Barriers to implementing pharmacoeconomics: interview study.

Background: Pharmacoeconomics estimates the value of pharmaceutical products and services and provides healthcare decision-makers with valuable information. Pharmacoeconomic evaluations have not been found to be influential in the Jordanian health care system. Although pharmacoeconomics as a concept is becoming more recognized in the pharmaceutical world, there are still some barriers to its implementation. Objective: To establish the perceived barriers to the implementation of pharmacoeconomics in Jordan. Method: A qualitative study with semi-structured interviews was conducted. Participants were chosen if they might benefit from the application of pharmacoeconomics; such as members of Pharmacy and Therapeutics Committees (PTCs) in public, private, and teaching hospitals; administrative pharmacists on drug pricing committees; those who produce pharmacoeconomic data such as academics; and administrative pharmacists in the Joint Procurement Department (JPD). The interviews were recorded and transcribed. Transcripts were analyzed using a thematic analysis approach. Result: Three main barriers to the implementation of pharmacoeconomics were identified. These were related to the nature of the decision-making process, the lack of pharmacoeconomic data, and inadequate knowledge about pharmacoeconomics. Conclusion: The current use and impact of pharmacoeconomic evaluations in Jordanian healthcare decision-making is restricted, in part, due to the barriers outlined by the respondents.

Drug Selection for Formulary Inclusion: An Exploratory Case Study of Oncology Medicines in Jordan.

BACKGROUND: Access to healthcare services including innovative treatments is one of the most important objectives of healthcare system in Jordan. This research summarized one of the actual practices pertaining to health priority setting in Jordan with official requirement to use cost-effectiveness analysis. OBJECTIVES: To address the role of economic evidence to inform the decisions and rationales drawn by health policy experts to optimize resources mobilization for new cancer drugs. METHOD: The research reported a case study of formulary setting priority in Jordan. Documentary collation and analysis of a secondary source (meeting minutes) produced by decision committee were conducted by the research team. The decisions and rationales shaped by panelists for 22 newly registered oncology drugs at Jordan Food and Drug Administration were reviewed and described. RESULTS: It was found that the absence of official health economic guidelines in the country and informal use of cost-effectiveness analysis by the panelists appeared to flaw the importance of incremental cost-effectiveness ratio (ICER). Nevertheless, "the lower the ICER, the better the drug" was the primary factor in all committee's decisions to inform resources mobilization. Despite of the latter, 7 drugs were selected for formulary inclusion for different oncology disease areas in Jordan. CONCLUSIONS: Priority setting for new cancer drugs is not well-informed in Jordan. Nevertheless, this research revealed different disadvantages that appear to militate against the perspective of the study. Recommendations for implementation and enhancement of health economic evaluation include further investment in capacity building (eg, prepare qualified health economists) and create incentive to improve availability and accessibility of local data.

Implementation and monitoring of decisions by pharmacy and therapeutics committees in South African public sector hospitals.

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.

Hospital pharmacy services in the Pacific Island countries.

RATIONALE, AIMS AND OBJECTIVES: Non-communicable diseases have become an increasing problem in the Pacific Island countries (PICs). With the medical supply system often attached to hospitals in PICs, the training of hospital pharmacy staff has become increasingly important. This study aimed to explore hospital pharmacy services in the PICs using these validated surveys (BS26-27 and BS28-31 surveys) focusing upon hospital pharmacists' influence on prescribing and quality use of medicines. METHOD: The BS26-27 and BS28-31 surveys were distributed online to pharmacy directors in hospitals in the PICs in 2011 and 2013, respectively. Surveys were made available in both English and French. RESULTS: In total, data from 55 hospitals were received (77% of the hospital sample in PICs) for either the BS26-27 or BS28-31 survey. From the responses received, 97% (36/37) of hospitals had a formulary, with 81% (26/32) of hospitals having a Pharmacy and Therapeutics (P&T) committee. Furthermore, 67% (24/36) of respondents stated that they provided some sort of clinical pharmacy service. On average, hospitals had two pharmacists involved in clinical pharmacy services. In BS28-31, over 75% (n=27) of respondents believed having a strong relationship with other health care professionals, having effective communication skills and taking professional responsibility for the medicines prescribed as 'mostly' or 'strongly' facilitating clinical services. CONCLUSIONS: Hospital pharmacists' participation on P&T committee and clinical services is common in the PICs. Such services enhance medication selection and reduce wastage. Although there are still too few hospital pharmacists in PICs, additional support aimed at enhancing their team building and communication skills will allow them to expand their roles and continue to improve patient health outcomes.

Formulary systems and pharmacy and therapeutics committees in the Western Pacific Region: exploring two Basel Statements.

