TY - JOUR
T1 - Initiatives and reforms across Scotland in recent years to improve prescribing; findings and global implications of drug prescriptions
AU - MacBride-Stewart, Sean
AU - McTaggart, Stuart
AU - Kurdi, Amanj
AU - Sneddon, Jacqueline
AU - McBurney, Stephen
AU - do Nascimento, Renata Cristina Rezende Macedo
AU - Mueller, Tanja
AU - Kwon, Hye-Young
AU - Morton, Alec
AU - Seaton, R. Andrew
AU - Timoney, Angela
AU - Bennie, Marion
AU - Sefah, Israel
AU - Pisana, Alice
AU - Meyer, Johanna Catherine
AU - Godman, Brian
PY - 2021/12/30
Y1 - 2021/12/30
N2 - Objective: Global expenditure on medicines is increasing driven by a number of factors. These include the launch of new premium-priced medicines for complex diseases including oncology, rise in non-communicable diseases especially with ageing populations and changes in clinical practice. There are also concerns with the rise in antimicrobial resistance due to inappropriate prescribing of antimicrobials as well as concerns with polypharmacy. Both situations increase morbidity, mortality and costs. We are aware of ongoing activities across Scotland to improve the managed entry of new medicines, including new oncology medicines, improve the prescribing of antimicrobials as well as enhance the prescribing of low-cost multiple sourced medicines and biosimilars without compromising care. In addition, seeking to address concerns with polypharmacy. Consequently, we wanted to document these multiple measures and their outcomes to provide an overview to inform all key stakeholders in Scotland as well as the global community as resource pressures grow. Methods: A narrative review of the literature documenting examples of ongoing national and regional initiatives across Scotland to influence future prescribing and their impact where known across multiple disease areas. Significant findings: The co-ordinated approach to improve the prescribing of new medicines limited the prescribing of dabigatran when first launched with recent research providing guidance on the effectiveness and safety of different direct oral anticoagulants as more are launched. The patient reported outcome measures project and other ongoing research activities, including linking datasets, is progressing under the Cancer Medicines Outcomes Programme in Scotland to improve future care with typically differences in the effectiveness of new cancer medicines in routine care versus clinical trials. The Scottish Antimicrobial Prescribing Group is also active in Scotland instigating multiple measures to improve antimicrobial prescribing. This includes improving the dosing of gentamicin and vancomycin as well as reducing the prescribing of antibiotics for women with urinary tract infections. Multiple activities have also resulted in high International Non-proprietary Name (INN) prescribing in Scotland at between 91.4% to 100% across a range of medicines. In addition, increased the prescribing of low-cost multiple sourced medicines versus patented medicines in a class or related class, as well as biosimilars, leading to considerable savings without compromising care. There have also been initiatives to address concerns with the rising costs of combination inhalers for patients with respiratory diseases as well as areas of polypharmacy with varying success. Conclusion: Multiple and co-ordinated approaches have improved the quality and efficiency of prescribing in Scotland. Additional measures are still needed and we will continue to monitor the situation.
AB - Objective: Global expenditure on medicines is increasing driven by a number of factors. These include the launch of new premium-priced medicines for complex diseases including oncology, rise in non-communicable diseases especially with ageing populations and changes in clinical practice. There are also concerns with the rise in antimicrobial resistance due to inappropriate prescribing of antimicrobials as well as concerns with polypharmacy. Both situations increase morbidity, mortality and costs. We are aware of ongoing activities across Scotland to improve the managed entry of new medicines, including new oncology medicines, improve the prescribing of antimicrobials as well as enhance the prescribing of low-cost multiple sourced medicines and biosimilars without compromising care. In addition, seeking to address concerns with polypharmacy. Consequently, we wanted to document these multiple measures and their outcomes to provide an overview to inform all key stakeholders in Scotland as well as the global community as resource pressures grow. Methods: A narrative review of the literature documenting examples of ongoing national and regional initiatives across Scotland to influence future prescribing and their impact where known across multiple disease areas. Significant findings: The co-ordinated approach to improve the prescribing of new medicines limited the prescribing of dabigatran when first launched with recent research providing guidance on the effectiveness and safety of different direct oral anticoagulants as more are launched. The patient reported outcome measures project and other ongoing research activities, including linking datasets, is progressing under the Cancer Medicines Outcomes Programme in Scotland to improve future care with typically differences in the effectiveness of new cancer medicines in routine care versus clinical trials. The Scottish Antimicrobial Prescribing Group is also active in Scotland instigating multiple measures to improve antimicrobial prescribing. This includes improving the dosing of gentamicin and vancomycin as well as reducing the prescribing of antibiotics for women with urinary tract infections. Multiple activities have also resulted in high International Non-proprietary Name (INN) prescribing in Scotland at between 91.4% to 100% across a range of medicines. In addition, increased the prescribing of low-cost multiple sourced medicines versus patented medicines in a class or related class, as well as biosimilars, leading to considerable savings without compromising care. There have also been initiatives to address concerns with the rising costs of combination inhalers for patients with respiratory diseases as well as areas of polypharmacy with varying success. Conclusion: Multiple and co-ordinated approaches have improved the quality and efficiency of prescribing in Scotland. Additional measures are still needed and we will continue to monitor the situation.
KW - antimicrobials
KW - biosimilars
KW - generics
KW - healthcare reforms
KW - new medicines
KW - oncology
KW - polypharmacy
KW - Scotland
UR - http://www.ijcem.com/V14_No12.html
M3 - Review article
SN - 1940-5901
VL - 14
SP - 2563
EP - 2586
JO - International Journal of Clinical and Experimental Medicine
JF - International Journal of Clinical and Experimental Medicine
IS - 12
ER -