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Holst SS, Møller CH, Vermehren C, Trolle S, Hansen B, Kirkedal ABK, Christensen HR, Jacobsen T, Mathiasen R, Andersen JÞT, Gade C. Establishment of a children's Drugs and Therapeutics Committee to ensure evidence-based and cost-effective medical treatment for children. Br J Clin Pharmacol 2024; 90:378-387. [PMID: 37879905 DOI: 10.1111/bcp.15944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/01/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023] Open
Abstract
The prevalence of undocumented medical treatments among children is a significant issue, as well as many EU countries lack access to newly developed children-friendly medicines. Consequently, there is a pressing need for supplementary resources that can facilitate informed decision-making regarding children's medication. We therefore aim to describe the process of establishing a children's Drug and Therapeutics Committee (cDTC), as well as the preparing and implementation of recommendations for children in the capital region of Denmark. Following the guidelines outlined by the World Health Organization, we established a cDTC, and recommendations for paediatric medication practice were constructed from assessments of medication use patterns among children in the capital region between 2019 and 2021. The recommendations were meticulously crafted based on evaluation of the current marketing authorization landscape and existing best available evidence. In 2019, the capital region established the first cDTC supported by expert councils and an editorial board. A total of 2429 purchase item numbers covering 1 222 846 defined daily doses and 592 088 purchased packages covering 10 200 000 defined daily doses were identified in the secondary and primary sectors, respectively. Three comprehensive lists covering recommendations for newborns and children were published between 2021 and 2020 totaling 331 recommended pharmaceutical products. The recommendations primarily intended for use in the secondary healthcare sector were implemented through the revision of 38 paediatric- and six neonatal product ranges throughout capital region. In conclusion, recommendation lists for children governed by a cDTC provide a rational auxiliary tool that can be immediately implemented in the clinic.
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Affiliation(s)
- Sara Sommer Holst
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Camilla Holten Møller
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Charlotte Vermehren
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark
| | - Stine Trolle
- The Hospital Pharmacy, Copenhagen University Hospital, Copenhagen, Capital Region of Denmark, Denmark
| | - Bente Hansen
- Department of Pediatrics and Adolescents Medicine, Copenhagen University Hospital Northern Zealand, Copenhagen, Denmark
| | - Ann-Britt Kiholm Kirkedal
- Department of Pediatrics and Adolescents Medicine, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Hanne Rolighed Christensen
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Thorkild Jacobsen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - René Mathiasen
- Department of Children and Adolescents Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jón Þór Traerup Andersen
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christina Gade
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Kimbowa IM, Ocan M, Mukonzo J, Nakafeero M, Eriksen J, Stålsby Lundborg C, Ogwal-Okeng J, Obua C, Kalyango J. The role of medicines and therapeutics committees structure in supporting optimal antibacterial use in hospitals in Uganda: A mixed method study. PLoS One 2024; 19:e0289851. [PMID: 38241225 PMCID: PMC10798471 DOI: 10.1371/journal.pone.0289851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/21/2023] [Indexed: 01/21/2024] Open
Abstract
Although the roles of Medicines and therapeutic committees (MTCs) have been expanding, there is limited information on the role of their structure in optimal antibacterial use in hospitals, especially in low-and-middle-income countries. Our study explored the structure and role of MTC in supporting antibacterial use in regional referral, general hospitals and tertiary private not-for-profit (PNFP) hospitals in Uganda. We conducted an explanatory sequential mixed-method approach with triangulation to explore the structure and functional role of MTCs from August 2019 to February 2020 in hospitals in Uganda. Quantitative data was collected using an interviewer-administered questionnaire among chairpersons or secretaries of MTCs and was analysed using descriptive statistics. We conducted key informant interviews using an interview guide among long-term serving members of MTCs to collect qualitative data which triangulated the quantitative data. The study revealed that sixteen hospitals had successfully established MTCs with an average duration of the MTCs' existence of 5.6 (+2.7) years. The membership of the MTCs varied between 7 and 14, with a median value of 10, and the majority of members in MTCs were pharmacists (15 out of 16) and clinical specialists (13 out of 16). The most frequent subcommittees of the 16 hospitals MTC were supply chain (n = 14), antimicrobial stewardship (n = 13), and infection control (n = 12). Majority (14 out of 16) of the MTCs supported availability and access of antibacterial use by selecting and evaluating antibacterials agents for their formulary lists using established criteria. Additionally, 15 out 16 MTCs conducted antimicrobial stewardship activities to support optimal antimicrobial use. In our study, MTC membership and subcommittees were critical structural components that aided the selection and evaluation antibacterials on hospital formulary lists and they supported optimal antibacterial use through implementing various antimicrobial stewardship activities. There is a need for the Ministry of Health to conduct more training on operationalising MTCs structures in all hospitals.
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Affiliation(s)
- Isaac Magulu Kimbowa
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Ocan
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jackson Mukonzo
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mary Nakafeero
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Celestino Obua
- Office of the Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joan Kalyango
- Department of Pharmacy, Makerere University College of Health Sciences, Kampala, Uganda
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Henman MC, Ravera S, Lery FX. Council of Europe Resolution on the Implementation of Pharmaceutical Care-A Step Forward in Enhancing the Appropriate Use of Medicines and Patient-Centred Care. Healthcare (Basel) 2024; 12:232. [PMID: 38255119 PMCID: PMC10815874 DOI: 10.3390/healthcare12020232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Pharmaceutical care was proposed to address morbidity and mortality associated with medicine-related problems. It utilises the pharmacist's expertise in medicines, their relationship with the patient and cooperation with other healthcare professionals to optimise the use of medicines. The European Directorate for the Quality of Medicines & HealthCare (EDQM), part of the Council of Europe, found significant variation in the acceptance of pharmaceutical care and in the implementation of pharmaceutical care in Europe. A multidisciplinary group was established to draft a statement of principles and recommendations concerning pharmaceutical care. Through face-to-face meetings, circulation of draft texts and informal consultation with stakeholders, the group produced a resolution. On 11 March 2020, the resolution was adopted by the Committee of Ministers of the Council of Europe. It explains pharmaceutical care and illustrates pharmacists' contribution to medicine optimisation in different care settings. Pharmaceutical care's value to health services and its place in health policy were emphasised by addressing the risks and harms from suboptimal use of medicines. Pharmaceutical care can improve medicine use, promote rational use of healthcare resources and reduce inequalities in healthcare by realigning the roles and responsibilities of pharmacists and healthcare professionals. EDQM will promote and advocate for the implementation of pharmaceutical care by enacting practice Resolution CM/Res(2020)3.
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Affiliation(s)
- Martin C. Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, D02 PN40 Dublin, Ireland
| | - Silvia Ravera
- European Directorate for the Quality of Medicines and HealthCare (EDQM), Council of Europe, F-67081 Strasbourg, France; (S.R.); (F.-X.L.)
| | - Francois-Xavier Lery
- European Directorate for the Quality of Medicines and HealthCare (EDQM), Council of Europe, F-67081 Strasbourg, France; (S.R.); (F.-X.L.)
