the horizon:

• ·         European Commission approves empagliflozin (Jardiance®) for type 2 diabetes
• ·         European CHMP recommends approval of dexamfetamine sulphate (Dexamed®) for the second-line treatment of ADHD
• ·         Anoro® (umeclidinium/vilanterol) approved in EU for treatment Of COPD

Highlighted Evidence:

• ·         Hypertension management in England: a serial cross-sectional study from 1994 to 2011

Opportunities to join us at the Centre for Medicines Optimisation

We've currently got two vacancies we're looking to fill.  

Application details and further post information are available from http://www.keele.ac.uk/vacancies/

Pharmaceutical Adviser (Secondary care)

 Secondment for 18 months

(Part time 7 hours per week)

This is an opportunity to join a well-established and respected team working with the NHS.  The post holder will contribute to and help develop a wide portfolio of services to support the optimal use of medicines. 

You will have experience of successful leadership of a team providing medicines optimisation advice in a secondary care setting. You will be able to provide a secondary care perspective on critical appraisals and systematic reviews, prescribing analysis, research projects and production of papers for publication.  You will also have the opportunity to contribute to both Undergraduate and Postgraduate teaching within the School of Pharmacy.

You will have postgraduate qualifications, preferably to doctoral level, and be used to working at the equivalent of professorial level with colleagues both internal and external to the university.

For an informal discussion about the post, please contact Professor Stephen Chapman, Deputy Head of School, Head of Medicines Optimisation/Enterprise on 01782 734131, or email s.r.chapman@keele.ac.uk.

Closing date for applications: 4^th May 2014

Post reference: ALC14/16

Data Analyst (Full Time)

12 month fixed term contract (to cover maternity leave)

Starting Salary: Grade 5 £20,972

You will be required to organise the collection, analysis and dissemination of prescribing data and other health related data across a number of projects and in a variety of formats, collaborating with a wide range of data and health professionals.  You will work closely with the Senior Data Analyst, Programme Lead and Medicines Evaluation scientists/pharmacists within the Centre for Medicines Optimisation, to ensure that data is provided in a timely manner to meet the needs of our customers.

Educated to A level standard or equivalent, you will be a skilled user of Microsoft Office, including advanced knowledge of Microsoft Excel, Microsoft Access and VBA.  You will also be a logical thinker and effective team player with strong organisational skills.  A high level of numeracy, accuracy and attention to detail are also essential.  

Further details regarding the post can be obtained from Jo Lockett, Senior Data Analyst, on 01782 734134 or via email at j.lockett@keele.ac.uk, from 28^th April 2014.

Closing date for applications: 4^th May 2014

Post Reference: SE14/18

Keele is the largest UK campus University and is home to Keele’s multidisciplinary Faculty of Health that includes, as well as Pharmacy, the Schools of Medicine, Health and Rehabilitation, and Nursing & Midwifery.  We are situated rurally in North Staffordshire with easy access to the motorway network. The Peak District, Cheshire and Shropshire are all within short distances.  Newcastle-under-Lyme is one mile away and the City of Stoke-on-Trent with a main line rail service network is approximately 7 miles way.

For all vacancies at Keele University please see http://www.keele.ac.uk/vacancies/

New Medicines Optimisation Lead: Jonathan Underhill

The Keele Centre for Medicines Optimisation within the School of Pharmacy is pleased to announce the appointment of Jonathan Underhill as Medicines Optimisation Lead. Jonathan will be working 2 days a week while continuing his role as Associate Director Medicines Evidence within the NICE Medicines and Prescribing Centre. This appointment strengthens the excellent working relationship between Keele and NICE and provides an opportunity to enhance the support the Centre offers to its customers.

Jonathan is a pharmacist who has worked for over 15 years in prescribing support and was instrumental in developing the highly successful therapeutic educational programme of the former National Prescribing Centre. He said “implementing National guidance at a local level remains a huge challenge for prescribing teams within CCGs and trusts. The networks to support this have been eroded in many areas and there is a real need for high quality educational support for prescribing teams. We know from our work on evidence-informed decision making what helps implement evidence into practice, but we need to develop interventions that help people put that into practice. We found at NPC that sharing good ideas and collaborating with others is key to producing demonstrable results.”

