The Danish Ministry of HealthAnalysis of management of medicines and drugs in Danish hospitals

The Challenge

To address the prospect of a continuous increase in medicines expenditure, the Danish Government and Danish Regions decided, as part of their economic agreement for 2016, to look into management of medicines and drugs in Danish hospitals.

Implement conducted this enquiry for the Ministry of Health. Our analysis addressed the following issues:

• Management of medicines and drugs in Danish hospitals. This included mapping of logistical and clinical practices as well as identifying the primary reasons for waste of medicines and drugs.
• Identification of opportunities for improvement.
• Management methods that have produced good results.

We based our analysis on observations and interviews with chief physicians, medical nurses, pharmacologists and hospital pharmacies all over Denmark. In addition, we calculated the purchase of medicines and drugs based on statistics from the Health Data Authority. Data from the Danish Regions’ electronic medicine modules were not available in a format that allowed for further analysis.

Results

Addressing each of the issues above, our analysis rendered the following conclusions:

Management of medicines and drugs

Our findings showed that all Danish regions in recent years have taken significant measures to optimise logistics in the supply chain and handling of medicines and drugs to minimise avoidable waste. We saw more management – both at national and regional level – of clinical treatment options when it comes to the use of expensive pharmaceuticals. Primarily through the central healthcare authorities that regulate and advise on the use of expensive hospital medicines and drugs.

Logistics and clinical practice are regulated through guidelines and similar measures. Apart from purchase statements, there is scarce management information on medicines and drugs consumption that can document the volume of prescribed, dispensed and administered pharmaceuticals, the volume of discarded medicines and drugs and the clinical relevance of treatment choices for specific patients.

Finally, when it comes to reducing the use of medicines and drugs, the wards have limited financial incentives to do so since they do not have to cover the lion’s share of these costs themselves. Moreover, the general awareness among clinical staff and patients about the cost of pharmaceuticals is low. So lack of knowledge is another contributing factor to why expensive pharmaceuticals are not handled with more care.

Opportunities for improvement

Implement identified the following areas where we see potential for improvement:

• Disposal of cytostatics
• Antibiotics and antifungal treatments
• Substitution of specific medicines and drugs
• Dispensing of medicines and drugs with no patient payment attached
• Polypharmacy
  
  

In each case, we describe the potential for improvement, present the basis of calculation and estimated potential and/or describe how to increase awareness.

Effective management methods

The analysis identified effective methods for management of medicines and drugs, which could be disseminated and used with increased impact. In fact, many of these are already in use in many hospitals, albeit in different variations and to different degrees.

Tried and tested management methods include rules and competences, knowledge about current practice and its consequences and follow-up on knowledge about practices. In addition, data on purchased, applied and administered medicines and drugs should be available in a format that allows for ongoing quality assessment as well as management information.

Implement submitted the report in the spring of 2016. The Ministry of Health and the partners behind the 2016 financing agreement are now following up on the conclusions of the report.