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PubMed1983

National drug formularies: lessons from Latin America.

Although pharmaceuticals comprise up to 40% of the health care budget in developing countries, the majority of the population does not have access to many of the essential drugs needed to treat prevalent diseases. This situation demands the development of a national formulary of essential drugs for the public sector. The approach used in developing countries is to select drugs of choice for the treatment of prevalent morbidities and avoid therapeutic duplication, unacceptably dangerous drugs, or drugs of unproven efficacy. Drugs are selected based on a review of the prevalent morbidities, health care worker training, patient characteristics, and efficacy/risk information resulting from scientifically sound studies. An added component to the formulary is the inclusion of concise, unbiased prescribing information for each drug selected. A number of product selection guidelines were proven to be effective in establishing and maintaining an essential drug formulary for developing countries. These guidelines include: 1. Selection of drugs with proven efficacy and acceptable risk; 2. Selection of minimum number of drugs needed to treat the prevalent diseases; 3. Inclusion of new products only if they are found to have distinct advantages over products currently in use; 4. Inclusion of combination products only when they provide true benefit over single ingredients; 5. Selection of drugs with clear "drug of choice" indications for prevalent diseases; 6. Evaluation of the administrative and cost impact of products; and 7. Selection of drugs with established high quality.

Developing Countries↗
PubMed1995

Generic enteral formulas: a new idea for the 1990s.

Generic equivalent enteral formulas are now commercially available. The purpose of this article is threefold: (1) to define generic equivalents and compare both their nutritional and monetary differences with brand name products, (2) to provide the clinician with factors to consider when evaluating generic formulas--the source and distribution of macronutrients and micronutrients, and patient tolerance, nutritional status and outcome--and (3) to provide information on how to incorporate generic enteral formulas onto an institution's enteral formulary. In today's environment of diminishing health care budgets, generic enteral formulas can play a role in cost containment without sacrificing quality nutritional care.

Aged↗
PubMed1994

Monitoring drug use in palliative care.

A computerized system for monitoring drug use which makes use of the British National Formulary (BNF) drug categories and a departmental formulary (DF) has been developed. Data entry takes less than one week of secretarial time per annum. Details of drug use in 385 patients three weeks after referral to a National Health Service palliative care unit over five years form the basis of this report. The median number of drugs per patient was five, with a maximum of 11; 97% of the drugs were from the DF. Analgesics were the commonest category of drugs used. The 10 most commonly used drugs included three analgesics (morphine, co-proxamol, flurbiprofen), two laxatives (co-danthrusate, lactulose), dexamethasone, metoclopramide, ranitidine, temazepam and amitriptyline/dothiepin. Seventeen per cent of patients received two preparations from the same second level BNF category (analgesics excluded). The concurrence was questionable in about half of these, and mostly related to the use of laxatives or to hypnotics and anxiolytics. Several unexpected inclusions in the top 10 drugs illustrate the need for quantification rather than pontification about drug use in palliative care. Examination of duplicate prescribing provides a forum for examining ways of simplifying drug regimens.

Adult↗
PubMed1980

Effectiveness of a cephalosporin education program--a pharmacy education program.

In October, 1977, a cephalosporin drug-use review and an educational program were initiated to maximize savings in the pharmacy budget at UCSF and to revise the formulatory to include only one parenteral cephalosporin. The results of the drug-use review were presented to the Pharmacy and Therapeutics Committee where our proposal for an education campaign to encourage appropriate dosing of cefazolin was approved. An explanatory document comparing cephalosporin costs and equivalency was developed for hospital-wide distribution. Pharmacy staffs were informed of program objectives to coordinate education efforts. Physician education was undertaken via document and personal contact with pharmacy personnel. A drug-use review one month after institution of the cephalosporin education program showed marked changes in physician prescribing habits, with greater impact on services where pharmacists were members of the medical rounding team. A change to appropriate dosage prescribing of cefazolin resulted in significant cost savings to the pharmacy budget. These findings resulted in formulary revision to cefazolin as the single cephalosporin available at UCSF. Because cefazolin is available from more than one manufacturer, we were able to obtain a lower bid price the following year, thus realizing an additional cost savings.

California↗
PubMed1982

Clinical pharmacy services in a pediatric ambulatory care clinic.

The implementation of pharmacy services in an ambulatory pediatric clinic has met with initial success in acceptance by the medical and nursing staffs, the administrator, and the patient population. Errors in medication dispensing and prescription labeling have decreased, and patient understanding of prescribed therapy has improved. The number of ER visits by clinic patients has been reduced since the implementation of our service. The importance of patients' understanding directions for use and of dispensing medications in childproof containers for the pediatric population cannot be overstressed. A future goal of our service is to expand the pharmacist's clinical role to allow further participation in pharmacokinetics, specialty clinics, teaching, and patient education. Further documentation of the value of such services is essential to the expansion of the pharmacist's role in patient care.

California↗
PubMed1983

Hospital pharmacy in Portugal and its future trends.

The authors begin by presenting a brief historical summary of hospital pharmacists' activities in Portugal, especially since the 1950s. They state their views on the present situation of hospital pharmacy in various aspects, namely: general legislation; activities and premises of pharmacy services; pharmaceutical career and staff recruitment; the National Hospital Formulary of Medicines and Pharmacy and Therapeutic Committees; acquisition, production and distribution of medicines; and clinical pharmacy activities. Future trends of hospital pharmacy in Portugal are summarized, stressing the following points: evolution of production and information, unit dose distribution, and steady increase of other clinical pharmacy activities.