PURPOSE: The use of formulary systems and pharmacy and therapeutics (P&T) committees in the Western Pacific Region (WPR) and the factors associated with their use were explored. METHODS: Minor additions were made to a previously validated survey and reviewed by a WPR advisory committee. The Basel Statements 26 and 27 survey was made available in eight languages and sent electronically to 1989 hospital pharmacy directors through respective hospital pharmacy associations in the WPR. RESULTS: A total of 797 responses (40%) from 34 nations were received. Of these responses, 87% of hospitals (691 of 797) used a formulary. Also, 93% of respondents (619 of 664) indicated that their hospital had a P&T committee. However, only 44% of respondents (274 of 626) reported that more than half of their formulary medicines were linked to standard treatment guidelines. Furthermore, only 41% of hospitals (247 of 601) had a policy for off-label medication use. The pharmacy directors' perceived benefits of formularies were correlated with having more formulary medicines linked to standard treatment guidelines, basing their use on the best available evidence, and having a policy for the use of off-label medicines. CONCLUSION: A large proportion of hospitals in the WPR have implemented formularies and P&T committees. Although formularies are commonly used, their effectiveness may be limited, as formularies are often not linked to standard treatment guidelines or the best available evidence.

Describen la experiencia cubana en el uso racional de medicamentos en pediatría / Improving children´s medicines: cuban experience of rational drug therapy

La legislación europea y norteamericana debería mejorar la información sobre la que se basa la medicina para realizar prescripciones a los niños. La utilización de fármacos en relación con esos datos se denomina uso racional de medicamentos. En muchos hospitales se establecieron Comités Fármaco-Terapéuticos para intentar mejorar la utilización de medicamentos. Se ilustra la tarea de un Comité Fármaco-Terapéutico en un hospital pediátrico de Camag³ey, Cuba, para destacar lo que es posible lograr. El uso inapropiado de antibióticos es uno de los mayores problemas, tanto en el hospital como en la poblacion. El control de la utilización de antibióticos junto con la creación de protocolos y la educación puede resultar en una terapia con antibióticos más racional. Los antibióticos son sólo un ejemplo de un grupo de medicamentos cuya prescripción puede mejorarse. Los Comités Fármaco-Terapéuticos pueden desempeñar un papel fundamental para asegurar que los niños reciban medicamentos de forma segura en las condiciones apropiadas.(AU)

Una encuesta sobre las opiniones de los estudiantes de la Universidad Abierta en Estonia / A survey of pharmacy students’ opinions at the Open University in Estonia

En 2004, además de los 37 estudiantes de la Universidad de Tartu que terminaron los estudios a tiempo completo, obtuvieron el título de farmacéutico también los primeros 64 auxiliares de farmacia de la Universidad Abierta (enseñanza a distancia), que ya realizaban el trabajo de auxiliar farmacéutico durante los estudios. Su formación de auxiliar farmacéutica la obtuvieron en la escuela profesional superior. Después de 3,5 años de estudios universitarios, se hizo una encuesta anónima para descubrir su opinión sobre los estudios cursados. La mayoría de los estudiantes, tanto los de la escuela profesional superior como los de la Universidad, fueron estimulados para estudiar Farmacia por sus padres, amigos, conocidos o colegas. Entre las motivaciones principales para entrar en la universidad se destacan la oportunidad de recibir un sueldo más alto y mejores posibilidades de promoción. Por lo general, están contentos con la organización de los estudios, el nivel de los conocimientos adquiridos, la instrucción recibida y los materiales de estudio. Casi la mitad reconoce que sería adecuado realizar un cambio respecto a los bloques de asignaturas en el plan de estudios – desean, en general, reducir el volumen de asignaturas basadas en química. La Universidad Abierta proporciona una buena oportunidad de formación a nivel universitario, partiendo de la base de los estudios de auxiliares de farmacia y permite este grado de formación sin límite de edad. La presente encuesta de evaluación constituye una base para la creación de un sistema de valoración y de garantía de la calidad de estudios. Esto ayuda a desarrollar el currículo de Farmacia

In the year 2004, in addition to the 37 full-time students who graduated from the University of Tartu, the first 64 are already working as pharmacist’s assistants have received their pharmacy education in the Open University (distance learning). Their pharmaceutical education comes from the professional school. After 3.5 years of studying at the university, an anonymous survey was carried out to find out the students’ opinions about the program they graduated from. The students, both in professional school and in university, have received the impulse to study pharmacy from their parents, friends or colleagues. The main motivations for entering the university were the opportunity of higher salary, and better opportunities of promotion. The students are predominately satisfied with the level of the organisation of the studies, teaching and the study aids. Almost half of the students consider it right to change the proportions of the modules in the curriculum – they wish to reduce the importance of the subjects based on chemistry. The Open University is a good opportunity to prepare pharmacists with university education on the basis of the education of the pharmacist’s assistant and enables life-long learning without age limits. The survey, as feedback, is the basis of creating a system for evaluating and ensuring the quality of the studies. This enables the development of the curricula of pharmacy

Factors that influence prescribing decisions.

