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

Abstract

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.