title: An investigation into the effect of advice from the Scottish Medicines Consortium on the use of medicines in Scotland's Health Service.
abstract: OBJECTIVE
  The aims of the study were to determine the effect of advice from the Scottish Medicines Consortium (SMC) on the use of medicines within Scotland's National Health Service (NHS) and generate hypotheses that may explain differences in the impact of advice on the use of individual medicines.
  
  
  METHODS
  A retrospective analysis of medicine advice issued between January 2002 and December 2005 was performed. The inclusion criterion was medicines with a 'not recommended for use' decision (NRD) from the SMC (57 out of 207 medicines submitted). The exclusion criteria were medicines used predominately in secondary care and medicines with multiple indications. In total, 20 medicines fulfilled these criteria. The volume of prescribing was measured by each medicine's gross ingredient cost to the prescribing budget.
  
  
  RESULTS
  Before the SMC published advice there was use, though limited, of all 20 medicines. After an NRD, the pattern of use was variable, with the use of some medicines stabilizing or declining but others increasing. We identified factors to help explain unexpected use in some cases. These included delays between medicine launch and initial SMC advice, the publication of conflicting advice from different national bodies and failure to engage with relevant clinical experts early in the medicine review process.
  
  
  CONCLUSIONS
  This study demonstrates the complex relationship between advice following health technology assessment and change in clinical practice. When this study was done there were significant limitations in the collection of prescribing data within the NHS, which recent changes promise to improve.
authors.affiliation: SMC Evaluation Team, National Medicines Utilization Unit, Information Services Division, NHS National Services Scotland, Gyle Square, Edinburgh EH12 9EB, UK. m.bennie@nhs.net
authors.forename: Marion
authors.initials: M
authors.lastname: Bennie
authors.forename: James
authors.initials: J
authors.lastname: Dear
authors.forename: Sharon
authors.initials: S
authors.lastname: Hems
authors.forename: Corri
authors.initials: C
authors.lastname: Black
authors.forename: Laura
authors.initials: L
authors.lastname: McIver
authors.forename: David J
authors.initials: DJ
authors.lastname: Webb
mesh_terms: D011307:Drug Prescriptions / Q000592:standards* / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D017144:Focus Groups; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012606:Scotland; D013222:State Medicine / Q000458:organization & administration* / Q000592:standards; D013673:Technology Assessment, Biomedical