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Since the 1990s there has been a focus on increasing the clinical quality and financial efficiency of prescribing in primary care. In 1994, an Audit Commission report suggested that more rational prescribing by general practitioners ‘will lead both to better quality care for patients and to major economies in drug expenditure.’1 The report highlighted areas where savings could be made and recommended greater use of generic prescribing and the more contentious option of therapeutic substitution, which involves transferring patients from expensive drugs to much cheaper ones usually within the same class. Therapeutic substitution is not straightforward and requires careful input and follow-up from clinicians and patients to ensure that it is undertaken safely, effectively and without adversely affecting patient care.1 Examples of cost-saving therapeutic substitutions that have previously been promoted in primary care include transferring people from higher cost H2-receptor antagonists, proton pump inhibitors, diuretics, nitrates, alpha-adrenoceptor blocking drugs and statins to much lower cost options within …
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