Revista de Cuidados Farmacêuticos e Sistemas de Saúde
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Initiatives among Authorities to Improve the Quality and Efficiency of Prescribing and the Implications

Godman B, Acurcio FA*, Guerra Júnior AA, Alvarez-Madrazo S, Faridah Aryani MY, Bishop I, Campbell S, Eriksson I, Finlayson AE, Fürst J, Garuoliene K, Hussain S, Kalaba M, Jayathissa S, Abdol Malek AA, Małecka-Massalska T, Mansor Manan M, Martin A, Pedersen H, Sović Brkičić L, Smoleń A, Truter I, Wale J and Gustafsson LL

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.