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Kabba JA, Koroma MM, James PB, Kitchen C, Xu S, Chang J, Saeed A, Malik UR, Jiang M, Fang Y. Pilot drug and therapeutic committee programme in Sierra Leone: A descriptive mixed method study. Br J Clin Pharmacol 2023; 89:20-33. [PMID: 33398910 DOI: 10.1111/bcp.14716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/30/2020] [Accepted: 11/29/2020] [Indexed: 11/29/2022] Open
Abstract
AIMS Irrational medicine use is a global crisis, but incidences are proportionately higher in low- and middle-income countries such as Sierra Leone. This study explores the structure, functions and challenges of drug and therapeutics committees (DTCs), an intervention towards irrational medicine use recently piloted in Sierra Leone. METHODS A 2-phase mixed-method study design was used in this study. Firstly, a cross-sectional survey was conducted on all pharmacists who have worked for at least 1 year in DTC-piloted hospitals, using an online questionnaire to assess DTCs' structure, indicators and challenges. In phase 2, all eligible pharmacists were invited for a semistructured online interview using the WhatsApp messaging application to get deeper insights into the key issues that emerged from the survey; however, only 5 of the 7 consented to participate. MS Excel 2019 and NVivo version 12 were respectively used for data management and analysis. RESULTS A total of 6 survey responses and 5 interviews were included in the analysis. Participants are pharmacists from the 7 hospitals in Sierra Leone where DTC was piloted. Most DTCs are comprised of a minimum of 10 members consisting of both medical and hospital administrative staff. The main functions of DTCs are ensuring rational medicines use, monitoring and reporting adverse drug reactions. All 7 hospitals with established pilot DTCs have different subcommittees operating at varying functionality levels, ranging from effective to nonfunctional. The main challenges in DTC functions and maintenance are funding (n = 6), DTC decision implementation (n = 4), and unmotivated members (n = 4). Strategies suggested to improve DTCs at public hospitals and nationwide include resource allocation, monitoring and evaluating DTC functions and its members' capacity building. CONCLUSION DTCs present a compelling opportunity towards achieving rational medicines use at the hospital level in Sierra Leone. Nonetheless, the lack of funding and operational resources are significant limitations that must be noted by policymakers before expanding DTC programmes to other hospitals in Sierra Leone.
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Affiliation(s)
- John Alimamy Kabba
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Mark Momoh Koroma
- Department of Epidemiology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, Guangdong, China
| | - Peter Bai James
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Chenai Kitchen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Sen Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Amna Saeed
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Usman Rashid Malik
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
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Yang J, Zheng L, Guan YY, Li PB, Lv YT. Evaluating the effectiveness of drug and therapeutics committees (DTCs) in controlling irrational drug use: A retrospective analysis. J Clin Pharm Ther 2022; 47:995-1001. [PMID: 35233796 DOI: 10.1111/jcpt.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE This study aimed to explore methods to optimize the function of Drug and Therapeutics Committees (DTCs) in controlling irrational drug use. Clinical pharmacologists contribute their specific knowledge and skills to DTCs and help guide rational therapeutics. The DTC is the highest organization of hospital pharmacy management. METHODS From January 2016 to August 2021, the DTC promoted the optimization of clinical drug treatment schemes and reduced unreasonable drug use by improving the organizational framework, clarifying the division of functions, regularly monitoring drug use, organizing expert comments, scientific decision-making and functional intervention. During this time, we statistically analysed typical management cases, irrational drug use and drug cost to evaluate the effectiveness of the DTC's management. RESULTS AND DISCUSSION The DTC's intervention led to a significant reduction in prescribing errors (65.98%, p < 0.05); the intervention acceptance rate increased by 16.37%; and the rate of problem resolution increased by 45.84% (p < 0.05). The level of drug treatment was improved, and the proportion of patients' drug expenses was reduced. WHAT IS NEW AND CONCLUSION The DTC carried out a series of continuous improvement work that played a significant normative role in clinical drug use. Giving more power to the DTCs can significantly improve the level of drug treatment and reduce unreasonable drug use, which reduces unnecessary drug expenses.
