Initiatives and reforms across Scotland in recent years to improve prescribing; findings and global implications of drug prescriptions

Sean MacBride-Stewart, Stuart McTaggart, Amanj Kurdi, Jacqueline Sneddon, Stephen McBurney, Renata Cristina Rezende Macedo do Nascimento, Tanja Mueller, Hye-Young Kwon, Alec Morton, R. Andrew Seaton, Angela Timoney, Marion Bennie, Israel Sefah, Alice Pisana, Johanna Catherine Meyer, Brian Godman

Research output: Contribution to journalReview articlepeer-review

Abstract

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.
Original languageEnglish
Pages (from-to)2563-2586
Number of pages28
JournalInternational Journal of Clinical and Experimental Medicine
Volume14
Issue number12
Early online date15 Dec 2021
Publication statusPublished - 30 Dec 2021

Keywords

  • antimicrobials
  • biosimilars
  • generics
  • healthcare reforms
  • new medicines
  • oncology
  • polypharmacy
  • Scotland

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