Prof Steve Chapman who is Deputy Head of the School of Pharmacy / Head of Medicines Optimisation & Enterprise said “supporting people to deliver the medicines optimisation challenges around poor adherence, medicines related hospital admissions, medication errors across primary and secondary care and in care homes, as well as the level of medicines waste is a key objective of the Centre. Jonathan and I have a shared vision around how we can help prescribing teams meet these challenges and deliver the care that their patients deserve. We will review our business plan in consultation with our stakeholders to ensure the service we offer meets their needs and is scalable nationally and globally.”

Dr Paul Chrisp, Programme Director at the NICE Medicines and Prescribing Centre said “I am delighted to support Jonathan’s academic placement at Keele. This gives NICE and Keele an excellent opportunity to collaborate on our shared goals around Medicines Optimisation and implementation of best practice.”

About the Keele Centre for Medicines Optimisation

Keele Centre for Medicines Optimisation is a not-for-profit organisation based at Keele University in the School of Pharmacy, providing tailored, cost-effective, prescribing support solutions to the NHS.

With nearly 20 years experience in delivering medicines management solutions and optimising medicines use, our services include:

• Prescribing data analysis (primary and secondary care)
• Quality Outcome Framework achievement data
• Secondary care outpatient and inpatient episode statistics
• Clinical evaluation (critical appraisal) services
• Medicines optimisation support materials 
• Medicines optimisation strategic action planning
• Mapping and spatial analysis of health related data sets

Working with GPs, commissioners and local medicines management teams, we offer a wide range of medicines management services, from user-friendly, affordable, prescribing summaries for an individual practice right through to a comprehensive service, providing comparative prescribing data and action planning for a cluster of healthcare providers.

"Our aim is to encourage high-quality, evidence-based prescribing, to achieve the best care for patients. We pride ourselves on providing a responsive service that reflects current, key policy drivers, such as QIPP."

We work alongside GPs, CCGs,and hospital trusts and believe that outsourcing prescribing support activities to Keele offers healthcare providers a practical, cost-effective and, importantly, flexible option, as medicines management services are reconfigured.

Examples of our work are available on this site (take a look at the "Open Access Materials" area) and we'd also recommend reading the feedback from our existing customers

MTRAC review perampanel and zonisamide

The latest MTRAC committee meeting discussed the prescribing of perampanel adjunctive therapy and zonisamide monotherapy for the treatment of partial (or focal) seizures in epilepsy.

It was the committee’s opinion that perampanel should only be used in a tertiary care setting, and that patients receiving treatment with perampanel were likely to receive continued specialist supervision and treatment.

With zonisamide the committee agreed that zonisamide monotherapy should only be considered when other NICE-recommended first- and second-line treatment options have proved ineffective or are not tolerated.

Each of the commissioning support sheets can be accessed from http://centreformedicinesoptimisation.co.uk/mtrac/committee-recommendations

The next committee meeting is on the 24^th October and will be discussing nalmefene for the treatment of alcohol dependency and melatonin for the treatment of primary insomnia.

If you’d like to know more about MTRAC or join the mailing list, more information is available from our website at http://centreformedicinesoptimisation.co.uk/mtrac

September's outputs from Keele's 'Medicines Optimisation' team

Another busy month for the team at Keele University's Centre for Medicines Optimisation, trying to get our antibiotics-themed educational outreach pack (we call them our Actions for Commissioning Teams [ACT] packs) out in time for the winter peak in antibiotic prescribing. This latest ACT pack actually addressed three 'antibiotics-related' QIPP topics from the medicines and prescribing team NICE:

1. Antibiotic prescribing, in particular the use of broad-spectrum antibiotics 
2. Three-day trimethoprim for uncomplicated UTIs in women
3. Minocycline for acne

In relation to the prescribing data provided to our CCGs and practices on the above topics, the variation in use of co-amoxiclav across CCGs was notable, as was use of minocycline (although the prescribing data indicate a marked decline in use of the latter in recent months). 
 