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Affiliation(s)
- Jing Yang
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, China.,Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lei Zheng
- Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yu-Yao Guan
- Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Pi-Bao Li
- Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yong-Tao Lv
- Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Larsen LK, Outzen EM, Gazerani P, Plet H. Complexity of Drug Substitutions Caused by Drug Tenders: A Mixed-Methods Study in Denmark. Hosp Pharm 2021; 56:314-320. [PMID: 34381267 PMCID: PMC8326852 DOI: 10.1177/0018578719894980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The objective of this study was to investigate factors influencing the complexity of drug substitutions caused by drug tenders in a Danish hospital setting. Methods: A sequential explanatory mixed-methods approach was employed. In the first phase, a custom-made, self-administered questionnaire was distributed to 58 pharmacists and pharmaconomists employed at the Hospital Pharmacy in the North Denmark Region. The questionnaire consisted of 13 questions, which helped to obtain quantitative information on factors complicating drug substitutions. The results were used to inform the construction of an interview guide for a focus group interview held in the following qualitative second phase of the study. The focus group included 11 pharmacists and pharmaconomists from the Hospital Pharmacy in the North Denmark Region working with drug substitutions. The focus group interview was conducted to facilitate validation of results from the questionnaire survey and to add further perspectives on identified factors influencing the complexity of drug substitutions. Results: Findings from both phases of the study revealed that implementation of drug substitutions is more complex when drug strength or pharmaceutical form of a drug changes, compared with changes of drug trade name or package size. Furthermore, it was established that Anatomical Therapeutic Chemical classification codes could be used to identify drug substitutions that are typically complex, for example, L01 and N05. Several external factors were also found to influence implementation of drug substitutions, for example, related to drug usage, number of end users, and hospital wards. Conclusions: From a hospital pharmacy point of view, multiple factors were identified that could influence and complicate the implementation of drug substitutions with different impact size. Those factors included both changed characteristics of drugs, Anatomical Therapeutic Chemical classification codes involved in substitution, and external factors.
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Affiliation(s)
- Lina Klitgaard Larsen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | | | - Parisa Gazerani
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Hanne Plet
- Hospital Pharmacy of the North Denmark Region, Aalborg, Denmark
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Matlala M, Gous AGS, Meyer JC, Godman B. Formulary Management Activities and Practice Implications Among Public Sector Hospital Pharmaceutical and Therapeutics Committees in a South African Province. Front Pharmacol 2020; 11:1267. [PMID: 32973508 PMCID: PMC7466677 DOI: 10.3389/fphar.2020.01267] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/31/2020] [Indexed: 02/03/2023] Open
Abstract
Introduction The World Health Organization identified Pharmaceutical and Therapeutics Committees (PTCs) at district and hospital levels as one of the pivotal models to promote rational use of medicines (RUM). This is endorsed by the Government in South Africa. Formulary development and management is one of the main functions of PTCs. This study aimed to describe the formulary management activities among PTCs in public hospitals in Gauteng Province, South Africa, following initiatives to promote RUM in South Africa. Methods Qualitative, nonparticipatory, observational study, observing 26 PTC meetings. Data were coded and categorized using NVivo9® qualitative data analysis software. Themes and sub-themes were developed. The themes and sub-themes on formulary management are the principal focus of this paper. Results More than half of the observed PTCs reviewed their formulary lists. There was variation in the review process among institutions providing different levels of care. Various aspects were considered for formulary management especially requests for medicines to be added. These included cost considerations (mainly focusing on acquisition costs), evidence-based evaluation of clinical trials, patient safety, clinical experience and changes in the National Essential Medicines List (NEML). The tertiary PTCs mostly dealt with applications for new non-EML medicines, while PTCs in the other hospitals mainly requested removal or addition of EML medicines to the list. Conclusion This is the first study from Gauteng Province, South Africa, reporting on how decisions are actually taken to include or exclude medicines onto formularies within public sector hospitals providing different levels of care. Various approaches are adopted at different levels of care when adding to- or removing medicines from the formulary lists. Future programs should strengthen PTCs in specialized aspects of formulary management. A more structured approach to formulary review at the local PTC level should be encouraged in line with the national approach when reviewing possible additions to the NEML.
