Survey Shows 71% Of GPs Are Concerned That Financial Restrictions Are Hindering Best Practice In Cardiovascular Disease (CVD) Risk Management
63% of respondents have exception coded patients who failed to reach CVD targets on statins alone despite alternative treatments being available
Despite government calls to stop commissioners blacklisting the use of certain NICE, SIGN and SMC approved medicines, an MSD sponsored survey of over 450 UK GPs, reveals the extent of local prescribing restrictions being placed on cholesterol-lowering medications. Key survey findings:1
- 93% (n=422) have been told to switch a patient’s dyslipidaemia medication to a cheaper alternative
- 68% (n=100) of GPs feel frustrated by restrictions on their prescribing autonomy and 60% (n=89) think cost is restricting best medical practice
- Of the 63% (n=284) of GPs who have exception coded patients not reaching CVD targets with statins alone, 42% (n=120) cited this as due to local prescribing restrictions or pressure from local authorities
- Of the reasons given for exception reporting CVD patients not reaching CVD targets, GPs commonly cite patient intolerance to statins despite alternative types of cholesterol-reducing medication being available
While generic statins are the first treatment of choice in cholesterol management, GPs have a range of other (NICE/SMC/SIGN) approved medications which they may choose to prescribe to patients at high risk of CVD or who have experienced tolerability issues with statins. However, the survey suggests that many GPs are unable to prescribe these medications due to financial reasons and these restrictions mean that some prescribers are unable to follow accepted national guidelines.
Lipidologist Dr Dermot Neely, Co-chair of HEART UK’s Familial Hypercholesterolemia (FH) Guideline Implementation Team, expressed concern at the findings of the recent research; “Prescribing restrictions for high intensity lipid-lowering medication in CVD could be putting a significant number of our patients at unnecessary risk. FH is a condition comparable to Type 1 diabetes and, unless treated to optimal low-density lipoprotein (LDL) cholesterol targets, people with FH could suffer the sort of premature arterial damage we see in people with Type 1 diabetes with poor glycaemic control. It is hard to imagine people with Type 1 diabetes being denied the insulins they need in the way that FH patients are being denied access to the specialist care and lipid-lowering medications recommended by the current NICE clinical guidelines.”
A particular example of a cholesterol-lowering medicine to which access is being restricted is Ezetrol (ezetimibe). Despite the drug being NICE, SMC and SIGN approved, 68% (n=306) of surveyed GPs said that they had experienced restrictions in its prescribing, with 76% (n=234) of these GPs believing this is due to financial restrictions in their area.1 Tellingly, when asked whether they would prescribe ezetimibe more widely if there were no such restrictions, 71% (n=321) of GPs confirmed that they would, with 70% (n=225) of those saying it would be in high-risk or hard-to-treat patients.1
The results of the survey are even more significant in light of recent British Heart Foundation data which showed that a third of patients prescribed statins do not take their medication.2 Access to a wide range of appropriate treatment can help play an important role in the reduction of cardiovascular disease in the primary care setting, and in the prevention of significantly more expensive treatment of a vascular event in secondary care.
1. OnePoll 2012. GP survey. Data on File. MSD. See ‘About the survey’ above for details of research.
2. British Heart Foundation. 1 in 3 cholesterol patients put their hearts at risk. Available from: http://www.bhf.org.uk/default.aspx?page=14691[Last accessed June 2012]