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GPs bear brunt of inefficient hospital cardiovascular prescribing

By Nigel Praities

GPs are being left to switch patients to generics or face missing tough NHS targets because hospital cardiologists are routinely prescribing branded medicines to patients without clinical reason, a new study published online in the Quarterly Journal of Medicine reveals.

As many as 52% of patients discharged from the cardiac wards of two London hospitals were taking at least one branded drug, according to the research.

But when medical records were examined, the researchers could only identify a clinical reason for the branded prescription in 13% of cases.

The GPC said the results showed specialists were not adhering to the same strict protocols that have been introduced in primary care, and called for a review of the current system. In primary care, 95% of cardiovascular drugs are prescribed generically.

But the study, which examined medication charts and hospital notes for 1,008 consecutive hospital patients, found branded drugs represented about a third of all statin prescriptions, a quarter of all prescriptions for ACE inhibitors and ARBs, and almost a fifth of [beta]-blocker prescriptions.

But clinical reasons for use of a branded medicine were identified in only 8% of patients taking statins, 12% of those on ACE inhibitors or ARBs and 7% of those on [beta]-blockers.

Study leader Dr Emily Corp, a clinical researcher at the Barts and the London NHS Health Trust, concluded: ‘Our survey shows that whilst there may be clinical situations where branded drugs are better and so justify the cost, in most cases when branded drugs are used, a generic equivalent would have comparable efficacy and safety, at a much reduced cost to the NHS.'

The researchers estimated £11m a year could be saved across the NHS if hospital consultants stuck to the same guidelines GPs currently adhere to.

Dr Brian Dunn, GPC negotiator and member of the GPC clinical and prescribing subcommittee, said hospitals should ensure the job of switching patients to generic equivalents was not just left to primary care.

‘The problem is when we get a discharge letter requested a prescription by brand name, we need to make a judgment about whether the consultant specifically meant to prescribe by brand, or whether the consultant would be happy if we prescribed generically.'

‘Much prescribing is initiated in secondary care, and it would be easier for GPs if doctors in secondary care had clearer prescribing policies. Secondary care needs to look at its prescribing policies as primary care has already done,' he said.

Secondary care doctors have not been adhering to the same strict prescribing protocols found in primary care, the GPC claimed Secondary care doctors have not been adhering to the same strict prescribing protocols found in primary care, the GPC claimed

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