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Affiliation(s)
- Moliehi Matlala
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-rankuwa, South Africa
| | - Andries G S Gous
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-rankuwa, South Africa
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-rankuwa, South Africa
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-rankuwa, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Alefan Q, Alshareef S, Al-Shatnawi S. Drug and therapeutics committees in Jordanian hospitals: a nation-wide survey of organization, activities, and drug selection procedures. Pharm Pract (Granada) 2019; 17:1590. [PMID: 31897253 PMCID: PMC6935542 DOI: 10.18549/pharmpract.2019.4.1590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/06/2019] [Indexed: 11/14/2022] Open
Abstract
Background Drug and Therapeutics Committees (DTCs) were founded about a century ago as a guide for dealing with drugs in hospitals. Since then, it has shown a vital role in rational drug use in terms of regulatory and educational activities. Objective To describe structures, functions, and activities of hospital DTCs. Methods A questionnaire was developed based on previous studies. Questions consisted of information on respondents' demographics; structures, functions, and activities of DTCs; drug selection process and resources used, and factors and criteria used in drug selection. Results The overall response rate was 95%. DTCs were mainly present in most large hospitals (45%). All DTCs had hospital pharmacists in their structure and most of them (66%) met monthly. The main responsibilities of DTCs were related to general prescribing policies. The number, frequency, and severity of adverse drug reactions were the most reported criteria for the drug selection process. Legal implications for practical, economic, and organizational factors were the most important factors that were reported for drug selection. Conclusions DTCs are mainly present in most large hospitals. The main responsibilities of the DTC in Jordanian hospitals are general prescribing policies, drug selection, hospital formulary editing, and reporting of ADR to external authorities.
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Affiliation(s)
- Qais Alefan
- PhD. Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. Irbid (Jordan).
| | - Somayya Alshareef
- MSc. Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. Irbid (Jordan).
| | - Samah Al-Shatnawi
- PhD. Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. Irbid (Jordan).
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Friesen P, Caplan AL, Miller JE. Managing conflicts of interest in pharmacy and therapeutics committees: A proposal for multicentre formulary development. J Clin Pharm Ther 2019; 45:249-255. [PMID: 31657022 DOI: 10.1111/jcpt.13067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/27/2019] [Accepted: 09/23/2019] [Indexed: 01/23/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE While many countries have central agencies responsible for formulary development, within the United States, each hospital, health care system, or insurance provider has their own pharmacy and therapeutic committee, leading to both inefficiencies and inequalities across formularies. The number and variety of processes within pharmacy and therapeutic committees also increases the likelihood that conflicts of interest will influence the development of formularies. We sought to determine how such influences could be reduced by reviewing international evidence related to the presence and harms of conflicts of interest in formulary development. METHODS Several approaches have been taken to reduce the influence of conflicts of interest in pharmacy and therapeutics committee processes, including include disclosure, recusal, exclusion, universal consideration and dual committees. The feasibility of each of these approaches is considered in the context of the United States. RESULTS AND DISCUSSION A proposal is drawn from the discussion of various approaches to conflicts of interest in pharmacy and therapeutics committees: multicenter formulary development. WHAT IS NEW AND CONCLUSION Multicentre formulary development, where resources are pooled across institutions, may lead to a reduction in the influence of conflicts of interest in pharmacy and therapeutics committee processes in the United States, increasing the chances of including the most safe, efficacious and cost-effective drugs on formularies.
