outcomes_strategies_drug_utilization
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Sunday 14 November 2010
Influencing Prescribing in Primary Care in the NHS
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Medicines Information provision in the UK
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Thursday 26 August 2010
EVALUATION OF HEALTH OUTCOMES AFTER IMPLEMENTATION OF DIFFERENT STRATEGIES TO ACHIEVE RATIONAL USE OF DRUGS IN BRITISH COLUMBIA.
Labels: Z15
James Wright. Managing Director and Chair, Therapeutics Initiative. University of British Columbia. Vancouver (Canadá).
Background
The Therapeutics Initiative was established in 1994 with two main mandates: 1) to provide physicians and pharmacists with up-to-date, evidence-based, practical information on prescription drug therapy, and 2) to advise the Ministry of Health on the best available evidence of benefits and harms of new and existing prescription drugs. In the beginning we had the privilege of working with a small number of enlightened individuals within Pharmacare in the Ministry. Pharmacare and the Therapeutics Initiative had the common goal of optimizing use of prescription drugs and appreciated that prescribing practices in general were far from optimal.
Policies implemented
1. Therapeutics Letter 6 times per year to provide physicians and pharmacists with the best available evidence about the benefits and harms of drugs and drug classes.
2. Letters provide drug cost information for physicians.
3. Funding of new drugs was based on the best available evidence; a new drug only became a full benefit if it represented a therapeutic advantage or a cost advantage over appropriate alternatives (outcomes based coverage).
4. Reference based pricing of equivalent drugs within a drug class.
5. Restricted access with exemptions in special cases.
Reasons why the policies were successful
1. The Therapeutics Initiative did not allow anybody with a conflict of interest to participate in decision-making about assessment of evidence.
2. Setting up the questions for systematic review was an interactive process.
3. The drug assessment working group followed Cochrane methodology and improved their skills at critical appraisal and assessing risk of bias over time.
4. Independent researchers were contracted to evaluate the impact of the policies on drug utilization and health outcomes.
5. Ministry of Health personnel remained committed to outcomes based coverage despite political pressures.
Outcomes
1. The Therapeutics Initiative (TI) and Letter (TL) had a high acceptance rate based on a 2006 survey: >80% of general practitioners and >90% of pharmacists felt the TI was meeting its mandate. TL 64 Your opinions of the Therapeutics Letter. The 2006 Survey. http://www.ti.ubc.ca/letter64 full report. http://ti.ubc.ca/PDF/Survey2006Report.pdf
2. Drug utilization and drug costs are substantially lower in BC for most classes of drugs as compared to the rest of Canada. TL 72 Prescription drug costs. BC vs Canada. http://www.ti.ubc.ca/letter72
3. The different policies were shown to NOT have an adverse effect on health care utilization or health outcomes (eg. Outcomes of reference pricing of angiotensin-converting-enzyme inhibitors. N Engl J Med 2002;346:822-9)
4. Enormous pressure was put on the government to abolish the Therapeutics Initiative and drug policies.
5. No new drug classes (eg. Statins) have been subjected to the reference based pricing policy since 1998.
Conclusion
I will end my talk by a discussion of:
1. The lessons learned by the Therapeutics Initiative during the last 16 years.
2. What is wrong with the global system of prescription drug discovery, clinical drug trials, drug marketing, and drug regulation?
3. Ways in which the system could be improved.
Therapeutics Letter diciembre de 2008
The Canadian Rx Atlas
Therapeutics Letter mayo de 2007
OUTCOMES OF REFERENCE PRICING FOR ANGIOTENSIN-CONVERTING–
ENZYME INHIBITORS
Background
The Therapeutics Initiative was established in 1994 with two main mandates: 1) to provide physicians and pharmacists with up-to-date, evidence-based, practical information on prescription drug therapy, and 2) to advise the Ministry of Health on the best available evidence of benefits and harms of new and existing prescription drugs. In the beginning we had the privilege of working with a small number of enlightened individuals within Pharmacare in the Ministry. Pharmacare and the Therapeutics Initiative had the common goal of optimizing use of prescription drugs and appreciated that prescribing practices in general were far from optimal.
