News – February 2006

Contents

• NICE recommends statins for prevention of CVD
• Guidelines in Practice Awards
• PRODIGY guide updated
• High fruit and vegetable intake cuts stroke risk
• White Paper sets out expanded role for local GP services
• SIGN updates dementia guideline

NICE recommends statins for prevention of CVD

Adults with evidence of cardiovascular disease (CVD) and those at high risk should be treated with statins, according to the recently published technology appraisal from NICE.

High risk is defined as a 20% or greater risk of developing CVD over the next 10 years.

“This is very good news for patients. Statins are life saving. We have been too conservative in the use of statins in Britain and GPs welcome this announcement as something we have wanted for a long time,” commented Dr Mayur Lakhani, Chairman of the RCGP.

The guidance also emphasises the importance of considering other risk reduction strategies when initiating statin treatment, such as stopping smoking and other lifestyle measures.

“It is essential that the use of statins is seen in conjunction with lifestyle changes as well as the use of other drugs to lower blood pressure and prevent vascular events,” said Dr Alan Begg, a member of the Primary Care Cardiovascular Society.

A local costing template is available in the form of a spreadsheet that can be used to estimate the cost of fully implementing the guidance locally. A national costing report has also been produced.

NICE is developing a clinical guideline on cardiovascular risk assessment due to be published in September 2007.

Copies of the full guidance, and the quick reference guide, for NICE Technology Appraisal 94, Statins for the prevention of cardiovascular events, as well as the implementation tools, can be downloaded from the NICE website:www.nice.org.uk

See also ‘Statins can significantly reduce risk of CVD’.

Guidelines in Practice Awards

Now is the time to start thinking about entering this year’s Guidelines in Practice Awards.

The overall Award, sponsored by the journal, is open to primary or shared care projects to implement any national evidence-based clinical guidance in the NHS, including the indicators in the nGMS contract.

The winning team will receive an Award of £4,000 to roll out their project and the two runners up will receive £1,000 each.

There will also be a number of sponsored categories for projects in specific clinical areas.

The winning team in each sponsored category will receive £3,000.

Full details on the entry criteria for all the categories plus instructions on how to enter will be published in the March issue of Guidelines in Practice.

Closing date for entries is 30 June 2006.

PRODIGY guide updated

PRODIGY has updated its guidance handbook PRODIGY Knowledge: practical, reliable, evidence-based guidance.The second edition, published by TSO, covers guidance on 155 acute and chronic conditions usually managed in primary care and ‘first contact’ care. For details on how to order a copy go to: www.prodigy.nhs.uk

High fruit and vegetable intake cuts stroke risk

An increased consumption of fruit and vegetables is associated with a reduced risk of stroke, according to a study in The Lancet. Compared with individuals who ate less than 3 servings a day, the relative risk of stroke was 0.89 for those who had 3-5 servings, and 0.74 for those who ate more than 5 servings a day. The meta-analysis included data on more than 250,000 individuals, followed up for an average of 13 years.

Lancet 2006; 367: 320-26

White Paper sets out expanded role for local GP services

Government plans to move healthcare services into the community so that patients can be treated closer to home are outlined in the White Paper, published at the end of January.

Over the next year the Department of Health will be looking at different models of care including services provided by GPs with special interests (GPwSIs).

ENT is one of the services singled out for shifting care to community settings. Where appropriate otitis externa and rhinitis can be managed by GPwSIs in the community, the document states.

The DH will be working with the specialty associations and Royal Colleges to define pathways to provide the right care in the right settings. Around 20-30 demonstration sites will be studied covering six specialties: ENT, dermatology, urology, gynaecology, trauma and orthopaedics, and general surgery.

Practices and PCTs will be responsible for commissioning services for these and later on other specialties using recommended models of delivery.

In a statement issued jointly with the RCP, the RCGP said: “The proposal to bring some of the services currently provided by hospitals into the community is sensible provided that this is done in a supported and structured way making the best use of doctors, both specialists and generalists, working to defined standards and care pathways.”

Dr Hamish Meldrum, Chairman of the BMA’s general practitioners committee commented: “Patients value being able to access services closer to their home. Doctors in both primary and secondary care will wish to work together to look at how services can be planned locally to best deliver high quality, local care.”

Our Health, Our Care, Our Say: a new direction for community services. Department of Health, 2006

Sign updates dementia guideline

SIGN has revised its guideline on the diagnosis and treatment of dementia to incorporate the latest evidence.The updated guideline covers non-pharmacological interventions as well as drug treatments. There is a section on information for patients and carers and advice on implementation and audit. The full guideline Management of patients with dementia and the quick reference guide should be posted on the SIGN website: www.sign.ac.uk in March.

Guidelines in Practice, February 2006, Volume 9(2) © 2006 MGP Ltd further information | subscribe