Transcript Anne Hiltz

Anne Hiltz, Director Pharmacy and Renal Program
Nova Scotia Health Authority
Speaker has no real or potential conflicts to disclose
in relation to this presentation
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Established April 1, 2015 as an
amalgamation of nine previous health
districts with over 23,000 employees and
2500 physicians
Includes all health care organizations
(acute, tertiary, quaternary, community,
mental health, addictions, forensics) with
the exception of the IWK Health Centre
Comprised of four zones
$94 million dollars in drug expenditures
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Current state of transition with district drug
formulary decision-making still in place
Majority of presentation will focus on
existing state within previous Capital District
Health Authority, now Central Zone of Nova
Scotia Health Authority
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No mandate to align hospital formulary with
provincial drug plan
Good working relationship with Pharmacy
Services, Department of Health and
Wellness
Commitment to focus on alignment
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All formulary and drug policy decisions
across the district (nine sites and roughly
50% of provincial population) approved at
the District Drugs and Therapeutics
Committee (DD&T), with the exception of
newer oncology drugs approved by the
province
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On admission, patients kept on current
medication even if non-formulary in hospital
mainly for safety reasons and issues with
medication reconciliation
Drug reviews only initiated upon request of
prescribers (e.g. levetiracetam)
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Three types of reviews:
 Drugs on provincial formulary
 Drugs not on provincial formulary and
hospital-only drugs
 High-cost non-formulary drugs
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Budget impact analysis only completed and
reviewed at DD&T
If above a set dollar limit, request for
funding goes to Executive
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Complete review prepared by a
subcommittee of DD&T in consultation
with stakeholders
Safety, efficacy and all elements of cost
considered (e.g. IV irons)
Both pharmacoeconomic and ethics
expertise on DD&T
Recommendations are taken to DD&T with
the committee voting on the
recommendations
Excellent collaboration between different
departments within hospital (e.g. NOAC’s)
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Drug requested usually by a specialist to
VP, Medicine
Pharmacy reviews evidence (often limited)
and makes recommendation to VP
VP informs requestor of decision
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Knowledge of committee members
increased
Willingness of most clinicians throughout
organization to wait on provincial decision
before submitting request (i.e. NOACs)
Increased engagement in process
Enabled by co-leadership model across
organization
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Eagerness to use all new drug entities in a
tertiary care organization
Perception that decisions made by both
CADTH and the province are related mainly
to cost and not efficacy
Lack of depth of knowledge re: evidence
informed decision-making by some
individuals
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Structure of DD&T in a provincial health
authority?
Will there will one single formulary for the
province?
How will all parts of the province be
represented?
Challenge of developing a single provincial
hospital formulary with many smaller
community hospitals while aligning it with
the province, especially if not mandated