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GPs buried under trusts' workload dump

Statin switching to generics backed by research

By Nigel Praities

The Government's drive to force up use of generic statins does not appear to have come at the cost of missed cholesterol targets, a new analysis concludes.

Practices in PCTs with high use of generic statins were no less successful at hitting QOF cholesterol targets than those in areas with lower generic use, the researchers found.

The study – the first to look at the impact of NHS statin policy on QOF scores – offers some support for the national programme to switch patients from branded to generic drugs.

Despite generic statin prescribing of 84% in some areas of the country, average achievement of QOF indicators for coronary heart disease, stroke and diabetes all remained over 70% in the data from 2005 to 2006. There was no evidence of higher levels of exception reporting in areas which achieved higher QOF scores.

Pulse exclusively revealed last year that the NHS target for generic statin prescribing would be raised from 70% to 77% this year, with additional indicators being introduced for other drugs, including PPIs and antiplatelets.

The new findings may allay fears that the focus on cutting prescribing costs in primary care will harm patient care.

Study leader Dr Duncan Petty, a lecturer in medicines management at the University of Leeds, said his findings suggested that even where PCTs were being particularly active at encouraging switching to generic simvastatin, it did not appear to rebound on cholesterol control. ‘Simvastatin seems to be effective at the population level for the majority of patients, particularly at the 40 mg dose,' he said.

Dr Petty added that he had repeated the analysis for 2006-07 data and the results were similar, but warned overall data didn't preclude from there being problems with individual patients. ‘There is a need to titrate to the correct dose or use a more potent statin for some,' he cautioned.

Dr Bill Beeby, chair of the GPC clinical and prescribing subcommittee, said the research was ‘reassuring' but didn't look at all the issues associated with statin prescribing. ‘It is not looking at the quality of the reduction and only gives half the story. So for example it doesn't look at your HDL ratio, which isn't a QOF target,' he said.

The research was published in the April edition of the Journal of Health Services Research and Policy.

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