High Cost Statin Prescribing and Cardiac Networks National Meeting 31st October 2006

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High Cost Statin Prescribing and Cardiac
NetworksNational Meeting31st October 2006

• East Surrey / North Sussex Local Cardiac Care
  Network
• Dr John V Howard
• GPwSI Cardiology

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East Surrey PCT
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Making the change at the PCT
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Previous experiences at Townhill

• Fundholding
• 3rd Wave Practice
• Practice formulary agreed
• Savings vired for other patient services
• More recent changes
• Omeprazole gt lansoprazole
• Respiratory MDI gt CFC Free

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Making the change at Townhill

• Agreement
• PCT Pharmacy advisors
• Partnership and clinician accord
• Implementation plan
• Prescribing lead clinician
• Practice manager and Prescribing staff
• Patient information
• Explanation letter
• Brief details on repeat prescription
• Continuous over 3 months

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Making the change at Townhill

• Patient reaction outcome
• Moderate number of consultations
• Face to face
• Telephone
• Trickle factor
• Expense of extra blood lipid checks
• Outcome
• Confident of agreed change
• Prescribing incentive benefit

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Widening the Change

• LCCN
• Empowering Secondary Care prescribing
• Effect of local dynamics
• Consultants identify why not on simva
• Patient Shadow Board feedback
• Support for the strategy, but
• Personal experience of side effects
• Experience of specific problems
• Share experience and consider strategy
• Will Locality Commissioning achieve this?

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Widening the Change

• Other PCT Practices
• Locality Commissioning and Cluster Groups
• Resistance from some ?No fundholding experience
• Hesitancy from many ?Previous poor experience
• Support for change
• Learn from others
• Evidence basis Moon J, Bogle R. BMJ, June 2006
• Clinical Governance Leads
• PCT Pharmacy Advisers
• Secondary Care Lead

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Statins at SASH

• David Heller
• Chief Pharmacist

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Policy

• Approved by Area Prescribing Committee
• Trust
• 4 PCTs
• GPs
• Initial input from Cardiologists
• Personal contact with interested consultants

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Policy

• Simvastatin first choice for primary and
  secondary prevention
• 20mg rising to 40mg if tolerated
• Atorvastatin or rosuvastatin for patients
  intolerant to or unsuccesful on simva

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Implementation

• Written communication
• Pharmacist interventions
• Consistent message
• Feedback from PCT concerning one prescriber
• Patients own drugs

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Non simvastatin prescribing

• Mixed consultants surgeons, physicians
• 90 admitted on atorvastatin
• Very few initiated on atorvastatin
• Minimal prescribing on FP10s
• Auditing shortly

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• HEALTH WARNING

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Health Warning

• Constant battle
• August effect
• New doctors and new pharmacists
• Needs to become cultural
• Do Consultants monitor their teams performance?

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Atorvastatin 10mg Tablets
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Simvastatin no significant fall
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Conclusion

• Agreement is achievable
• Implementation is achievable
• Dont take your eye off the ball!
• Needs whole system approach

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