NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • December 21st, 2023
Medication covered by this agreement Donenezil Galantamine RivastigmineMemantine Indications for shared care Dementia and Alzheimers Disease as per NICE NG97. Full details in main body of document Specialist Prescribing and Monitoring Responsibilities (summary) GP / Community Team - Primary Care Prescribing and Monitoring Responsibilities (summary) • Confirm diagnosis and clarify supervision• Notify the GP of the need to initiate therapy• Provide details of how the medication will be collected and any support required• Discuss benefits, side effects and prescribing guidelines of treatment with the patient and carer.• Ascertain willingness by the patient to take their medication and co-operation (within the bounds of their illness)• Recommend appropriate dose to initiate treatment.• Communicate any changes in treatment with the primary care prescriber as appropriate.• Monitor response to treatment and advise continuation for up to three months to the prescriber within 28 days of the ini
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENT FRAMEWORKNorfolk And • December 7th, 2023
Shared Care Agreement for initiation of Guanfacine in children and continuation into adulthood Monitoring Level 1 - Prescribe the drug and perform a higher level of monitoring, e.g. 6-monthly SUMMARY FRONT SHEET – SEE MAIN BODY OF DOCUMENT FOR FULL INFORMATION Generic and Proprietary/Brand Name Guanfacine (Intuniv®) Indications for shared care • Licensed use - Treatment of ADHD in children and adolescents where stimulants are not suitable, not tolerated or ineffective.• Locally-agreed off-label use - Continuing treatment in adults whose symptoms persist and who have shown clear benefit from treatment. See below for further details.• Guanfacine must not be initiated in new adult patients. Specialist Prescribing and Monitoring Responsibilities (full details below) GP / Community Team - Primary Care Prescribing and Monitoring Responsibilities (full details below) • Diagnose patient and provide information.• Ensure the patient understands treatment may be stopped if they do not attend for
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENT FRAMEWORKNorfolk And • June 11th, 2024
Shared care guidelines - Stimulants for Attention Deficit Hyperactivity Disorder (ADHD) in Children & Young People aged at least 6 years old
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENT (SCA) FRAMEWORKNorfolk And • February 19th, 2024
Shared care guidelines - Melatonin for Sleep Disorders in Children Monitoring level Level Amber 0 – prescribe the drug and perform basic monitoring, such as annual review.
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • April 2nd, 2024
Generic and Proprietary/Brand Name Methylphenidate plain: Generic, Ritalin®, Medikinet®Methylphenidate modified-release:Concerta XL®, Delmosart®, Matoride XL®, Xaggitin XL®, Xenidate XL®See appendix 1 for comparative costs of these once-daily methylphenidate products Equasym XL®, Medikinet XL®Dexamfetamine: GenericLisdexamfetamine: Elvanse®, Elvanse Adult®Atomoxetine: Strattera® Indications for shared care In line with NICE NG 87 (March 2018) stimulants and atomoxetine are indicated for the treatment of Attention Deficit/Hyperactivity Disorder (ADHD) as part of a treatment package where remedial measures alone prove insufficient.For newly diagnosed cases in adulthood:Specialist Initiation, with the GP taking over prescribing responsibility in line with this Shared Care Agreement1. Drug treatment is the first-line treatment for adults with ADHD with either moderate or severe levels of impairment.2. Methylphenidate or lisdexamfetamine should normally be tried first in newly diagnosed cas
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • November 10th, 2023
Generic and Proprietary/Brand Name Goserelin 3.6mg / Triptorelin 3mg / Leuprorelin Acetate 3.75mgZoladex 3.6mg / Decapeptyl SR 3mg / Prostap SR DCS 3.75mg Indications for shared care • Management of endometriosis, including pain relief and reduction of endometrial lesions. Evaluation of the hypoestrogenic state prior to oophorectomy• Pre-operative management of uterine fibroids to reduce their size and associated bleeding. Specialist Prescribing and Monitoring Responsibilities – summary. Full details in main body of document GP / Community Team - Primary Care Prescribing and Monitoring Responsibilities – summary. Full details in main body of document None required, but many will be reviewed in clinic 4 months into treatment. The GP will ensure that the patient is not suffering from unacceptable side effects. Should LHRH agonists be discontinued please contact the appropriate hospital consultant as soon as possible. Patient Information Manufacturer’s Patient Information Leaflet with ade
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • March 25th, 2024
Generic and Proprietary/Brand Name Naltrexone / Adepend® Indications for shared care Alcohol Use Disorder (AUD) to assist in maintenance of abstinence - Initiated after consultation from Drug and Alcohol Agencies Specialist Prescribing and Monitoring Responsibilities – summary. Full details in main body of document GP / Community Team - Primary Care Prescribing and Monitoring Responsibilities – summary. Full details in main body of document Prescribing:Naltrexone therapy should be initiated in secondary care. The mechanism of action and expected effects and side effects and duration of therapy should be explained to the patient using the NRP (or equivalent) Patient Information Leaflet. Monitoring:Detailed specialist monitoring requirements are explained in full further down in the main body of the document Prescribing:The patient’s GP may be asked to take over the prescription for naltrexone after 4 weeks of abstinence (e.g. post detoxification). Monitoring:NICE does not recommend rout
