eGuidelines.co.uk
Login | Register

News – September 2005

Contents

ASCOT study prompts NICE and BHS to review hypertension guidance

Cardiovascular mortality can be reduced by 24% and stroke by 23% in patients with hypertension using a combination of calcium channel blocker with an ACE inhibitor compared with the commonly used beta-blocker and thiazide regimens. These were the key findings from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) after a median follow-up of 5.5 years.

The ASCOT trial results have triggered a collaboration between NICE and the British Hypertension Society to consider the impact of the data on hypertension guidelines.

The appointment of a joint Expert Advisory Group to review the impact of the ASCOT data is a strategy to provide clear NHS guidance from a single source.

ASCOT is a randomised controlled trial on the prevention of CHD and other vascular events. It involved 19 257 hypertensive patients. One group of patients received the beta blocker atenolol with or without a thiazide diuretic. The other group of patients received the calcium channel blocker amlodipine with or without the ACE inhibitor perindopril.

Patients were at moderate risk, similar to many hypertensive patients seen in general practice.

The study included lipid lowering with atorvastatin. The Lipid Lowering Arm of ASCOT has been previously published.

The Blood Pressure Lowering Arm of ASCOT was presented at the European Society of Cardiology Congress, in Stockholm, earlier this month and was published in the Lancet on-line.

Significant risk reductions were shown with the amlodipine-based regimen compared with the atenolol based therapy: the risk of strokes was reduced by 23%; total coronary events by 13%; cardiovascular deaths by 24%; and new cases of diabetes by 30%.

Atorvastatin further reduced the remaining risk, irrespective of the patient’s original cholesterol level.

Dr Adrian Brady, consultant cardiologist at Glasgow Royal Infirmary and member of the executive committee of the British Hypertension Society commented: “The results of ASCOT are substantial and important. We must consider whether the much-used regimen of beta-blockers followed by thiazides is the automatic choice for our patients. These drugs are no longer likely to be seen as first-line treatment for all patients with hypertension.”

Professor Peter Sever, co-chairman of the ASCOT study cautioned, “Diuretics and beta-blockers are an effective and proven combination for lowering blood pressure and its associated risks. What ASCOT has shown is that for many patients the combination of newer drugs may be an even better option.

“Patients should discuss the implications of ASCOT with their physicians before any modification of treatment is considered.”

Guidelines in PracticeAwards 2005

The winners of this year’s Guidelines in Practice Awards will be announced in the November issue of the journal. The Awards recognise innovative primary and shared care schemes to implement national guidance in the NHS. Members of the winning teams will be presented with their Awards at an after dinner ceremony at The Café Royal, London on Thursday 3 November. The overall winning entry will be published in the November issue of Guidelines in Practice. Details on how to enter the 2006 Awards will be announced in the journal early next year.

COPD guide for general practice

The British Lung Foundation has produced a quick reference guide to help GPs manage exacerbations in patients with COPD.The guide contains a flow chart to aid decision making on whether patients should be admitted to hospital or managed at home and to encourage follow up and review. It also contains suggestions for drawing up personal action plans for patients. Copies of The treatment and prevention of exacerbations in COPD: the role of primary care can be obtained by calling the BLF information line on 020 7688 5555.

Stroke tool will aid transfer of care

The RCP has launched a document on the transfer of care of stroke patients to encourage seamless transition when patients are discharged back into the community. It is designed to include essential information on assessments on transfer, rehabilitation and follow up appointments and home care arrangements as well as diagnosis, investigations and treatment.The document contains a form that the consultant completes and then copies to the GP and the patient.The tool has been piloted in both primary and secondary care. Copies and further information are available from the RCP website: www.rcplondon.ac.uk

GPs and patients reap the benefits of first year of new GMS contract

GPs have achieved near maximum scores on the quality and outcomes framework in the first year of the new GMS contract.

Figures published by the Department of Health, at the end of August, show that the average score for practices in England was 959 out of a total of 1050 points.

The figures for Scotland, published 3 months earlier, demonstrated that practices there achieved an average score of 971 points.

The nGMS contract, introduced in April 2004, is the first to pay practices for delivering quality care based on evidence that interventions by practices would make a difference to patients. Each point was worth £77.50 in 2004/2005 and will be increased to £124.60 in 2005/2006.

Dr Hamish Meldrum, chairman of the BMA’s General Practitioners Committee commented: “These are outstanding results and first and foremost they are good news for patients. The quality and outcomes framework has shown that GPs can quickly adapt to new and better ways of working.”

However, he added a note of caution that there may be valid reasons for some practices achieving lower scores.

“A lower score does not necessarily mean a practice is a lower quality one. For instance, a higher number of patients with certain types of disease could make the quality points more difficult to achieve,” he explained. Staff shortages could also affect scores.

Dr Nigel Watson’s practice in Hampshire achieved the maximum score of 1050 points. “The average QOF scores show the high quality of general practice in the UK. They also demonstrate that if GPs are given a challenge not only do they rise to it, they also deliver,” he said.

“Most practices have found that the evidence based contract has produced improvements in care in a significant number of areas, in particular improved control of blood pressure, cholesterol levels and diabetes,” added Dr Watson who is chief executive of Wessex LMCs.

There are four domains within the framework: clinical, organisational, additional services and patient experience. The clinical domain, which covers ten disease areas, is the largest with 550 points available.

Commenting on the achievement of practices in Scotland, Dr Mary Church, joint chair of the BMA’s Scottish GPC, said: “I believe GPs and their teams have done a magnificent job in delivering unparalleled standards of care to their patients and the quality achievement information has demonstrated this.”

“GP practices, by improving care, can reduce the need for patients to be placed on a waiting list or admitted to hospital,” she added.

Lanark GP Dr Jill Murie, a member of the Scottish New GMS Quality Working Group, said that the critical factors for successful achievement in the QOF are “effective leadership, the infrastructure, capacity and organisation of clinics including teamwork and skill mix.”

“The commitment must be shared by the whole primary care team,” emphasised Dr Murie.

Guidelines in Practice, September 2005, Volume 8(9)
© 2005 MGP Ltd
 further information | subscribe