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Affiliation(s)
- Phoebe Friesen
- Biomedical Ethics Unit, Department of Social Studies of Medicine, McGill University, Montreal, QC, Canada
| | - Arthur L Caplan
- Division of Medical Ethics, NYU School of Medicine, New York, NY, USA
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Schiff GD, Tripathi JB, Galanter W, Paek JL, Pontikes P, Fanikos J, Matta L, Lambert BL. Drug formulary decision-making: Ethnographic study of 3 pharmacy and therapeutics committees. Am J Health Syst Pharm 2019; 76:537-542. [DOI: 10.1093/ajhp/zxz022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Gordon D Schiff
- Center for Patient Safety Research and Practice, Brigham and Women’s Hospital, Boston, MA
| | - Jaya B Tripathi
- Center for Patient Safety Research and Practice, Brigham and Women’s Hospital, Boston, MA
| | - William Galanter
- Department of Pharmacy Practice and Pharmacy Systems, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Jamie L Paek
- College of Pharmacy, University of Illinois at Chicago College of Medicine
| | - Pam Pontikes
- Center for Education and Research on Therapeutics, John H. Stroger Hospital of Cook County, Chicago, IL
| | - John Fanikos
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA
| | - Lina Matta
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA
| | - Bruce L Lambert
- Center for Communication and Health, Northwestern University, Chicago, IL
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11
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Mashaba TP, Matlala M, Godman B, Meyer JC. Implementation and monitoring of decisions by pharmacy and therapeutics committees in South African public sector hospitals. Expert Rev Clin Pharmacol 2018; 12:159-168. [PMID: 30407089 DOI: 10.1080/17512433.2018.1545572] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The National Drug Policy in South Africa has achieved its objective in establishing and strengthening Pharmacy and Therapeutics Committees (PTCs) in public sector hospitals. However, little is known about the implementation of decisions by PTCs and the monitoring thereof. Consequently, there is a need to investigate this. Areas covered: We sought to address this via an online survey distributed to pharmacists working in public sector hospitals across South Africa with perceived functioning PTCs, with a 32.3% response rate to the survey. Expert commentary: Membership of all PTCs included a pharmacist, who in most cases (51.2%) held the secretariat position. Principal PTC activities were encouraging rational medicine use (RMU) (86.0%), pharmacovigilance (82.6%) and implementing standard treatment guidelines (STGs) (77.9%). Only a third (37.5%) stated that they were using indicators to monitor PTC performance. Where collected, indicator data were mostly used for providing feedback to PTCs (83.3%). Most hospitals (95.1%) implemented PTC decisions; however, 62.0% mentioned guidelines on implementing PTC decisions did not exist in their hospital. The majority of respondents (65.4% and 83.8%, respectively) indicated PTC decisions were evaluated and reviewed in their hospitals. Overall, a high percentage of respondents stated the main activities of PTCs were to enhance RMU as well as implement STGs. However, guidelines on implementation of decisions by PTCs are currently lacking and most PTCs were not monitoring their performance. This needs to be addressed.
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Affiliation(s)
- Tsakane P Mashaba
- a Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa
| | - Moliehi Matlala
- a Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa
| | - Brian Godman
- a Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa.,b Strathclyde Institute of Pharmacy and Biomedical Sciences , Strathclyde University , Glasgow , UK.,c Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet , Karolinska University Hospital Huddinge , Stockholm , Sweden.,d Health Economics Centre , University of Liverpool Management School , Liverpool , UK
| | - Johanna C Meyer
- a Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa
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Matlala M, Gous AG, Godman B, Meyer JC. Structure and activities of pharmacy and therapeutics committees among public hospitals in South Africa; findings and implications. Expert Rev Clin Pharmacol 2017; 10:1273-1280. [PMID: 28776442 DOI: 10.1080/17512433.2017.1364625] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The WHO identified Pharmacy and Therapeutics Committees (PTCs) as a pivotal model to promote rational medicine use in hospitals. This matches a key South African (SA) government objective to establish PTCs in all hospitals to ensure rational, efficient and cost-effective use of medicines. However, documentation on the functionality of PTCs in public hospitals in SA is limited. Areas covered: This study aimed to address this. A 3-phased mixed methods approach involving questionnaires, observations of PTC meetings and semi-structured interviews was used. The findings were converged during the interpretation phase. Expert commentary: Most professionals were represented in the PTCs, with variations across hospitals. Membership of PTCs included a pharmacist, who in the majority of cases was the secretary. PTC activities included dissemination of decisions (100%) and formulary management (89.5%). However, reporting of adverse drug reactions (ADRs) and medication errors was typically poor at all hospital levels. Lack of expertise of pharmacoeconomic analysis and evidence-based decision-making in formulary management was identified as a key challenge in formulary management. In conclusion, future programmes should strengthen PTCs in specialised aspects of formulary management. Further training in the principles of pharmacovigilance is needed to enhance ADR reporting, as well as to ensure compliance with both WHO and provincial guidelines.
