About a year ago, the Provincial Government has implemented a medication management initiative in long term care setting. The initiative focuses on encouraging the utilization of the most cost effective agent(s) within the 7 drug categories.

Medication Management Initiative

These 7 drug categories include:

  1. ACE-inhibitors – where ramipril is the preferred agent.
  2. ARB inhibitors – where telmisartan is the preferred agent.
  3. Diltiazem – where Diltiazem SR extended release capsule (Diltiazem T) is the preferred formulation / agent.
  4. Proton Pump Inhibitors – where pantoprazole sodium (Tecta) is the preferred agent.
  5. Bisphosphonates – where alendronate (Fosamax) is the preferred agent.
  6. Long Acting Muscarinic Anticholinergic Antagonist (LAMA) – where Glycopyrronium (Seebri) is the preferred inhalation agent / device for new therapy.
  7. Serotonin Norepinephrine Reuptake Inhibitor – where venlafaxine (Effexor) should be the preferred agent for new therapy.

Some physicians have been resistant to the concept while others would incorporate the most cost effective agents whenever possible.  While the management initiative is meant to be cost saving for the government, they are quick to ensure the impact to the patient is minimal – that is, it is completely voluntary. The initiative should not result in any additional costs to the patients or families.

But what about cost to other resources? The pharmacist has to review the resident’s medication profile to determine if the substitution is clinically appropriate, the physician has to decide whether he or she would agree with the recommendation and the nurse will have to get in touch with the power of attorney for the consent. Once consent is obtained, the pharmacy will have to process the order changes. It is a long process with additional demand from other resources.

I personally would support any initiatives to help with cost saving to the health care system. But sometimes I wonder why we don’t consider therapeutic substitution, when this is in fact what we are doing, only in a more labour intensive process. I can see that it is not appropriate for everyone, especially if the patient does not tolerate a specific brand, or takes medications crushed where not all brands or formulations are suitable for. In these exceptional cases, then it can be written as “no sub” for no substitution.

But perhaps not all physicians would agree with the policy for therapeutic substitution, that this policy may be seen as a limitation to physicians’ abilities to practice medicine freely and independently.

If you have any experience with the medication management initiative, what have your experience been so far?

Thank you for reading my post.

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