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Showing posts from May, 2014

Three key issues in trying to increase the use of statins in the UK

Statistics from the OECD show that the per capita use of statins in the UK is the highest in Europe and the second highest in all OECD countries. There are a number of reasons for this, which include the emphasis on evidence-based medicine in the training of UK doctors; the 2004 GP contract which introduced incentives for the management of long-term conditions such as coronary heart disease and diabetes; and the NHS Health Check programme which aims (amongst its objectives) to increase the use of statins for the primary prevention of cardiovascular disease (CVD) in people with a 20% or more 10-year risk of CVD.

The National Institute for Health & Care Excellence (NICE) is now proposing to reduce the threshold for starting statins for the primary prevention of CVD from its current threshold of a 20% 10-year CVD risk to a 10% 10-year CVD risk. Although this could have significant benefits for the health of the population, there are three issues that need to be considered. These iss…

Why we need better information on the side-effects of statins

In a response to an editorial published in the BMJ by Dr Fiona Godlee, I discuss the need for better information to be available on the side-effects of statins. This is a a key issue in the debate about trying to widen the use of statins because of the discordance between rates of side-effects of statins in clinical trials and in clinical practice.

In clinical trials, the incidence of side effects from statins is low and similar in the intervention and placebo groups.[1] In contrast, observational studies using primary care databases report a much higher rate of potentially serious side effects (such as myopathy and renal failure) in people taking statins.[2, 3] Even these rates derived from clinical records may under-estimate the true incidence of side effects in people taking statins because not all patients with side effects will inform their doctor and not all doctors will enter a relevant diagnostic code in the patient’s electronic medical record.

Many general practitioners will…

Cognitive function in doctors and dentists with suspected performance problems

In a study published in the the journal JRSM Open, we examined the performance assessments and cognitive function of practitioners referred to the National Clinical Assessment Service (NCAS) in 109 practitioners over the age of 45 years referred to NCAS between 1 September 2008 and 30 June 2012.

The main outcome measures were reasons for referral of practitioners and their characteristics; details of their assessments including screening for cognition using Addenbrooke's Cognitive Examination Revised (ACE-R); outcome of the process.

Reasons for referral included ‘clinical difficulties’ and ‘governance or safety issues’. Eighty-seven practitioners scored above 88 on ACE-R. Twenty-two were found to have an ACE-R score of ≤88. On further assessment, 14 of these 22 practitioners were found to have cognitive impairment. The majority of all practitioners were found to be performing below the expected level of practice for someone at their grade and specialty. Of those scoring ≤88 on th…