Respiratory conditions - quality prescribing strategy: improvement guide 2024 to 2027

11. Recommendations

Using the clinical guidance and prescribing recommendations contained in this guide.

Clinicians should:

Develop a clear management plan collaboratively with patients at the centre adopting the “what matters to me?” principles and the 7-Steps medication review process. Clinicians should optimise prescribing of medicines, reduce the potential for harm, manage patient expectations and consider the environmental impact of their prescribing.

Follow a clinically appropriate approach to initiation of medication, discussing risks and benefits and incorporating agreed criteria for stopping/continuing medication. Inhaler technique remains a key component of co-production of positive clinical outcomes. Therefore, review of inhaler technique should be undertaken as a priority. This is of particular importance due to the growing variety of inhaler devices – ongoing review is recommended.

Review effectiveness, tolerability and adherence on a regular basis. Medicine burden and waste should be reduced where possible, in line with the Scottish Government’s Polypharmacy guidance.

Ensure awareness of relevant changes to inhaler formularies, new inhalers to market, carbon emissions of inhalers and updated guidance.

Pursue non-pharmaceutical approaches wherever possible, either alone or in conjunction with medicines. Self-management should be actively encouraged and supported for appropriate patients.

Clusters should:

Engage with local Medicines Management Teams and review respiratory prescribing data. View the National Therapeutic Indicators for respiratory prescribing including prescribing information by GP cluster on the shinyapp.^[85]

Respiratory prescribing issues should be included in the Cluster Quality Improvement plan if deemed a priority. Reduction of carbon emissions is a national priority and this document provides guidance on how to reduce carbon emissions due to respiratory prescribing.

Secondary care teams should:

Engage with pharmacy teams to ensure hospital prescribing is in line with local formulary.

Understand the influence that secondary care prescribing has in the primary care setting and educate associated staff.

Health Boards should:

Consider this guidance alongside the data provided on prescribing positions and trends. Prescribing action plans set out local priorities for how Health Boards will continue to improve quality of medicines management. These action plans should, where appropriate, encourage use of this document to drive that improvement.

Nominate a local lead from within Medicines Management and a local clinical lead from within the local Managed Clinical Network or Respiratory Community. The two leads should work closely together to drive delivery and implementation of the recommendations within this document with the local Managed Clinical Network, where possible.

Ensure the primary/secondary care interface is appropriately developed. Given the considerable influence that local secondary care prescribing culture has on primary care clinicians, it is vital to ensure engagement with secondary care clinicians. Encourage ownership of primary care data by clinicians in both settings.

Review local prescribing pathways and formulary and support clinicians, based on current SIGN guidance and environmental issues.

Ensure non-pharmacological management is promoted within prescribing action plans.