Transcript WHY DID UNIT DOSE DISPENSING HARD TO BE IMPLEMENTED

EVALUATION OF TYPE C
HOSPITAL FORMULARY
IN YOGYAKARTA
Anggriani Y, Pudjaningsih D,
Suryawati S
Department of Clinical Pharmacology, Faculty
of Medicine, Gadjah Mada University,
Yogyakarta
Abstract
Problem Statement: Many pharmaceutical products on the market are new and nonessential drugs. Appropriate selection is needed
to support rational use of drugs. Establishing and maintaining a good hospital formulary is one way to increase drug selection
efficiency.
Objectives: To evaluate and compare the quality of 7 hospital formularies in Yogyakarta, and to determine the processes used to
maintain the formulary in each hospital.
Indicators: number of brand-name products, % of essential drugs, % generic drugs on the list, % drugs supported by the primary
literature, % drugs with a single ingredient, and % generic drugs kept in stock.
Design: Descriptive-analytical, explorative case study.
Setting and Population: 5 public hospitals and 2 private hospitals in Yogyakarta.
Method: Seven Hospital Formulary Lists were evaluated. Quantitative data included the numbers of each the followings: total
number of drugs on the list, number of drugs in brand name, number of drugs in generic name,, the number of essential drugs, and
number of drugs supported by primary literature. At the time of inspection, following data were collected, ie, number generic drugs
available, and the number of non-formulary drug. A Chi-square test was applied to see if there was any difference between public and
private hospitals. Information on the process of maintaining a formulary was obtained from qualitative data, including in-depth
interviews with Drug and Therapeutic Committee (DTC) members and representative doctors from 4 wards (Obstetrics and
Gynecology, Pediatrics, Surgery, and Internal Medicine). Qualitative data were analyzed by content analysis.
Outcome Measures: The quality of a formulary was measured by the number of brand-name products, % of essential drugs, %
generic drugs on the list, % drugs supported by the primary literature, % drugs with a single ingredient, and % generic drugs kept in
stock. The process of maintaining a formulary was measured by frequency of revision, % of nonformulary drugs, and observation of
DTC meetings.
Results: Although no hospital showed an ideal formulary list, the quality of public hospital formularies was relatively better than that
of private hospital formularies. The comparison of public vs private hospitals, as shown by the indicators, were respectively as
follows: the number of brand-name drugs (296–532 vs. 513–1575); percentage of essential drugs (41–71% vs. 20–28%); percentage
of generic drugs on the list (26–50% vs 17–18%); percentage of drugs supported by the primary literature (73–90% vs. 67-73%);
percentage of drugs with a single ingredient (41–71% vs. 20–28%); and percentage of generic drugs kept in stock (26–48% vs 13–
16%).The consistent differences between the two types of hospitals were significant (P= 0,00). The percentage of nonformulary-drug
procured and the nonformulary drug kept in stock were lower in hospitals that had frequent formulary revisions and established policy
on formulary revision. Regular meetings for formulary management was not yet established. In both public and private hospitals, the
DTC tended to accommodate the doctors’ requests.
Conclusions: The quality of public hospital formularies was better than that of private hospitals, but both of them were found not yet
satisfactory. The process for maintaining a hospital formulary has not yet been established at the hospitals studied.
Background