BACKGROUND: Strategies to control the quality and cost of medication use are largely dependent on the ability to alter selection of medications. Previous models of prescribing behavior have focused on physicians. In the hospital setting, clinical pharmacists and formulary committee members are also key players in drug therapy decision-making. Differences between physicians, formulary committee members, and clinical pharmacists have not been compared. Knowledge of these differences could have importance in predicting the effectiveness of strategies designed to influence drug use in this setting. OBJECTIVE: To describe and compare the opinions of physicians, clinical pharmacists, and formulary committee members with respect to key factors that influence medication prescribing in community hospitals. METHODS: Physicians, clinical pharmacists, and formulary committee members were solicited to participate. A trained interviewer administered a standardized questionnaire designed to elicit opinions of participants regarding the importance of factors thought to influence drug prescribing. Responses were described using descriptive statistics, and differences between the groups were determined by post hoc analysis. RESULTS: A total of 150 individuals participated in the study. Safety, effectiveness, formulary status, and restrictions on prescribing were considered highly influential by all participants. Physicians rated the availability of drug samples and personal experience higher (more influential on prescribing) than clinical pharmacists and formulary committee members. Clinical pharmacists and formulary committee members rated the influence of recommendations by clinical pharmacists, prescribing guidelines, and cost or cost comparisons higher than physicians. Factors that were drug-related or that involved policy-related programs tended to be more influential than indirect factors. CONCLUSIONS: Those who seek to implement programs to alter medication use should recognize and employ factors that are most influential in the decision-making process. Further, it may be important to consider differences that exist between key participants in the medication use process.

Diffusion of innovation II: Formulary acceptance rates of new drugs in teaching and non-teaching British Columbia hospitals--a drug development perspective.

Diffusion theory was used to examine differences in adoption rates of new drugs by British Columbia teaching and non-teaching hospitals. Surveys were mailed in September 1990 to 41 hospital pharmacies (response rate = 88%), requesting hospital pharmacy directors to provide formulary inclusion dates of 29 study drugs marketed between July 1987 and March 1990. Of the 36 initial responses, 31 were suitable for further analysis and these were surveyed again in April 1993 (response rate = 100%) as to the formulary status of drugs not initially approved. The second survey ensured that all study drugs would have at least 36 months on the Canadian market when determining formulary acceptance times. Of the 29 study drugs, six were not approved for use in any of the 31 study hospitals. The six teaching hospitals had a median formulary approval time of 8.0 months compared to 12.8 months in the 25 non-teaching hospitals for the 23 study drugs. Although 21 of 23 study drugs were approved for use earlier in teaching hospitals than non-teaching hospitals, only alfentanil was found to be adopted significantly earlier (U = 11, n1 = 5, n2 = 19, alpha = 0.05). Variations in formulary approval times for new drugs have a bearing on patient care, Pharmacy and Therapeutics Committees, hospital budgets, and pharmaceutical firm revenues.

Drug and therapeutics committees: the relationships among structure, function, and effectiveness.

Reported are the results of a national study of Australian hospitals that assessed the effectiveness of drug and therapeutics committees (DTCs), identifies factors that influence effectiveness, and recommends methods to improve effectiveness. Data were collected by questionnaires sent to 184 hospital directors of pharmacy and a subset of 53 chairpersons of DTCs. Response rates were 88.6% and 84.9%, respectively. Membership, chairperson, secretary, meeting frequency, and decision-making functions were analysed by hospital bed numbers and compared with standard accepted literature criteria and previous study findings. A comparison of pharmacist and chairperson perception as to the weakest aspect of DTCs in attaining rational therapy revealed widely differing views, based on factors outside respondents' own control. Perceptions of resources required to overcome DTC weakness also varied between the two groups. No statistically significant association was found between the assessment of outcome of DTC activities (influence on pharmacy management, hospital policy, medical management, and prescribing) and structural variables such as DTC objectives, chairperson, reporting relationship, meeting frequency, and hospital size or type. The results challenge widely held assumptions of the association between DTC effectiveness and structural variables. Further study of structural and cultural variables, which might determine effectiveness, is required.

Drug-use evaluation programs in short-term-care general hospitals.

The results of a survey to assess drug-use evaluation (DUE) programs in short-term-care general U.S. hospitals are reported. During February 1992, questionnaires were mailed to pharmacy directors at 491 randomly selected short-term-care general hospitals with 100 or more beds. The questionnaire was designed to collect information on the characteristics of surveyed hospitals and their pharmacies, DUE program characteristics, and the perceptions of pharmacists about the DUE programs. The net response rate was 66.6% (327 usable replies). Pharmacists involvement in DUE program activities was found to be very high, with two thirds of respondents indicating they participated in all five ASHP-recommended activities. Pharmacists rated the effectiveness of current DUE programs as moderate, while the importance of pharmacist participation was perceived to be very high. Pharmacists were members of 97.9% of the respondents' DUE committees, but only 65.5% of the pharmacist members held voting privileges. Pharmacists reported devoting an average of 11.27 hours weekly to DUE-related tasks. Reasons used to select drugs for DUEs, interventions employed, uses of DUE results, and methods of evaluating the effectiveness of DUE programs all varied widely. In short-term-care general hospitals with 100 or more beds, pharmacists assigned to DUE activities were highly involved in DUE committees and programs. The effectiveness of these activities needs to be assessed in more detail.