Transcript Sirjana Pant

Hospital Formularies
Decision-Making Process
a CADTH Environmental Scan
Kathleen Kulyk
Liaison Officer – Saskatchewan
on behalf of Sirjana Pant
2015 CADTH Symposium
April 13, 2015
Background
 Pharmacy and Therapeutics Committees function at various
levels to make formulary decisions
 Independent process resulting in variations in formularies
 More collaboration in recent years to
enhance continuity of care,
ensure equality of services, and
improve the ability to align the hospital formulary with
the publicly funded provincial outpatient drug program
1
Introduction
Survey-based Environmental Scan
- Level of awareness and use of CADTH products and
services at Canadian health authorities and hospitals.
- Identify potential opportunities for CADTH to support
formulary review processes at Canadian health authorities
and hospitals
- Explore the level of collaboration between these health
authorities and hospitals and the public drug plans when
formulary decisions are being made.
Pant S, Sherwood V, and Chelak K. Hospital Formularies Decision-Making Process. Ottawa: Canadian
Agency for Drugs and Technologies in Health; 2015. www.cadth.ca
2
Method
• 23 surveyed, responses received from 20 (June - October , 2014)
• Currently involved in a health authority or hospital formulary decisionmaking process (except Quebec) – Total 19 respondents in findings
• Representation from each province and territory.
• Representation from both urban and rural settings in all the provinces
(except Nova Scotia)
• All respondents from the territories represented institutions servicing
remote locations.
• Two respondents were located in urban centres but provided support for
remote locations (Nunavut and rural Ontario) via telepharmacy
3
Survey Questions on Collaboration
1. Describe any ongoing initiatives your institution may be initiating or
exploring to better support your drug review process?
2. How do provincial drug plan formulary decisions influence your drug
formulary decisions?
3. Are there any formal policies or informal processes in place and/or any
initiatives underway to align with provincial drug plan
recommendations?
4.
4
What challenges have been identified in your jurisdiction to align
hospital formularies with provincial drug plan formularies?
Limitations
- Not a comprehensive review
- Do not represent perspective of public drug plans
- Perspective of health authorities and/or hospitals only
- Small sample size
Identify potential trends
Possible explanations around existing variations
Encourage further discussion
5
Findings
6
Level of Collaboration between
1. Hospitals and HAs in a province/territory
2. Public Drug Plan, and HAs and Hospitals in
a province/ territory
7
Level of Collaboration
No. of
Respondents
(Total 19)
Use public drug plan formulary as a resource
therespondents,
13
Out of thein19
formulary decision-making process at their institution
.
Formal or informal policies and/or processes to align
10
 recommendations.
their formularies with provincial public drug
plan
Public drug plan representative in their respective
institution’s P&TC.
3
Formulary decision-making process is an independent
process, with no collaboration with the drug plans.
4
A committee (mandated by legislation) to make formulary 1
decisions for public drug plans, and health authority and (PEI)
hospital formularies.
8
Examples of Collaboration
BC
A provincial committee that has representatives from all HAs as
well as membership from the public drug plan. Information is
shared between drug plan and P&TC.
AB
No formal policy to align with the drug plan but efforts are made
to be consistent when possible.
SK
Re-establish the P&TC in the region as a multidisciplinary group.
Committed to alignment when possible.
Serving as a conduit between a hospital formulary committee and
in the provincial expert advisory committee .
MB Re-evaluating the role of the provincial D&TC.
Not formal process by hospital consider drug plan formulary
9
Informal discussions
Examples of Collaboration
ON ODB formulary is used as a reference
Collaborative consultation between hospitals within a LHIN
Share the drug review process work (telepharmacy)
In-house policies that allow community products to be continued
NB Informal effort to align with public drug plan formularies
Share in-house reviews with other HAs and provinces, when
possible.
NS
Public & private drug plan formularies considered (guidance)
PE
A single provincial D&TC
NL
Requested for a public drug plans representative to be a
member at the health authority’s P&TC.
10
Challenges in Aligning Hospital
Formularies With Provincial Drug Plan
Formularies
Challenges
 Role in the Health Care System
Perception of public drug plans solely as the funders
Factors Affecting the Overall Cost of Drug
cost of managing an illness and hospital contract cost
Decision-Making Process
 Factors influencing decision making.
 Limit hospital formulary listings to guide best practices.
 Viewpoints on who should influence decision making
12
Challenges
 Implementation and Resources
 Implementation of new medications, Inventory issues
and aligning with federal and provincial plan.
Product Type
Different therapeutic considerations; access to emerging
treatment (tertiary care centers); hospital formulary more
restrictive in general.
 Additional Issues
Lack of resources to support a single equitable process
Variation in local implementation
13
Conclusion
 Various ongoing (formal/informal) efforts
establishing a single committee to make formulary decisions for
both public drug plans and hospitals in a province,
establishing a single provincial hospital formulary,
establishing provincial-level working groups or advisory
committees,
re-evaluating the role of the P&TC, and/or
sharing drug reviews between institutions.
14
Conclusion
 Hospitals and HAs consider public drug plan coverage.
 Challenges in aligning with the public drug plan due to differences in
 the roles of these institutions in the health care system,
 factors affecting the overall cost of adding a drug to a formulary,
 decision-making processes,
 implementation and resources issues,
 product types.
15
16