Features

Secondary care can support PCT aims

Better communication between primary and secondary care allows hospitals to help primary care trusts meet their prescribing targets, according to research presented at the annual scientific meeting of the Drug Utilisation Research Group in February.

A problem faced by many PCTs is that medicines prescribed in hospitals might not correspond to those preferred in primary care and this can be expensive. For example, in December 2005 the prices of 28 omeprazole 10mg capsules and tablets in the Drug Tariff were £5.46 and £11.14, respectively, so PCTs preferred capsules to be prescribed.

However, these prices might not apply in secondary care — many hospitals receive discounts from suppliers. “The capsules and tablets could be the same price but in some cases, the price of tablets can be lower,” said Phil Woodvine, data analyst at the school of pharmacy, Keele University, said.

Patients prescribed omeprazole tablets in hospital cost the PCT more when they move into primary care. “Pharmaceutical advisers in our department say that GPs will try to switch [the patient to a PCT preferred product] but patients resist this. They do not want to change their medicine because it has been prescribed by ‘the specialist at the hospital’,” he explained.

One way of avoiding this situation is to inform hospital chief pharmacists of primary care targets and ask them to support PCTs. For example, in the West Midlands, the strategic health authority secondary care pharmaceutical adviser attended the chief pharmacists meeting and presented the PCT’s targets.

The result of this simple strategy was a decrease in the hospital prescribing of omeprazole tablets from 31 per cent to 1 per cent in three months (monitored using IMS Hospital drug issue data). Similar achievements were made with the prescribing of ramipril and lansoprazole. “The question remains why this type of dialogue had not already occurred between PCTs and hospitals regarding this and similar switches,” the researchers said.

They commented that NHS targets together with practice-based commissioning and integrated care pathways make it more important than ever that there is robust dialogue and collaboration between medicines management services in primary and secondary care.

In addition, if drug procurement choices in secondary care were aligned to primary care targets, this would free resources as well as provide more continuity for patients. The research was carried out by Keele University, in collaboration with West Midlands chief pharmacists.