System implemented to aid rational clinically led drug selection in
Northern Ireland
Pharmacists in Northern Ireland and the Netherlands have collaborated to develop and implement an evidence-based, transparent process for drug selection. The process has been used since January to decide which
angiotensin-converting enzyme inhibitors should be selected for use throughout
primary and secondary care in one health board in Northern Ireland.
Evaluation of the system was completed last month at one health board
trust.
A list of three ACE inhibitors has been identified to replace the previous
11 products, with a target prescribing rate of 70 per cent (to allow
some flexibility for treatments outside the selected list). Potential
savings of up to £1m per annum are projected as a result of this
approach. The system, known as STEPS (safe, therapeutic and economic
pharmaceutical selection) has been developed from the SOJA (system of
objectified judgement analysis) process.
The SOJA process involves the construction of a matrix in which the criteria
for drug selection, such as clinical efficacy, tolerability and interactions,
are listed and are assigned weighting points. The drugs or products under
consideration are then adjudicated and given a percentage score for each
criterion. The matrix is then completed for each product by multiplying
the percentage score by the weighting. An overall ranking for the products
then emerges.
The main strength of SOJA is that clinicians can be invited to determine
the selection criteria and the weightings. In this way drug selection
can be seen to be both rational and clinically led. In practice, the
choices that clinicians make are highly predictable and it is almost
always possible to achieve consensus, says Rob Janknegt, CZ, Sittard,
the Netherlands.
Consultants and GPs both liked the STEPS method, as it provided an objectified
approach to drug selection, commented Michael Scott, chief pharmacist,
United Hospitals Trust, Antrim. The standardisation of products, such
as ACE inhibitors, will improve patient safety by eliminating much of
the confusion that can be caused by the use of different agents and brands,
including parallel imports, Dr Scott added. The next step is for the
process to be extended and used to select the most appropriate statins
and proton pump inhibitors for use in the region. |
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