Written Answers. - Indicative Drug Target Scheme.
Alan Shatter
Ceist:
246
Mr. Shatter
asked the
Minister for Health and Children
his views on the Murphy report on indicative drug prescribing which found that 53 per cent of hospital consultants believed that the treatment of some clinical conditions had disimproved as a result of the scheme; and if he will make a statement on the matter.
[22263/97]
The indicative drug target (IDT) scheme was introduced for general practitioners in the general medical services scheme on 1 January 1993, following the review of the scheme in 1992 by the Department, the health boards, the Irish Medical Organisation, and the Irish College of General Practitioners.
In the course of that review, it was agreed by all sides that medicines were not always pre-scribed in the most effective manner and that there was significant potential for an improvement in prescribing practice leading to better patient care and better use of the available resources in the development of general practice. Accordingly, each doctor was encouraged to examine his-her existing prescribing practices with a view to availing of opportunities to make prescribing more effective and less costly for all his-her patients. To assist in this process, doctors were provided with indicative drug targets, for patients on their panels, which had been constructed on the basis of average prescribing costs weighted by age and sex criteria.
As an incentive to doctors, the IDT scheme provided that a portion of the savings made would be made available to the individual doctor for practice development projects which received the prior approval of the relevant health board. The balance of the savings made is allocated to the relevant health board for investment in general practice projects within the board's area.
At every stage during the process of reaching agreement on the IDT scheme and in the subsequent implementation of that agreement, all of the parties to the review mentioned above clearly understood and accepted that it was the duty and obligation of doctors, individually and collectively, to provide the most appropriate management and to optimally utilise the available resources for patient care. It was and is similarly understood and accepted that the right of the doctor to prescribe for the patient, as he-she considers necessary, remains absolutely in place.
The report referred to by the Deputy was that of the expert review group, chaired by Professor Michael Murphy, Professor of Clinical Pharmacology, University College, Cork, which conducted a review of the IDT scheme at the request of the Department. The purpose of the review was to provide an independent evaluation of the effect of the IDT scheme on the quality of patient care with particular reference to changing patterns in prescribing.
The review group received oral and written submissions from a broad range of interests affected by the scheme including patients, doctors, pharmacists and the pharmaceutical industry. Intensive analysis was carried out on the prescribing by the 223 general practitioners in the Eastern Health Board region with panels in excess of 500 patients. To complement the analysis, surveys were also conducted among the selected samples of doctors, pharmacists and patients. The figure mentioned in the question relates to a small postal survey of hospital consultant physicians. However, a main conclusion in the report was that there was no discernible negative effects on the overall quality of prescribing.
Overall, I am satisfied with the success of the indicative drug target scheme. Most doctors are now achieving more rational and cost-effective prescribing which represents a successful outcome to the scheme put in place as a result of the findings of the review of the GMS mentioned earlier. The average annual rise in the GMS drug costs has fallen to approximately 6 per cent compared to 10 per cent prior to the inception of the scheme. The IDT scheme has been under constant review since its inception. The comprehensive Murphy report provides valuable information on prescribing and its recommendations will inform the development of the scheme in the future. The group's recommendations in regard to the establishment of an national pharmacoepidemiology database, a linked prescribing morbidity database and the need for pharmacoeconomic evaluation will be considered in the context of the role of a National Pharmacoeconomic Centre at Trinity College-St. James's Hospital which is currently being established under the direction of Professor John Feely, Professor of Pharmacology and Therapeutics. Other recommedations, particularly those in relation to informing patients of the scheme, will be taken into account in future discussions on the scheme.
Arising from savings made under the IDT scheme, significant resources have been provided for the development of general practice which, in turn, has resulted in a more comprehensive and better quality service for patients. It is important to point out that the IDT scheme does not provide the general practitioner with a personal remunerative advantage, rather it provides a means for investment in facilities, equipment and services in his-her practice in the first instance and for other practices in the health board's area. Such investment is to the advantage of all patients.
