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PubMed1991

Formulary issues at a pediatric hospital: experience at Children's National Medical Center.

At Children's National Medical Center in Washington, DC, patients treated range from premature babies to 21-year-olds. Therefore, a broad base of drug therapy is practiced. University affiliated, the facility serves as the pediatric department for George Washington University School of Medicine. This hospital is seen as an innovator in specialized areas, such as neonatology, pediatric trauma, oncology, and organ and bone marrow transplantation. P & T Committee participation and communication are excellent, allowing members to focus sharply on therapeutic issues. One of their successful strategies has been the institution of a rather extensive subcommittee structure, which has facilitated intense but timely formulary review and strengthened drug policy. In this exclusive Hospital Formulary interview, Dr. George Cohen and Mr. Stephen Allen, Chairman and Secretary of the P & T Committee, respectively, share their experiences, providing insight for other P & T Committee members in hospitals serving both children and adults nationwide.

Child↗
PubMed1991

Issues in the selection of local anesthetics.

Several factors influence the safety with which neural blockade is performed, and something as simple as proper packaging can make a significant difference. For example, bulk packaging, individual boxes, and labels all should be color coded for easy identification and to alert the prescriber of ingredients requiring particular caution. One must also take care not to confuse single-use with multiple-use products, if the latter cannot be eliminated from formulary. Furthermore, substitutions must be made properly, particularly to avoid complications associated with products that contain preservatives.

Anesthetics, Local↗
PubMed1990

Formulary decision making in a specialty hospital: effective management of potent and costly drug therapies.

Substantial progress has been made in the treatment of cancer in the past few decades. Complex drug therapy regimens, supportive-care therapies, and therapeutic complications--namely, infection--have made clinical management challenging, however. In this exclusive Hospital Formulary interview, Michael Keating, MD, and William Dana, PharmD, Chairman and Secretary, respectively, of the University of Texas M.D. Anderson Cancer Center's P & T Committee, discuss successful methods of maintaining an effective formulary in a cancer center. Although efficacy and toxicity of therapy remain the primary considerations when evaluating drugs, with a formulary weighted with cancer chemotherapeutic agents, antibiotics, and other supportive intravenous formulations, cost is also critical. These health professionals describe how they balance the issues associated with rational, yet cost-effective drug therapy.

Antineoplastic Agents↗
PubMed1990

Impact of a pharmacist education program on nonformulary drug use.

The effect of an educational program for pharmacists that included instructions for handling nonformulary drug requests and determining suitable formulary alternatives for frequently prescribed nonformulary drug requests was measured. Results indicate a significant increase in the number of appropriate nonformulary drug dispensings when the postintervention phase was compared with the preintervention phase. Other values, including the financial impact per nonformulary drug request, did not differ significantly between the two phases. Since all nonformulary drug requests require pharmacist time, a more cost-effective nonformulary drug policy might focus the pharmacist's efforts on nonformulary drug products that are more costly than their formulary alternatives.

Cost-Benefit Analysis↗
PubMed1991

How a longstanding P & T Committee identifies and meets current therapeutic challenges.

The P & T Committee at the University of Michigan, Ann Arbor, has run smoothly for some time. Nevertheless, it is not immune to today's fiscal and drug therapy challenges. In this exclusive Hospital Formulary interview, Dr. Jeoffrey Stross, chairman; Dr. Richard deLeon, secretary; and Dr. Burgunda Volger, a key University Hospital P & T Committee member, candidly describe their committee's philosophy and the mechanics by which it functions. This committee uses restriction to modify inappropriate prescribing, but it also carries out educational activities. As newer, more expensive, therapies become available, the responsibility to ensure efficacious, safe, economical therapy becomes increasingly complex. The following discussion highlights some of their strategies for success.

Drug Therapy↗
PubMed1991

P & T Committee rises to challenges of the changing healthcare environment.

The ever-increasing importance of the P & T Committee is well illustrated in this exclusive interview with members of a committee from a leading academic, private-practice, health-science center--Rush-Presbyterian-St. Luke's Medical Center. The participants detail the progress achieved in P & T Committee policy making, particularly in recent years. Unprecedented change in the healthcare environment has demanded a more aggressive P & T Committee, and theirs has responded appropriately. Because the medical staff at Rush constitute a unique blend of academicians and private practitioners, the mechanics of their decision making tends to be consensus-related, while the implementation of those decisions is education-oriented. Other P & T Committees can learn from their political and professional strategies in the management of drug therapy.

Chicago↗
PubMed1992

Multi-purpose evaluation of H2-antagonist usage.

At Cabrini Medical Center, drug usage evaluation (DUE) and monthly purchasing data analysis were used to determine the indications for which H2 antagonists were being used, the appropriateness of parenteral therapy, the use of extended dosing intervals, and the cost effectiveness of cimetidine (Tagamet). The study was also used to review a decision of the P & T Committee to maintain cimetidine and remove ranitidine from the hospital formulary.

Cimetidine↗
PubMed1992

Surfactant replacement therapy: development of criteria for appropriate use. Ohio State University Hospitals.

At The Ohio State University (OSU) Hospitals, DUE criteria were established when colfosceril palmitate, a synthetic surfactant, was added to the formulary in January 1991. The DUE criteria were designed to assure appropriate drug use, educate physicians, and establish an effective way to monitor drug use and patient outcome (ie, response rate and complications). The criteria include a mechanism for evaluation and modification of the guidelines, as necessary. In addition, a review process will be used to determine the therapy's cost effectiveness and to serve as a guideline for making recommendations on other surfactant formulations as they become available.

