Quality Use of Medicines for Cardiovascular Health - National Heart ...

Before a cardiovascular event (cont.)
Before a cardiovascular event
The bulk of cardiovascular risk assessment
and prescribing is done in general practice.
However, general practice is under significant
pressure. A particular problem for GPs is the
growing volume of clinical evidence and
guidelines they are expected to know. The
amount is far greater than they have to time
read, and the volume too large to remember.
GPs find keeping up to date difficult, especially
when their patients have several conditions or
are taking several medicines. The information
available to guide GPs is very fragmented
and difficult to access as a whole. There is
growing evidence that guidelines are not being
translated into clinical practice.
More effective ways need to be found to
provide GPs with information in ways that are
manageable and memorable. Where effective
methods have been found, they need to be
more widely used.
Counselling and education
Some patients do not understand what their
doctor tells them about cardiovascular disease or
their treatment. Research has shown that patient
confusion is responsible for nearly two-thirds
of medicine-related problems after discharge
from hospital. Research has also found that,
while consumers are generally satisfied with
their doctor’s technical knowledge, they felt that
GPs’ greatest weakness is in communicating.
The problem is not just a matter of doctors’
skill, but also a lack of time to counsel patients,
particularly when managing chronic diseases.
Possible solutions include:
• providing doctors with training on how to
communicate with their patients
• making greater use of nurses in general
practice and hospitals to ‘interpret’ doctors’
directions for patients and carers
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Initiating medicines
There is evidence that some doctors are underprescribing
medicines which have been shown
to be effective in reducing the risk of CVD.
These include ACE inhibitors, beta-blockers and
lipid-modifying drugs. Doctors would benefit
from advice and training on:
• the degree of current under-prescribing
• risks posed by under-use of these medicines
• appropriate use of these medicines
• appropriate target doses
Some of the common medicines used to reduce
risk of cardiovascular disease can have side
effects initially, and it may take doctors some
time to find a formulation or combination
of medicines that is well-tolerated by the
patient. This might involve switching between
medicines, as well as titrating doses up and
down. Many patients do not understand the
reasons for these changes. Because of this, and
the side effects, some patients refuse treatment.
Some doctors need help explaining to
consumers —before commencing a new
medicine—why switching and changing doses
is often necessary initially, and how long it may
take to find a suitable medicine or combination
of medicines.
• greater counselling by pharmacists when
dispensing medicines.
Consumer medicine information
An important tool for educating consumers
about their medicines is the Consumer
Medicine Information (CMI) sheet. By law, all
prescription and pharmacist-only medicines
must have CMI. Topics that CMIs cover include:
– the purpose of the medicine
– issues to consider before taking the medicine
– how to take the medicine correctly
– what to do while taking the medicine
– side effects
– a description of the medicine.
CMI is the only standardised consumer
information prepared for each individual
medicine. They are normally provided
by pharmacists at the time the medicine
is dispensed.
A 2004 review of pharmacies found that only
12 per cent of consumers received a CMI when
dispensed a prescription medicine. Also, many
health professionals, including nurses and
specialist doctors, do not know that CMI exist.
There is a widespread belief that consumers do
not know to ask for CMI.