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| 2011 |
PPG Members: Margaret Brown (MB), Brian Burrage (BB), Emilio Ceraudo (EC), Patricia Daniels (PD), John Doland (JD), David Harper (DH), Chris Stannard (CS), L.M. Stockman (LMS)
Margaret Moffat (MM) and Terri Pope (TP) were absent with apologies.
Michael Boughton-Fox (MBF) resigned.
Surgery Representatives: Trish Hawitt Palmer (THP)
Invited Speaker: Jeremy Liew (JL)
The minutes from the meeting of 27 April 2011 were approved.
The meeting was largely given over to Jeremy Liew, Principal Pharmacist, Clinical Services and Training, NHS Cambridgeshire. He answered a number of questions prepared earlier by the group regarding medications and prescriptions.
Q: What are the differences between brand name and generic drugs? When is one preferred over the other?
A: Licensing! The company which develops a drug generally gets exclusive rights to manufacture and market it for five years. Pharmaceutical research and development is a very costly process so this exclusivity allows the company to make back that money. After that five years, other companies are allowed to make generic versions of the drug. The active ingredient is always the same but the excipients (the other so-called inactive ingredients) may differ. The generic drug company must show that their formulation works the same as the brand name version. The generics tend to be much cheaper than the brand name versions because the generic drug companies don't have to invest in the research and development of new drugs.
Sometimes a drug which is used for one condition is found to be helpful in another. If the company which developed the drug can prove this, then that company may receive another exclusive five-year license for the drug in this other context.
Recalls of drugs can occur for many reasons. If a company produces things incorrectly, then the drugs may be recalled. Also, if the drug is shown to have too many severe side effects, it may be permanently withdrawn from the market. This is called license withdrawal and can occur at any time, even within the first five years.
There may be clinical reasons for preferring one version (brand name or generic) over another version. This usually has to do with allergies or sensitivities to the excipients.
Q: If a patient prefers one generic version to another (perhaps because one is easier to swallow or the inactive ingredients are an issue in certain formulations), can s/he request that particular version? If so, does s/he ask the GP or the pharmacy?
A: If there is no clinical difference, then patients can request a particular version.
Q: What are the options for patients who have difficulty swallowing tablets?
A: We try to discover what the underlying difficulty is. Is there a psychological problem? Is there a physical problem? Sometimes speech therapy can help. In other cases, it is possible to crush or dissolve the medication. Many drugs which must be swallowed whole are drugs which need to last a long time and are designed to dissolve slowly. Others are damaging to the oesophagus. Crushing or dissolving these tablets in liquid may compromise their effectiveness.
Q: Why are prescriptions limited to one month's supply?
A: A one-month supply reduces waste and improves safety. It is estimated that a quarter to a third of prescribed medications go to waste! This amounts to billions of pounds every year. Some of the waste is due to patients ordering what they don't need. In other cases it is due to patients not taking their medications according to instructions. In rare instances, drugs are withdrawn from use for safety reasons so it is best not to have huge stockpiles in peoples' medicine cabinets at home.
JD asked about patients who are on long-term medication, perhaps for life, and are stable. It is inconvenient to come to the surgery constantly picking up repeat prescriptions. THP said that batch prescriptions were often appropriate in such cases.
JD then brought up the problem of finance. For some, the cost of another prescription every month is prohibitive. THP said that pre-payment certificates were the best option and that there were informational leaflets in the surgery on how to obtain these.
Q: Sometimes a patient is prescribed a drug by a hospital consultant which is then (repeat) prescribed through the local surgery. If a patient has problems with or questions about this drug, should the patient contact the consultant or the GP?
A: At the time of prescribing, patients should ask what the purpose of the drug is and how long they are to take it. Unfortunately, hospital consultants don't always communicate effectively with GPs about why, how long, etc. Prescriptions are all about risk, that is, reducing the risk of an adverse event. If a patient's risk is already low, then taking a drug doesn't reduce the risk very much. It is a trade off between risk and benefit. Ask ask ask!
Q: Who performs prescription reviews in the surgery? If a patient has multiple prescriptions or even just a single prescription plus dietary supplements, who can they ask about drug interactions?
A: Both the doctors and the nurse practitioner conduct prescription reviews.
Q: What is the Yellow Card scheme? Who uses it?
A: The Yellow Card scheme is used by both patients and health professionals to gather information about side effects of drugs. The Medicines and Healthcare products Regulatory Agency uses this information to continually monitor drug safety. More information is available online at http://yellowcard.mhra.gov.uk/.
Q: What should a patient do if s/he experiences bothersome or (lifestyle) limiting side effects, particularly from long-term or life-time medication?
A: It may be possible to switch to a similar but different drug that gives as good an outcome. PD enquired if the GPs will explain the differences between the drugs. THP replied that this part of the reason why medication reviews are carried out with patients.
Q: If a patient has allergies or sensitivities to certain excipients (inactive ingredients), is it possible for the prescribing GP to find out what is in a drug before prescribing it? Is this information included in the patient's medical records?
A: Physicians can call JL to find out about excipients for allergy/sensitivity information.
Q: The Drinking Water Inspectorate rates the water in Bar Hill as 'hard' verging on 'very hard'. (The rest of Cambridgeshire is much the same.) Some common drugs, like bisphosphonates for osteoporosis and levothyroxine for hypothyroidism, are not absorbed effectively if at all when taken with calcium. What is the recommendation in such cases?