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • November 10th, 2023
Generic and Proprietary/Brand Name Darbepoetin alfa / Aranesp® Indications for shared care • Monthly monitoring of blood pressure.• Monthly check of haemoglobin levels, 3-monthly check of ferritin, transferrin saturation (Tsat) and reticulocyte haemoglobin equivalent (RET-He) for patients on darbepoetin alfa therapy initiated by the hospital specialist anaemia team• Administration of darbepoetin alfa by the GP practice nurse or community nurse for patients who are unable to self-inject darbepoetin alfa and who have no relatives/carers who are able to inject darbepoetin alfa Specialist Prescribing and Monitoring Responsibilities– summary. Full details in main body of document GP / Community Team - Primary Care Prescribing and Monitoring Responsibilities – summary. Full details in main body of document • Prescribe darbepoetin• Ongoing supply via homecare service• Initial monitoring and baseline assessmentspecialist anaemia team• Contact GP after initiation when a shared care arrangement
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • March 25th, 2024
Shared care guidelines for use of Mercaptopurine in Ulcerative Colitis & Crohn’s Disease Monitoring Amber level 2 – Prescribe drug and perform more intense level of monitoring,
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • March 25th, 2024
Generic and Proprietary/Brand Name Colistimethate sodium (Colistin) / Colomycin Powder for Injection, Infusion or Inhalation Indications for shared care Long-term management of chronic pulmonary infection due to Pseudomonas aeruginosa in adult and paediatric patients with non-cystic fibrosis bronchiectasis. Specialist Prescribing and Monitoring Responsibilities – summary. Full details in main body of document GP / Community Team - Primary Care Prescribing and Monitoring Responsibilities – summary. Full details in main body of document Prescribing:• Administration of the first (test) dose with lung function monitoring• Training the patient/carer in use of nebulised antibiotics• Prescription and supply (via hospital pharmacy) of the first month of colistin and diluents• Supply and ongoing maintenance of an appropriate nebuliser/compressor system• On-going supply of plastic syringes to measure diluent volumes• Assess response to treatment and to discontinue if no benefit• Ongoing clinical
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • November 10th, 2023
Generic and Proprietary/Brand Name IM Testosterone esters - Sustanon 250®Oral Testosterone undecanoateSustanon 250® Restandol® Testocaps® Indications for shared care This shared care agreement is to support primary care with the management of boys with absent/delayed puberty requiring exogenous testosterone therapy under the care and supervision of paediatric endocrinologists. This includes boys with hypogonadotropic hypogonadism (HH) of various etiologies, androgen deficiency secondary to testicular failure (hyper gonadotrophic hypogonadism) of various etiology, and constitutional delay of growth and puberty (CDGP). The aim of testosterone replacement therapy is to mimic the normal pattern of puberty and mimic requirements at different stages of pubertal development. This guideline aims to provide the clinician withtestosterone dosing regimens for pubertal induction, progression and post-pubertal maintenance. Specialist Prescribing and Monitoring Responsibilities – summary. Full detai
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • March 25th, 2024
Shared care guidelines for use of Tacrolimus in Ulcerative Colitis Monitoring level Amber Level 1 – Prescribe drug and perform higher level of monitoring,
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • March 26th, 2024
Generic and Proprietary/Brand Name • Mycophenolate mofetil – available as generic products from several manufacturers• Mycophenolic acid (as Mycophenolate sodium)• CellCept®, Myfenax® – treatment is interchangeable between mycophenolate mofetil brands and generics• Myfortic® (Mycophenolic acid (as Mycophenolate sodium)) – not interchangeable with other mycophenolate salts Indications for shared care • Post adult solid organ transplant• Shared-care will only be considered appropriate at least three months post-transplant and only when the immunosuppression regimen is stable, co-morbid conditions such as hypertension are being treated. Specialist Prescribing and Monitoring Responsibilities – summary. Full details in main body of document GP / Community Team - Primary Care Prescribing and Monitoring Responsibilities – summary. Full details in main body of document • Review patient in clinic.• Inform the patient of side effects and long term monitoring before initiating treatment.• Prescri
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • March 26th, 2024
Shared care guidelines for Oral and Subcutaneous Methotrexate for various indications – full details shown on page 2Monitoring level - AMBER Level 3 – Prescribe the drug and perform significant monitoring including measurements such as height, weight, blood pressure and ECG. Monthly monitoring is necessary Generic and Proprietary/Brand Name MethotrexateTablets: Matrex® - generics also availablePre-filled pens: Metoject® 50mg/ml strength, and Nordimet® 25mg/ml strength;Pre-filled syringes: Zlatal® 25mg/ml strength – generic pre-filled syringes also availableRegarding injection devices: the product that the patient has been initially trained on should not be changed without adequate retraining on an alternative device. It is recommended to confirm with the patient which product is being used to ensure continuity of care Indications for shared care • Treatment of rheumatoid arthritis, juvenile idiopathic arthritis, connective tissue disease, Felty's Syndrome, psoriasis, Crohn’s disease
