Transcript Poster presentation

Establishing Effective Hospital
Drug and Therapeutics
Committees: a situational
analysis
Ndhlovu C E, Simoyi T
National Drug and Therapeutics Policy Advisory
Committee, Ministry of Health and Child Welfare,
Harare, Zimbabwe
Establishing Effective Hospital Drug and Therapeutics Committees: A Situational Analysis
Ndhlovu C E , Simoyi T. National Drug and Therapeutics Policy Advisory Committee, Ministry of Health
and Child Welfare, Harare, Zimbabwe
Abstract:
Problem statement: Not much is known about the existence and operations of hospital drug and therapeutics
committees (HDTCs) in developing countries. Following ICIUM 1997, the Zimbabwe National Drug and
Therapeutics Policy Advisory Committee (NDTPAC) established a subcommittee for the establishment and
organisation of hospital drug and therapeutics committees (HDTCs). In 1998, 8 hospitals were chosen as pilot
centres for the establishment of formal HDTCs. The fate of the national subcommittee and the pilot HDTCs was
established. Objectives: Data to determine the current membership of the national subcommittee as well as
whether or not the pilot HDTCs still existed as originally planned was collected.
Design: Descriptive cross-sectional study.
Setting and Study Population: Members of the NDTPAC and the senior healthcare workers in the central,
provincial and district hospitals. Data was collected started in July 2003 and was finalised by end of February
2004.
Outcome Measure: Membership on the committees and the reasons for failure to continue
with the activities of the committees were determined. The fate of the national subcommittee was established by
determining who was still in the NDTPAC and where the rest of the members were. By phoning or emailing the
hospital’s medical superintendent or district medical officer, the data about the pilot centres was collected.
Reasons for the failure to raise that person will be established and documented..
Results: Four years ago the national subcommittee consisted of 10 members, with the majority based in Harare.
One was based at the Provincial level. Currently, the subcommittee is not active. Only 4 of its original members
are still based in the country. Four are working abroad. One is still a member of the NDTPAC. Of the 8 pilot
centres, only one continued to function from the outset. One of the hospitals could not be reached for comment.
Discussion: The NDTPAC no longer has within its membership anyone formally trained in the setting up of
hospital drug and therapeutics committees. The two resource persons originally identified as prepared to
spearhead this activity are both now based in the UK and hence are not available to implement and monitor
activities on the ground.
Conclusions: We have not had and still do not have the capacity to set up and monitor the activities of HDTCs
throughout the country. Other administrative level hospital meetings at which drug issues are discussed, e.g.
Medicine divisional monthly meetings at a central hospital like Parirenyatwa, should be recognised as HDTCs.
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Study Funding: Ministry of Health and Child Welfare, Harare, Zimbabwe
Background/Introduction
• Not much is known about the existence and operations of hospital drug and
therapeutics committees(HDTCs) in the developing world. The Zimbabwe National
Drug Policy(ZNDP) was formulated in 1987 and the current edition was published
in 1995. One of its objectives was “to encourage health workers to participate in
collaborative management of drugs in their institutions in order to promote the
rational use of drugs”.
• At national level, there is the National Drug and Therapeutics Policy Advisory
Committee(NDTPAC) which was established in 1992 and has been active since its
inception. At the local level, however, not much seems to be taking place on a
formal basis. As a follow up to ICIUM 1997, the NDTPAC established a
subcommittee for the Establishment and Organization of Drug and Therapeutics
Committees(DTCs) in Zimbabwe1. In 1998, 8 hospitals were chosen as pilot centres
for the establishment of formal hospital drug and therapeutics committees. 2 were at
central level, 3 at provincial level and 2 were church-related district hospitals and 1
was a privately run hospital.
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Objectives
• To determine the fate of the subcommittee which had been
set up by the NDTPAC for the process of establishing
HDTCs countrywide.
• To find out if the 8 pilot hospital drug and therapeutics
committees which were set up in 1998 were still
functional.
• If they had folded up, to find out why they were no longer
functional.
