Reactions 1704, p5 - 2 Jun 2018
UK surveillance of home-delivered
medicines "not good enough"
The quality of drug surveillance for specialised
medicines delivered via local homecare companies is
"currently not good enough", say researchers from the
In a recent editorial published in The BMJ, Mr Anthony
Matthews and his colleagues from the London School of
Hygiene and Tropical Medicine acknowledged that
prescribing of specialised medicines via homecare
services is a rapidly expanding market (value
>£1.5 billion in 2016), and that such services "have
become an increasing priority for the NHS [National
Delivering drugs directly to patients increases
accessibility to patients with long-term conditions (e.g.
multiple sclerosis), and also saves the government
money as they are free of sales tax.
Mr Matthews and his colleagues distributed
questionnaires to 126 acute hospital trusts in England,
but only 47 (37%) responded. Of these, 28 of the
respondent trusts claimed that their hospital pharmacies
processed all of the homecare medicines dispensed.
However, Mr Matthews and his colleagues expressed
their concerns that the proportion of hospital-monitored
homecare medicines "may be even lower in the 63% of
trusts that did not respond". They emphasised that "this
situation seriously compromises the validity of large scale
pharmacovigilance studies in the post-licensing phases of
Currently, there is a lack of connection between
hospital prescribing systems and patient clinical records
making it difficult to assess the true incidence of drug-
induced adverse reactions.
While commercial homecare providers are expected
to report suspected ADRs to the UK’s MHRA (via its
Yellow Card Scheme), Mr Matthews and his colleagues
noted that it is imperative to record the source of these
reports (i.e. employer of the reporter) in order to identify
any potential under-reporting.
The current surveillance system for homecare-
delivered medicines "is so weak that it is a ticking time
bomb", and "urgent action is needed to protect both, and
to fully understand the benefit-risk profile of new and
innovative medications", concluded Mr Matthews and
Matthews A, et al. Safety of medicines delivered by homecare companies. BMJ
361: [2 pages], 22 May 2018. Available from: URL: https://doi.org/10.1136/
Reactions 2 Jun 2018 No. 17040114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved