Appendix 1: Rationale for a national prescribing practices network
A significant proportion of drug therapy, especially for "high-risk" groups such as children and elderly people, may be suboptimal. Examples of suboptimal prescribing include: prescribing a medication when none is needed; using an expensive drug when a cheaper and equally effective alternative exists; giving the wrong dose or timing doses incorrectly; prescribing unnucessary drugs to counteract or augment drugs already prescribed; failing to perform ongoing medication review and to discontinue drugs no longer required; failing to inform patients or consumers fully of the expected benefits and risks of drugs and to consult with patients on their choices or preferences with regard to therapies. Concerns regarding suboptimal prescribing are not limited to any single region of the country.
Expenditure on drugs is rising at a faster rate than spending on any other aspect of health care; therefore, the cost effectiveness of drug therapy in comparison with that of other interventions deserves close scrutiny.
Current initiatives by provincial governments to control the costs of pharmaceutical reimbursement through increasingly restrictive formularies, thus shifting costs to third-party payers or patients, urgently requires rigorous evaluation with respect to its impact on health outcomes, spending and pharmaceutical innovation.
There is still a major problem in bringing high-quality, current evidence on therapeutics to influence frontline practising physicians at the time of prescribing. A similar coordinated effort directed at consumers is needed and will require extensive planning in view of the tremendous variability in consumer attitudes.
Data on important clinical outcomes resulting from changes in practice as well as accurate drug-consumption data stratified by prescriber and consumer characteristics are crucial for evaluative research. The coordination, harmonization and communication of such data would be a major task for a national prescribing practices network.
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