STEPSelect: a tool for medical-pharmaceutical professional communities
STEPSelect is essentially an online medicines selection and information tool to support the procurement of preferred medicines and to optimize pharmacy input into patient care. As such it forms the basis of medicines management aiming at further standardization in primary and secondary care through the implementation of guidelines, formularies and medication reconciliation.
Concerted effort & Quality driven
Medicines selection must be based on rational, clinically relevant criteria, such as safety, documented effects on clinical end points and ease of administration. The acceptance and compliance of the outcome of this selection process can be enhanced by the bottom up involvement of the scientific evidence, knowledge, insights, experience of professional communities themselves. Their role in medicines selection is essential and should be more collective and aimed at concerted effort. One shares an individual responsibility to address routine care in a more standardized way within a limited budget. But in this context procurement should be in the first place quality driven and not primarily cost driven based on biased practice experience.
Significant patient benefits
Patient care is more and more executed by inter-professional complementary services, whereby prescribers and pharmaceutical care providers collaborate. The chain of services should not only be reviewed but also managed prospectively, and medicines selection is a paramount part of medicines management. The selection process however is not just about ‘gathering around the table’. The process must be comprehensive, transparent and rational. STEPSelect is a professional tool to support the medicines selection process with these qualities. As such it fuels the further implementation of professional integrated medicines management services, in primary and secondary care, from procurement to formulary management. The main interest of the medical-pharmaceutical community in this approach is NOT to isolate procurement in a merely budgetary approach but to adopt the principles of medicines selection to ease many other procedures in the clinically effective, safe and economic prescribing of medicines in an integrated manner. Integrated Medicines Management (IMM) in Northern Ireland has in this respect achieved significant patient benefits, including reduced length of stay in hospital (av of 2 days) and a reduced re-admission rate (20%).
STEPSelect: a solution for ‘decision making units’ of the NHS
The NHS is currently undergoing extensive changes per the government white paper Equity and Excellence: Liberating the NHS (2010). Where NICE would control access of medicines on the market in the past; now, that responsibility is given to the Health Board.
Decision making units (DMU’s) as health bards, PCG’s and trusts could use STEPSelect as a tool to ease their decision making process for entry and regulation of new and/or existing medicines within the region. Based on rationale in line with the principles as described in Equity and Excellence: Putting patients and public first, Improving health care outcomes, Autonomy, accountability and democratic legitimacy and Cutting bureaucracy and improving efficiency.
As the government is trying desperately to control expenditure and has to deal with budget cuts as well, STEPSelect can concretise a more cost-effective selection and procurement of preferred medicines. The savings of using STEPSelect in the procurement of medicines would appeal to the DMU as well since environmental and organizational factors such as the economic outlook in the UK, the policies (budget cuts) and objectives are in line with the abilities of the product.
Procurement of medicines can be more effective when it is integrated as part of medicines management services and should therefor be further professionalised. The professionalisation and integration of selection and procurement in the context of medicines management are leading principles in STEPSelect.
Northern Ireland has a programme to improve all aspects of medicines management for several years. It has seen efficiency gains of £140 million, against a medicines expenditure in primary and secondary care of £500 million. STEPSelect played a fundamental and significant role in this process.