Most patients in our practice have for decades had shared care for blood and prescription monitoring when on DMARDs and when attending their GP when unwell. I suspect, like myself, most GPs have wide experience already with methotrexate, sulfasalazine, and occasionally azathioprine as they are also used in patients with inflammatory bowel disease and occasionally severe psoriasis. The article by Lythgoe and Abraham completely misses up-to-date clinical intelligence regarding DMARDs, which for me revolve around GP education in likely issues for patients on monoclonal antibodies.1 I wish you had written about this as that is where my educational needs lie — can I have an updated clinical intelligence article about monoclonal antibody shared care?
I would like to share a piece of clinical intelligence: I have always asked patients to remember when to take their methotrexate and folic acid by following the medication’s initial letter so Methotrexate on a Monday and Folic acid on a Friday. This seems to stick in the patient’s mind and works well.
The authors recommend 5–10-yearly reinforcement of pneumococcal vaccination but I cannot find this in chapter 25 of Public Health England’s ‘Green Book’ on pneumococcal vaccination.2 Guidance needs to be uniform and if NICE wants pneumococcal vaccination re-administered to patients on, for example, methotrexate then this needs to be reflected in changes to the ‘Green Book’, which is an excellent career-through guide.
- © British Journal of General Practice 2016