title: Devolving of statin prescribing to general practitioners for HIV-infected patients receiving antiretroviral therapy.
abstract: Serious adverse events and medication errors are common in clinical practice and are associated with significant morbidity and mortality. Management of HIV-positive patients is likely to become more complex as people age, developing multiple medical conditions and thus requiring polypharmacy. We undertook a casenote review and interview of patients on antiretroviral therapy (ART) to audit the safety of devolving statin prescribing to general practitioners (GPs). Of 26 patients only 50% had their statin prescribing successfully been devolved to GPs. Many experienced significant difficulties and two of 26 (8%) were switched to simvastatin while receiving a protease inhibitor. We demonstrate that prescribing ART and non-ART medication by different practitioners on different sites can potentially expose patients to serious life-threatening adverse events. We make recommendations to minimize these risks and suggest that care pathways are reviewed to ensure they remain both convenient and user-friendly without compromising patient safety.
authors.affiliation: Department of Genitourinary Medicine, Camden PCT, The Mortimer Market Centre, Off Capper Street, London WC1E 6JB. paul.benn@camdenpct.nhs.uk
authors.forename: P D
authors.initials: PD
authors.lastname: Benn
authors.forename: R F
authors.initials: RF
authors.lastname: Miller
authors.forename: L
authors.initials: L
authors.lastname: Evans
authors.forename: J
authors.initials: J
authors.lastname: Minton
authors.forename: S G
authors.initials: SG
authors.lastname: Edwards
mesh_terms: D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D004347:Drug Interactions; D011307:Drug Prescriptions; D005194:Family Practice; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008508:Medication Errors; D008875:Middle Aged; D019338:Polypharmacy; D011787:Quality of Health Care
chemical_list: D044966:Anti-Retroviral Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors