NHS Evidence – the portal that provides free access to authoritative clinical and nonclinical evidence and best practice – would be a good place to start. Following an overhaul of the resource completed a few months ago, the presentation of information has been reconfigured with a new focus on medicines. The new version helps you more easily access best practice, care pathways and information for patients.
So what types of information would be useful in dealing with your patient case study? New medicines topic pages provide free access to the British National Formulary. By running a search on your patient’s statin you would be able to quickly clarify the common side effects and identify other suitable alternatives to discuss with the GP. The topic pages link to valuable resources collated by the National electronic Library for Medicines, the electronic Medicines Compendium, and products developed by the National Prescribing Centre. For the benefit of your patient you would be able to readily access Patient Information Leaflets to boost understanding of the prescribed treatment. And, for further information, you would be able to find Summaries of Product Characteristics. If your patient happened to raise a more unusual query, you could access medicines Q&As from UK Medicines Information (UKMI).
Over 250,000 resources
Direct from NHS Evidence you could find shared decision aids to help explore your patient’s perspectives of his medicines and the reasons why he may not want to, or is unable to, use them as prescribed. NHS Evidence provides access to over 250,000 resources from over 1,500 sources, including NICE guidelines. In this instance, the Medicine Adherence Guideline could help improve compliance and concordance to ultimately achieve a better health outcome for your patient.
To support your patient in quitting smoking you could access the NICE Pathway (http://pathways. nice.org.uk/pathways/smoking); this would allow you to visualise ‘at a glance’ what NICE has recommended around smoking across all of its products, including clinical guidelines, technology appraisals and public health guidance. The Pathway would enable you to easily drill down to find the latest recommendations for your patient. Based on his needs and an awareness of where he previously failed within the smoking cessation cycle, you might offer him referral to an intensive support service or nicotine replacement therapy.
All guidance available on NHS Evidence is carefully selected from organisations which you can rely on for good quality information. However, only organisations whose guidance processes meet the exacting standards set by NHS Evidence are approved under its accreditation scheme. Approaches to guidance production change all the time and it’s important to know that organisations are addressing any gaps in their process and aspiring to reach the very highest benchmarks. Twenty six guidance development processes have been accredited so far, including the National Patient Safety Agency (for rapid response reports) and the Medicines and Healthcare products Regulatory Agency (for Pharmacovigilance Public Assessment Reports, Device Bulletins and Public Assessment Reports).
Further research options
Outside your day-to-day role dealing with patients you may be involved in research projects. Therefore it may be necessary for you to conduct literature reviews to refine your research question and objectives, highlight research possibilities you may have overlooked, gain insight into current opinions and discover whether explicit recommendations for further research into your topic have been made. If you work for the NHS and have an Athens account you can gain free access to eight databases of evidence (Medline, HMIC, CINAHL), e-books and various key journals (JAMA), enabling you to search across areas including management, pharmacology and medicines.
Whilst NHS Evidence is designed for professionals, I regularly recommend it to both patients and carers. Only patient information accredited under the Department of Health Information Standard is available through the portal, so patients can use it if they want to find out more about their condition, the lifestyle options that might improve it or the treatments available. I recently conducted a medicines use review for a diabetic patient who was having problems controlling his glucose levels. We went through his treatment regime and discovered that he was fully compliant with his medication but maintained poor dietary control. During the consultation I went on to NHS Evidence and accessed a patient decision aid from NHS Choices which offered tools to plan and manage a low fat, low sugar, healthy diet. As a result, he was able to make an informed decision to suit his lifestyle and help manage his diabetes effectively.
A priority for all pharmacists
A priority for all pharmacists A priority for all pharmacists is to improve quality of care in the most efficient way possible. The NHS Evidence Quality and Productivity collection outlines areas of potential disinvestment from NICE guidance and Cochrane reviews, and states where newly published systematic reviews indicate if an intervention is harmful, ineffective, or not supported by sufficient good quality evidence. Some interventions shown to be ineffective include antibiotics for the common cold and acute purulent rhinitis, and antiplatelet agents and anticoagulants for hypertension.
During the process of guidance development, NICE’s independent advisory bodies often identify examples of routine clinical practice that they recommend should be discontinued completely or not used routinely. These “do not do’s” are also collated in the Quality and Productivity collection. Recommendations relevant for pharmacists include not prescribing oral antibiotics to children with fever without apparent source.
As a pharmacist you want to deliver the highest quality care to your patients and to do this you need access to a high quality evidence base. In one place, NHS Evidence gives you the most up-to-date quality information, continuing medical education and support tools to help implement best practice. Against the backdrop of economic uncertainty and ageing population profiles, the demand for safe, cost effective and constantly improving clinical outcomes has never been more important. To start your search, go to www.evidence.nhs.uk
Dr Mahendra Patel
is a Fellow of the National Institute
for Health and Clinical Excellence (NICE),
senior lecturer in pharmacy practice at the
University of Huddersfield, and
adjunct professor of pharmacy in Pennsylvannia, USA.