Suchergebnisse

Many new drugs in the future will be very expensive and have major resource implications. Given current structures and legislation covering the prescribing of drugs, there are no clear means of controlling the use of these drugs to avoid diverting money away from other health care services and into drug treatment. This paper considers what mechanisms might be used by a purchaser to manage the introduction of an expensive new drug and uses interferon beta-1b for treating multiple sclerosis as an example. The most likely mechanism is the prescribing of the drug by a general practitioner on the advice of a neurologist. This would achieve a good benefit for the resources invested but would not control total expenditure. Devolving a limited budget for the drug to a specialist centre so that neurologists may prescribe it directly would be preferable, as this would link clinical, prescribing, and budgetary responsibility. These issues need to be addressed urgently by purchasers if major disruptions of services are to be avoided.

Despite evidence linking high levels of alcohol consumption to ill health, the number of people drinking above the 'sensible' limits is increasing. Clinicians in primary care can influence this trend by appropriate screening and advice. To do this they need to know the recommended sensible limits and also be able to translate commonly reported drinking levels into units of alcohol. A postal survey of 499 general practitioners and 343 practice nurses in Cornwall and South West Devon asked responders to calculate the number of units of alcohol contained in six different drinks and also state what they thought were the current sensible levels of consumption. The response rate was 63%. Less than 40% of responders were able to assess the units of alcohol in five out of the six drinks to within 10%. Over 70% of responders were unable to determine the alcohol content of all six drinks to within 30%. Forty-four per cent of responders now recommend an increased safe level of consumption at 28 units per week for men and 21 units per week for women, against the advice of the Royal Colleges and the BMA but in line with the levels suggested by the Government.