Medicines Management
Issue no 5, p1
September/October 2002

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Collaborative approach benefits English patients

Over 800 lives have been saved as a result of improvements made in coronary heart disease (CHD) care through the National Primary Care Collaborative programme.

Early results from an analysis of primary care trust mortality data between 1999–2000 show that CHD deaths in PCTs involved in the first and second waves of the NPCC fell by over 1,000 — four times more than that seen in PCTs not involved in the programme.

A report from the NPCC, covering the first two years of the programme, says this translates to just over 800 lives saved in participating PCTs, compared with the rest of England. Furthermore, the report says that replicating this improvement across the whole of England would mean nearly 6,000 fewer CHD deaths a year.

The NPCC says improvements have come as a result of rigorous, regular measurement. Four measures, reported on a monthly basis, are used as indicators of improving CHD care within participating general practices — the percentage of CHD patients taking aspirin and statins, the percentage of post-MI patients taking beta-blockers and the percentage of patients who have blood pressure below 140/85mmHg.

NPCC Director Dr John Oldham said: "It is a real demonstration of what practice-based teams can achieve."

Some practices in the collaborative had involved pharmacists, who had monitored medication and ensured that patients attended regular check-ups. "These have undoubtedly helped to achieve some of the improvements we have seen," Dr Oldham added.

Head of medicines management at West Gloucester Primary Care Trust, Saran Braybrook believes that greater pharmacist input, through medication reviews in CHD patients, could further improve outcomes.

She told Medicines Management: "The [primary care] collaborative does not tend to look at the medication side of things. It is key to get pharmacists involved in medication review. We found some people were on statins, but did not have adequately controlled cholesterol levels."

Research done by Ms Braybrook's medicines management team, presented at this year's British Pharmaceutical Conference in Manchester (IJPP 2002:10(suppl):R20), shows that pharmacist-led medication review can improve blood pressure control in hypertensive patients while also optimising prescribing costs. A total estimated saving of over £11,500 was made from reviewing calcium channel blocker therapy alone, and the cost of doing the review was far less than estimated prescribing savings.

"We found we could make some savings, but there were other spin-offs," said Ms Braybrook. The study identified 25 out of 211 reviewed patients (12 per cent) who had diastolic blood pressure over 90mmHg — 19 of them went on to have better control after the review. The majority of patients — 86 per cent — had their medication switched from nifedipine or amlodipine to felodipine, thus increasing cost-effectiveness. Furthermore, calcium channel blocker therapy was stopped in 8 per cent of patients, aspirin treatment was initiated in 13 per cent, and 19 per cent were referred for cholesterol tests.

Ms Braybrook said other areas in addition to hypertension were now going to be targeted as a result of the group's success.