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Published on 2 October 2008

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The effect on pharmacy of the changing medicines landscape

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Developments in biopharmaceuticals, a general increase in the use of medicines and an ageing population who require increasingly specialist medicines are changing the face of medicines

Ray Fitzpatrick

Consultant Editor

Recent editions of HPE have highlighted the changing face of medicines. It has been noted that there are now more biopharmaceuticals coming to market than conventional medicines. In this edition biopharmaceuticals also feature, as in the article on sorafenib tosylate for the treatment of kidney
cancer.

All these developments must be put in the context of the increasing use of medicines and the growing elderly population. In England the number of prescriptions per head of population has almost doubled in the last decade, and it is now over 40 prescription items per year in the over-60s.[1] This is particularly important for hospital pharmacy, given the fact that the elderly population is growing, and older people are more likely to be admitted to hospital than are the rest of the population.[2]

So what are the implications for hospital pharmacy of this changing landscape? First, the increasing use of medicines in practice clearly puts pressure on our services. I have made the point before that if we are to cope with the burgeoning number of medicines being prescribed we need to embrace new technology to assist us in the provision of these medicines closer to the point of care. Furthermore, as many of these new
medicines are in specialist areas and hospitals are becoming increasingly specialised, then these changes must have an effect on how we practice. In my view, three areas of hospital pharmacy practice will be affected: clinical, aseptic services and procurement.

From a clinical perspective this presents tremendous opportunities for pharmacists to make significant contributions to the pharmaceutical care of patients. Alternative brands of biopharmaceuticals (biosimilars) can have significantly different pharmacokinetic and activity properties depending on the manufacturing process. Clearly, this understanding of the differences in what may appear to be similar medicines is the domain of the pharmacist. Changing to an alternative biopharmaceutical may require a whole raft of activities to educate prescribers, which would not necessarily be the case with conventional generic medicines. This requires not only a thorough knowledge of the subject but also high-level communication skills.

Many of these biopharmaceuticals and complex new delivery systems for existing medicines will require preparation immediately before use. There is a growing pressure for less ward preparation of injectable medicines in the interests of patient safety. Therefore, much of the preparation of these newer medicines must be undertaken in aseptic units. This will require redesign of units to allow segregation of activities involving biologics and gene therapy. There will also be a need to reconfigure workflow patterns, perhaps using computer modelling.

Finally, to cope with this increased workload, we will have to outsource some of our current aseptic activity to third-party commercial companies, so-called ‘purchasing for safety’. In addition, many hospitals in the UK are using homecare companies to provide specialist medicines for long-term conditions. Therefore, hospital pharmacy procurement units will have to develop specifications for these new provider services.

References
1. Information Centre, Prescribing Support Unit. Prescription cost analysis England 2006, April 2007.
2. Lord Darzi. High quality healthcare for all: NHS Next Stage Review final report. Norwich: The Stationery Office, 2008.



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