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A PROSPECTIVE AUDIT OF PRESCRIPTIONS FOR ORAL METHOTREXATE AND

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A PROSPECTIVE AUDIT OF PRESCRIPTIONS FOR ORAL METHOTREXATE AND Powered By Docstoc
					  A PROSPECTIVE AUDIT OF PRESCRIPTIONS FOR ORAL METHOTREXATE
 AND INFORMATION RECEIVED BY RHEUMATOLOGY PATIENTS IN PRIMARY
                             CARE
Cristín Á Ryan, Carole Callaghan, Moira Kinnear. Lothian Pharmacy Practice Unit, NHS Lothian,
Edinburgh


Aim of study
Oral methotrexate is taken once weekly in rheumatology patients. Prescribing and dispensing errors
                                          1,2
have been associated with this regimen.       This study aimed to review current prescribing of
methotrexate in the management of rheumatological conditions in Lothian.


Materials and Methods
Standards were generated from literature and peer review for prescribing and provision of information
to patients receiving methotrexate. A data collection form incorporating these standards was designed
and reviewed by lead community pharmacists from each locality. With their support, 5 forms were
posted with an explanatory covering letter and a 3 month return date to all 173 community pharmacies
in Lothian. Community pharmacists were asked to complete a form each time they received a
prescription for methotrexate. The results were analysed and recommendations made to address
practice that did not adhere to the agreed standards


Results
Responses were received from 55/173 (32%) pharmacies. Four pharmacies indicated they had not
received any prescriptions for methotrexate during the data collection period. Of the 865 forms
distributed, 142 were returned (16%). The total number of patients receiving methotrexate for
rheumatological conditions in Lothian is unknown. Non-adherence to the standards is illustrated in
Table 1.

Table 1. Non-adherence to standards for methotrexate prescribing and information provision
Standards                                                     Non-adherence (%) n=142
Dosage frequency specified                                     15 (10 %)
Prescriptions for 2.5mg tablets only                           34 (24%)
Previous patient counselling                                   30 (21%)
Patients have a Patient Information Leaflet (PIL)              22 (15%)
Patients have a Shared Care Monitoring Card (SCMC)            101 (71%)


Conclusion
This survey identified several areas where the quality of methotrexate use in Lothian could be
improved: the provision of patient information at the outpatient clinic including a shared care
monitoring card and prescribing information to ensure exclusive use of 2.5mg tablets.


References
1. Society and NPSA in safety project. Pharm J. 2003;271:562
2. Cambridge Health Authority. Methotrexate toxicity: an inquiry into the death of a Cambridgeshire
   patient in April 2000. Cambridge: Cambridge Health Authority, 2000.

				
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