Initiatives and reforms across Scotland in recent years to improve prescribing; fndings and global implications of drug prescriptions.
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2021
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Objective: Global expenditure on medicines is increasingly driven by a number of factors. These include
the launch of new premium-priced medicines for complex diseases including oncology, a 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 polyphar-
macy. 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, we are 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 infuence future prescribing
and their impact where known across multiple disease areas. Signifcant fndings: The coordinated approach to
improve the prescribing of new medicines limited the prescribing of dabigatran when frst 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
typical 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% and 100% across a range of medicines. In addition, increased 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 coordinated approaches have improved the quality and effciency of prescribing pharmaceuticals in Scotland. Additional measures are still needed
and we will continue to monitor this situation.
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Antimicrobials, Biosimilars, Generics, Healthcare reforms
Citação
MACBRIDE-STEWART, S. et al. Initiatives and reforms across Scotland in recent years to improve prescribing; fndings and global implications of drug prescriptions. International Journal of Clinical and Experimental Medicine, v. 14, p. 2563-2664, 2021. Disponível em: <https://strathprints.strath.ac.uk/78512/>. Acesso em: 11 out. 2022.