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The study reported by Ang and co-workers is of great interest to health care providers, especially in view of its publication in a journal read by a general medical audience. It elegantly delineates two programmes that were launched in Singapore to facilitate the safe transition from acute hospital to the home of patients and aimed to decrease inpatient admissions and emergency department attendances, reduce the total inpatient length of stay, and diminish the expenses of care of patients .
In Malaysia, we have an integrated care transitions programme that enables stable patients discharged from hospital admissions to undergo subsequent care and continuous treatment follow-ups at designated primary health centres. For more than a decade, Ministry of Health Malaysia has commenced a discharge referral service to ensure the continuity of care and supply of medications with minimal discrepancies when patients are transferred from hospitals to health clinics.
Whilst the Guidelines for Inpatient Pharmacy Practice has been published to consolidate pharmaceutical care activities in both the outpatient and inpatient settings, little is known about the patterns of medications supplied to patients with stable chronic illnesses who receive follow-up care in primary care centres in Malaysia. To address the information gap on the costs and prescribing patterns of chronic medications in primary care settings, we analysed data from an urbanised government-funded health cl...
Whilst the Guidelines for Inpatient Pharmacy Practice has been published to consolidate pharmaceutical care activities in both the outpatient and inpatient settings, little is known about the patterns of medications supplied to patients with stable chronic illnesses who receive follow-up care in primary care centres in Malaysia. To address the information gap on the costs and prescribing patterns of chronic medications in primary care settings, we analysed data from an urbanised government-funded health clinic in Selangor, Malaysia through the quantification of prescriptions filled and dispensed to patients discharged by tertiary-based specialists.
A cross-sectional, retrospective study was conducted to analyse all prescriptions (n=547) of patients with chronic conditions who were discharged from a tertiary care hospital to Kelana Jaya Health Clinic between January 2017 and December 2017. The costs of medications were calculated based on the procurement price of medicines available at our facility during data collection. The overall costs spent on medications supplied to patients discharged from hospitals were (Malaysian Ringgit) RM39,304.00. The medications accounted for the highest expenditures were metformin (RM5,990.40), gliclazide (RM5,939.60), metoprolol (RM2,265.50), perindopril (RM1,846.95), and human insulin (RM1,817.30). The medications with the lowest spending were allopurinol (RM75.80), haematinic (RM72.00), potassium chloride (RM54.20), sertraline (RM50.20), and digoxin (RM16.80). The most commonly dispensed medications were simvastatin (785,218 tablets), metformin (74,880 tablets), budesonide metered dose inhaler (49,444 canisters), gliclazide (28,440 tablets), and perindopril (21,780 tablets), whereas the medicines that had the lowest rates of dispense were fluvoxamine (360 tablets), sertraline (360 tablets), digoxin (120 tablets), allopurinol (75 tablets), and potassium chloride (54 tablets).
In line with the specific aim of the post-discharge care programmes described by Ang and co-authors to reduce the total expenditures per patient for health services, we envisage utilsation of high-value medications will also help reduce the economic burden of treatment. The use of high-value medicines, defined as guideline-recommended and reasonably priced, should be a priority for all countries, particularly those with limited resources [2, 3]. High-value medicines are not preferentially prescribed in many health care settings and there is currently sparse evidence to demonstrate that higher-priced medications are more effective . Previous research has suggested that the utilisation of high-value medications has the potential to alleviate the financial burden attributed to increasing rates of treatment [2, 3]. In this respect, meticulously designed large cost-effectiveness studies are warranted to ascertain disease specific medications which will yield beneficial outcomes to patients. The study sites must be representative of a full range of health care settings across all states in the country. Identifying the higher-priced medications with known benefits over lower-cost alternatives can serve as a basis for high quality and cost-efficient care .
Future efforts and policies aimed at mitigating the burden of non-communicable diseases by paying particular attention to the role of primary health care centres will need to improve patient access to high-value medications, especially in low and middle-income countries.
1. Ang IYH, Tan CS, Nurjono M, et al. Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore. BMJ Open 2019;9:e027220. doi: 10.1136/bmjopen-2018-027220
2. Porter ME. A strategy for health care reform — toward a value-based system. N Engl J Med 2009;361:109−12. doi: 10.1056/NEJMp0904131
3. Su M, Zhang Q, Bai X, et al. Availability, cost, and prescription patterns of antihypertensive medications in primary health care in China: a nationwide cross-sectional survey. Lancet 2017;390:2559−68. doi: 10.1016/S0140-6736(17)32476-5
All authors would like to thank the Director-General of Health Malaysia for his permission to publish this correspondence.
This correspondence receives no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Declaration of competing interests
All authors declare they have no actual or potential conflict of interest relevant to this correspondence.