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  • Blood pressure madness

    As all pharmacists will know, some GPs introduce blood pressure medicines that according to guidelines are not recommended for particular patient groups, or in the wrong order, or with careless dose titration.

    The kind of thing I'm talking bout:

    - A 35 year old slightly overweight Indian lady, who has a strong family history of diabetes, started on bendroflumethiazide rather than other drugs.

    - A 75 year old lady given Doxazosin 8mg daily without any initial dose titration

    - Minoxidil intriduced by GP as second drug.

    The second two I intervened in and managed to get changed. I feel I should also attempt to tackle the first patient.

    But it's a tiring job to get past the receptionists, deal with the patients who get very worried when I started discussing this with them etc, deal with the doctor who initially tried to be dismissive etc.

    I'm sure all of you will have LOADS more examples.

    My question is: should we intervene in every single case (milder ones in which there may not necessarily be a large risk of a bad outcome) or only the worst and most harmful cases?

  • #2
    Re: Blood pressure madness

    Spend as much time on a rx as 90pence dispensing fee would cover!

    Comment


    • #3
      Re: Blood pressure madness

      Just keep on at it.....good work

      send them a laminated copy of recent NICE/BHS guidelines

      I'm sure doxasosin is 4th line ,as for minoxidil...unbelievable...nobody uses that any more or do they?

      U can get the PCT pixies (johneps' description) to look into it if you are really worried and think that patient safety is being compromised
      Kemzo the pharmacist forumly known as kemzero

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      • #4
        Re: Blood pressure madness

        NPSA reports that name the PCT usually get some attention.

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        • #5
          Re: Blood pressure madness

          Originally posted by kemzero View Post
          Just keep on at it.....good work

          send them a laminated copy of recent NICE/BHS guidelines

          I'm sure doxasosin is 4th line ,as for minoxidil...unbelievable...nobody uses that any more or do they?

          U can get the PCT pixies (johneps' description) to look into it if you are really worried and think that patient safety is being compromised
          If you'd tried the equivalent 30 years ago you'd have been told EXACTLY where to go. Much higher opinion of pharmacist skills now.

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          • #6
            Re: Blood pressure madness

            Thank you for your article about Blood pressure!

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            • #7
              Re: Blood pressure madness

              Originally posted by the old merlin View Post
              If you'd tried the equivalent 30 years ago you'd have been told EXACTLY where to go. Much higher opinion of pharmacist skills now.
              I'm surprised that things could ever have been worse.... considering gps ain't exactly very happy to receive pharmacist advice now.

              BTW in 'The Pharmacist' magazine second issue from last, a GP wrote an article saying that things used to be better between the two professions and that they've got more strained of late.

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              • #8
                Re: Blood pressure madness

                Originally posted by Raju View Post
                I'm surprised that things could ever have been worse.... considering gps ain't exactly very happy to receive pharmacist advice now.

                BTW in 'The Pharmacist' magazine second issue from last, a GP wrote an article saying that things used to be better between the two professions and that they've got more strained of late.
                I am fortunate that I work in an environment where physicians and pharmacists work side by side. I think the relationship is better since we physically are located in the same building on the same floor. I think there is tension in the other settings here in the U.S. and also with community pharmacy as well. I think the key as to why we've developed such a good relationship is that they see the value in our work and see that in order to effectively manage a population, you must utilize your team. We are part of that team. We remove work from their plates, freeing them up for the higher acuity patients. I think that showing this value while at the same time, showing that we are not encroaching upon their territory...brings to surface what we have to offer. It sounds like the UK is trying to move in this direction based on the 2020 vision paper. I hope it happens there. The other piece that helps here is that the newer physicians are used to training with us and our residents in their residencies and have worked with us before.

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                • #9
                  Re: Blood pressure madness

                  Originally posted by the old merlin View Post
                  If you'd tried the equivalent 30 years ago you'd have been told EXACTLY where to go. Much higher opinion of pharmacist skills now.
                  I can go back 30 years - just - doctors used to have their lunch hours in the pharmacy - fill in the bits they'd missed on prescriptions - we'd both share our concerns about patients.
                  There was less opportunity for outright criticism of prescribing because there was less in the way of either local or national guidelines - and less in the way of evidence. Querying interactions brought a reasoned response e.g "Thanks for phoning, the practice in hospital was to half the dose of theophylline for the duration of antibiotic treatment - so if you could reiterate that advice to the patient I'd appreciate it"

                  Perhaps being able to credit professional samples to their accounts helped.

                  Yeah life was more relaxed.

                  Jeff

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                  • #10
                    Re: Blood pressure madness

                    Originally posted by Raju View Post
                    I'm surprised that things could ever have been worse.... considering gps ain't exactly very happy to receive pharmacist advice now.
                    I get regular queries from both GPs and other prescribers.

                    The standard reply to manufacturers can't supply issue is a brief history - a diagnosis and a prescription for whatever obtainable alternative I then suggest.

                    Changing prescribing habits is more difficult.
                    I find it easier to begin by focussing on one habit that effects lots of patients e.g metoclopramide paed for as first choice for a child that vomits. Success then being measured as a decrease in prescribing rather than an absence of.

                    Jeff

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                    • #11
                      Re: Blood pressure madness

                      Originally posted by Jeff View Post
                      I can go back 30 years - just - doctors used to have their lunch hours in the pharmacy - fill in the bits they'd missed on prescriptions - we'd both share our concerns about patients.
                      There was less opportunity for outright criticism of prescribing because there was less in the way of either local or national guidelines - and less in the way of evidence. Querying interactions brought a reasoned response e.g "Thanks for phoning, the practice in hospital was to half the dose of theophylline for the duration of antibiotic treatment - so if you could reiterate that advice to the patient I'd appreciate it"

                      Perhaps being able to credit professional samples to their accounts helped.

                      Yeah life was more relaxed.

                      Jeff

                      Mine in Toxteth used to come in the middle of their morning housecalls for a cup of coffee and a smoke !!!

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