Policies implemented
1. Therapeutics Letter 6 times per year to provide physicians and pharmacists with the best available evidence about the benefits and harms of drugs and drug classes.
2. Letters provide drug cost information for physicians.
3. Funding of new drugs was based on the best available evidence; a new drug only became a full benefit if it represented a therapeutic advantage or a cost advantage over appropriate alternatives (outcomes based coverage).
4. Reference based pricing of equivalent drugs within a drug class.
5. Restricted access with exemptions in special cases.
Reasons why the policies were successful
1. The Therapeutics Initiative did not allow anybody with a conflict of interest to participate in decision-making about assessment of evidence.
2. Setting up the questions for systematic review was an interactive process.
3. The drug assessment working group followed Cochrane methodology and improved their skills at critical appraisal and assessing risk of bias over time.
4. Independent researchers were contracted to evaluate the impact of the policies on drug utilization and health outcomes.
5. Ministry of Health personnel remained committed to outcomes based coverage despite political pressures.
Outcomes
1. The Therapeutics Initiative (TI) and Letter (TL) had a high acceptance rate based on a 2006 survey: >80% of general practitioners and >90% of pharmacists felt the TI was meeting its mandate. TL 64 Your opinions of the Therapeutics Letter. The 2006 Survey. http://www.ti.ubc.ca/letter64 full report. http://ti.ubc.ca/PDF/Survey2006Report.pdf
2. Drug utilization and drug costs are substantially lower in BC for most classes of drugs as compared to the rest of Canada. TL 72 Prescription drug costs. BC vs Canada. http://www.ti.ubc.ca/letter72
3. The different policies were shown to NOT have an adverse effect on health care utilization or health outcomes (eg. Outcomes of reference pricing of angiotensin-converting-enzyme inhibitors. N Engl J Med 2002;346:822-9)
4. Enormous pressure was put on the government to abolish the Therapeutics Initiative and drug policies.
5. No new drug classes (eg. Statins) have been subjected to the reference based pricing policy since 1998.
Conclusion
I will end my talk by a discussion of:
1. The lessons learned by the Therapeutics Initiative during the last 16 years.
2. What is wrong with the global system of prescription drug discovery, clinical drug trials, drug marketing, and drug regulation?
3. Ways in which the system could be improved.
Therapeutics Letter diciembre de 2008The Canadian Rx AtlasTherapeutics Letter mayo de 2007OUTCOMES OF REFERENCE PRICING FOR ANGIOTENSIN-CONVERTING–ENZYME INHIBITORS
Monday 9 August 2010
Round Table 2 Lecture 2: MEDICINES INFORMATION IN THE UNITED KINGDOM
Labels: Communications
David Erskine. Director: London & South East Medicines Information Service
Background
There are around 220 medicines information centres based in hospitals in the United Kingdom. We collaborate at a regional level to achieve consistency in training materials, enquiry answering procedures, and access to information resources. The Regional Directors meet regularly to provide strategic direction in areas like IT developments, procurement of resources, and reducing duplication of effort.
Medicine information pharmacists mainly answer clinical enquiries from other healthcare professionals (both those providing services and those commissioning them). In total around 250,000 enquiries are answered every year. We also train around 1500 pharmacists every year in the skills needed to identify, interpret and communicate information about medicines.
Internet sites
We publish all our policies, training materials and support information on our website. (www.ukmi.nhs.uk). This site is intended to be used mainly by pharmacists who work in medicine information centres.
Over the last 10 years we have also created a large and very busy website called the National Electronic Library of Medicines (www.nelm.nhs.uk). This website enables anyone to access the information and advice we generate about medicines and now has over 12,000 subscribers (mainly healthcare professionals). Every year over 30 million records are downloaded from the site.
