Drug formulary decision-making in two regional health authorities in British Columbia, Canada

Armstrong, Kristy Anne; Mitton, Craig; Carleton, Bruce; Shoveller, Jean

doi:10.1016/j.healthpol.2008.04.006

Cited by 15 publications

(12 citation statements)

References 22 publications

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“…A two-stage study was performed, comprising a survey followed by semi-structured interviews with purposively selected informants. By using these complementary methods it was possible to gather structured data concerning the aspects of Chilean hospitals that are described in the literature as factors that influence the innovativeness of institutions [8,10,22,23], and it was also possible to explore relevant issues and processes in context.…”

Section: Methodsmentioning

confidence: 99%

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Selection of medicines in Chilean public hospitals: an exploratory study

Collao

Smith²,

Barber³

2013

BMC Health Serv Res

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BackgroundThere is a growing interest in high income countries to control expenditure on medicines by improving the rationale for their selection. However, in middle income countries with differing priorities and needs, little attention has been paid to this issue. In this paper we explore the policies and processes for the selection and use of medicines in a group of hospitals in Chile, a middle income country which has recently joined the OECD.MethodsA combination of qualitative and quantitative methods was used. A national survey questionnaire was distributed to investigate the role and operation of PTCs (Pharmacy and Therapeutics Committees). Interviews were conducted with key actors in the selection of medicines in large urban public hospitals.ResultsThe national survey had an overall response rate of 42% (83 out of 196), whilst 7 out of 14 hospitals participated in the qualitative study. High complexity hospitals are large urban hospitals; all of which claim to have a working PTC. The pharmacy offices are mainly involved in dispensing medicines with little involvement in clinical duties.The interviews conducted suggest that the formulary of all the hospitals visited is no more than a stock list. PTCs are unable to influence the prescribing practices of doctors. Members do not feel prepared to challenge the opinions of specialists requesting a certain drug, and decisions are based primarily on costs. The inclusion of medicines in the clinical practice of hospitals is as a result of doctors bypassing the PTC and requesting the purchase of exceptional items, some of which are included in the formulary if they are widely used.ConclusionsThere is an urgent need to develop medicine policies in hospitals in Chile. The procedures used to purchase medicines need to be revised. Central guidance for PTCs could help ensure a more rational use of medicines. PTCs need to be empowered to design formularies which cover all the clinical needs of doctors, training members in the analysis of scientific evidence beyond their own specialities. An influential PTC can take the appropriate measures and design workable policies to enforce a cost effective-use of resources.

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Section: Methodsmentioning

confidence: 99%

“…The questionnaire requested information on hospital size, complexity, and the existence of a PTC [8,10,22-28] (Additional file 1). …”

Section: Methodsmentioning

confidence: 99%

Selection of medicines in Chilean public hospitals: an exploratory study

Collao

Smith²,

Barber³

2013

BMC Health Serv Res

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“…A second type of challenge with the use of PE is the need to embed it within other decision criteria and an unruly decision making context. Efficiency considerations often fall by the wayside and are trumped by evidence of clinical benefit, political and/or other considerations (Martin et al, ; Eddama and Coast, ; Boon et al, ; Armstrong et al, ). There is no agreement on what these decision criteria should be, how important they should be relatively to one another, nor is there a common framework for how they should be used in combination (Chabot and Rocci, ; Boon et al, ; Franken et al, ; McDonald et al, ; Franken et al, ; Cleemput et al, ; Drummond, ; Franken et al, ).…”

Section: Challeges Of a Regionalized Review Processmentioning

confidence: 99%

The evolution of the cancer formulary review in Canada: Can centralization improve the use of economic evaluation?

Wranik

Gambold

Hanson

et al. 2016

Int J Health Plann Mgmt

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SummaryPublic reimbursement of drugs is a costly proposition for health care systems. Decisions to add drugs to the public formulary are often guided by review processes and committees. The evolution of the formulary review process in Canada's publicly funded health system is characterized by increased centralization and systematization. In the past, the review of evidence and recommendation was conducted at the regional level, but was replaced with the pan‐Canadian Oncology Drug Review in 2011. We assess the extent to which centralization and systematization of the review process have responded to past challenges, focusing on the use of economic evaluation in the process. Past challenges with economic evaluation experienced by regionalized review committees were identified from literature and qualitative data collected in the province of Nova Scotia. We categorize these using a typology with a macro‐, meso, and micro‐level hierarchy, which provides a useful framework for understanding at which level change is required, and who has the authority to influence change. Using grounded theory methods, we identify approaches used by Nova Scotia past committee members to compensate for perceived shortcomings of the process. These include an undue reliance on other committee members, on the multidisciplinarity of the committee, and on past decisions. Using a policy analysis approach, we argue that centralization and systematization of the review process only partially address the shortcomings of the previous regionalized process. Lessons from Canada can inform policy discussions across all health systems, where similar challenges with the formulary review process have been identified. © 2016 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.

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“…No previous detailed study has been conducted in tertiary paediatric hospitals, with most studies being surveys or qualitative studies exploring functions and decision making 14–16. Our study is of relevance to paediatric and adult institutions internationally because we identified common and similar challenges such as limited resources and ethical and political issues influencing decision making.…”

Section: Discussionmentioning

confidence: 93%