Pharmaceutical policies: effects on rational drug use

Aaserud, Morten; Dahlgren, AT; Sturm, Heidrun; Kösters, JP; Hill, Suzanne; Furberg, C.D.; Grilli, Roberto; Henry, David; Ad, Oxman; Ramsay, Craig; Ross‐Degnan, Dennis; Soumerai, S. B.

doi:10.1002/14651858.cd004397

Cited by 7 publications

(6 citation statements)

References 9 publications

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“…We reviewed the methodological adequacy of studies identified by our search. Based on the ability of specific research designs to control adequately for common threats to internal validity [ 8 , 11 , 12 ], our definition for methodologically adequate studies included: randomized controlled trials (RCTs); pre-post studies with non-randomized comparison group(s); and interrupted time series analysis with or without comparison group. Interrupted time series designs examine changes in outcomes of interest using multiple observations (at least 4 by our definition) before and after an intervention [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

Interventions designed to improve the quality and efficiency of medication use in managed care: A critical review of the literature – 2001–2007

Ross‐Degnan

Soumerai

et al. 2008

BMC Health Serv Res

119

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Background: Managed care organizations use a variety of strategies to reduce the cost and improve the quality of medication use. The effectiveness of such policies is not well understood. The objective of this research was to update a previous systematic review of interventions, published between 1966 and 2001, to improve the quality and efficiency of medication use in the US managed care setting.

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Section: Methodsmentioning

confidence: 99%

Interventions designed to improve the quality and efficiency of medication use in managed care: A critical review of the literature – 2001–2007

Ross‐Degnan

Soumerai

et al. 2008

BMC Health Serv Res

119

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“…Their effectiveness is unclear, although prior-authorisation schemes appear to have a substantial impact on prescribing [15]. Systematic reviews of the effects of pharmaceutical policies, including restrictions on reimbursed drugs, are underway [16]. …”

Section: Discussionmentioning

confidence: 99%

The Effects of Mandatory Prescribing of Thiazides for Newly Treated, Uncomplicated Hypertension: Interrupted Time-Series Analysis

et al. 2007

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BackgroundThe purpose of our study was to evaluate the effects of a new reimbursement rule for antihypertensive medication that made thiazides mandatory first-line drugs for newly treated, uncomplicated hypertension. The objective of the new regulation was to reduce drug expenditures.Methods and FindingsWe conducted an interrupted time-series analysis on prescribing data before and after the new reimbursement rule for antihypertensive medication was put into effect. All patients started on antihypertensive medication in 61 general practices in Norway were included in the analysis. The new rule was put forward by the Ministry of Health and was approved by parliament. Adherence to the rule was monitored only minimally, and there were no penalties for non-adherence. Our primary outcome was the proportion of thiazide prescriptions among all prescriptions made for persons started on antihypertensive medication. Secondary outcomes included the proportion of patients who, within 4 mo, reached recommended blood-pressure goals and the proportion of patients who, within 4 mo, were not started on a second antihypertensive drug. We also compared drug costs before and after the intervention. During the baseline period, 10% of patients started on antihypertensive medication were given a thiazide prescription. This proportion rose steadily during the transition period, after which it remained stable at 25%. For other outcomes, no statistically significant differences were demonstrated. Achievement of treatment goals was slightly higher (56.6% versus 58.4%) after the new rule was introduced, and the prescribing of a second drug was slightly lower (24.0% versus 21.8%). Drug costs were reduced by an estimated Norwegian kroner 4.8 million (€0.58 million, US$0.72 million) in the first year, which is equivalent to Norwegian kroner 1.06 per inhabitant (€0.13, US$0.16).ConclusionsPrescribing of thiazides in Norway for uncomplicated hypertension more than doubled after a reimbursement rule requiring the use of thiazides as the first-choice therapy was put into effect. However, the resulting savings on drug expenditures were modest. There were no significant changes in the achievement of treatment goals or in the prescribing of a second antihypertensive drug.