We present different types of information about medicines on the site and then link it using coding, so that for each medicine you can find the latest news, national guidelines, good quality reviews, safety information, and changes in product licence and monitoring advice. We collaborate with other centres across the country to compile this information and every day a pharmacist scans around 20 resources to identify new information, summarise it, categorise it and publish it on the site. A daily email is sent out to our registered users highlighting the new information on the website that day and users can elect to receive all the updates for that day or only ones which reflect their particular interests (e.g. oncology).
We have recently added a few communities to our site, so for example pharmacists that work in prisons can share material and communicate more easily with each other using the community section of the website. We also now support hospitals that want to post their formularies on the site so that local doctors and pharmacists can find out what medicines are used by their local specialists.
Finally we also now include literature about medicines management so that users can not only obtain evidence about the medicines themselves but also evidence about the service support needed to ensure that they are used safely, effectively and cost effectively.
By focusing our resources on proactive publication of information on this website we feel that we can maximise the impact of the work we do by influencing a much larger audience than we would otherwise be able to communicate with on a one-to-one basis.
Background
There are around 220 medicines information centres based in hospitals in the United Kingdom. We collaborate at a regional level to achieve consistency in training materials, enquiry answering procedures, and access to information resources. The Regional Directors meet regularly to provide strategic direction in areas like IT developments, procurement of resources, and reducing duplication of effort.
Medicine information pharmacists mainly answer clinical enquiries from other healthcare professionals (both those providing services and those commissioning them). In total around 250,000 enquiries are answered every year. We also train around 1500 pharmacists every year in the skills needed to identify, interpret and communicate information about medicines.
Internet sites
We publish all our policies, training materials and support information on our website. (www.ukmi.nhs.uk). This site is intended to be used mainly by pharmacists who work in medicine information centres.
Over the last 10 years we have also created a large and very busy website called the National Electronic Library of Medicines (www.nelm.nhs.uk). This website enables anyone to access the information and advice we generate about medicines and now has over 12,000 subscribers (mainly healthcare professionals). Every year over 30 million records are downloaded from the site.
We present different types of information about medicines on the site and then link it using coding, so that for each medicine you can find the latest news, national guidelines, good quality reviews, safety information, and changes in product licence and monitoring advice. We collaborate with other centres across the country to compile this information and every day a pharmacist scans around 20 resources to identify new information, summarise it, categorise it and publish it on the site. A daily email is sent out to our registered users highlighting the new information on the website that day and users can elect to receive all the updates for that day or only ones which reflect their particular interests (e.g. oncology).
We have recently added a few communities to our site, so for example pharmacists that work in prisons can share material and communicate more easily with each other using the community section of the website. We also now support hospitals that want to post their formularies on the site so that local doctors and pharmacists can find out what medicines are used by their local specialists.
Finally we also now include literature about medicines management so that users can not only obtain evidence about the medicines themselves but also evidence about the service support needed to ensure that they are used safely, effectively and cost effectively.
By focusing our resources on proactive publication of information on this website we feel that we can maximise the impact of the work we do by influencing a much larger audience than we would otherwise be able to communicate with on a one-to-one basis.
Round Table 2 Lecture 1: Influencing prescribing in primary care in the NHS
Labels: Communications
Janice Steele. Acting Chief Pharmacist. Croydon Primary Care Trust
Background
Very historically in the United Kingdom, clinical pharmacists tended to be only based in hospitals where they were shown to have a large influence on how drugs are used. No equivalent expertise was made available to support general practitioners prescribing in primary care. However for the last 15 years pharmacists have been employed by the NHS to work with general practitioners to improve the safety and cost-effectiveness of their prescribing in the same way as clinical pharmacists work with doctors in hospitals. Over that time the expertise of primary care based prescribing advisors has increased and now these pharmacists focus on the following areas to maximise their impact:
Areas of activity for a prescribing advisor
*Data analysis: Designing a range of prescribing indicators and competencies which can be used to identify outliers and areas for improvement. There is also work underway to enable commissioners to link drug expenditure to clinical outcomes.
