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Perspectives and achievements with Rational Pharmacotherapy Meeting under Danish EU presidency

Perspectives and achievements with Rational Pharmacotherapy Meeting under Danish EU presidency Implementation of Rational Pharmacotherapy Copenhagen , November 6, 2002 WHO/EURO Kees de Joncheere, Regional Adviser Pharmaceuticals. Overview of the presentation.

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Perspectives and achievements with Rational Pharmacotherapy Meeting under Danish EU presidency

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  1. Perspectives and achievements with Rational Pharmacotherapy Meeting under Danish EU presidency Implementation of Rational Pharmacotherapy Copenhagen , November 6, 2002 WHO/EURO Kees de Joncheere, Regional Adviser Pharmaceuticals

  2. Overview of the presentation • Pharmaceutical policies in Europe • Rational use of medicines • Comparing European countries • Improving the prescribing and use of medicines • Concluding remarks

  3. Challenges for pharmaceutical policies in Europe • Equitable access for patients to effective, safe and good quality medicines • Enhancing appropriate use of medicines for better health outcomes • Ensuring value for money • Balance with industrial policy objectives Values underpinning health systems : equity, quality, solidarity, participation and accountability

  4. Pharmaceutical policies and the EU • EU regulatory framework and legislation • National responsibilities on pricing and reimbursement (“subsidiarity”) • Transparency directive • Industrial policy communication 1995 • Single market communication 1998 • Public health communication 2000 • Portugal 2000, EU MINE , DG5/health High Level committee, G 10 , … • Review 2000-1

  5. Medicines and Public health in EU • Future of the European system for evaluations and supervision of medicinal products • Relevance of the added therapeutic value of medicinal products ( registration criteria ? Placebo or comparator?) • Aspects determining innovation and research • Rational use of medicinal products • Importance and evolution trends for the information systems • Increasing use of generic medicines • Adoption of EU public health action plan, 2002

  6. Rational use of medicines • Right patient with right indication • Right medicine • Right dose/administration • Right information • Right moment to stop or change

  7. Inappropriate use leads to • Adverse effects • Sub-optimal outcomes • Waste of resources ( money, health professionals and patients time)

  8. Why are drugs not used rationally ? • Lack of training and knowledge • Marketing practices • Financial incentives for irrational use • Availability problems • Patient expectations • Prescribing as a means to finish the consultation • Health systems and services effects • …

  9. Measuring and monitoring the use of medicines • Describe and compare existing situations and patterns • Identify differences and potential problems • Monitor results of interventions • Lessons drawn from other countries` experiences

  10. From drug utilisation to cost-effective intervention (1) • Drug utilisation studies tend to be descriptive, aggregated data : WHAT? • Indicator studies more focused on rational drug use: WHAT? HOW MUCH? • Qualitative studies WHY? SO WHAT?

  11. From drug utilisation to cost-effective intervention (2) • Intervention studies HOW MUCH? WHY? (intervention) HOW MUCH NOW? ConclusionDOES IT WORK? IS THE INTERVENTION EFFECTIVE? • Management studies IS THE INTERVENTION REPRODUCABLE?IS IT COST-EFFECTIVE?

  12. Examples of indicators (WHO/INRUD) Prescribing indicators • Average number of drugs per encounter (<2) • Percentage of drugs prescribed by generic name (close to 100%) • Percentage of encounters with an antibiotic prescribed (<30%) • Percentage of encounters with an injection prescribed (<10%) • Percentage of drugs prescribed from EDL or formulary (close to 100%)

  13. Examples of indicators (EU countries ) • Rate indicators • NSAIDs • antibiotics • benzodiazepines • anti-ulcer drugs • inhaled corticosteroids • Choice indicators • inhaled corticosteroids/beta agonists • quinolones/total antibiotics • short/long acting NSAIDs • PPI/total anti-ulcer • trimethoprim/cotrimoxazole

  14. Examples of indicators(con`t) • Appropriateness • drugs of limited value • agreement with clinical practice guidelines • ASA after AMI • ACE-s in CHF • Statins in secondary prevention • Economic • choice of branded/generic agents • cheaper drug classes • compliance with budgets • Errors • drug-drug interactions • duplication (drug or class) • dosage

  15. Challenges on monitoring drug use • Pharmaco-epidemiology is often concerned with links between exposure and outcomes (usually adverse) • Drug prescribing data-sets have other uses • Budget tracking and forecasting • Examining trends in drug use • Assessing appropriateness of drug selection and accuracy and safety of prescribing • Clear need for going beyond basic statistics and for developing better analytical methods and benchmarking tools

  16. Challenges for monitoring drug use • Intercountry variability as ‘learning device’ • Improving networking of researchers and policy makers • Gap between sales/aggregated consumption data and individual patient data (privacy!)

  17. Financial measures on improving prescribing and containing costs • Fixed and indicative budgets for prescribers • Budgeting for regions, PHC groups with pay-back mechanisms • Price regulations and reference prices • Patient co-payment • Financial incentives to pharmacies for better dispensing • Differential reimbursement rates • Promote generics

  18. Managerial measures on improving prescribing and containing costs • Positive and negative lists • Disease management • Restrict distribution and prescription • Prescribing support systems • Regulate marketing, approved indications and commercial information • Practice guidelines

  19. Improving prescribing and containing costs : educational and informational measures • Formularies • University training and continuing information • EBM - evidence based practice guidelines • Pharmaceutical care • Prescriber information • Drug committees in hospitals and primary care, coordinated approach • Feedback and discussion of drug use data • Behavioural approaches • Patient information

  20. Promoting rational prescribingEffective interventions • Combination of strategies • Participation and ownership by health professionals • Follow-up to avoid relapse • Feedback and active discussion • Best practices

  21. Promoting rational prescribingproven effective interventions • Standard treatment guidelines, when evidence-based, developed with end-users, with active dissemination and follow-up • Essential Medicines lists, • Hospital Drugs and Therapeutic Committees • Undergraduate training • Discussion groups with feedback of prescribing data • “Academic detailing” • Comprehensive approach, with all components

  22. Promoting rational prescribinginterventions that need more testing Mixed results, probably effective: • Pharmacists interventions • Public education • Financial incentives and reimbursement measures Mixed results, probably ineffective: • Drug information bulletins and other printed materials used in isolation • Arbitrary prescription limitations • Traditional stand-up lecturing

  23. Patient experience of illness social circumstances attitude to risk values preferences Health professional diagnosis disease aetiology prognosis treatment options outcome probabilities Promoting rational use : involving patients and sharing experience Picker Institute

  24. Conclusions • Room for improving drug use, e.g minimising risk and improving outcomes • Important role for health professionals , patients and coordinated team approach • Need for better evidence and information on interventions that work

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