Assessment of indicators for hospital drug formulary non-adherence

Abstract

Background: Translation of rational drug therapy into practice remains an international problem. Although pharmacotherapeutic treatment guidelines (PTGs) as managerial tools are favoured over hospital drug formularies (HDFs), the latter are still applied in most hospitals. HDF enforcement often leads to timeconsuming consultation from the perspective of both pharmacy sta and prescriber. So far, research on HDFs has only been conducted outside Europe. Moreover, this research has only been descriptive. Straightforward indicators qualitatively characterising HDF non-adherence have never been assessed. Methods: A retrospective 1:1 case-control study was conducted across three general teaching hospitals. Non-HDF requests were compared with HDF requests. Data were multivariably analysed, considering patient, prescriber, drug, and HDF characteristics as possible indicators for non-adherence. Results: HDF adherence was almost universal across characteristics. Non-adherence was characterised by newly marketed drugs, drugs that were part of patients' pre-admission drug therapy, drugs with many fellow drugs within the drug group on the market, and drugs originating from a drug group for which the HDF was highly restrictive. Contrary to common perception, nonadherence was independent of medical specialty, therapeutic area, and patient characteristics. Conclusion: This research provides an epidemiological framework for hospitals (drug and therapeutics committees) for evaluating pharmacy data on HDF nonadherence. It can be used for educational tailor-made feedback to prescribers and for drug selection when the inclusion of newly marketed drugs is considered or HDF restrictiveness for certain drug groups is reconsidered. Moreover, it demonstrates the importance of a regional approach involving secondary and primary health care to establish continuity in seamless care of drug therapy.

Impact of removal and restriction of me-too medicines in a hospital drug formulary on in- and outpatient drug prescriptions: interrupted time series design with comparison group

“…Although there may be some residual use of some withdrawn medications, this is in line with other studies which indicate that adherence to drugs formularies by hospital health professionals, albeit very high (80–95%) [15–17], is not 100%.…”

Impact on In‐ and Out‐of‐Hospital Drug Prescriptions of Including a More Expensive Me‐Too Antidepressant in a Hospital Drug Formulary: a Controlled Longitudinal Study

“…Although there are descriptive studies that show high intrahospital adherence to HDF medications (since compliance is not mandatory and there may be medication use outside of the formulary), 12,[36][37][38][39][40] there are very few studies which analyze the effect of alterations in an HDF on the two healthcare settings (in-hospital and out-of-hospital). [9][10][11] On the other hand, there are other kind of studies which show involvement of the hospital in changes in prescribing patterns [41][42][43] and furnish evidence of the specific contextual factors that can affect the impact sought with this type of intervention.…”

Discontinuities in drug use upon hospital discharge

“…Non-adherence to the drug formulary could exist on two levels: the active substance was in the HDF but in the form of a different product, or the active substance was not in the HDF at all. The HDF used in the Hilversum Hospital, can be regarded as 'restrictive', meaning that non-formulary prescriptions are not honoured in principle 9 .…”