Initiatives among Authorities to Improve the Quality and Efficiency of Prescribing and the Implications

Godman B,Acurcio Fa,Guerra Junior Aa

doi:10.4172/2376-0419.1000113

Godman B, Acurcio Fa + Show 1 more

Open Access

https://doi.org/10.4172/2376-0419.1000113

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Abstract

Introduction: Medicines have made an appreciable contribution to improving patient care in recent years. However, European and other countries are increasingly struggling to fund new premium priced medicines. This has resulted in models to optimise their utilisation as well as multiple initiatives to improve the prescribing of established medicines including enhancing the use of low cost generics, improving adherence to prescribing guidance as well as access to medicines, ensuring adequate doses are prescribed and improving patient adherence rates especially in chronic asymptomatic conditions. Objective: Review a range of demand-side initiatives in ambulatory care across different countries and their resultant effects to provide future direction. Methodology: Principally a narrative review of case histories of published studies. Results: Measures to encourage the prescribing of low cost generics versus originators and patented products in a class can release considerable resources without compromising care. However, there is no ‘spill over’ effect between classes. Consequently, multiple demand-side measures are needed to effect changes in physician prescribing habits. In addition, there are classes where there is caution, e.g. atypical antipsychotics. Activities surrounding the ‘Wise List’ in Stockholm healthcare region, including continuous medical education with resultant high prescribing adherence rates to a list of approximately 200 medicines, provides guidance to authorities where there are currently limited programmes to improve the quality of prescribing. Adequate dosing can be a concern necessitating strategies to assess current dosing levels to plan for the future including potential ways to address this. There are also concerns with adherence rates especially among patients with chronic asymptomatic diseases. This is resulting in activities by authorities to address this including adherence clinics. Discussion: Multiple measures can enhance the quality and efficiency of prescribing, and authorities need to continually learn from each other to achieve desired results. The involvement of all key stakeholder groups including patients, pharmacists and physicians can enhance the rational use of medicines and enhance prescribing efficiency.

Highlights

Medicines have made an appreciable contribution to improving patient care in recent years
Regarding potential initiatives to enhance the prescribing of generics versus originators, the findings in Scotland provide an example of a long-term approach to enhance International Non-proprietary name (INN) prescribing
The findings suggest that both supply-side measures lowering the prices of generics to 2% to 10% of pre-patent loss prices, coupled with multiple demand-side reforms, can appreciably enhance prescribing efficiency for pertinent classes once generics become available in the class

Summary

Introduction

Medicines have made an appreciable contribution to improving patient care in recent years. European and other countries are increasingly struggling to fund new premium priced medicines This has resulted in models to optimise their utilisation as well as multiple initiatives to improve the prescribing of established medicines including enhancing the use of low cost generics, improving adherence to prescribing guidance as well as access to medicines, ensuring adequate doses are prescribed and improving patient adherence rates especially in chronic asymptomatic conditions. Pharmaceutical expenditure is coming under increasing scrutiny worldwide [3,4] with expenditure rising by more than 50% in real terms during the past decade among OECD countries [5] This growth has resulted in pharmaceutical expenditure the largest, or equalling the largest, cost component in ambulatory care, and in some countries is up to 60% of total healthcare expenditure [4,6]. J Pharma Care Health Sys 1: 113. doi:10.4172/2376-0419.1000113 available resources, caused by well defined factors including ageing populations, rising patient expectations and the continued launch of new premium priced technologies as single or combined entities [3,79]

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