Using clinical evidence

Barton, Stuart

doi:10.1136/bmj.322.7285.503

Cited by 54 publications

(35 citation statements)

References 13 publications

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“…This is in line with the general situation in North West England, where the region achieved substantial savings from prescribing generic PPIs and statins versus originators and single-sourced products [40]. This again endorses previous findings that multiple interventions are typically needed to help positively influence prescribing [2, [41][42][43]. The introduction of ScriptSwitch also helped conserve resources; however, there are further opportunities for savings in the future.…”

Section: Generalsupporting

confidence: 86%

Initiatives to enhance the quality and efficiency of statin and PPI prescribing in the UK: impact and implications

McGinn¹,

Godman²,

Lonsdale³

et al. 2010

Expert Review of Pharmacoeconomics & Outcomes Research

122

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The findings are in line with expectations and do provide examples to other European countries. This includes a high rate of INN prescribing, low reimbursed prices for generic simvastatin and omeprazole and growing utilization of higher strength statins. The high rate of INN prescribing reduces the need for additional measures that have been instigated in other European countries to further enhance the prescribing and dispensing of generics to fully realize the resource benefits. Additional demand side measures are feasible and have already been instigated to conserve resources.

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Section: Generalsupporting

confidence: 86%

Initiatives to enhance the quality and efficiency of statin and PPI prescribing in the UK: impact and implications

McGinn¹,

Godman²,

Lonsdale³

et al. 2010

Expert Review of Pharmacoeconomics & Outcomes Research

122

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“…However, additional reforms are needed to further improve ARB prescribing efficiency, especially when prescribing habits are ingrained. This mirrors the results from other studies where multiple demand side measures are needed to appreciably change utilisation patterns given the complexities of prescribing decisions [4,8,9,12,15,41,[46][47][48].…”

Section: Discussion and Future Implicationssupporting

confidence: 71%

Influence of lifting prescribing restrictions for losartan on subsequent sartan utilization patterns in Austria: implications for other countries

Bucsics¹,

Godman²,

Burkhardt³

et al. 2012

Expert Review of Pharmacoeconomics & Outcomes Research

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Introduction: Prescribing restrictions for angiotensin receptor blockers (ARBs) limited their utilisation in Austria. Recently generic losartan became available with its prescribing restrictions lifted whilst still in place for patented ARBs. Objectives: Assess the impact of the lifting of the prescribing restriction on (a) utilisation of losartan in ambulatory care versus other single ARBs, (b) expenditure per DDD (defined daily dose) of losartan as well as total ARB expenditure, and (c) utilisation of ARB combinations. Lastly, suggest potential measures that could be introduced to further enhance ARB prescribing efficiency. Methodology: Quasi-experimental study of the utilisation of different ARBs alone or in fixed dose combinations (FDCs) using a segmented time series. Utilisation measured in DDDs, defined as 'the average maintenance dose of a drug when used in its major indication in adults'. Costs measured as total expenditure for different ARBs as well as their expenditure/ DDD. Results: Losartan utilisation increased significantly following the withdrawal of prescribing restrictions (P>0.001). Utilisation of patented ARBs also increased, but the growth rate was appreciably reduced once restrictions were lifted for losartan (P>0.01). As a result, total expenditure of single ARBs increased but at an appreciably lower rate than utilisation, helped by total expenditure/ DDD for losartan declining by 78% over the study period. There was continuing appreciable utilisation of FDCs. Conclusions: Lifting of prescribing restrictions for losartan significantly enhanced its utilisation, increasing ARB prescribing efficiency, providing direction to other European authorities. Additional reforms are needed to further switch utilisation from other ARBs to additionally improve prescribing efficiency. These are being considered as more ARBs lose their patents.

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“…65,66 There is little doubt that clinical inertia contributes enormously to the burden of potentially preventable adverse events, deaths, and excess long-term health care costs caused by inadequate chronic disease control. 16,17,67 Clinical inertia derives from a number of sources and is influenced by physician, patient, and office system factors. Physician factors include specific decisionmaking pathologies, overestimation of care actually delivered, disagreement with evidence-based goals of care, and "soft reasons" to avoid the efforts required to intensify therapy.…”

Section: Resultsmentioning

confidence: 99%

“…For every 20 patients with SBP 10 mm Hg above 150 mm Hg, there will be 1 additional heart attack or stroke, plus 1 additional occurrence or worsening of a microvascular complication over 5 years. 6,8,12,[16][17][18][19] More than 12 million adults are under treatment for type 2 diabetes in the United States, and at best only 20 percent simultaneously have their A1c, SBP, and LDL at goal. Thus, clinical inertia in diabetes care may lead to several hundred thousand serious adverse events, billions of dollars of excess health care charges for these events, and tens of thousands of excess deaths per year in the United States alone.…”

Section: Costmentioning

confidence: 99%

Clinical Inertia and Outpatient Medical Errors

O’Connor¹,

Sperl-Hillen²,

Johnson³

et al. 2005

PsycEXTRA Dataset

115

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Clinical inertia is defined as lack of treatment intensification in a patient not at evidence-based goals for care. Clinical inertia is a major factor that contributes to inadequate chronic disease care in patients with diabetes mellitus, hypertension, dyslipidemias, depression, coronary heart disease, and other conditions. Recent work suggests that clinical inertia related to the management of diabetes, hypertension, and lipid disorders may contribute to up to 80 percent of heart attacks and strokes. Clinical inertia is, therefore, a leading cause of potentially preventable adverse events, disability, death, and excess medical care costs. This paper addresses three specific objectives: (1) to present a conceptual model of clinical inertia that takes into account recent developments in human factors research, cognitive science, and organizational behavior; (2) to operationally define clinical inertia and propose simple clinical protocols that can be used to identify and map its incidence across populations of patients and physicians; and (3) to propose future research to reduce clinical inertia by specifically targeting the root causes of the problem. Ultimately, a better understanding of clinical inertia and the development of specific interventions to reduce it may be a productive strategy to reduce passive errors that contribute to hundreds of thousands of adverse events and tens of thousands of premature deaths annually in the United States.

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Using clinical evidence

Cited by 54 publications

References 13 publications

Initiatives to enhance the quality and efficiency of statin and PPI prescribing in the UK: impact and implications

Initiatives to enhance the quality and efficiency of statin and PPI prescribing in the UK: impact and implications

Influence of lifting prescribing restrictions for losartan on subsequent sartan utilization patterns in Austria: implications for other countries

Clinical Inertia and Outpatient Medical Errors

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