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Affiliation(s)
- Moliehi Matlala
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Pretoria , South Africa
| | - Andries Gs Gous
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Pretoria , South Africa
| | - Brian Godman
- b Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.,c Department of Laboratory Medicine, Division of Clinical Pharmacology , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden.,d Health Economics Centre , Liverpool University Management School, Liverpool University , UK
| | - Johanna C Meyer
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Pretoria , South Africa
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Larsen MD, Schou M, Kristiansen AS, Hallas J. The influence of hospital drug formulary policies on the prescribing patterns of proton pump inhibitors in primary care. Eur J Clin Pharmacol 2014; 70:859-65. [PMID: 24770928 DOI: 10.1007/s00228-014-1681-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 04/07/2014] [Indexed: 01/02/2023]
Abstract
AIM This study had two aims: Firstly, to describe how prescriptions for proton pump inhibitor (PPI) in primary care were influenced by a change of the hospital drug policy, and secondly, to describe if a large discount on an expensive PPI (esomeprazole) to a hospital would influence prescribing patterns after discharge. METHODS This register study was conducted at Odense University Hospital, Denmark, and by use of pharmacy dispensing data and a hospital-based pharmacoepidemiological database, the medication regimens of patients were followed across hospitalisation. The influence of hospital drug policy on prescribings in primary care was measured by the likelihood of having a high-cost PPI prescribed before and after change of drug policy. RESULTS In total, 9,341 hospital stays in 2009 and 2010 were included. The probability of a patient to be prescribed an expensive PPI after discharge decreased from 33.5 to 9.4%, corresponding to a risk ratio of 0.28. In primary care after discharge, 13.4% of esomeprazole use was initiated in the hospital, and this was 8.4% for PPIs in general. After the change of hospital drug policy, this decreased to 6.5% for esomeprazole and increased for the recommended PPIs pantoprazole and lansoprazole to 14.6 and 26.1%, respectively. The effect of a large discount on expensive PPI to hospital was 14.7%, and this decreased to 2.6% when coordinating drug policy in hospital and primary care. CONCLUSION The likelihood of having an expensive PPI prescribed after hospital stay decreased when coordinating drug policy and the influence of a large discount to hospital could be minimised.
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Affiliation(s)
- Michael Due Larsen
- Faculty of Health Sciences, Institute of Public Health, Clinical Pharmacology, University of Southern Denmark, J. B. Winsløwsvej 19, 2. sal, Odense M, 5000, Denmark,
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Lima-Dellamora EDC, Caetano R, Gustafsson LL, Godman BB, Patterson K, Osorio-de-Castro CGS. An analytical framework for assessing drug and therapeutics committee structure and work processes in tertiary Brazilian hospitals. Basic Clin Pharmacol Toxicol 2014; 115:268-76. [PMID: 24528496 DOI: 10.1111/bcpt.12215] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/03/2014] [Indexed: 12/25/2022]
Abstract
University teaching hospitals usually provide tertiary care and are subject to early adoption of new technologies, which may compromise healthcare systems when uncritically adopted. Knowledge on the decision-making process - drug selection by drug selection committees or DTCs - is crucial to improve the quality of care. There are no models for studying the selection of drugs in Brazilian healthcare services. This study aims to discuss DTC structure and the processes regarding adoption of medicines in tertiary university hospitals in Brazil and to propose an analytical structure for providing direction for the future. State of the art content regarding drug selection processes and DTC procedures was reviewed in three databases. Information on the medicine selection process in a Brazilian gold standard teaching hospital was collected through observations and a review of existing procedures. A structured discussion on medicine selection and DTC procedures in tertiary hospitals ensued. This discussion resulted in findings that were organized in three dimensions, composing an analytical framework for the application in tertiary Brazilian hospitals (i) motivations for the adoption of drugs; (ii) necessary structural and organizational aspects for decision-making; and (iii) criteria and methods employed by the decision-making process. We believe that the suggested framework is compatible with tertiary Brazilian hospitals, because a gold standard in the country was able to conduct all its procedures in the light of WHO and international recommendations. We hope to contribute in producing knowledge which may hopefully be adopted in tertiary hospitals across Brazil.
