Development Centre for Drug Therapy

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

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Abstract

A new governmental agency, the Development Centre for Drug Therapy, has been established under the Ministry of Social Affairs and Health. The purpose of the agency is to promote rational drug therapy by influencing physicians' prescribing behaviour. The agency will use methods like information dissemination and education of physicians and will be in close collaboration with hospitals and health care centres. The agency is Government funded and independent from pharmaceutical companies.

Purpose of health policy or idea

• The Finnish Government has for long been concerned about increasing pharmaceutical expenditure and has introduced several measures to contain drug costs more efficiently. At the same time there is evident lack of independent drug information, especially concerning new products. In this situation, a new governmental agency named the Development Centre for Drug Therapy has been established under the Ministry of Social Affairs and Health. The main objective of the agency is to promote rational drug use in Finland by influencing physicians' prescribing behaviour. The director of the agency was appointed July 2003 and the rest 7 to 8 staff members will be appointed in early 2004.
• According to preliminary plans the agency's main activities are to provide independent education and information concerning drug therapies to physicians, and to produce feed back information to physicians and health care units about their prescription patterns. Important methods used in education are small group and problem based learning. The agency will collaborate with other organisations providing continuous medical education for physicians. The key tool of the agency in training activities is a network of local contact persons in collaboration with hospital districts.
• The implementation of treatment guidelines and other evidence based knowledge in practice is a practical goal for the agency's training activities and information dissemination. The agency does not compile its own treatment guidelines, but uses existing treatment guidelines in Finland and other countries. Most Finnish national treatment guidelines are issued by the Finnish Medical Society Duodecim.
• The agency is funded by the Government and it will be in close collaboration with hospitals and health care centres. The Government's intention in establishing this agency is to control rising drug expenses and to promote efficient use of limited health care resources. The agency is supposed not to have any financial or other ties with pharmaceutical companies.

Main points

Main objectives

Purpose of this policy is to promote rational drug therapy in Finland.

Type of incentives

1. for physicians: information and training on rational prescribing;
2. for health care units and payers (municipalities and the Social Insurance Institution): containment of pharmaceutical expenses.

Groups affected

Physicians, Health Care Units, Payers

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

There is a great need to provide independent information on drugs to physicians and to have limited resources of health care used in the most efficient way. Founding the new governmental agency is an important step towards these goals.

Political and economic background

Since 1998 the Ministry of  Social Affairs and Health has partly funded the ROHTO programme which has same goals as the new agency. The project has now ended and its work will be continued by the new agency.

The importance of the continuation of the ROHTO programme was notified in "the Decision in Principle by the Council of State on Securing the Future of Health Care" published by the Government in April 2002. This decision also secured governmental funding for this work.

There was no pressure to comply with EU or other international regulations.

Change based on an overall national health policy statement

The Decision in Principle by the Council of State on securing the future of health care

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The idea of this policy process is not completely new. Since the economic depression in the early 1990's the need of independent drug information for doctors have been stated in different reports and by various governmental working groups. In 1997 an ad hoc working group published a report on controlling drug costs. The report suggested a project promoting rational prescribing, for instance, by providing information and training for doctors. Soon after that the ROHTO programme was started. Most active stakeholders in this process were the Ministry of Social Affairs and Health, Social Insurance Institution, Finnish Medical Society Duodecim and Finnish Medical Association.

The aim of the ROHTO programme was to steer physicians' prescription practices to a more rational direction. The principle of the action programme was to encourage physicians to review critically their own prescription practices. Methods for achieving this were education in small groups and workshops, extensive information activities and national support measures. The ROHTO programme was managed by the Finnish Medical Society Duodecim. The programme was evaluated in 2002 and it was rated to have been important.

 In 2001 the Government initiated "the National Project to Ensure the Future of Health Care". One outcome of this was "the Decision in Principle by the Council of State on Securing the Future of Health Care" issued by the Government in 2002. In the decision the need of securing the continuation of the ROHTO programme was highlighted. At the same time, the Council of State promised to allocate EUR 1.3 million to the ROHTO programme annually.

Soon after this The Ministry of  Social Affairs and Health made plans to enact the Development Centre for Drug Therapy, and thus to establish a government agency to continue the activities of the ROHTO programme. The bill on the agency was passed in the Parliament in the same year.

