OTC statins assessment poor
Criteria used by pharmacists to assess patients for over-the-counter statins are inaccurate and may be leading to under-treatment of high-risk individuals, say researchers.
Guidelines for risk assessment from the Royal Pharmaceutical Society of Great Britain, used by pharmacists, correlate badly with Framingham equations, a research letter in the BMJ shows.
Study leader Dr Graham Mackenzie, a specialist registrar in public health at NHS Fife, told Pulse: 'If a high-risk patient goes and gets low-dose treatment you're missing a trick. Patients should have a full assessment before being given a statin.
'The score GPs use is a more robust, evidence-based tool. As pharmacists are using one approach and GPs another, there's the potential of a mismatch.'
The disparity was most prominent if blood pressure and cholesterol testing, which researchers said are not always available in pharmacies, were not included in the assessment with 18 per cent of people at low risk and 39 per cent at high risk misclassified as moderate risk and eligible for OTC statins.
Dr John Ashcroft, CHD lead for Erewash PCT and a GP in Ilkeston, Derbyshire, said: 'Essentially I don't think OTC statins are a good idea. I personally think anybody who would reach the criteria for an OTC statin should be risk-assessed properly and have a statin prescribed at a proper dose.'
Dr John Pittard, a GP in Staines, Middlesex, and CHD lead at North Surrey PCT, said: 'The more people take an interest in their cholesterol the better, and the more pharmacist support we can get the better.'
But he added: 'If you're doing an assessment without cholesterol it's not going to be very good. We're going to get more apparent conundrums if they're not doing assessments properly.'
Previous research – reported by Pulse in March, and cited by the researchers – showed a sharp decrease in GP statin prescriptions following simvastatin's shift to OTC.
The findings were published in last month's Pharmacoepidemiology and Drug Safety.