Development of a prescriptive appropriateness project in RSAs affiliated with Local health authority of Vercelli: repercussions on the correct use of the drug and on the economic sustainability of the SSN.

Abstract

Law 405/2001, DGR of 30 July 2012, n. 45-4248 and the DGR of 2 August 2013, n. 85-6287 provide that ASLs guarantee the direct distribution of drugs from the Company's Therapeutic Handbook (PTA) necessary for the treatment of patients in residential and semi-residential care. In this context, some critical issues have emerged such as: long dispensing times with repercussions of "extemporaneous" prescriptions in the area by GPs and consequent disbursements under contract (CONV) and distribution on behalf (DPC), poorly controlled stocks of medicines within the structures, lack of appropriateness of therapies, significant increase in costs. The final objective is to describe the process of supplying and managing medicines for guests hospitalized in facilities for the elderly and disabled (here in after RSA) and identify strategies to optimize appropriateness pathways. METHODS In 2022, there were 46 RSAs present in ASL VC, of which 31 were enrolled in the project and for which a retrospective descriptive study was conducted. Each RSA sends an Excel and a PDF (stamped and signed by the GP) of the drug request to the SC Farmaceutica Territoriale (SFT). The request indicates: date of completion, GP, tax code/patient name, surname, drug, quantity, dosage, AIFA note, any notes. The SFT checks the requests for quantity (packages requested/indicated dosage) and quality (prescriptive appropriateness) and forwards them to the Hospital Pharmacy for processing. RESULTS From 2019 to 2022, enrollment grew from 18 to 31 RSAs and guests from 1,387 to 1,678 with an average age of 83.84 (± 11.64); at the same time, there was a reduction in the average number of drugs given to patients from 62.5 to 47.3 and in prescriptions per patient from 32.8 to 31.7. Over the years the percentage of checks carried out by the SFT has increased from 2% to 5%. The most frequent inappropriatenesses were: lack of known AIFA (22.5%), missing PT (12.3%), drugs outside PTA (11.2%), expired PT (9.3%), absence of diagnosis (6.5%). The gross per capita affiliated pharmaceutical expenditure of €163.83 in 2019 fell to €136.97 in 2022 (-19%). The DPC increased from €27.83 to €38.80 in relation to the expansion of the drugs included in the PHT. DISCUSSION The project guarantees, through prescriptive appropriateness paths, a more controlled and punctual supply of the drug with a consequent reduction in the expenditure paid by the NHS. It also highlights the importance of the figure of the pharmacist, as a drug specialist, for the correct management and organization of procedures aimed at obtaining favorable results such as the deprescribing of drugs. CONCLUSION The project will continue with the enlistment of other RSAs and the proposal to include the pharmacist in the Supervisory Commission which inspects the structures to evaluate the management of the drug on site to guarantee the protection of patient health.