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Affiliation(s)
- Elisangela da Costa Lima-Dellamora
- School of Pharmacy, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Sergio Arouca National School of Public Health, Post-Graduate Program -Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Plet HT, Kjeldsen LJ, Christensen RDP, Nielsen GS, Hallas J. Do educational meetings and group detailing change adherence to drug formularies in hospitals? A cluster randomized controlled trial. Eur J Clin Pharmacol 2013; 70:109-16. [PMID: 24077960 DOI: 10.1007/s00228-013-1589-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to examine whether educational meetings and group detailing could increase the use of drugs from the ward lists or the drug formulary in hospitals. METHODS Twelve medical wards from two hospitals were randomized into three groups: control, basic and extended intervention. All wards had a ward list review before interventions. Moreover, the basic intervention consisted of an educational meeting, and the extended intervention included two group detailing sessions. The proportion of drugs used from the ward list or hospital drug formulary (HDF) was the primary outcome. Data (defined daily doses [DDDs], numbers and cost [Euros]) on drugs sold to the wards were retrieved from the two hospitals from 1 July 2011 to 31 August 2012. BASELINE DATA from July to September 2011, and follow-up data: from June to August 2012. RESULTS The proportion of formulary drugs used increased for the extended intervention group (0.04, range -0.02 to 0.09) and basic intervention group (0.03, range -0.03 to 0.09) in comparison with a decrease in the control group (-0.01, range -0.03 to -0.02). The interventions did not significantly change odds for selecting drugs from the formulary in comparison with the control group (basic intervention: OR 1.09 [95 % CI 0.81 to 1.46]; extended intervention: OR 1.00 [95 % CI 0.75 to 1.35]). CONCLUSIONS In this study, educational meetings and group detailing do not significantly improve adherence to ward lists or HDF. The adherence to the formularies at baseline was relatively high, which may explain why the interventions did not have a significant effect.
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Plet HT, Hallas J, Kjeldsen LJ. Adherence to hospital drug formularies and cost of drugs in hospitals in Denmark. Eur J Clin Pharmacol 2013; 69:1837-43. [PMID: 23765410 DOI: 10.1007/s00228-013-1540-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate adherence rates to hospital drug formularies (HDFs) and cost of drugs in hospitals. METHODS Data on drugs used during 2010 were analyzed for ten hospitals (two hospitals from each of the five regions), constituting 30 % of hospitals and 45 % of hospital beds in Denmark. Drug use data from individual hospitals were retrieved from the hospital pharmacies. Adherence to the HDFs was analyzed for selected substances characterised by extensive use both in primary and secondary sectors (ATC codes A10, B03, C03, C07, C08, C09, C10, J01, N02, N05 and R03). Within each group, we also identified the drugs constituting 90 % of the volume (= DU90%) and the adherence to the HDF in this segment (Index of Adherence). RESULTS Substances used by hospitals varied between 598 and 1,093. The proportion of used substances that were on the HDF varied between 14 % and 44 %. University hospitals used a significantly higher total number of substances (median 165 vs. 139, p = 0.019) and cost/DDD [(median 5 vs. 2 Euros, p = 0.033), p = 0.033] in the DU90% segment than the regional hospitals. Index of adherence varied between 43 % and 91 %. For the selected ATC codes, the index of adherence was between 76 % and 100 %. CONCLUSIONS Adherence to the selected ATC groups was high, which means that the most commonly used substances are included in the HDFs, even though a variation existed. A large variation existed between the hospitals in the number of substances at HDFs.
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Affiliation(s)
- Hanne T Plet
- Department of Clinical Pharmacology, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsloews Vej 19,2, 5000, Odense, Denmark,
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