Prescribers' formularies and rational drug use - abstract

ABSTRACT

Traditional formularies were comprehensive "recipe books". As a result of initiatives of the Pan American Health Organisation, five Caribbean countries created National Formularies which were merely limited lists of from 400 (St. Vincent) to 850 (Jamaica) chemical entities. These lists often bore little relation to drugs available, and initially had little impact on prescribing. In 1989, Barbados established an effective Formulary Committee, with mechanisms for annual revision of a National Formulary. The third edition was a "Prescribers' Formulary", with guidance on selection and prescribing of drugs; a twelfth edition appeared in 1990. The Eastern Caribbean Drug Service produces a similar formulary for the members of the OECS (Organisation of Eastern Caribbean States). The impact of both formularies on local prescribing has been increasing steadily. A Drug Utilisation Review (DUR) Pilot Study was carried out at major private Bridgetown pharmacies early in 1991, to assess the extent of use of formulary drugs and Benefit Service schemes. Fifty-one percent of all scripts were for benefit Service items (free for patients of certain ages, under 16 or over 65, or with certain chronic diseases or cancer). Seventy-four per cent of all prescribed items were for formulary drugs. Of the remaining 26 per cent, 6 per cent were the same generic name but a different brand from the formulary drug. These figures show that the Barbados National Formulary markedly influences prescribing practices, including use of generic names and the learning of new brand names associated with lower cost and locally manufactured drugs. The promotion of rational drug use at lower cost depends on an effective formulary process, and a respected prescribers' formulary. The essential components are a restricted list (never more than 500 drugs), use of generic names, rigorous testing of quality (there is a Caribbean Regional Drug Testing Laboratory in Jamaica), continuity of selection of drugs for chronic diseases, a "cost effective" approach, participation of health professionals in drug selection and protocols and, above all, recognition by all of the formulary as a national guide to rational drug use. The failure of most Caribbean countries to develop national drug policies or effective formularies is due both to the lack of appropriately trained professionals and to the failure of Governments and health planners to recognise these principles (AU)