Prescribing

Identify and address barriers to tailored prescribing in your practice

• Often patients take multiple medications which carry a treatment burden. They can benefit from treatment which is tailored to their individual circumstances, but clinicians report barriers to this in practice. These barriers include a perceived lack of permission, lack of time to prioritise tailored prescribing, lack of professional skills and confidence and a lack of feedback on their performance to know if they’re making appropriate decisions.

Suggested WiseGP action:

Review your practice’s medicines review policy- consider which barriers you experience (detailed further in article below) and how you would tackle them to improve tailored prescribing.

Read more here: https://bmcfampract.biomedcentral.com/track/pdf/10.1186/s12875-017-0705-2

Avoid bath additives and be guided by patient/ parent preference when prescribing emollients

• Bath additives offer no benefit over emollients or emollient soap substitutes, so should not be prescribed. When the effectiveness of lotions, creams, ointments and gels has been compared for treatment of childhood eczema, no difference has been found between these 4 main types of emollient. Parents/children value choice as they may prefer certain products due to their thickness or absorbency.

Suggested WiseGP actions:

1. Share evidence regarding bath additive and emollient prescribing as detailed above at a practice meeting.

2. PCN pharmacist audit on bath additive prescriptions.

Read more about the research informing these recommendations here:

https://www.bmj.com/content/361/bmj.k1332

https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00146-8/fulltext

https://bjgp.org/content/72/719/e390

Combining medications to manage diabetic peripheral neuropathic pain

The efficacy of either amitriptyline, pregabalin, gabapentin or duloxetine is similar for the treatment of diabetic peripheral neuropathic pain. If pain relief is suboptimal on one of these drugs after 6 weeks, a combination (amitriptyline and pregabalin or duloxetine and pregabalin) has been shown to be well tolerated and can lead to improved pain relief.

Suggested WiseGP actions:

1. In a practice teaching session, share this recent evidence with prescribers and discuss where this may fit with chronic pain guidelines.

Read more about the research informing these recommendations here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01472-6/fulltext?dgcid=raven_jbs_etoc_email

Splitting tablets for flexibility and cost savings

• Except for sustained-release medications, a systematic review has found that tablet splitting to facilitate lower medication doses and reduced costs appears to be safe.

• Although some older adults may struggle to split tablets without tablet splitters, little evidence was found to justify tablet-splitting concerns other than the need to avoid splitting sustained-release preparations.

Suggested WiseGP actions:

• When prescribing, consider the option of splitting tablets for greater flexibility in dosing.

• Share this evidence with your PCN pharmacists, so they feel more confident recommending this practice, whether for cost savings or dose flexibility.

Read more about the evidence informing these recommendations here: https://bjgpopen.org/content/6/3/BJGPO.2022.0001