Choosing ACE-inhibitors instead of sartans: Encouraging results of an evidence-based policy in Emilia-Romagna, Italy

Published:April 20, 2015DOI:https://doi.org/10.1016/j.ejim.2015.04.006
      Pharmaceutical policies favoring appropriate prescribing must be based on solid evidence on drug effectiveness and safety, better if shared with relevant stakeholders [
      • Eccles M.P.
      • Grimshaw J.M.
      • Shekelle P.
      • Schünemann H.J.
      • Woolf S.
      Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest.
      ]. To translate this knowledge into practice further steps are generally needed, like setting specific indicators and goals [
      • Kötter T.
      • Blozik E.
      • Scherer M.
      Methods for the guideline-based development of quality indicators—a systematic review.
      ] and associating economic incentives [
      • Sturm H.
      • Austvoll-Dahlgren A.
      • et al.
      Pharmaceutical policies: effects of financial incentives for prescribers.
      ]. 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 [
      • Gruppo di lavoro multidisciplinare
      • Emilia-Romagna Regione
      Documento regionale di indirizzo per gli usi appropriati di ACE-Inibitori e sartani.
      ]. 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%.

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