Examples on...

[hannahd]

I need to find an example of:
a) a situation where local or national guidelines are deliberately not used to select treatment for a patient

b) a situation where a medicine is used off-license.

These can be on items on an FP10 (just dispensed), supplementary prescribing or OTC sales.

Please can anybody help?

[Jeff]

a) Cannot answer specifically without breeching patient confidentiality - but most local or national guidelines allow some concessions to individual patient preferences.
e.g.Cox2 for elderly patient willing to accept risks in exchange for the ability to walk up the stairs rather than crawl.

b) Where there is no licenced treatment. e.g. Aricept and Lewy Body Dementia
Use of many medicines in children

Jeff

[Zoggite]

I have a patient who is being prescribed Chloramphenicol eye ointment 1% for use on an infected leg-wound...

[johnep]

I have great trouble with stairs. currently just taking paracetamol, aspirin and ibuprofen with a lansaprazole to keep stomach happy.

Where can I find proof that Arcoxia vastly superior to ibuprofen.
johnep

[Linnear]

b) Betnesol soluble tablets used as a mouthwash is actually off license if I remember right.

[hannahd]

Thanks for the replies.

I'm now sorted with (b).

For (a) I just need to mention a specific guideline (e.g. NICE) and a situation where something was prescribed that is totally deviant from that guideline. Don't need to mention patient details except for other co-morbidities (if relevant). The tricky bit is that many of these guidelines have concessions for particular patients (as Jeff mentioned) and since this is in the guideline, it can't be used as an example!

[_Rob_]

I had a patient with NHL and who was being treated with R-CHOP. A few weeks later, the patient was reviewed at the Haem'o'hell (Haematology) MDT which I was attending. Anyway, it transpired that the patient did not have CD20+ B-cells. The Rituximab was not going to be beneficial to the patient, it was against NICE guidance and was costing lots of money. We did a bigger review of the patients on R-CHOP and found that this was not an isolated case, the haematologists were just adding in the Rituximab because they felt it was beneficial. We stopped this excessive prescribing of Rituximab and saved lots and lots and lots and lots of money for the tax payers

Was this the kind of thing you were after???

Here are some links to help:

NHL

NICE guidance NHL - Rituximab



_RoB_

[hannahd]

That is absolutely fab!!!! Not only did you give me an example (with great references), you also enhanced my knowledge of an area I know very little about. Cheers Rob!!!!

[johnep]

Well I am still ignorant as I do not know what the acronyms stand for. Please clarify for a poor old gent.
johnep

[Zoggite]

NHL: non-hodgkins lymphoma;
R-CHOP: Rituximab, Cyclophosphamide, Doxorubicin Hydrochloride, Oncovin(=vincristine), Prednisolone;
CD20 is the name of a protein found on the surface of one of the main types of normal white blood cells (B-cell lymphocytes). It is also present on the surface of most of the abnormal B-cell lymphocytes that occur in some types of non-Hodgkin lymphoma. Rituximab acts by attacking both abnormal (malignant) and normal B-cell lymphocytes.
MDT= Multi-Disciplinary Team.