A group of Toronto physicians have drafted a list of 125 essential medicines for use in Canada, publishing their findings in the Canadian Medical Association Journal’s online publication CMAJ Open.
Provincial formularies that list thousands of medications — the Ontario Drug Benefit formulary lists 3,800 drugs, for example — make it difficult for physicians to know “the most effective, safe and appropriate medications” to prescribe, the authors write. In contrast, formularies in Britain and Sweden list just a few hundred drugs.
The authors also note an essential medicines list could lead to a national formulary and the beginning of a national pharmacare scheme. It could also reduce drug costs by allow provinces to focus their bargaining on far fewer products.
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After creating the list, the authors audited two Toronto-area family health teams to determine how frequently the patients’ prescribed medications were on the list. For patients at the urban clinic, 90.8 per cent of their medications were covered. For patients at the suburban clinic, 92.6 per cent of their total prescriptions were covered.
“These preliminary results suggest that, although smaller than the essential medicines lists of other countries, this list still covers most medications and patients,” the authors wrote, also noting further research is needed to look into how applicable the list is in communities outside the Toronto area, how the list could affect prescribing patterns and how such changes in prescribing patterns could affect patients.
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To create the list, the authors adapted the World Health Organization’s essential medicines list, which had 448 entries. They removed 368 items from the list, including: entries that weren’t medications (such as condoms); that were similar to other entries but with less convenient routes of administration; that had the same indication as other listed items; that aren’t commonly used in Canadian primary care; and that are prescribed by specialists. They also added 28 medications to the list, based on Canadian clinical practice guidelines and other literature, for a total of 108 entries.
Peer reviewers, recruited in a variety of ways, made 46 suggestions to modify the list, of which a panel of five clinician-scientists voted to accept 29 (11 replacements, 12 additions and six removals). After analyzing prescribing patterns at the two primary care centres, the researchers added 16 medications.
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