STEPS (Safe Therapeutic Economic Pharmaceutical Selection) is a tool for the rational, safe, evidence-based, cost-effective selection and procurement of medicines and medical devices within a comprehensive professional framework aiming at medicines optimisation. It is one of the most successful projects on integrated medicines management (IMM) developed in Northern Ireland. STEPSelect is a unique tool in which better quality of care is achieved, patient safety is improved and major cost savings are realized. It is important to take into account that medicines management needs both a clinical and a pharmaceutical foundation. Thus from that perspective, the STEPS process was developed in Northern Ireland, the Safe Therapeutic Economic Pharmaceutical Selection method.
In this programme matrix models were used in the first step to identify the most clinically efficacious products within a pharmaceutical class. In the next step of the STEPS process, the packaging of the products selected in the first step was judged in a prospective manner using a standard regionally agreed template. This was then followed by a third step incorporating both procurement and a budget impact analysis. Finally, only the best valued medicines (usually two or three) were chosen as the preferred medicines (and supplier) in Northern Ireland.
The STEPS approach is well accepted by both prescribers and pharmacists because of the fact that product selection is based on quality aspects, such as efficacy, documented effects on end-points, safety, tolerability and ease of use.
The first pilot results with STEPS were discussed in a conference in Northern Ireland, January 2008, organised by the Northern Health and Social Care Trust. Under the motto ‘Quality + Safety = Improvement + Efficiency’, improved health outcomes can also be attained at reduced healthcare costs. The efficiencies achieved by this approach are therefore freed up to allow further investment in healthcare so creating a virtuous circle.