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An evaluation of consultant and registrar prescribing in the outpatient setting

Session Poster Session 3

Speaker Clare Thomson

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : C L Thomson (London,GB), G L Campbell (London,GB), S Rita (London,GB)

Authors:
C L Thomson1 , G L Campbell1 , S Rita2 , 1Guy's and St Thomas' NHS Foundation Trust - London - United Kingdom of Great Britain & Northern Ireland , 2Kings College London - London - United Kingdom of Great Britain & Northern Ireland ,

Citation:

Background

Despite the presence of national and European guidelines, prescribing for heart failure with a reduced ejection fraction remains sub-optimal.  The UK National Heart Failure Audit (2016-17) shows that only 44% of patients are discharged on a combination of ACE-inhibitor, beta blocker and aldosterone antagonist. A local audit in 2016 has shown that at 6 months post-discharge, only 25% patients are on maximal therapy, despite attending out-patient appointments.

Purpose

This study looked at clinical documentation in out-patient appointments to review whether changes were made to medication.  The main aim was to determine current prescribing practice and impact on medicines optimisation.

Methods

This study looked at all heart failure out-patient appointments in January and February 2018. Patients were reviewed by a registrar or consultant.

A range of clinical and demographic information was collected, including medication changes made and drug class. The letters were checked for clarity of documentation of medication, allergy status and patients' adherence with prescribed medicines for heart failure.

Any recommendations were categorised and then reviewed whether change had occurred at the next out-patient appointment.  Patients were excluded if they did not have a follow-up appointment, had passed away before their appointment, or did not attend.

Results

694 patients attended an out-patient appointment in January and February 2018 and 50% (n=347) had a change to their medication recommended. 

The majority of patients (67.4%) had their current medications only partly documented.  Very few patients had their allergy status (1.6%) or adherence (5.3%) documented.  3.5% of patients had none of their current medications documented.

A total of 485 medication changes were recommended with half (50.5%) requiring the patient’s community general practitioner to action the change. 21.0% of patients were issued a prescription.  The most commonly prescribed class of medication were beta blockers (22.7%), ACE-inhibitors (17.7%) and diuretics (16.9%).

Of the 214 patients who had a change recommended and attended a follow-up appointment, adherence to medication changes was 77.4%. Asking the general practitioner to action the change made up the highest proportion of medication changes (41.5%) but the lowest rate of advice followed (68.1%).

Conclusion

Prescribing for patients at heart failure outpatient appointments is low and general documentation of medication and adherence is poor.
Half of medication changes are recommended for the general practitioner to action, which can incur a delay in medicines optimisation, as only 68.1% of these changes had been made when the patient attended for follow-up.  The lowest percentage was when a change was recommended by a registrar.
Further extension of this study is needed to understand the barriers to prescribing and review the current processes to reduce the delay in medicines optimisation.

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