Welcome to the Right Decision Service (RDS) newsletter for April 2024.
Tactuum has been working hard to address the issues experienced during the last week. They have identified a series of three mitigation measures and put the first of these in place on Friday 3rd May. If this does not resolve the problems, the second mitigation will be actioned, and then the third if necessary.
Please keep a lookout for any slowing down of the system or getting locked out. Please email myself, mbuchner@tactuum.com and onivarova@tactuum.com if you experience any problems, and also please raise an urgent support ticket via the Support Portal.
Thank you for your patience and understanding while we achieve a full resolution.
A rotating carousel presenting some of the key RDS tools and capabilities, and an editable slideset, are now available in the Resources for RDS providers section of the Learning and Support toolkit.
The redesign of RDS Search and Browse is still on-track for delivery by mid-June 2024. We then plan to have a 3-week user acceptance testing phase before release to live. All editors and toolkit owners on this mailing list will be invited to participate in the UAT.
The archiving and version control functionality is also progressing well and we will advise on timescales for user acceptance testing shortly.
Tactuum is also progressing with the deep linking to individual toolkits within the mobile RDS app. There are several unknowns around the time and effort required for this work, which will only become clear as the work progresses. So we need to be careful to protect budget for this purpose.
These have all been compiled and effort estimated. Once the redesign work is complete, these will be prioritised in line with the remaining budget. We expect this to take place around late June.
Many thanks to those of you completed the value and impact survey we distributed in February. Here are some key findings from the 65 responses we received.
Figure 1: Impact of RDS on direct delivery of care
Key figures
Figure 2 shows RDS impact to date on delivery of health and care services
Key figures
These data show how RDS is already contributing to NHS reform priorities and supporting delivery of more sustainable care.
Saving time and money
Quality assurance and governance
Service innovation and workforce development
A few examples of toolkits published to live in the last month:
Some of the toolkits the RDS team is currently working on:
Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.
Thanks to all of you who have responded to the retrospective quality audit survey and to the follow up questions. We still have some following up to do, and to work with owners of a further 23 toolkits to complete responses. An interim report is being presented to the HIS Quality and Performance Committee.
Eight clinical services and two public library services are undertaking tests of change to implement the Being a partner in my care app. This app aims to support patients and the public to become active participants in Realistic Medicine. It has a strong focus on personalised, person-centred care and a library of shared decision aids, as well as simple explanations and videoclips to help the public to understand the aims of Realistic Medicine. The tests of change will inform guidance and an implementation model around wider adoption and spread of the app.
With kind regards
Right Decision Service team
Healthcare Improvement Scotland
29/02/24 - atogepant tablets 10mg, 60mg SMC2599 added.
29/02/24 - rimegepant oral lyophilisate 75mg SMC2521 and 2603 added.
Base selection of migraine prophylaxis on age, gender and co-morbidity:
Titrate over several weeks and continue for a further 3 months, then assess and discontinue if ineffective.
Other antiepileptic drugs for migraine prophylaxis, the use of which should be discussed with a specialist, include gabapentin off-label: refer to BNF for dosing instructions.
Flunarizine unlicensed is used under specialist advice in patients with episodic migraine with failure to, or side-effects from, classical preventative migraine therapy.
Guidelines:
Tablets 10mg, 40mg
40mg 2 to 3 times daily; maintenance 80 to 160mg daily.
Modified release capsules 80mg, 160mg
maintenance 80 to 160mg daily.
Tablets 10mg, 25mg, 50mg
Migraine prophylaxis: initially 10mg at night, increased if necessary to maintenance of 50 to 75mg at night.
If amitriptyline is poorly tolerated consider nortriptyline.
Tablets 10mg, 25mg
Migraine prophylaxis if amitriptyline is poorly tolerated off-label: initially 10mg at night, increased if necessary to maintenance of 50 to 75mg at night.
SPS article: Using contraception with enzyme-inducing medicines (Feb 2023).
Tablets 25mg, 50mg, 100mg
Migraine prophylaxis: initially 25mg at night for 1 week, increased in increments of 25mg/day at weekly intervals up to 50mg twice daily. Some patients may experience a benefit at 25mg twice daily. See SPC for dosing in renal impairment.
MHRA advice: Avoid in women of child-bearing age and those who are overweight (April 2018)(www.gov.uk).
Valproate medicines are contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met (MHRA advice April 2018)
Crushable tablets 100mg
Migraine prophylaxis: off-label, initially 200mg twice daily; doses up to 500mg twice daily are effective in most patients.
Enteric coated tablets 200mg, 500mg
Migraine prophylaxis: off-label, initially 200mg twice daily; doses up to 500mg twice daily are effective in most patients.
Limited value in prophylaxis of migraine (SIGN 155). It may cause increased appetite and weight gain. It can also cause drowsiness and so night-time dosing may help prevent day-time sedation. Use with caution in patients with a history of epilepsy.
Tablets 500 micrograms, 1·5mg
Initially 500 micrograms at night increased gradually to usual dose of 1·5mg at night or in 3 divided doses; may be further increased up to maximum daily dose of 4·5mg (but rarely necessary), maximum single dose 3mg.
Solution for injection in a pre-filled pen 70mg/mL (specialist initiation and supply only)
Prophylaxis of migraine in adults with chronic migraine, who have at least four migraine days per month and in whom at least three prior prophylactic treatments have failed.
Solution for injection pre-filled syringes 225mg/1·5ml (hospital use only)
225mg once a month OR 675mg every three months.
See SMC advice 2226.
For prophylaxis of migraine in adults who have at least four migraine days per month.
SMC restriction: for the treatment of patients with chronic and episodic migraine who have had prior failure on three or more migraine preventive treatments.
Homecare is the preferred option - contact nhsh.homecare@nhs.scot.
Solution for injection pre-filled pens 120mg/ml (hospital use only)
240mg loading dose THEN 120mg injected subcutaneously once a month
See SMC advice 2313.
Prophylaxis of migraine in adults who have at least 4 migraine days per month.
SMC restriction: for the treatment of patients with chronic and episodic migraine who have had prior failure on three or more migraine preventive treatments.
Concentrate for solution for infusion 100mg (Restricted: hospital use only)
See SMC advice 2547: prophylaxis of migraine in adults who have at least 4 migraine days per month.
SMC restriction: for patients with chronic and episodic migraine who have had prior failure on three or more migraine preventive treatments.
Tablets 10mg, 60mg (Aquipta®) (Restricted: specialist initiation only)
Initiation and review in Secondary Care. May be prescribed in Primary Care for maintenance treatment only.
SMC2599: Prophylaxis of migraine in adults who have at least four migraine days per month.
Ordering atogepant:
AbbVie Direct ordering contact details:
Customer Services
Tel: 0800 783 1699
Email: orders.kr@abbvie.com
Oral lyophilisate 75mg (Vydura®) (Restricted: Specialist initiation only)
Initiation and review in Secondary Care. May be prescribed in Primary Care for maintenance treatment only.
SMC2603: For the preventive treatment of episodic migraine in adults who have at least four migraine attacks per month.
SMC restriction: for patients with episodic migraine who have at least 4 migraine attacks per month, but fewer than 15 headache days per month and who have had prior failure on three or more migraine preventive treatments.
TAM (Treatments and Medicines) NHS Highland