NICE guidance has failed to end "postcode prescribing"
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《英国医生杂志》
London
The National Institute for Clinical Excellence (NICE) has so far failed to end the "postcode prescribing" that it was designed to eliminate when it was set up five years ago, a report from the institute has shown.
An analysis of how trusts have acted on 28 treatment reviews, involving 33 sets of recommendations, which was commissioned by the institute and published this week, shows that only around half have been implemented properly. The analysis covers guidance issued up to 2003.
NICE had advocated first line use in 10 sets of recommendations and second or third line treatment in a quarter (24%). A third of the recommendations applied to a defined group of patients.
The analysis concludes that although the institute's guidance tended to be more often positive than negative in tone, and that it has spurred market growth in some areas, only 12 of the 28 sets of guidelines had been implemented well.
It found good compliance with recommendations for the new drugs it reviewed for bowel cancer, Crohn's disease, diabetes, and obesity and for asthma inhalers for children.
But 12 sets of guidance had been insufficiently acted on, including new drugs for advanced ovarian cancer, arthritis, and schizophrenia, as well as home haemodialysis and surgery for obesity.
The analysis found that funding for obesity surgery, for example, varied from trust to trust, with insufficient capacity and long waiting lists common problems. Just 12 trusts carry out 90% of all surgery for obesity.
Four guidelines, including the use of interferon beta for multiple sclerosis and metal hip replacements, seem to have been "over implemented," with more patients being treated than projected.
An implementation review from the Association of the British Pharmaceutical Industry, submitted to the institute last month, concluded that uptake of guidance among strategic health authorities varies considerably. But it warned that issues surrounding implementation were complex and beset by conflicting priorities. There was "no magic bullet," it said.
A similar audit by the pharmaceutical company Roche on four of its own drugs, concluded that guidance had helped patients to access medicines "at a level comparable with other European Union countries."
But it also felt that the problem of postcode prescribing had increased. "In all areas, the gap has now widened between the best and the worst NHS organisations charged with implementing guidance," it said.
An institute spokesperson commented: "Implementation may not be happening consistently, but take-up by many trusts is rising despite this, and the figures are still improving."
In a bid to secure a more consistent approach, NICE has advertised for an implementation director and has posted a new section on its website to support those responsible for acting on its guidance.(Caroline White)
The National Institute for Clinical Excellence (NICE) has so far failed to end the "postcode prescribing" that it was designed to eliminate when it was set up five years ago, a report from the institute has shown.
An analysis of how trusts have acted on 28 treatment reviews, involving 33 sets of recommendations, which was commissioned by the institute and published this week, shows that only around half have been implemented properly. The analysis covers guidance issued up to 2003.
NICE had advocated first line use in 10 sets of recommendations and second or third line treatment in a quarter (24%). A third of the recommendations applied to a defined group of patients.
The analysis concludes that although the institute's guidance tended to be more often positive than negative in tone, and that it has spurred market growth in some areas, only 12 of the 28 sets of guidelines had been implemented well.
It found good compliance with recommendations for the new drugs it reviewed for bowel cancer, Crohn's disease, diabetes, and obesity and for asthma inhalers for children.
But 12 sets of guidance had been insufficiently acted on, including new drugs for advanced ovarian cancer, arthritis, and schizophrenia, as well as home haemodialysis and surgery for obesity.
The analysis found that funding for obesity surgery, for example, varied from trust to trust, with insufficient capacity and long waiting lists common problems. Just 12 trusts carry out 90% of all surgery for obesity.
Four guidelines, including the use of interferon beta for multiple sclerosis and metal hip replacements, seem to have been "over implemented," with more patients being treated than projected.
An implementation review from the Association of the British Pharmaceutical Industry, submitted to the institute last month, concluded that uptake of guidance among strategic health authorities varies considerably. But it warned that issues surrounding implementation were complex and beset by conflicting priorities. There was "no magic bullet," it said.
A similar audit by the pharmaceutical company Roche on four of its own drugs, concluded that guidance had helped patients to access medicines "at a level comparable with other European Union countries."
But it also felt that the problem of postcode prescribing had increased. "In all areas, the gap has now widened between the best and the worst NHS organisations charged with implementing guidance," it said.
An institute spokesperson commented: "Implementation may not be happening consistently, but take-up by many trusts is rising despite this, and the figures are still improving."
In a bid to secure a more consistent approach, NICE has advertised for an implementation director and has posted a new section on its website to support those responsible for acting on its guidance.(Caroline White)