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“…We developed a taxonomy of health system topics and iteratively refined it by drawing on existing categorization schemes and by using it to categorize progressively larger bundles of systematic reviews and systematic review protocols. First, we drew on system-wide categorization schemes, such as the WHO’s ‘building blocks of health systems’ [ 11 ], and on domain-specific schemes such as those related to human resources policy, pharmaceutical policy, and implementation strategies [ 6 , 7 , 12 , 13 ]. For example, we gained insights on governance arrangements from WHO’s ‘leadership and governance’ category; insights regarding financial arrangements from WHO’s ‘health financing’ category, and from the non-clinical (i.e., financial) aspects of WHO’s ‘medical products and technologies’ category (however, we also included four other sub-categories of financial arrangements that were not covered by the WHO framework).…”

Section: Methodsmentioning

confidence: 99%

“…Such a taxonomy would ideally be organized in a way that reflects the ways in which these groups think about health systems (i.e., by focusing on ‘policy levers,’ which can include both health system arrangements and implementation strategies) and using terminology they are familiar with. While a number of taxonomies exist [ 10 ], they tend either to lack the specificity needed to capture the many different types of policy levers that exist (e.g., World Health Organization (WHO) ‘building blocks of health systems’ taxonomy [ 11 ]) or the breadth of levers available in health systems (e.g., taxonomies focusing on particular health system domains such as human resources or pharmaceutical policy [ 12 , 13 ]).…”

Section: Introductionmentioning

confidence: 99%

Developing and refining the methods for a ‘one-stop shop’ for research evidence about health systems

Lavis

Wilson

Moat

et al. 2015

Health Res Policy Sys

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BackgroundPolicymakers, stakeholders and researchers have not been able to find research evidence about health systems using an easily understood taxonomy of topics, know when they have conducted a comprehensive search of the many types of research evidence relevant to them, or rapidly identify decision-relevant information in their search results.MethodsTo address these gaps, we developed an approach to building a ‘one-stop shop’ for research evidence about health systems. We developed a taxonomy of health system topics and iteratively refined it by drawing on existing categorization schemes and by using it to categorize progressively larger bundles of research evidence. We identified systematic reviews, systematic review protocols, and review-derived products through searches of Medline, hand searches of several databases indexing systematic reviews, hand searches of journals, and continuous scanning of listservs and websites. We developed an approach to providing ‘added value’ to existing content (e.g., coding systematic reviews according to the countries in which included studies were conducted) and to expanding the types of evidence eligible for inclusion (e.g., economic evaluations and health system descriptions). Lastly, we developed an approach to continuously updating the online one-stop shop in seven supported languages.ResultsThe taxonomy is organized by governance, financial, and delivery arrangements and by implementation strategies. The ‘one-stop shop’, called Health Systems Evidence, contains a comprehensive inventory of evidence briefs, overviews of systematic reviews, systematic reviews, systematic review protocols, registered systematic review titles, economic evaluations and costing studies, health reform descriptions and health system descriptions, and many types of added-value coding. It is continuously updated and new content is regularly translated into Arabic, Chinese, English, French, Portuguese, Russian, and Spanish.ConclusionsPolicymakers and stakeholders can now easily access and use a wide variety of types of research evidence about health systems to inform decision-making and advocacy. Researchers and research funding agencies can use Health Systems Evidence to identify gaps in the current stock of research evidence and domains that could benefit from primary research, systematic reviews, and review overviews.Electronic supplementary materialThe online version of this article (doi:10.1186/1478-4505-13-10) contains supplementary material, which is available to authorized users.

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Pharmaceutical policies: effects on rational drug use

Cited by 7 publications

References 9 publications

Interventions designed to improve the quality and efficiency of medication use in managed care: A critical review of the literature – 2001–2007

Interventions designed to improve the quality and efficiency of medication use in managed care: A critical review of the literature – 2001–2007

The Effects of Mandatory Prescribing of Thiazides for Newly Treated, Uncomplicated Hypertension: Interrupted Time-Series Analysis

Developing and refining the methods for a ‘one-stop shop’ for research evidence about health systems

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