Some GPs Can Take Months to Adopt New Prescribing Guidelines From Medscape (The BMJ)

[holyshedballs]

medscape.com/viewarticle/91...

Substantial differences exist in the speed of uptake by GP practices of a new prescribing regime, a study found.

The findings in The BMJ suggested that although most practices adopted new guidelines, some showed rapid, coordinated change, while others changed only gradually.

The authors said the piecemeal adoption exposed health systems "to substantial avoidable costs and exposes patients to suboptimal clinical care".

Open Prescribing

Researchers from the University of Oxford and Canada's University of Victoria set out to determine how clinicians vary in their response to new treatment guidance, using an automated change detection technique.

They drew on data from OpenPrescribing.net, an open database which rationalises raw prescribing data from 8078 GP practices in England.

The study concentrated on two prescribing changes over a 5-year period:

A switch to generic oral contraceptive desogestrel from the branded form (Cerazette) in 2012

A change to the first line antibiotic choice for treating uncomplicated urinary tract infection from trimethoprim to nitrofurantoin at various time points after 2014

Most GP practices eventually changed their prescribing pattern, the study found, but when that happened varied substantially.

For instance, a large proportion of practices switched from Cerazette in early 2013. However, a quarter did not show their most substantial change for 14 months, and the slowest 10% did not initiate any change for another 6 months.

When it came to the antibiotic, a quarter of practices did not make their largest change until 29 months after the guidance was released. Also, the slowest 10% took 32 months to switch.

Further Research Needed

The authors stressed that they carried out an observational study and were unable to prove cause and effect. However, they said that their data was reliable, using information from all GP practices in England.

In a linked editorial, Emma Wallace, senior lecturer in general practice at the Royal College of Surgeons in Ireland, said: "Future research should now focus on why this variation is so large, and how open data can help to drive timelier uptake."

She added: "Having a clear and consistent message across clinical guidelines is important to support the uptake of new practices."

I think we can expect a similar story for the change in NHS guidelines for prescribing T3. So I think we have to be vigilant when coming across GPs who are not aware fo the changes and "help" them to make referrals to NHS Endos and prescribing T3 for those who need it.

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Some ("ALL" could be a more appropriate word) doctors seem unaware that the GMC INSTRUCTS them to inform a patient of any medications that may improve their health, if they aware of their existence, irrespective of whether they are permitted to prescribe them.

So when you make enquiries about being prescribed NDT, for example, you should NOT receive the answer "it's not licensed", as happened to me, you should get an explanation of the fact it may possibly be beneficial but the doctor is not permitted to prescribe it because........followed by the words supplied to him (as they are to every doctor) by the local CCG on a "recommendation" document.

That would be a vast improvement, that would be an accurate explanation of the situation, that would not be an answer to the patient's complaints, that would be acceptable to the GMC.

So why is the GMC failing to hound doctors for failing to obey INSTRUCTIONS???

[helvella Administrator Thyroid UK]

Not all changes to prescribing would ever appear in such sources. The one that I am thinking about is morning versus bed-time dosing with levothyroxine.

It is well over ten years since papers started to appear which supported bed-time dosing.

Still we see standard advice is an unthinking, unresearched statement to take in the morning.

I wonder how many more years will pass before dose timing becomes universally accepted as being significant? (I daren't even consider how long until effort is made to help the patients make the best choices for themselves.)

Published in 2007:

ncbi.nlm.nih.gov/pubmed/172...