Our latest Monthly Script newsletter has also just been published (an 'open-access' version of the Monthly Script is available on our website).  In this latest newsletter, we highlight the recent update to the NICE guideline on Urinary Incontinence in women.  The updated guideline contains several changes concerning treatment-choice, including a new recommendation that immediate-release (I/R) tolterodine and once-daily darifenacin are now also both recommended as first-line antimuscarinics, in addition to I/R oxybutynin, for women with overactive bladder or mixed urinary incontinence).(We note that I/R tolterodine is now available as a lower cost generic and that there is evidence to suggest that it is associated with a lower risk of dry mouth than I/R oxybutynin).
In light of these new recommendations, we took the opportunity to look at current levels of use of these first-line treatments in our subscriber CCGs (calculated as number of items of I/R oxybutynin, I/R tolterodine and darifenacin as a % of antimuscarinic items). Use ranges from 10 to 36% currently across our subscriber CCGs. We also reported current average spend on antimuscarinincs (reported as Net Ingredient Cost [NIC]/antimuscarininc item) and estimated annual savings for CCGs based on a move to the 25th percentile value for NIC/item (amounting to >£200K for some subscriber CCGs). 

The Monthly Script also reported findings of the TIOSPIR trial, which appear to offer some reassurance over the safety of tiotropium delivered via the Respimat device for the treatment of COPD.  The trial, which  was a randomised, double-blind, head-to-head comparison of tiotropium Respimat and triotropium Handihaler, was undertaken following reports of a numerical increase in all-cause mortality with tiotropium Respimat compared with placebo (e.g. link to exisiting MHRA safety advice on tiotropium Respimat).  TIOSPIR randomised patients with COPD (n = 17,135) to either tiotropium Respimat (2.5 mcg or 5 mcg once daily) or tiotropium HandiHaler (18 mcg once daily).  The primary safety outcome for this study was risk of mortality (non-inferiority analysis). During a mean follow-up of 2.3 years, tiotropium Respimat 2.5 mcg/day and 5 mcg/day were both found tobe non-inferior to tiotropium HandiHaler for risk of mortality (Respimat at a dose of 5 mcg vs. HandiHaler:hazard ratio, 0.96; 95% confidence interval [CI], 0.84 to 1.09; Respimat at a dose of 2.5 mcg vs. HandiHaler: hazard ratio, 1.00; 95% CI, 0.87 to 1.14).

We also highlight a recent analysis of use of lipid lowering drugs for primary prevention of CVD amongst UK General Practices, which suggests that that over half of patients prescribed such treatments do not meet current guideline criteria for treatment. The study also found considerable underuse of the drugs in eligible patients.

Another month....another Monthly Script....!

Hello readers!

The August-13 open-access version of our Monthly Script Newsletter has just gone live. 

Included in this month's newsletter are updates from NICE, notably the new guidance on varicose veins (offer less invasive treatments before surgery) and new public health guidance on BMI measurements (extend the application of the lower BMI thresholds of 23 kg/m² to indicate ‘increased risk’ and 27.5 kg/m² to indicate ‘high risk’ of type 2 diabetes used in Asian populations also to black African and African-Caribbean populations). 

We were also interested to learn that the European Medical Agency (EMA) is now starting its review of zolpidem - the FDA recently mandated the lowering of recommended doses of zolpidem for some patients, in particular women, due to concerns over next-day effects. 

Some of you may recall the Dispatches Programme broadcast earlier this year on the safety of GLP-1 based therapies for diabetes.  The EMA has now completed its review of GLP-1 therapies, concluding that “presently available data do not confirm recent concerns over an increased risk of pancreatic adverse events with these medicines”. 

In  relation to prescribing data, this month we provide updated estimates of the additional (and substantial!) costs to our subscriber CCGs following divestment of Epanutin, and, prompted by the Advertising Standards Authority recent censure of the Society of Homeopaths, we report on comparative spend of homoeopathy products (interesting variation seen locally).

Hope you find the newsletter of interest!