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At the heart of general practice since 1960

Cox-2 advice stalled

Patients are being put at risk from dangerous drug combinations because hospital doctors are failing to provide GPs with adequate discharge information, researchers claim.

An audit of prescribing errors in general practice identified 'multiple system errors', many of them involving a lack of communication between secondary and primary care.

In 61 per cent of cases where contraindicated drug combinations were prescribed, the GP had 'continued a

drug or combination prescribed by a hospital doctor'.

The researchers warned of 'deficiencies in communication' after finding hospital doctors often failed to provide GPs with enough information to 'understand or challenge hospital prescribing decisions'.

But they said GPs had 'ultimate responsibility' for their own prescribing.

Study author Professor Tony Avery, professor of primary care at the University of Nottingham and a GP in the city, said: 'The system, as it is, isn't safe.'

He said consultants often ignored warnings in GP referral letters and prescribed contraindicated drugs.

More than a third of the contraindicated drug combinations identified in the study involved the prescription of a non-selective ?-blocker to a patient with asthma, despite GP referral letters.

Professor Avery urged GPs to contact consultants with fears over contraindicated prescribing and said hospital doctors should include more information on monitoring, rather than just diagnosis and prescription.

Dr David Jenner, NHS Alliance chair, said there was a 'nationwide' problem with inadequate or non-existent discharge information.

But he said: 'Prescribers are responsible for checking that what they are prescribing is correct and that they do take enough of a medical history.'

The study, published in Drug Safety (January), reviewed prescribing to 38,000 patients in four Nottingham practices, in order to identify cases where there had been potential drug-drug or drug-disease interactions.

In 44 of the 62 cases identified, the co-prescribing was found to be unjustified. But the researchers said overall rates of adverse reactions in general practice were low.

By Cato Pedder

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