Development of a prescription appropriateness project in RSA affiliated with ASL VC: impact on the appropriate use of drug and the economic sustainability of the NHS_an update.

INTRODUCTION 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 2024, the RSAs present in ASL VC were 46, of which 36 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 compilation, GP, tax code/patient name and surname, drug, quantity, dosage, AIFA note, any notes. The SFT checks the requests for quantity (packages requested/indicated dosage) and quality (prescribing appropriateness) and forwards them to the Hospital Pharmacy for processing. RESULTS From 2019 to 2024, enrollment increased from 18 to 36 RSAs and guests from 1,387 to 2,058 with an average age of 84.60 (± 11.25); at the same time, there was a reduction in the average number of drugs per patient from 62.5 to 61.7 and prescriptions per patient from 32.8 vs 32.6. Over the years, the percentage of checks carried out by the SFT increased from 2% to 3%. The most frequent inappropriatenesses were: lack of AIFA note (21.4%) and PT (15.4%), prescription not compliant with AIFA notes 1 (12.1%) and 48 (4.7%) to which IPPs are subject, expired PT (12.4%), request for drugs outside PTA (9.8%), absence of diagnosis for antipsychotics (6.3%), Gross per capita agreed pharmaceutical expenditure of €163.83 in 2019 dropped to €98.25 in 2024. The DPC increased from €27.83 to €35.55 in relation to the expansion of drugs included in the PHT. DISCUSSION The extension of the study to the years 2023 and 2024 consolidated the results obtained in the study relating to the period 2019-2022, confirming how effective the pharmacist figure is in the management of drugs within RSAs. It is in fact a complex process in which different healthcare professionals intervene in the various phases (prescription, dispensing, preparation, administration, monitoring, suspension of the drug) and the systematic intervention of the pharmacist is fundamental in order to pursue a double benefit both in terms of prescribing appropriateness and economic sustainability. CONCLUSION Given the positive outcomes, the project plans to involve additional RSAs and to include the pharmacist in the Supervisory Commission responsible for inspecting the facilities. This will allow for on-site evaluation of drug management practices to ensure the protection of patient health.