Wasted opportunity?
Redressing the balance

Wasted opportunity?

The latest offering from the National Institute for Clinical Excellence has just been published. “Prophylaxis for patients who have experienced a myocardial infarction: drug treatment, cardiac rehabilitation and dietary manipulation” (see p567) makes recommendations for patients who have survived a heart attack and aims to decrease subsequent early deaths.

This is a first for the NICE, which is to publish a range of clinical practice guidelines in future, but on first glance it may not provide the overview that many pharmacists might have hoped it would. The trouble with post-MI treatment is that it has already generated a huge number of guidelines and protocols, partly because MI is so common and partly because it is susceptible to effective intervention. However, expectations that the NICE guidance would be the definitive guidance to all guidelines are not met. It does not add much to the recommendations made in the National Service Framework on Coronary Heart Disease and in parts it may even be self-contradictory.

This does seem something of a wasted opportunity for the Government and the National Health Service. It might have been hoped that NICE resources should have been devoted to some clinical areas that national service frameworks are unlikely to visit for at least three years. If such an approach had been adopted, best practice could have been promulgated across as wide a range of clinical areas as possible, instead of simply repeating what has been done elsewhere and possibly better.

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Redressing the balance

Although hospital prescribing represents 20 per cent of the total spend on medicines in the National Health Service, relatively little information is available about effective prescribing in secondary care. Much has been written about effective prescribing in primary care and the part medicines management can play.

In this week’s issue we carry an article, “A comprehensive system for managing medicines in secondary care” (pp 585–88), which goes some way to redress the balance. The authors describe how they have established a robust process in North Staffordshire Hospital, Stoke on Trent, that tackles many of the challenges facing pharmacists and clinicians today from the introduction of new medicines to creating an awareness of prescribing costs at the most senior level in the hospital. The team has managed to control prescribing costs without compromising quality. Although the system may not be exactly reproducible in other trusts, at a minimum it is a starting point for discussions within those trusts that have not yet designed their own system.

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