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Many pharmaceutical products on the market are new
and nonessential drugs.
Increasing number of new drugs being introduced to
medical doctors need a strong hospital drug policy
and instruments to manage the hospital formulary list.
Hospital formulary list is often developed without
adequate process
Even if there is a guide, the decision is oftenly based
on individual interest.
Appropiate selection is needed to support rational use
of drugs.
Quality of hospital formulary?
Objectives
 To
evaluate and compare the quality of
7 hospital formularies.
 To determine the processes used to
maintain the formulary in each hospital
Methods
 Descriptive-analytical, explorative case study
 5 Public and 2 Private Hospitals
 The quality of hospital formularies were observed by
looking at some indicators, i.e.,:
• Number of brand-name products
• Percentages of generic drugs on the list
• Percentages of essential drugs (drug from NEDL)
• Percentages of drugs supported with the primary
literature
• Percentages of drugs with a single ingridient
• Percentages of generic drugs kept in stock
Outcome Measures
The quality of a formulary was measured by
the number of brand-name products, % of
essential drugs, % generic drugs on the list,
% drugs supported by the primary literature,
% drugs with a single ingredient, and %
generic drugs kept in stock.
The process of maintaining a formulary was
measured by the frequency of revision, % of
nonformulary drugs, and observation on
minutes on DTC meetings.
Results 1: The values of each
indicator in 7 hospitals
Public Hospitals
Indicators
Private
Hospitals
F
G
A
B
C
D
E
525
441
382
532
296
513
1575
 Brandname
products
619
570
388
686
308
1002
2153
% Generic drugs on
the list
37
35
26
34
50
17
18
% Drugs from NEDL
61
41
49
41
71
28
20
% Drugs with primary
primary literature
61
41
49
41
71
28
20
% Drugs with single
ingredient
90
77
73
80
90
67
73
%Generic drugs kept
in stock
31
26
29
27
48
16
13
 Active ingredients
Hospital
E shows relatively better perfomance compared to the other hospitals
Hospital G shows the worst perfomance among 7 hospitals
Results 2: Number of non-formulary drugs
vs frequency of revision
Public Hospitals
Private
Hospitals
Indicators
A
B
C
D
E
F
G
% Non-formulary drugs
drugs procured
31
34
24
7
1
65
3
% Non-formulary drugs
drugs in stock
41
27
36
28
1
64
9
Frequency of revision
1
4
3
1
4
0
1
1995
2000
1999
2001
200
1
1996
2001
Year of the newest
edition

Hospital E, which perfomed better on result 1, its formulary is among the most
most frequently revised
Results 3: Criteria for drug
selection
HOSPITALS
A
B
C
1.Certificat
1.Certificate
1.Price
1. Track record
1.Track record
1. Certificate
1. Certificate
te of GMP
GMP
2. Price
e of GMP
2. Price
2.Continuous
of the industry
industry
2. Price
3. Continuous
delivery
4. Lag time of
delivery
record of the
the industry
2.Price
3.Continuous
delivery
4.Lag time of
delivery
e of GMP
2. Price
3. Continuous
delivery
e of GMP
2. Price
3. Continuous
delivery
4. Lag time of
of delivery
delivery
D
E
F
G
Results 4: Step in developing hospital formulary list
1. Listing all drugs available in stock
2. Distributing the existing drug list and drug
request forms to medical doctors
3. Establishing criteria for drug selection and revise
formulary in DTC meeting.
 Parties involved : DTC members and
Doctors
 Request is discussed only if attended by
doctors who request the new drug
4. Discussing the requests
5. Official announcement of the new formulary by
the hospital director.
Results 5: Mechanisms of new drug
additions into formulary
Hospital B, C, D and E
Hospital A, F, G
Fill in the drug request form
Fill in the drug request form
Submit to pharmacy department
Submit to pharmacy department
Discuss drug requests in DTC
meeting
Procured by the pharmacy
department
Distribute supplementary
formulary
Procured by the pharmacy
department
Other findings
 DTCs in private hospitals tend to
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accommodate the doctors’ request
Doctors perceived that generic and essential
drugs were not sufficient to clinical needs
Formulary development and management
were not well established due to inadequate
financial support.
DTCs do not have regular meetings to
manage formulary list
Request form to deletion is unfortunately is not
available at all hospitals
Conclusions
 Tendency of DTC in private hospitals to
accommodate the doctors request
1. Although no hospital showed ideal formulary list, the
quality of public hospital formularies was relatively better
than that of private hospitals formulary, due to:
 Doctors’ general perception that essential and
generic drugs are not sufficient to clinical needs
2. The mechanism to manage hospital formulary is not well
established, mostly because:
 Financial support is inadequate
 Regular meetings for formulary revision in not yet
established