Browsing by Author "Morton, Alec"

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    Initiatives and reforms across Scotland in recent years to improve prescribing; fndings and global implications of drug prescriptions.
    (2021) MacBride-Stewart, Sean; McTaggart, Stuart; Kurdi, Amanj Baker; Sneddon, Jacqueline; McBurney, Stephen; Nascimento, Renata Cristina Rezende Macedo do; Mueller, Tanja; Kwon, Hye-Young; Morton, Alec; Seaton, Ronald Andrew; Timoney, Angela; Bennie, Marion; Sefah, Israel Abebrese; Pisana, Alice; Meyer, Johanna Catherine; Godman, Brian
    Objective: Global expenditure on medicines is increasingly driven by a number of factors. These include the launch of new premium-priced medicines for complex diseases including oncology, a rise in non-communicable diseases especially with ageing populations and changes in clinical practice. There are also concerns with the rise in antimicrobial resistance due to inappropriate prescribing of antimicrobials as well as concerns with polyphar- macy. Both situations increase morbidity, mortality and costs. We are aware of ongoing activities across Scotland to improve the managed entry of new medicines, including new oncology medicines, improve the prescribing of antimicrobials as well as enhance the prescribing of low-cost multiple sourced medicines and biosimilars without compromising care. In addition, we are seeking to address concerns with polypharmacy. Consequently, we wanted to document these multiple measures and their outcomes to provide an overview to inform all key stakeholders in Scotland as well as the global community as resource pressures grow. Methods: A narrative review of the literature documenting examples of ongoing national and regional initiatives across Scotland to infuence future prescribing and their impact where known across multiple disease areas. Signifcant fndings: The coordinated approach to improve the prescribing of new medicines limited the prescribing of dabigatran when frst launched with recent research providing guidance on the effectiveness and safety of different direct oral anticoagulants as more are launched. The patient reported outcome measures project and other ongoing research activities, including linking datasets, is progressing under the Cancer Medicines Outcomes Programme in Scotland to improve future care with typical differences in the effectiveness of new cancer medicines in routine care versus clinical trials. The Scottish Antimicrobial Prescribing Group is also active in Scotland instigating multiple measures to improve antimicrobial prescribing. This includes improving the dosing of gentamicin and vancomycin as well as reducing the prescribing of antibiotics for women with urinary tract infections. Multiple activities have also resulted in high International Non- proprietary Name (INN) prescribing in Scotland at between 91.4% and 100% across a range of medicines. In addition, increased prescribing of low-cost multiple sourced medicines versus patented medicines in a class or related class, as well as biosimilars, leading to considerable savings without compromising care. There have also been initiatives to address concerns with the rising costs of combination inhalers for patients with respiratory diseases as well as areas of polypharmacy with varying success. Conclusion: Multiple and coordinated approaches have improved the quality and effciency of prescribing pharmaceuticals in Scotland. Additional measures are still needed and we will continue to monitor this situation.
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    Ongoing activities to optimize the quality and efficiency of lipid-lowering agents in the Scottish National Health System : influence and implications.
    (2018) Leporowski, Axel; Godman, Brian; Kurdi, Amanj Baker; MacBride-Stewart, Sean; Ryan, Margaret; Hurding, Simon; Nascimento, Renata Cristina Rezende Macedo do; Bennie, Marion; Morton, Alec
    Background: Prescribing of lipid-lowering agents (LLAs) has increased worldwide including in Scotland with increasing prevalence of coronary heart disease, and higher dose statins have been advocated in recent years. There have also been initiatives to encourage prescribing of generic versus patented statins to save costs without compromising care. There is a need to document these initiatives and outcomes to provide future direction. Method: Assessment of utilization (items dispensed) and expenditure of key LLAs (mainly statins) between 2001 and 2015 in Scotland alongside initiatives. Results: Multiple interventions over the years have increased international nonproprietary name prescribing (99% for statins) and preferential prescribing of generic versus patented statins, and reduced inappropriate prescribing of ezetimibe. This resulted in a 50% reduction in expenditure of LLAs between 2001 and 2015 despite a 412% increase in utilization, increased prescribing of higher dose statins (71% in 2015) especially atorvastatin following generic availability, and reduced prescribing of ezetimibe (reduced by 72% between 2010 and 2015). As a result, the quality of prescribing has improved. Conclusion: Generic availability coupled with multiple measures has resulted in appreciable shifts in statin prescribing behavior and reduced ezetimibe prescribing, resulting in improvements in both the quality and efficiency of prescribing.
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    Real-world evaluation of the impact of statin intensity on adherence and persistence to therapy : a Scottish population-based study.
    (2020) Nascimento, Renata Cristina Rezende Macedo do; Mueller, Tanja; Godman, Brian; Stewart, Sean MacBride; Hurding, Simon; Acúrcio, Francisco de Assis; Guerra Júnior, Augusto Afonso; Teodoro, Juliana Alvares; Morton, Alec; Bennie, Marion; Kurdi, Amanj Baker
    Aim: To assess associations between statin intensity and adherence, persistence and discontinuation of statin therapy in Scotland. Method: Retrospective cohort study, using linked electronic health records covering a period from January 2009 to December 2016. The study cohort included adult patients (≥18 years) newly initiating statins within Greater Glasgow and Clyde, Scot land. Study outcomes comprised adherence, discontinuation and persistence to treat ment, stratified by three exposure groups (high, moderate and low intensity). Discontinuation and persistence were calculated using the refill-gap and anniversary methods, respectively. Proportion of days covered (PDC) was used as a proxy for adherence. Kaplan-Meier survival curves and Cox proportional hazard models were used to evaluate discontinuation, and associations between adherence/persistence and statin intensity were assessed using logistic regression. Results: A total of 73 716 patients with a mean age of 61.4 ± 12.6 years were included; the majority (88.3%) received moderate intensity statins. Discontinuation rates differed between intensity levels, with high-intensity patients less likely to dis continue treatment compared to those on moderate intensity (prior cardiovascular disease [CVD]: HR 0.43 [95% CI 0.34-0.55]; no prior CVD: 0.80 [0.74-0.86]). Persis tence declined over time, and high-intensity patients had the highest persistence rates. Overall, 52.6% of patients were adherent to treatment (PDC ≥ 80%), but adher ence was considerably higher among high-intensity patients (63.7%). Conclusion: High-intensity statins were associated with better persistence and adherence to treatment, but overall long-term persistence and adherence remain a challenge, particularly among patients without prior CVD. This needs addressing.