*Horizon scanning: Work to identify new cost pressures (e.g. new drugs coming to market) and then work with clinicians to manage those pressures. Also work with clinicians to maximise saving as drug become generic (come off patient).
Design annual Work plan to prioritise areas of activity for each general practice.
*Working at the interface: To manage the entry of new drugs into the NHS by agreeing place in therapy, where the drug will be prescribed and how it will be monitored (shared care). Also agree what drugs will be in a joint primary/secondary care formulary. And improve communication between hospitals and general practice by agreeing what information about medicines will be communicated when a patients is admitted and discharged from hospital.
*Communication of Information Pharmacists work to improve the quality of information available to prescribers using :
- newsletters
- internet sites
- practice visits sharing good practice
- links with medical education
- computer software to give messages at the point of prescribing
- use of incentive schemes
*Creating and maintaining a Trained workforce: - needs a clinically trained workforce to maintain credibility
- requires good communication skills
- requires an understanding of primary care (compared with hospital)
- needs support with evidence based messages e.g. statin packs to support therapeutic switching.
- Needs close liaison with medicines information service and clinical networks.
The future
In 2008, the NHS spent £11 billion on medicines which accounts for about 18% of the total money spent on the NHS and 70% of the drugs budget is accounted for by medicines prescribed in primary care. The NHS now employs over 1000 pharmacists working in Primary Care Trusts to help manage the risk associated with that budget and through the mechanisms described they have reduced the increase in drug spend from over 10% a year to less than 3% a year in primary care despite a large increase in the amount of drugs prescribed (especially for prevention of cardiovascular disease). In addition to ensuring drugs have been used cost effectively a number of drug safety issues have also been addressed successfully. New areas of activity now also include reducing drug related hospital admissions and reducing waste with medicines through poor compliance.
Background
Very historically in the United Kingdom, clinical pharmacists tended to be only based in hospitals where they were shown to have a large influence on how drugs are used. No equivalent expertise was made available to support general practitioners prescribing in primary care. However for the last 15 years pharmacists have been employed by the NHS to work with general practitioners to improve the safety and cost-effectiveness of their prescribing in the same way as clinical pharmacists work with doctors in hospitals. Over that time the expertise of primary care based prescribing advisors has increased and now these pharmacists focus on the following areas to maximise their impact:
Areas of activity for a prescribing advisor
*Data analysis: Designing a range of prescribing indicators and competencies which can be used to identify outliers and areas for improvement. There is also work underway to enable commissioners to link drug expenditure to clinical outcomes.
*Horizon scanning: Work to identify new cost pressures (e.g. new drugs coming to market) and then work with clinicians to manage those pressures. Also work with clinicians to maximise saving as drug become generic (come off patient).
Design annual Work plan to prioritise areas of activity for each general practice.
*Working at the interface: To manage the entry of new drugs into the NHS by agreeing place in therapy, where the drug will be prescribed and how it will be monitored (shared care). Also agree what drugs will be in a joint primary/secondary care formulary. And improve communication between hospitals and general practice by agreeing what information about medicines will be communicated when a patients is admitted and discharged from hospital.
*Communication of Information Pharmacists work to improve the quality of information available to prescribers using :
- newsletters
- internet sites
- practice visits sharing good practice
- links with medical education
- computer software to give messages at the point of prescribing
- use of incentive schemes
*Creating and maintaining a Trained workforce: - needs a clinically trained workforce to maintain credibility
- requires good communication skills
- requires an understanding of primary care (compared with hospital)
- needs support with evidence based messages e.g. statin packs to support therapeutic switching.
- Needs close liaison with medicines information service and clinical networks.
The future
In 2008, the NHS spent £11 billion on medicines which accounts for about 18% of the total money spent on the NHS and 70% of the drugs budget is accounted for by medicines prescribed in primary care. The NHS now employs over 1000 pharmacists working in Primary Care Trusts to help manage the risk associated with that budget and through the mechanisms described they have reduced the increase in drug spend from over 10% a year to less than 3% a year in primary care despite a large increase in the amount of drugs prescribed (especially for prevention of cardiovascular disease). In addition to ensuring drugs have been used cost effectively a number of drug safety issues have also been addressed successfully. New areas of activity now also include reducing drug related hospital admissions and reducing waste with medicines through poor compliance.