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Methods
•
Data about the whereabouts of the original members of the
subcommittee of the NDTAPC was obtained through verbal
communication with members of the Department of Pharmacy
Services in the Ministry of Health and Child Welfare. This data
could be also be cross-checked with the pilot centres. The current
doctors-in-charge of the hospitals that were pilot centres were
contacted by phone and using a standardised questionnaire, data
about how much the doctor new about the previous HDTC as well
as its fate was obtained. Two of the centres had to be contacted by
email as it proved very difficult to get through, by telephone, to
the hospitals during the final data collection period which was set
to be at the end of February just to make the information as up to
date as possible. The demographic data about each hospital was
obtained from Ministry of Health and Child welfare databases.
The medical superintendent or district medical officer was the
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informant.
Results
• The Subcommittee of the NDTPAC:The original
Subcommittee of the NDTPAC for the establishment and
organisation of DTCs consisted of 10 members: 3
clinicians and lecturers, 2 Clinical Pharmacologists and 5
Pharmacists. 8 of these members were based in Harare i.e
at central administrative level. Only one was based at a
Provincial level, this being a Principal Pharmacist. 6 were
employed via the University whereas only 3 were Ministry
of Health and Child Welfare employees. One was a
Pharmacist with the army. Currently this subcommittee is
not active. Only half (5) of its members are still based in
the country and of these, 3 are employed by the University,
I by the MOHCW and the last one is in the private sector. 4
are working outside the country. Only one of this original
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group is still a member of the NDTPAC.
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Membership by Speciality
2004
1999
0
5
10
15
7
2004
1999
Su
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M
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itt
O
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O
H
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Membership by Primary
Employer
0
5
10
15
Number of members
8
Hospital Size
• Hospital size by number of beds
1200
1000
800
600
400
Bed size
Wa-Pvt
Hre-Central
Mp-Central
Mu-Prov
Gw-Prov
Bi-Prov
B-Church
0
A-Church
200
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Situational analysis - pilot centres
Pharmacist present?
Aware of current
HDTC?
No
Yes
Aware of HDTC in 1998?
Was contact person there
in 1998?
0
2
4
6
8
10
Discussion
• With the high staff attrition rate especially with regards to
pharmacists, it was suspected that none of the pilot centres would
still be functional. This was confirmed by finding only one pilot
centre still active since 1998. It was interesting to note that this
particular hospital had never had a pharmacist and was currently
using a nurse aide as their “pharmacy technician”. Their remaining
functional is most likely to be explained by having a doctor in
charge who has attended a national rational drug use course and who
has remained in charge from as early as 1998.
• 75% of the doctors asked were aware of the original pilot activities
and seemed to blame the demise of the committees to the loss of the
original founder members. The NDTPAC itself no longer has within
its membership anyone formally trained in the setting up of hospital
drug and therapeutics committees. The two resource persons that
they originally hoped would spearhead this activity are both now
based in the UK and hence not available to implement and help
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monitor activities on the ground.
Conclusions/Recommendations
•
Most hospitals do regularly hold some administrative level meetings at which
drug issues are discussed e.g Medicine division monthly meetings at central
hospitals. Such meetings are not formal HDTCs but do carry out some of the
objectives of a hospital drug and therapeutics committee such as discussing
drug stockouts and observed drug use problems. If their pharmacy issues were
well documented, monitored and evaluated, there would not be a need to
introduce yet another meeting to already stressed out staff. In view of the high
staff turnover at our hospitals, setting up of formal hospital drug and
therapeutics committees is proving to be difficult. Hence it is recommended
that the objectives of the HDTCs be carried out and monitored via existing
regular meetings such as division meetings which are usually attended by the
administrators of hospitals. The administrators would ,therefore, collate and
feedback all the information from the various divisions so that rational use of
drugs can be achieved.
Reference:
1. Establishing an Effective Drug and Therapeutics Committee: A practical
manual developed in Zimbabwe, October 1999, National Drug and
Therapeutics Policy Advisory Committee(draft document)
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