OptimiseRx continues to provide your prescribers with trusted content led by national guidance that is up to date, timely and specific to the patient. We believe at this time more than ever, the best practice, safety and quality messages can be a great support to all those working with patients in primary care.
We are constantly reviewing the latest national guidance around COVID-19 and assessing its suitability for OptimiseRx messages. We are aware of the increased pressure everybody is under and that local processes are being developed or are already in place to support your prescribers and patients.
New Best Practice Messages
We have authored the national messages below using advice from the Royal College of General Practitioners (RCGP) as a reference source which you can enable if you feel they would be useful in your local area. You can add your own local text and URLs to the messages as required to support workflows you may already have in place locally.
Warfarin preparations: consider prescribing a Direct-acting Oral Anticoagulant (DOAC) for suitable patients (COVID-19 pandemic workload prioritisation)
The RCGP (March 2020) recommends that consideration should be given to changing suitable patients taking warfarin onto a DOAC as part of workload prioritisation during the COVID-19 pandemic, removing the need for regular INR monitoring.
Progestogen-only intrauterine contraceptive devices: consider prescribing a progestogen-only oral contraceptive for suitable patients (COVID-19 pandemic workload prioritisation)
Progestogen-only contraceptive implants: consider prescribing a progestogen-only oral contraceptive for suitable patients (COVID-19 pandemic workload prioritisation)
Progestogen-only contraceptive depot injections: consider prescribing a progestogen-only oral contraceptive for suitable patients (COVID-19 pandemic workload prioritisation)
The RCGP (March 2020) recommends that consideration should be given to prescribing a progestogen-only oral contraceptive as an interim measure to mitigate the need for checking and changing coils as part of workload prioritisation during the COVID-19 pandemic. Refer to the Faculty of Sexual and Reproductive Healthcare (FSRH) guidance for further information.
Best Practice Message Amendments
We have amended some of our existing messages after the recent publication of NICE COVID-19 rapid guidelines, new recommendations from the Specialist Pharmacy Service (SPS) on drug monitoring in primary care and MHRA guidance during COVID-19 pandemic.
Antimicrobial Resistance and Stewardship
Antibiotics: doxycycline (or amoxicillin if doxycycline unsuitable) recommended for the first-line treatment of community acquired pneumonia in non-pregnant patients aged 18 years and over (COVID-19 rapid guideline)
NICE (NG165, Apr 2020) recommend a 5-day course of doxycycline (or amoxicillin, if doxycycline unsuitable) for the first-line treatment of community acquired pneumonia.
NG165 COVID-19 rapid guideline now supersedes previous NICE pneumonia guidelines during the COVID pandemic recommending doxycycline over amoxicillin.
Monitoring Messages
Methotrexate: monitor and record full blood counts at least every 3 months (reduce frequency during COVID-19 pandemic workload prioritisation)
Methotrexate: monitor and record liver function tests at least every 3 months (reduce frequency during COVID-19 pandemic workload prioritisation)
The Specialist Pharmacy Service (SPS, April 2020) recommends that monitoring intervals can be extended by up to every 6 months in stable patients as part of workload prioritisation during the COVID-19 pandemic; patients at higher risk of toxicity are not suitable for blood monitoring extension.
Lithium: monitor and record lithium levels at least every 6 months (reduce frequency during COVID-19 pandemic workload prioritisation)
Lithium: monitor and record thyroid function (no evidence of measurement within the previous 6 months) (reduce frequency during COVID-19 pandemic workload prioritisation)
Lithium: monitor and record serum calcium levels (no evidence of measurement within the previous 6 months) (reduce frequency during COVID-19 pandemic workload prioritisation)
Lithium: monitor and record lithium levels (no evidence of measurement of lithium levels within the previous 3 months) (reduce frequency during COVID-19 pandemic workload prioritisation)
The Specialist Pharmacy Service (SPS, April 2020) recommends that monitoring intervals can be extended by up to 3 months in stable patients as part of workload prioritisation during the COVID-19 pandemic. Monitoring intervals of patients at higher risk should not be extended and should be continued as per their normal monitoring interval.
Warfarin: monitor and record INR at least every 3 months (unless self-monitoring) (reduce frequency during COVID-19 pandemic workload prioritisation)
The Specialist Pharmacy Service (SPS, April 2020) recommends that monitoring intervals can be extended by up to 3 months in stable patients as part of workload prioritisation during the COVID-19 pandemic. Monitoring intervals of patients at higher risk should not be extended and should be continued as per their normal monitoring interval.
Sodium valproate and valproic acid preparations: compliance with pregnancy prevention programme required for female patients of childbearing potential (further advice during COVID-19 pandemic)
MHRA guidance (May 2020) on PPP management during the COVID-19 pandemic advises that valproate initiation should take place via face-to face consultations with social distancing, or remote consultation for patients shielding due to health conditions. Annual review should take place via virtual or telephone consultation.
