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In Denmark there is increasing focus on the cost effectiveness of medicine use in the Danish healthcare system. At the same time, patient safety is an important issue for politicians and healthcare professionals. This has led to the implementation of several national initiatives to support healthcare professionals, ensure the correct choice of medicines and monitor drug treatment.
Other initiatives include implementation of treatment standards, the development of coordinated lists of recommended drugs between hospitals and general practitioners (GPs) and shared registration of the patient's actual drug treatment between hospitals and GPs. In addition, the hospital pharmacies in Denmark are implementing a new joint IT system providing data on the use of medicines in Danish hospitals.
The Danish Council for the Use of Expensive Hospital Medicines (RADS)
In October 2009 the Board of the Danish Regions set up the Council for the Use of Expensive Hospital Medicines (RADS) to ensure that all patients have equal access nationally to treatment with expensive hospital medicines (box 1). This is accomplished through common clinical treatment guidelines for the use of each medication; adherence to these guidelines is mandatory.
RADS deals with
Drugs that are a major hospital expense
Drugs characterised by rapidly increasing costs
New medications with a high cost potential
Areas in which regional consensus is needed
On an ongoing basis, RADS appoints committees composed of leading national experts in different clinical fields who prepare the common national treatment guidelines. The committee chairmen are nominated by the Organization of Danish Medical Societies. The common clinical treatment guidelines allow the regions to obtain better drug prices through joint tenders for medicines. RADS thus has a dual purpose: to improve the quality of drug therapy and to obtain lower drug prices. In other words: more health for the same money.
The pharmaceutical organisation Amgros manages each tender for drugs in accordance with RADS guidelines. After tender completion the recommendation is issued and the brand names of the drugs, which should be selected, are added. RADS receives information about the tender results, drug recommendations and compliance goals for named drugs. This information is then forwarded to the regions which are responsible for implementation of the guidelines and the accompanying recommendations.
Monitoring and follow-up
Amgros monitors regional drug use based on consumption data, thus providing an indication of drug usage in each region as well as any deviation from the stipulated compliance goals. Regional drug consumption down to hospital clinic level is examined, this information can be useful in clinical discussions of actual use in individual clinics. The clinical discussion is done in conjunction with hospital pharmacies and the Regional Drug and Therapeutics Committees.
Coordinated recommendations between hospitals and the primary sector
All hospitals have a list of recommended drugs approved by the Regional Drug and Therapeutics Committees. These lists are integrated into the electronic physician order entry systems.
In primary care a comparable list of drug recommendations (‘basislisten’) is prepared jointly by the Danish national health authorities and GPs. The GP has direct access to basislisten through their local IT system and is obliged by agreement with the regions to follow its recommendations.
The lists are based on evidence of effects and side effects, patient safety and price. In each region the lists are coordinated with the aim of treating the patient with the same type of drug in hospital and at home, which also helps to control drug expenditure.
Shared Medication Record (FMK)
Denmark is currently implementing the Shared Medication Record (FMK). Hospitals in two of the five regions have access to FMK through their electronic physician order entry systems. FMK is a Danish Health and Medicines Authority national database containing information on all Danish citizens' medicine purchases over the past 2 years as well as an updated list of current prescriptions for each citizen.
When FMK is fully implemented, the patient, GP, emergency doctors, dentists, and other relevant healthcare personnel treating the patient will have access to updated drug information.
FMK will allow:
Anyone treating the patient has easy and fast access to updated drug information
Better correlation between primary and secondary healthcare (hospital, GP, home care, medical specialist, dentist, etc)
Greater safety regarding correct medication across sectors.
Less need to remember the name and dosage of current medicine.
FMK will help prevent inappropriate medication (eg, incorrect dosage, drug interactions) and thus can improve the safety and quality of medical treatment. It is important that doctors remember to update the record each time they change the treatment of a patient. The patient must also inform the doctor if the medicine is not being used as prescribed.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
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