Cost-Benefit Analysis↗
PubMed1992

A multidisciplinary process to determine, communicate, and manage an antibiotic formulary.

This article describes a collaborate process developed by the Pharmacy & Therapeutics Committee to define, determine, communicate, and manage an effective antibiotic formulary. Multiple professional disciplines represented by the antibiotic subcommittee evaluated each classification of antibiotics and recommended a preferred drug(s) for each classification. Decisions were based on relative safety, efficacy, and cost with minimal duplication of therapeutic equivalent antibiotics. A therapeutic interchange policy was unnecessary because extensive communication measures developed by the committee proved effective. The strategy used strengthened pharmacist/physician working relationships. This process permitted rationality and understanding by the medical staff, which resulted in unanimous formulary acceptance.

Anti-Bacterial Agents↗
PubMed1992

Issues in formulary management: therapeutic interchange. The value, cost, and quality of therapeutic interchange.

Therapeutic interchange is a process of substituting a prescribed medication with one that offers therapeutic and cost benefits. The practice not only provides short-term savings but also is associated with decreases in lengths of stay in hospitals and total hospital drug expenses. There may be medicolegal implications when FDA-approved indications differ for interchanged drugs. The potential for liability is decreased when a standard of care is met, but since standards can change, guidelines should be reviewed regularly. High-tech, high-cost drugs are sometimes appropriate for therapeutic interchange. Pharmacy and therapeutics committees should assure best value by considering indirect expenses, quality, and therapeutic outcome, as well as product cost. Therapeutic interchange programs enable pharmacy managers to neutralize or at least slow the rate of drug cost increases, ensuring appropriate utilization of resources and more favorable patient outcomes.

Biotechnology↗
PubMed1992

Current treatment of gram-positive infections: focus on efficacy, safety, and cost minimalization analysis of teicoplanin.

The current health care environment has had a significant impact on hospital Pharmacy and Therapeutics Committee formulary decisions. In evaluating a new therapy for formulary inclusion, a cost savings along with equivalent or an improvement in patient care and safety is optimal. Teicoplanin is an investigational glycopeptide antimicrobial agent with a spectrum of activity similar to vancomycin. Unlike vancomycin, however, teicoplanin has a long elimination half-life permitting administration once daily, and is well tolerated when given intramuscularly. In addition, teicoplanin is associated with a favorable safety profile. Red man syndrome does not appear to be a significant clinical problem. Results of our cost minimalization analysis using the average acquisition costs of vancomycin revealed that teicoplanin (400 mg), at an average acquisition cost of less than $28.46 when administered intravenously and $30.93 when administered intramuscularly, offers a clinically efficacious, safe, and less expensive alternative to vancomycin therapy.

Cost Savings↗
PubMed1993

Clinical appropriateness, therapeutic equivalence, and cost of conversion of H2 antagonist therapy.

A 12-month drug monitoring program targeting the use of H2 antagonists was initiated at the Erie County Medical Center, a 650-bed academic teaching hospital in Buffalo, NY. Discussed in this article are the development of indicators used to determine appropriateness of therapy, implementation of a H2 antagonist monitoring and screening program, examination of the effect of the program on budgetary expenditures for H2 antagonist therapy, evaluation of adverse effects and potential drug interactions associated with drug use, and measurement of possible drug cost savings resulting from the implementation of the program.

Cimetidine↗
PubMedDate not supplied

Reducing outpatient costs of nonsteroidal antiinflammatory drugs at a Department of Veterans Affairs teaching hospital.

OBJECTIVE: To determine how formulary changes, based on the recommendations of a clinical pharmacy specialist, affected outpatient nonsteroidal antiinflammatory drug (NSAID) prescribing patterns and drug costs in a Department of Veterans Affairs (VA) teaching hospital. DESIGN: Cost-benefit analysis. SETTING: VA teaching hospital. PATIENTS: Outpatient veterans. INTERVENTIONS: Sulindac, piroxicam, and diflunisal were removed from the formulary and made available only on a case-by-case review process. Buffered aspirin and phenylbutazone also were removed from the formulary; these drugs were made unavailable altogether. Ibuprofen, indomethacin, salsalate, enteric-coated aspirin, and plain aspirin retained their formulary status and were available for routine prescribing. MAIN OUTCOME MEASURES: Changes in the number of prescriptions dispensed and in prescription costs for each NSAID were measured 3 months before and 5 and 21 months after implementation of formulary changes. RESULTS: No prescriptions were dispensed for diflunisal, buffered aspirin, and phenylbutazone 21 months after implementation of the formulary changes. During this same period, prescriptions for sulindac and piroxicam declined 95.7 and 97.1 percent, respectively. The average cost per outpatient NSAID prescription declined from $14.78 to $4.75 (67.9 percent) after 21 months. An extrapolated yearly savings of $137,704 was calculated. CONCLUSIONS: Formulary changes based on recommendations of a clinical pharmacy specialist resulted in altered physician prescribing patterns and reduced outpatient drug costs for NSAIDs in a VA teaching hospital.

Anti-Inflammatory Agents, Non-Steroidal↗