Thursday 15 July 2010
SCIENTIFIC PROGRAMME
Labels: Z15
Download programme (PDF)WEDNESDAY 27TH OCTOBER 2010
16:00-19:00 Pre-Congress Workshops.
Workshop 1. Risk-sharing agreements: New strategies to drug reimbursement decisions.
Antoni Gilabert Perramon.
Josep Lluís Segú Tolsa.
Cristina Espinosa Tomé.
Workshop 2. Web 2.0 and internet resources: tools to manage scientific knowledge.
Ernesto Barrera Linares.
Cruz Bartolomé Moreno.
Workshop 3. Decision making: Other Evidence Based Products.
Juan Ignacio Martín Sánchez.
Workshop 4. From evidence to recommendations: the GRADE system.
Arritxu Etxeberria Agirre.
Rafael Rotaeche del Campo.
Workshop 5. Development of effectiveness indicators related to the clinical management.
Mª José Calvo Alcántara.
Olga Larrubia Muñoz.
Workshop 6. Conflict resolution strategies.
Jesús Ángel Sánchez Pérez.
20:30 Welcome reception at the Zaragoza City Hall. Cocktail.
THURSDAY 28TH OCTOBER 2010
9:00-10:30 Oral Communication session 1
Chairperson: Flora Pérez Hernández.
10:30-11:00 Opening Ceremony
11:00-11:30 Coffee Break. Poster viewing. Exhibition
11:30-13:00 Round Table 1: Challenges and opportunities of primary care pharmacy on new technologies.
Chairperson: Javier Garjón Parra.
Lecture 1: Health professionals adaptation to new technologies.
José Manuel Picas Vidal.
Lecture 2: Clinical decision support systems in clinical practice.
Eva Comín Bertrán.
Lecture 3: Clinical evaluation of prescription: One step forward.
Encarnación Cruz Martos.
Lecture 4: Pharmacotherapeutic follow-up: role of new technological tools.
Nora Izko Gartzia.
13:00-14:30 Opening Lecture: Management of illusion in changing times.
Emilio Duró Pamies.
14:30-16:00 Lunch.
16:00-17:30 Oral Communication session 2
Chairperson: Ana Mª Sangrador Rasero.
17:30–18:00 SEFAP Strategic plan presentation 2010-2013.
Arantxa Catalán Ramos. Presidenta de la SEFAP
18:00 E-Posters discussion (atended).
20:30 Guided tour: Historic center of Zaragoza and Pilar Basílic .
FRIDAY 29TH OCTOBER 2010
9:30-11:00 Oral Communication session 3
Chairperson: Luis Carlos Saiz Fernández.
11:00-11:30 Coffee Break. Poster viewing. Exhibition.
11:30-13:00 Round Table 2: National and internacional experiences: a vision to share.
Chairperson: Pilar Astier Peña.
Lecture 1: Influencing prescribing in primary care in the NHS.
Janice Steele.
Lecture 2: Medicines Information in the UK.
David Erskine.
Lecture 3: Pharmaco-epidemiological studies in partnership with BIFAP. First experiences.
Juan Erviti López.
Lecture 4: Variability on pharmaceutical prescription. Is geography destiny too?.
Enrique Bernal Delgado.
13:00-14:00 Closing Lecture: “Evaluation of health outcomes after implementation of different strategies to achieve rational use of drugs in British Columbia.
James Wright.
14:00-14:30 Closing Ceremony of XV Congress of SEFAP.
14:30-16:00 Lunch.
16:00-18:00 General Assemby of SEFAP.
21:00 Clossing Dinner. Prize giving: Oral communications and e-posters.
Available on www.sefap.org
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