A: JL said that this was a very interesting question to which he had no answer but that he was investigating it further.
[JL consulted with his colleagues at the East Anglia Medicines Information Service at the Department of Pharmacy & Medicines Management (Ipswich Hospital), and replied to this question via email. He said that they were unable to find any clinical evidence that hard tap water was unsuitable for medicine administration. While it is theoretically possible that hard water does indeed reduce the absorption of certain drugs to some unspecified degree, there is no good data on the subject. If patients are concerned about this possibility, then they can take their medicine with a brand of bottled water known to be low in calcium. The mineral content of bottled water is listed on the label.]
BB asked about taking pills with beverages other than water. JL said to read the enclosed medication leaflet.
Q: Not everyone reads the leaflets that come with the medication and even if they do, the leaflets can be confusing or incomplete. What can be done to make sure patients are taking their medicine correctly for maximum benefit?
A: JL is particularly interested in patient education and agrees that much work needs to be done in this area.
Q: What are reliable online resources for information about both prescribed and over-the-counter drugs?
A: Two good websites for patients are http://www.cks.nhs.uk/ and http://www.patient.co.uk/. Patients should always interpret online information with their doctors. LMS asked how GPs felt about patients bringing in internet print outs. THP said that it wasn't a problem but patients should ask for a double appointment if they have a lot of questions. This is one reason why receptionists ask patients why they need an appointment.
Q: How can we educate patients on the proper use of medications: completing the course prescribed, taking them exactly as directed, when antibiotics are necessary, the dangers of mixing medicines with common dietary supplements, etc.?
A: JL would like to form patient groups to write things for other patients to read.
Q: What are the potential difficulties when travelling with medication? Security at airports can be intimidating and intrusive if a patient is travelling with medical equipment, including prostheses and special garments; large amounts of drugs; needles, etc. What documentation should a patient carry? And how much medication should a patient take with them on their trip?
A: Medication should be kept cool; avoid sunlight. X-ray machines should not cause a problem. If a patient is carrying controlled drugs or lots of different drugs, it might be a good idea for them to carry a letter from their GP. For ordinary drugs, a copy of the prescription should suffice.
Q: Who is eligible for free prescriptions?
Q: When is it worthwhile getting a prescription pre-payment card?
Q: How does a patient apply for a prescription exemption or pre-payment card?
A: THP answered these three questions. Patients with certain chronic conditions are eligible for free prescriptions and there are leaflets and application forms in the surgery for prescription exemption and pre-payment cards.
JL summarised that doctors and pharmacists worked together towards the patient's best interests.
BB thanked JL on behalf of the group for a very interesting and comprehensive discussion.
BB reported that MM had sent letters to the Bar Hill Residents' Association, the parish council and the Bar Hill News. The parish council made no financial promises but said to come back to them once it had been set up. There will be a stall at the village summer fête to drum up interest. JD wondered about the response of local companies if they find out a member of staff is a CFR. THP wanted to make it clear that this is completely separate from the maple surgery.
At the suggestion of Dr Boyle last month, LMS added directions for getting to Hinchingbrooke Hospital from Bar Hill. The new document is available at the surgery and online at the PPG's web site.
Action: LMS will periodically check the bus timetables and update the document as needed, sending the new versions to the surgery.
DH confirmed that the group has copyright over our articles which appear in the Bar Hill News so there are no issues regarding their reproduction, either online or on paper in the surgery.
CS said that he hadn't heard anything from the surgery about this matter. Approximately £1000 remains to be raised.
Action: THP will take it to the surgery.
Action: Deferred until next month.
The group reviewed the most recent draft of the brochure and passed on their suggestions and/or corrections to THP.
Action: THP will review the comments and incorporate them as required in the brochure.
THP pointed out that the maple surgery web pages on the main NHS web site allows for comments and urged the PPG members to give feedback via the web site.
CS enquired about the number of new patients at the maple surgery. THP said that there were both losses and gains and the net gain was approximately 80 patients. Patients who have moved to other practices in the past few years are unlikely to come back if they are satisfied with their current care. The new patients are mostly people new to Bar Hill.
THP said that the surgery was moving to a model with a static clinical team. With permanent salaried GPs with a mix of skills, the surgery should offer more consistency. CS asked if patients can request to see a male or female doctor and THP replied yes. THP pointed out that there have been difficulties in getting GPs, both male and female, who want to work five days a week.
THP asked for ideas for evening medical lectures. Some suggestions:
DH brought up some of the practicalities involved; namely, hiring the church hall, advertising and costs involved. The first talk might be as early as September. THP said that the Huntingdon practice (the Acorn Surgery) holds such talks quarterly.
MB reminded the group that insurance companies won't cover volunteer drivers if they accept money other than for expenses. Such drivers would also need CRB checks which are not free. It is unclear who would pay for such checks and if the surgery would even be allowed to do so.
Action: THP will investigate.
New business was deferred until next month due to the lateness of the hour.
The meeting adjourned at 8:08 p.m.
The next meeting of the PPG will take place at 6:30 p.m. on Wednesday, 29 June 2011, in the Octagon. Tea and coffee will be served before the meeting, from 6:00 p.m.
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