Mr. Darragh O'Loughlin:

A question was asked about the progress made in monitoring or controlling unnecessary prescribing and whether anyone is monitoring prescribers. The medicines management programme, run by Professor Michael Barry, is starting to address this through the issuing of recommendations. For example, if prescribing for gastric ulcers or gastroesophageal reflux disease, the recommendation is to use Lansoprazole rather than the other drugs in the same category because it is less expensive. If prescribing for cholesterol, the recommendation is to use Sandostatin because it is effective and less expensive than the others. It is only if that one does not work that it is recommended that prescribers move to the more expensive options. That programme has started and Professor Barry uses the Primary Care Reimbursement Service, PRCRS, data from the HSE to monitor prices.

As far as unnecessary prescribing is concerned, while the numbers of items prescribed and dispensed are increasing all the time, arguably that does not prove unnecessary prescribing. Rather, it is a result of the fact that more conditions are treatable now. Diabetes patients 15 years ago, for example, were not taking blood pressure or cardiovascular medicines but then it was discovered that such patients are at greater risk of cardiovascular disease and other organ diseases so doctors started prescribing these medicines before the patients developed such problems. The cardiovascular strategy holds that if patients have high blood pressure, their cholesterol levels should be controlled. Doctors are adding medicines to treatment regimes, the result of which has been to improve health and to increase the length of people's lives. It can also be argued that this results in savings in the context of hospital stays because if patients are at home and taking their prescribed medicines, they are not ending up in hospital.

We have always advocated medicine use reviews where a pharmacist would be paid to sit down once a year with a patient who has a number of different conditions and is taking a lot of prescription medicine and comb through all of the prescriptions and review the appropriateness of and need for each one. The pharmacist could make sure that the medication is both clinically appropriate and cost-effective, that is, that the patient is using the least expensive equivalent to treat his or her condition and is not taking anything that he or she should not be taking. Such medicine use reviews are used in the UK and have prevented people from ending up in hospital, as well as saving money.