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • March 27th, 2024
Shared care guidelines for Use of Sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fractionMonitoring Level 1 - Prescribe the drug and perform a higher level of monitoring e.g. 6 monthly Generic and Proprietary/Brand Name Sacubitril Valsartan / Entresto® Indications for shared care For treating symptomatic chronic heart failure with reduced ejection fraction Specialist Prescribing and Monitoring Responsibilities – summary. Full details in main body of document GP / Community Team - Primary Care Prescribing and Monitoring Responsibilities – summary. Full details in main body of document Prescribing:• Initiate and stabilise treatment before GP transfer• To provide the GP with appropriate information• To be available for advice if patient’s condition changes• To advise the GP of any dosage adjustments, monitoring, when to refer back and when and how to stop treatment• To ensure that procedures are in place for rapid re-referral of the patient by th
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • November 9th, 2023
Generic and Proprietary/Brand Name Generic name - Cinacalcet 30mg, 60mg or 90mg film-coated tablets, Brand name - Mimpara®.Please prescribe generically Indications for shared care For the treatment of primary hyperparathyroidism where parathyroidectomy is contraindicated, refused by patient or not suitable as per NHS England Cinacalcet commissioning guidance and where the patient’s treatment plan is stable and can appropriately be managed jointly between primary and secondary care. Specialist Prescribing and Monitoring Responsibilities – summary. Full details in main body of document GP / Community Team - Primary Care Prescribing and Monitoring Responsibilities – summary. Full details in main body of document • Assess the patient and establish the diagnosis, determine a treatment plan and ensure appropriate follow-up in conjunction with the GP• Initiate cinacalcet, monitor bloods (baseline and post-initiation) and stabilise treatment• Continue to monitor the patient and their therapy a
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • March 27th, 2024
Generic and Proprietary/Brand Name Leflunomide / Arava®; Generics are also available Indications for shared care Rheumatoid arthritis, psoriatic arthritis (licensed indications). Specialist Prescribing and Monitoring Responsibilities – summary. Full details in main body of document GP / Community Team - Primary Care Prescribing and Monitoring Responsibilities – summary. Full details in main body of document Prescribing:• Rheumatology medical team are responsible for the initiation and first 6 weeks of stable prescription of leflunomide.• Patient education will be undertaken by the Rheumatology multidisciplinary teamMonitoring:• Undertake pre-treatment monitoring of FBC, liver function tests (ALT and albumin), and creatinine eGFR.• Check FBC, eGFR, ALT and albumin every 2 weeks until a stable dose has been achieved for 6 weeks.• Specific monitoring explained in more detail below in main body of document regarding:o Lung diseaseo Liver diseaseo Occult viral infectionso Blood pressureo We
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • March 26th, 2024
Shared care guidelines for use of Sirolimus for adult solid organ transplant patients Monitoring level Amber 1 - perform higher level of monitoring e.g. 6 monthly review
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENT FRAMEWORKNorfolk And • July 30th, 2024
Shared care guidelines - Stimulants for Attention Deficit Hyperactivity Disorder (ADHD) in Children & Young People aged at least 6 years old
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • March 26th, 2024
Shared care guidelines for use of Tacrolimus in adult solid organ transplant patients Monitoring level Amber 1 - perform higher level of monitoring e.g. 6 monthly review
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • March 21st, 2024
Shared care guidelines for use of Azathioprine in autoimmune diseases Monitoring level – Amber 2 – perform more intense level of monitoring, eg 3-monthly
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • December 5th, 2023
Ciclosporin in the treatment of Rheumatic and Dermatological diseases Monitoring level - AMBER 2 - Prescribe the drug and perform a more intense level of
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTNorfolk And • March 25th, 2024
Generic and Proprietary/Brand Name Sulfasalazine - generic available, as well as Salazopyrin® (Pharmacia) and Salazopyrin EN-Tabs® (Pharmacia) Indications for shared care Treatment of inflammatory arthritis Specialist Prescribing and Monitoring Responsibilities – summary. Full details in main body of document GP / Community Team - Primary Care Prescribing and Monitoring Responsibilities – summary. Full details in main body of document • Identify patients who will benefit from treatment• Ensure patient tolerating sulfasalazine for first 10 weeks.• Ensure prior dissemination of sufficient information to patient’s GP and other carers.• Inform the GP that sulfasalazine has been commenced, and the dose and future plans for dose escalation• Ask for monitoring to be transferred to primary care once the dose has been stable for 6 weeks• Provide education to GPs, nurses, patients and their carers.• Agree any necessary dose changes.• Review the efficacy of the treatment at intervals and confirm
