NICE guideline helping to cut referrals
pharmafile | June 20, 2011 | News story | | GSK, NICE, bph
A NICE guideline on treating lower urinary tract symptoms (LUTS) in men is helping to cut referrals to urologists, thereby saving the health service money.
The findings come from a survey paid for by GSK, which markets a drug for benign prostatic hyperplasia, the most common cause of LUTS.
The survey results, jointly released by GSK and NICE, are good news for both organisations; they show the positive impact of NICE guidelines and the drugs they recommend on patients and NHS costs.
The survey was conducted by Opinion Health on behalf of GSK one year on from the launch of the guideline, and found 46% of GPs were following NICE’s recommendations. Meanwhile 41% also said they had greater confidence in conducting the necessary diagnostic tests, such as a digital rectal examination.
Of those GPs who said they were implementing the guideline, 80% reported that they had seen a reduction in referral costs. GPs not following the guideline reported being unsure about when to refer to a specialist, which could lead to unnecessary and costly hospital referrals.
NICE has produced a series of implementation tools to help increase uptake further, including an interactive case history described by a number of GPs as “a very helpful learning tool that is concise and informative”.
Prior to the NICE guideline, there was no national guidance for diagnosing and treating these symptoms in men, which meant that GPs were not always using the most effective treatments.
Around 1 in 4 men aged 40 and over will experience symptoms, such as needing to urinate urgently or frequently, retention of urine, hesitancy and incontinence.
In terms of drug treatment, the guideline only recommends medicines for men with bothersome LUTS when “conservative management options” have been unsuccessful or are not appropriate.
Other support tools include an online education tool produced in collaboration with the British Medical Journal (BMJ), audit support, and a costing template and report to help GPs calculate the potential financial savings of putting the guideline into practice.
NICE has also produced a LUTS commissioning guide which makes the case for commissioning a service for the management of LUTS in men, specifies service requirements, and helps to determine local service levels.
Dr John Rees, a GP with a special interest in urology who was involved in the development of the NICE guideline, said: “The guideline aims to reassure GPs that the majority of men with LUTS can be safely assessed and treated in the community and without the need for costly hospital referrals.
“These results show the importance of continuing to raise awareness and drive uptake of the guideline to ensure optimal patient care at a time when NHS resources are stretched and there are increasing pressures for savings to be made.”
Of those GPs who were not currently implementing the guideline, more than a quarter had high referral costs. It also found 97% of GPs surveyed agreed that more could be done to improve the management of LUTS in primary care.
LUTS are highly prevalent, with up to 30% of men older than 65 experiencing bothersome symptoms. The cost of treating the most common cause of LUTS, benign prostatic hyperplasia (BPH), alone, is estimated to be more than £180 million each year, 60% of which is incurred in secondary care. The NICE guideline was developed to address the need for further clinical advice on how to best diagnose, monitor and treat this large patient population more effectively within primary care.
The main reason stated by the GPs polled for not implementing the NICE guideline was lack of education and training and 57% agreed that further practical guidance would help to improve the management of LUTS in primary care. More than half said they would appreciate more specialised training.
Emma Malcolm, chief executive at Prostate Action, commenting on the survey results said: “The results show there is clearly a need for more training to be given around the NICE LUTS guideline.
“At Prostate Action we work closely with clinicians to provide education, but the demand for more support via education and training with the practicing GP community is clear and would also ultimately assist with the government’s Quality, Innovation, Productivity and Prevention (QIPP) agenda.”
Andrew McConaghie
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