Formularies, Hospital as Topic↗
PubMed1984

Hospital pharmacy practice in India.

The status of pharmacy practice was evaluated at six hospitals in India. Common drugs were available at private hospitals but the pharmacies at government hospitals had fewer than half of the needed drugs. Selection of the best generic drug appeared difficult because the bioavailability and pharmacokinetic data generally were not available. The hospitals did not have formularies. No unit dose and intravenous admixture services had been implemented. The patient profiles were not maintained. The pharmacists did not appear to provide any professional, educational, or clinical services to patients or physicians. Serum concentrations of drugs were not measured for monitoring therapy. A lack of clinical education and training of pharmacists, lower status and salaries in the hospital pharmacy compared with industry and government, and overall limited resources appear to be the important reasons for the present status of pharmacy practice.

Education, Pharmacy↗
PubMedDate not supplied

Improving patient care and pharmacy management: the effect of hospital formularies.

A study of the organizational features and implementation procedures associated with formulary use in major acute-care hospitals throughout Australia was undertaken. Data were collected via a questionnaire mailed to 57 directors of pharmacy. An 86-percent response was obtained. A high proportion of formularies was found to rate poorly in terms of organizational features (e.g., content, compilation methods, format) and process variables (e.g., effectiveness as a communication document, prescribing aid, or management tool). Methods of improving formulary effectiveness are outlined in the context of practical and normative research, including improving the quality of drug therapy, use of formularies in cost control, and improving user acceptance. The results confirm previous research showing that methods of improving organizational features and implementation procedures associated with formulary compilation and use are neither widely applied nor widely known. There is an urgent need to reassess the usefulness of formularies and improve their effectiveness by adopting recommendations resulting from past research.

Australia↗
PubMedDate not supplied

Therapeutic decision-making: a model for formulary evaluation.

A systematic approach of evaluating medications for a hospital formulary is discussed. The hospital formulary is a program of objective evaluation, selection, and use of medicinal agents in the hospital. In light of the ever-increasing numbers of new and/or improved therapeutic agents, formulary decisions must be made with an eye to the future. Therefore, it appears that the best means of choosing a medication for formulary addition, both clinically and economically, is to choose an agent based on its clinical indication(s). Examples of such indications are presented. Selecting formulary agents by indication rather than by simple drug cost or pharmacologic class should ensure the most effective utilization of therapeutic agents and hopefully a diminution of overall costs.

Anti-Bacterial Agents↗
PubMedDate not supplied

Antibiotic cost-containment.

A multidisciplinary, professional, and administrative approach to selecting therapeutic agents for formulary inclusion--as it is practiced at the Tuskegee Veterans Administration Medical Center--is described. The process by which members of a Drug Utilization Review Subcommittee evaluate drugs is explained in detail. Numerous factors, such as patient population characteristics, total therapy costs, adverse reactions, indications, dosage, and efficacy are considered. Findings, decisions, and economic cost-savings, specifically with respect to antibiotics, are revealed.

Aged↗
PubMedDate not supplied

Choosing cephalosporins for the formulary.

Proper selection of antibiotics for any formulary requires cooperation and communication with members of the pharmacy and therapeutics (P&T) committee and departments of infectious diseases, microbiology, and epidemiology. Ideally, P&T members need to know their institution's incidence and sources of infection (hospital- or community-acquired), antibiotic cure rates, and the adverse effects profiles of antimicrobial agents used. In addition, members need to be briefed on the findings of antibiotic utilization reviews performed. In vitro activity should be compared among similar classes of antibiotics and, when possible, local resistance rates should be considered. The pharmacokinetic properties of an antibiotic, such as peak concentration, protein binding, distribution characteristics, and elimination half-life, should be evaluated during the selection process, as should total cost of the drug, including costs associated with monitoring therapy. The three generations of cephalosporins are used as examples here to delineate differences in potency, pharmacokinetics, efficacy, and potential for causing adverse reactions during the ideal formulary evaluation process.

Cephalosporins↗
PubMed1989

Formulary conversion of cefoxitin usage to cefotetan: experience at a large teaching hospital.

The pharmacy and therapeutics committee at Hartford Hospital recommended replacement of cefoxitin with cefotetan, based on data reported in the literature regarding antimicrobial activity, pharmacokinetic profile, and adverse reactions. Once the recommendation was approved by the medical staff, an intense educational program was instituted, and all orders for cefoxitin were converted to cefotetan with appropriate dosage modifications. A total of 960 patients were treated in the first year; no major patterns of ineffectual therapy or adverse events associated with cefotetan usage have emerged. The mean cost of cefotetan therapy was $180.59, which is $130.26 less per patient than a comparable regimen of cefoxitin (mean cost of therapy $310.85). Based on the data analysis of cefotetan usage for a 12-month period, the actual annual savings due to therapeutic substitution of cefotetan for cefoxitin was $124.961. To further evaluate the clinical efficacy, safety, and savings of this therapeutic interchange, two separate retrospective reviews of patient medical records were performed. The first audit has been previously published in its entirety. In the subsequent audit, 284 additional patient medical charts have been reviewed. These patients received either cefotetan therapy or concomitant therapy of an aminoglycoside combined with either clindamycin or mezlocillin. Clinical outcomes were classified as an empiric cure or improvement for 99.4, 98.5, and 92.9 percent of patients, respectively. In this audit, elevated prothrombin time/partial thromboplastin time values and bleeding episodes were noted infrequently, as were other adverse reactions.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Coagulation Disorders↗