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Independent Contractors
Eastern and Coastal Kent PCT
.

Central nervous system

Condition

Recommendation for Buccal Midazolam for Patients with Epilepsy

Therapeutic group

 

Drug

Buccal midazolam

Text

There are a number of buccal midazolam preparation recommended by specialists in

East Kent

 

Recommendations have been produced to support safe prescribing within East Kent

Document title/link

Date issued

Recommendation for Buccal Midazolam for Patients with Epilepsy

August 2012


Condition

Amyotrophic lateral sclerosis form of Motor Neurone Disease

Therapeutic group

Drugs used in essential tremor,chorea,tics and related disorders

Drug

Riluzole

Text

 Riluzole has been agreed by the EKPG for shared care prescribing.  The shared care guideline below outlines the responsibilities of the specialists and GPs in managing patients prescribed riluzole

Document title/link

Date issued

Shared Care Guideline - Riluzole

February 2013

 

 

Condition

-

Therapeutic group

-

Drug

Co-Proxamol

Text

Patient letter to explain why prescription for co-proxamol have been amended to an alternative pain killer

Document title/link

Date issued

Patient letter - Co-proxamol

February 2010

 

 

Condition

-

Therapeutic group

Triptans

Drug

-

Text

Patient letter to explain why prescription for migraine treatment has been amended to an alternative.

Document title/link

Date issued

Patient letter - Triptans

February 2011

 

 

Condition

-

Therapeutic group

-

Drug

Orlistat

Text

 

NICE provides Clinical Guidance on Obesity which includes guidance on use of orlistat.

 

Orlistat is used as a weight management medication which blocks the absorption of fat. This helps patients identify foods which have high levels of fat and should therefore be avoided or eaten in very limited amounts. Orlistat does not block absorption of calories when eaten as carbohydrate or protein.

 

The licensed indication for orlistat is

  • Indicated in conjunction with diet for the treatment of obese patients with a body mass index (BMI) greater or equal to 30 kg/m², or overweight patients (BMI > 28 kg/m²) with associated risk factors.

  • Treatment with orlistat should be discontinued after 12 weeks if patients have been unable to lose at least 5 % of the body weight as measured at the start of therapy NB No indication is provided in the licensed indication of how long treatment should be continued for.

 

NICE guidance gives two additional recommendations to the licensed indication

  • Consider less strict goals for people with type 2 diabetes, because they may lose weight more slowly.

  • Continue for longer than 12 months (usually for weight maintenance) only after discussing potential benefits and limitations with the patient.

 

PCT policy is to provide orlistat within NICE guidance.

 

Clinical Commissioning Groups have asked if patient information can be provided to support their decision to work within the NICE guidance.

 

If a decision to prescribe outside of the policy is made, a record of why medication has been supplied would be required with details of how support and/or follow up is being provided would be acceptable.

Ref:

NICE Clinical Guidance 43 Obesity December 2006 (Updated Jan 2010)

A patient letter is provided with information to patients why continued use of orlistat is unlikely to support additional weight loss or maintenance of healthy weight and has therefore been removed from repeat status from the patient’s records.  Information on additional support available to support patients to manage their weight is provided.

Document title/link

Date issued

Patient letter template for practice use

August 2011

 

 

Condition

Stop Smoking Medication

Therapeutic group

 

Drug

-

Text

 

NICE provides Clinical Guidance on  Smoking cessation services which includes guidance on use of Smoking cessation medication

The evidence base for smoking cessation medication is for use within structured stop smoking services. The stop smoking services provide support such as identifying the triggers to smoke and ensuring patients have strategies to avoid or manage such triggers. The service undertakes a significant amount of preparation work with clients before making a quit attempt to increase the possibility of a positive outcome

Stop smoking services are available in a wide range of settings and although patients may approach practices with a view to stop smoking opportunistically, without planning a quit attempt, it less likely to be effective.

 

PCT policy is to supply stop smoking medication in line with the NICE guidance

 

Clinical Commissioning Groups have asked if patient information can be provided to support their decision to work within the national guidance.

 

A question and answer sheet is available for frequently asked questions and includes copies of the relevant letters to prescribers from the KCHT stop smoking services (when the patient has indicated a preference for supply of prescription only items).

 

Information on additional support available for patients to stop smoking is included in the patient letter.

 

If a decision to prescribe outside of the policy is made, a record of why medication has been supplied outside of the structured support services would be required with details of how support and/or follow up is being provided.

 

NICE Public Health Guidance 10 Smoking cessation services February 2008

 

A patient letter template is provided for practice use. 

Document title/link

Date issued

Frequently asked questions on providing stop smoking medication

August 2011

Patient letter to support supply of medication only within a structured stop smoking service August 2011

 

Condition

Dementia that Challenges

Therapeutic group

-

Drug

-

Text

Guidelines have been produced in collaboration with Kent and Medway Partnership Trust to provide prescribers with advice on the non pharmacological and pharmacological management of behavioural and psychological symptoms of dementia (BPSD). It is well recognised that antipsychotic medication, provides little clinical benefit for the majority of patients with BPSD and that these drugs pose a risk of a serious adverse outcome. Prescribers are encouraged to review their prescribing in line with this guidance.

Document title/link

Date issued

Guidelines for the Treatment of behaviour in Dementia that challenges

September 2011 

 

Condition

-

Therapeutic group

-

Drug

Benzodiazepine and Z-hypnotic Prescribing

Text

Illicit benzodiazepine use is common and a significant problem.  There is anecdotal evidence to suggest that there is diversion of legitimate prescription supply to the black market.  Benzodiazepines are not initiated in prison for offenders.  This document outlines NHS Eastern and Coastal policy on the prescribing of benzodiazepines and the related z-hypnotics.  This policy provides guidance on the prescribing of benzodiazepines and the z-hypnotics zaleplon, zolpidem and zopiclone.

 

SUMMARY

  • Benzodiazepine and z-hypnotics should be prescribed for short term use only

  • There are no licensed indications for the long term prescription of benzodiazepines

  • No repeat prescriptions for these drugs should be issued (only acute) unless in exceptional circumstances

  • Patients may become addicted to these drugs even after short-term treatment

  • Existing long-term patients should be gradually withdrawn from these drugs where possible

  • No prisoners are initiated on benzodiazepines during the course of their stay.

 

Document title/link

Date issued

Benzodiazepine and Z-hypnotic prescribing policy

July 2012 

 

One patient. One form.
Patient safety

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