Transcript Oral Presentation 1

Pharmacy and Therapeutics Committees
in Thai Hospitals under Health Reform
Sripairoj A, Liamputtong P, Harvey K
La Trobe University, Australia
Outline of presentation
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Background
Objectives
Methods and Samples
Results
Summary
Conclusion and Policy Implications
Background
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In Thailand, hospitals under the
Office of the Permanent Secretary
were first required to establish
Pharmacy and Therapeutics
Committees (PTCs) in 1987.
A Manual of Drug Administration
(1987) listed the expected structure,
roles and responsibilities of PTCs.
Since 1997, Thai hospitals have
faced economic crisis, quality
improvement and accreditation,
universal coverage health reform and
structural change in the Ministry of
Public Health (MoPH).
Objectives
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To examine PTC performance during this period of change and
reform.
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To determine the opinion of the PTC Chairpersons and the PTC
Secretaries about defining good PTC performance, ways to
improving PTC performance, and possible PTC performance
indicators.
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To create a Manual that provides more practical help on rational
drug use activities, including performance indicators.
Methods
Retrospective
document review
In-depth interviews
Questionnaire survey
A focus group
Participant observation
Sample & methods
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Seventeen hospitals (2 regional hospitals, 3 provincial hospitals,
and 12 district hospitals) in 4 regions of Thailand.
Ten key informants who were the Chairperson, the Secretary or
members of the PTC were interviewed.
Fifteen key informants who involved with PTC or who are
responsible for drug information centers were interviewed.
Questionnaires were distributed to 452 PTC Chairpersons and
Secretaries respectively in 25 regional hospitals, 67 provincial
hospitals and 360 district hospitals.
Eight key participants who were PTC stakeholders participated in
a focus group.
PTCs in 3 regional hospitals were observed.
Questionnaire results (1)
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The questionnaire response rate was 36% from PTC
Chairpersons and 66% from Secretaries.
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Around 90% of PTC Chairpersons were Hospital Directors and
90% of Secretaries were Heads of Pharmacy Department.
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The average of the number of PTC members in regional,
provincial and district hospitals was 19, 20, and 10 members,
respectively.
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There were only 2-3 PTC meetings in regional or provincial
hospitals and only 1-2 PTC meetings in district hospitals during
each fiscal year (from 1996-2002).
Questionnaire results (2)
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The most important PTC performance indicators suggested
by all PTC Chairpersons:
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Is PTC responsible for considering and approving allocation of drug
budget proposed by the Pharmacy section?
Does PTC have a document providing criteria for addition and deletion
of drug in the hospital drug list?
Does PTC have a policy to develop or implement Clinical Practice
Guidelines for common problems such as acute respiratory infection,
diarrheal diseases, hypertension, diabetes, epilepsy, and antibiotic
prophylaxis, etc.?
Does the PTC monitor Pharmacy drug dispensing to ensure it follows
written standards of pharmacy professional practice?
Does PTC conduct satisfaction surveys on hospital staff to receive
feedback on PTC performance?
Questionnaire results (3)
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The most important PTC performance indicators suggested by
PTC Secretaries:
 Does a document identifying goal, committee, objectives, and
functions of PTC exists?
 Is PTC authorised to select drugs to be included and excluded
in the hospital drug list?
 Does PTC monitor the percentage of drugs used outside
hospital drug list?
 Does the PTC monitor Pharmacy drug dispensing to ensure it
follows written standards of pharmacy professional practice?
 Does PTC have a policy to conduct satisfaction of
patients/clients on the hospital treatment service?
Questionnaire results (4)
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When asked about the most important factor needed for the
development of an effective PTC:
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When asked about external factors that can contribute to
improved performance of PTC both PTC Chairpersons and
Secretaries in all hospitals agreed that the most important
aspect was:
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the Chairpersons said it was an effective PTC Secretary; while
the Secretaries said it was an effective PTC Chairperson.
a national collaborative drug information center as a hub for information
exchange between PTC for a decision making purpose.
In addition, PTC Chairpersons and PTC Secretaries in
regional hospitals noted that:
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defining the function of PTC in the hospital accreditation criteria would
be helpful.
Results (5)
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The retrospective document review, in-depth interviews, a focus
group and participant observation noted that:
 Under new structure of Ministry of Public Health, there was no
distinctive responsible organization who support and monitor
PTCs.
 Some hospitals had not updated information about new PTC
members, functions or responsibilities.
 Most PTC activities still focused on drug selection and controlling
drug budget. Activities on rational drug use were few.
 Many PTCs had not set their own specific goals, objectives, role
and responsibilities.
 Often PTCs had no working plan and there was also no orientation
about goal, objectives, role and responsibilities for PTC members.
Results (6)
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Many suggested the need for a responsible organization
(perhaps under the Department of Health Service Support)
that would assist PTCs by:
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Updating Manual of PTC roles and responsibilities;
Providing opportunities for PTC networking e.g. by web site &/or Email discussion groups;
Providing information for PTC to make decisions;
Supporting the incorporation of PTC performance indicators in
hospital accreditation (Bureau of Inspection & Evaluation &/or The
Institute of Hospital Quality Improvement& Accreditation);
Encouraging Universities to provide educational programs.
Summary
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PTCs at all levels of hospital focused their activities on drug
selection and budget as this was the main focus of the 1987
“Manual”.
There were limited numbers of meetings of PTCs (1-2 in district
hospitals; 2-3 in regional or provincial hospitals).
The recommended PTC performance indicators were the number of
PTC meetings and the number of drug items in hospital drug lists.
Suggestions for improving PTC performance:
 Setting a responsible organization;
 Encouraging educational programs in universities; and
 Providing national drug information center and PTC
networking.
Conclusion & Policy Implications
There is a need for a responsible organization (perhaps under the
Department of Health Service Support) that would assist PTCs by:
 Updating a Manual regarding PTC roles and responsibilities;
 Providing opportunities for PTC networking e.g. by web site
&/or E-mail discussion groups;
 Providing information for PTC to make decisions;
 Supporting the incorporation of PTC performance indicators in
hospital accreditation monitored by:
 Bureau of Inspection & Evaluation &/or
 The Institute of Hospital Quality Improvement &
Accreditation;
 Encouraging Universities to provide PTC educational
programs.
“We cannot direct the wind
but we can adjust the sail.”
“Learning to live, living to learn
and have fun on improving
Pharmacy and Therapeutics
Committee performance.”