References
Medicines reconciliation of biologics on a primary care clinical system
Abstract
With increasing number of biologics gaining approval from the National Institute for Health and Care Excellence for a wide variety of both cancer and non-cancer clinical indications in secondary care, the need for accurate medicines reconciliation in primary care also increases. The risk of patient harm from incomplete medicines reconciliation is a consideration, particularly when patient data is transferred from a secondary care setting to a primary care setting. As part of a prescribing quality improvement project, a list of biologics prescribed by secondary care providers were reconciled on to patients' primary care clinical systems (EMIS) by clinical pharmacists and pharmacy technicians at a Clinical Commissioning Groups. Patients were identified by cross-referencing high-cost drug reports with clinical diagnostic codes (a mixture of READ codes and SNOMED-CT terms) on primary care clinical systems. In total, 192 medicines were reconciled safely on the relevant patients' notes across 16 different GP practices A further 81 medicines had already been reconciled at the start of the quality improvement project. The purpose of this article is three-fold; to expand the awareness of biologics in the context of medicines optimisation in the primary care arena, to discuss medicines reconciliations of biologics in primary care, including the role(s) of pharmacy professionals, and to discuss the wider implications of prescribing biologics in the light of ethical considerations such as veganism.
In the broadest sense of the word, ‘biologics’ are not anything new at all. Biologics have been defined by the American Food and Drug Agency (FDA, 2019) as being ‘composed of sugars, proteins, or nucleic acids or complex combinations of these substances, or may be living entities such as cells and tissues. Biologics are isolated from a variety of natural sources – human, animal, or microorganism – and may be produced by biotechnology methods and other cutting-edge technologies’. Using this definition products such as insulins, erthyropoetins and pancreatin, which are both well-established and frequently prescribed medicines, can be included. For the purposes of this article however, the term ‘biologics’ will refer to a paraphrased version of the latter part of the FDA (2019) definition ie ‘organic based medicines manufactured using new technology, which includes biotechnology’. The term ‘new’ in this context is highly subjective, given the rate of advancements in medicine, particularly in this 21st century. What might be new at the time of writing this article may not be new by the time this article is read. That said, ‘biologics’ (using this paraphrased definition) includes (but is not limited to) the following:
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