The main background motivation for this policy process was rising drug costs and the lack of independent information on drugs.

Approach of idea

The approach of the idea is described as:
renewed: Yes

Innovation or pilot project

Pilot project - the ROHTO programme can be considered as a pilot for the new

Stakeholder positions

The leadership role in founding the new agency lies with the Ministry of Social Affairs and Health. In addition to the ministry, the Social Insurance Institution managing the national health insurance reimbursing patients' outpatient medicinal expenses had a significant interest in methods to promote rational prescribing and to lower the rate of increase of drug costs. In addition to authorities, the Finnish Medical Society Duodecim had interest to secure the continuation of the ROHTO programme to which the society had invested a significant amount of its resources. One of the key objectives of the Finnish Medical Society Duodecim is to support the physicians' knowledge base needed in medical practise, for example, by promoting continuous education of physicians.

There have been no major opponents for the establishment of the new agency and the public debate on the initiative has been low. However, the National Agency of Medicines would have favoured that the activities of the ROHTO programme had been sited in its organisation. This was rejected because the high level of independence from existing stakeholders is tried to be achieved. Pharmaceutical industry has not openly voiced their opinion but some representatives of the industry have expressed their concern that the new agency may focus too much on curbing the cost and to decrease the pharmaceutical sales.

The main group to be affected by this policy initiative are physicians, which are rather positive towards the new agency.

Influences in policy making and legislation

The legislative process for the initiative was very quick. From the decision in principle made by the government it took only eight months to pass the bill on the Development Centre for Drug Therapy. The original idea did not significantly change in the legislative process and there was no significant involvement of other stakeholders than the Government and the Parliament in the process.

Legislative outcome

success

Adoption and implementation

The Ministry of Social Affairs and Health has the responsibility for starting the new agency and for providing funding and other prerequisites of the activities of the agency. The Ministry will also supervise and set targets for the operation of the agency. In addition, an advisory board representing relevant stakeholders will be formed to guide the work of the agency.

The main collaboration partners of the agency are hospital districts, hospitals and health care centres. The agency will also collaborate with the Social Insurance Institution and National Agency of Medicines in gathering statistical and other information on the use and prescribing of pharmaceuticals.

Monitoring and evaluation

The previous ROHTO programme has been evaluated (see http://www.stm.fi/suomi/eho/julkaisut/rohto/summary.htm )

The Development Centre for Drug Therapy is guided and supervised by its own advisory board and the Ministry of Social Affairs and Health.

Expected outcome

The Development Centre for Drug Therapy has a challenging task to promote rational drug therapy as the dissemination of information by the agency is unevenly competing in terms of resources with the marketing efforts of pharmaceutical companies. However, the agency still have a good opportunity to steer drug therapies to more rational direction, especially by concentrating some specific problematic issues. For the success of the agency, an important issue will be that key stakeholders have positive attitude towards the agency.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

The impact of the agency can not be evaluated yet, but partly based on experiences from the ROHTO programme the agency will probably have positive impact on quality and cost-efficiency of drug therapy.

References

Sources of Information

Helin-Salmivaara A, Huupponen R, Klaukka T & Hoppu K (2003) Focusing on changing clinical practice to enhance rational prescribing - collaboration and network enable comprehensive approaches. Health Policy 66:1-10.

Nikkarinen ?, Huvinen ?, Brommels M (2002) National consensus and local consideration. Changing the prescription practices by means of training. Evaluation Report of the ROHTO Project. Helsinki, 2002. (Reports of the Ministry of Social Affairs and Health)

http://www.stm.fi/suomi/eho/julkaisut/rohto/summary.htm

Decision in Principle by the Council of State on securing the future of health care. Brochures of the Ministry of Social Affairs and Health 2002:6eng

http://www.stm.fi/english/eho/publicat/bro02_6/bro02_6.pdf

Author/s and/or contributors to this survey

Lauri Vuorenkoski & Ilmo Keskimäki

Empfohlene Zitierweise für diesen Online-Artikel:

Lauri Vuorenkoski & Ilmo Keskimäki. "Development Centre for Drug Therapy". Health Policy Monitor, Oktober 2003. Available at http://www.hpm.org/survey/fi/a2/4