Pharmaceutical policies favoring appropriate prescribing must be based on solid evidence
on drug effectiveness and safety, better if shared with relevant stakeholders [
[1]
]. To translate this knowledge into practice further steps are generally needed, like
setting specific indicators and goals [
[2]
] and associating economic incentives [
[3]
]. In keeping with these general principles, in 2011 Health Authorities of Emilia-Romagna
(ER), a Region in Northern Italy, appointed a multidisciplinary panel to review and
discuss evidence on inhibitors of the renin–angiotensin system (ACE inhibitors and
sartans), widely used drugs with similar indications in cardiovascular medicine, nephrology
and diabetes. The objective was to set the evidence-base for implementing a prescribing
policy on the appropriate use of these drugs. The ER panel, including 24 among cardiologists,
nephrologists, diabetologists, internists, pharmacists and clinical pharmacologists
coming from different Local Health Authorities (LHAs) of the Region, produced a short
document recommending to prefer ACE-inhibitors to sartans when a treatment should
be started, highlighting the stronger evidence-base available for ACE-inhibitors and
consistently with the main clinical practice guidelines available on this topic [
- Sturm H.
- Austvoll-Dahlgren A.
- et al.
Pharmaceutical policies: effects of financial incentives for prescribers.
Cochrane Database Syst Rev. 2007; (Art. No.: CD006731)https://doi.org/10.1002/14651858.CD006731
[4]
]. The document was presented in local meetings and used in prescribing policy agreements
in each of the 11 Local Health Authorities (LHAs) of ER. Specific agreements differed
among LHAs but generally considered economic incentives – up to 0.8 euro per assisted
person – in case prescription of sartans did not exceed a threshold — down to 20%.Keywords
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References
- Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest.Implement Sci. 2012; 7: 60https://doi.org/10.1186/1748-5908-7-60
- Methods for the guideline-based development of quality indicators—a systematic review.Implement Sci. 2012; 7: 21https://doi.org/10.1186/1748-5908-7-21
- Pharmaceutical policies: effects of financial incentives for prescribers.Cochrane Database Syst Rev. 2007; (Art. No.: CD006731)https://doi.org/10.1002/14651858.CD006731
- Documento regionale di indirizzo per gli usi appropriati di ACE-Inibitori e sartani.(Accessible from)
- Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension.Ann Intern Med. 2008; 148: 16-29
- Effectiveness and efficiency of guideline dissemination and implementation strategies.Health Technol Assess. 2004; 8: 1-72
Article info
Publication history
Published online: April 20, 2015
Accepted:
April 3,
2015
Received in revised form:
April 3,
2015
Received:
March 31,
2015
Footnotes
☆Prior posting or presentations: data presented in this article have not been published elsewhere, nor are currently under review by another journal
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.