Pharmaceutical Clinical Effectiveness 2014-15 Pharmaceutical clinical effectiveness (PCE) is the outcome of the application of pharmaceutical skills directed to providing a systematic approach to rational product selection and use, consistently applied across secondary and primary care, taking account of clinical need, evidential product clinical performance, product presentation, safety characteristics and economic factors. The process can be applied to medicines, wound care and medical and surgical disposable products. It employs a multidisciplinary collaborative approach to reach consensus on the most appropriate clinical products and achieve the ownership and behavioural change necessary to make the decisions operational. Effectively, in medicines terms, it is the right medicine for the right patient at the right time and for the right cost. The PCE programme comprises therefore of a number of initiatives synergistically designed to optimise the implementation of the product selection process through effective procurement, prescribing policy and guidelines and pharmaceutical service improvements. The following therapeutic areas form the basis of the HSCB PCE Programme for 2014-15. Within each PCE area the objective is to ensure appropriate use of the drug groups according to national and regional guidelines. Pharmaceutical Clinical Effectiveness (PCE) 2014-15 PCE Area Aim Lipid Lowering drugs Reduce expenditure on lipid lowering drugs Respiratory - Asthma/COPD Reduce expenditure on respiratory medicines Respiratory - Oxygen Reduce expenditure on oxygen Respiratory - Antihistamines Reduce expenditure on antihistamines CNS - Antipsychotics Reduce expenditure on antipsychotics CNS - Hypnotics and Anxiolytics Reduce expenditure CNS - Specialist Analgesics & Compound Analgesics Reduce expenditure on specialist analgesics Objectives Reduce expenditure on statins by reducing rosuvastatin (cost and volume) and by increasing generic statins (simvastatin and atorvastatin) Reduce prescribing of ezetimibe and Inegy (cost and volume) Reduce expenditure on combination inhalers by promoting review of patients with asthma and appropriateness of stepping up Reduce spend on leukotriene receptor antagonists (LTRA) by ensuring appropriate review Develop and implement guidance to support the implementation of the new oxygen contract Optimisation of oxygen cylinder supply Increase use of most cost-effective anti-histamines (cetirizine, chlorphenamine and loratadine) as per formulary choices Increase prescribing of cost-effective atypical antipsychotics (generic olanzapine, risperidone and quetiapine) as a percentage of all atypical antipsychotics Reduce use of any antipsychotics for non-cognitive symptoms or challenging behaviour of dementia Reduce prescribing (volume) of Z drugs and benzodiazepines Reduce expenditure on pregabalin Reduce expenditure on lidocaine patches Reduce expenditure on lidocaine patches Increase prescribing of morphine sulphate as % of morphine sulphate, oxycodone, fentanyl and tapentadol Reduce expenditure on compound analgesics Reduce expenditure of Tramacet CNS - Opioid Patches Reduce expenditure on opioid patches CNS - Orlistat Reduce expenditure Increase prescribing of Mezolar patch as % of all fentanyl patches Reduce expenditure on buprenorphine and fentanyl patches Reduce expenditure (volume) of prescribing of orlistat Diabetes Reduce the prescribing of newer oral antidiabetic medications in line with NICE guidance NSAIDs (oral and topical) Reduce expenditure of BGM test strips in line with NICE guidance Reduce expenditure on NSAIDs - oral and topical Increase the number of prescription items for metformin and sulphonylureas as a percentage of the total number of prescription items for all antidiabetic drugs Reduce expenditure (volume) on inappropriate prescribing of BGMS Reduce overall volume of prescribing of oral NSAIDs Increase prescribing of low dose ibuprofen and naproxen as a % of all NSAIDs Reduce expenditure (volume) of Cox-IIs Food Supplements Reduce expenditure on selected food supplements Reduce expenditure of topical NSAIDs by promoting cost-effective product choices (piroxicam gel) Reduce expenditure on Omacor Reduce expenditure on Icaps, Ocuvite Reduce expenditure on provitamins eg Co-enzyme Q10 Reduce expenditure on probiotics, e.g. VSL Reduce expenditure on gamolenic acid Cost-effective Switch Formulations Product Standardisation Reduce expenditure on named drugs by implementation of the cost-effective switch formulations Reduce expenditure of identified products for switching included in product standardisation policy Reduce expenditure on named drugs by implementation of the cost-effective switch formulations Increase prescribing of product standardisation choices by implementing and monitoring contract uptake Increase prescribing of Contiflo to 70% Nutrition - Infant Milks Reduce expenditure on infant milks Reduce expenditure on infant milks Reduce expenditure on anti-colic products Nutrition - Oral Nutritional Supplements Reduce expenditure on oral nutritional supplements Reduce expenditure on oral nutritional supplements Nutrition - Gluten Free Reduce expenditure on gluten free products Reduce expenditure on all staple GF foods (It is difficult to measure expenditure as many items have no codes) Reduce expenditure (volume) of non-staple foods Dermatology Reduce expenditure on named dermatology 'specials' Reduce inappropriate prescribing (volume) of specific dermatology specials Reduce expenditure on suncreams by targeting prescribing that is outside ACBS diagnosis Reduce expenditure (volume) on cephalosporins and quinolones Reduce expenditure (volume) on all antibiotics Reduce expenditure on sunscreens Antibiotics Reduce expenditure on antibacterial drugs Generic Prescribing Increase appropriate generic switches Increase appropriate generic switches. Ensure new generic products are highlighted to the service and adopted before or as soon as they come to market.