Structure and activities of pharmacy and therapeutics committees among public hospitals in South Africa; findings and implications

Abstract

The WHO identified Pharmacy and Therapeutics Committees (PTCs) as a pivotal model to promote rational medicine use in hospitals. This matches a key South African (SA) government objective to establish PTCs in all hospitals to ensure rational, efficient and cost-effective use of medicines. However, documentation on the functionality of PTCs in public hospitals in SA is limited. Areas covered: This study aimed to address this. A 3-phased mixed methods approach involving questionnaires, observations of PTC meetings and semi-structured interviews was used. The findings were converged during the interpretation phase. Expert commentary: Most professionals were represented in the PTCs, with variations across hospitals. Membership of PTCs included a pharmacist, who in the majority of cases was the secretary. PTC activities included dissemination of decisions (100%) and formulary management (89.5%). However, reporting of adverse drug reactions (ADRs) and medication errors was typically poor at all hospital levels. Lack of expertise of pharmacoeconomic analysis and evidence-based decision-making in formulary management was identified as a key challenge in formulary management. In conclusion, future programmes should strengthen PTCs in specialised aspects of formulary management. Further training in the principles of pharmacovigilance is needed to enhance ADR reporting, as well as to ensure compliance with both WHO and provincial guidelines.

Knowledge, attitudes and practices of health care professionals towards adverse drug reaction reporting in public sector primary health care facilities in a South African district

“…Health status reports, including ADRs, are discussed at the Tshwane Health District Pharmaceutical and Therapeutics Committee (PTC) meetings on a quarterly basis. PTCs are now a formal requirement across sectors in South Africa [51]. Over the 18-month period prior to this study, very few ADRs were considered, which is a concern.…”

Point prevalence survey of antibiotic use and resistance at a referral hospital in Kenya: findings and implications

“…Adherence to agreed national guidelines should help improve future antibiotic use and reduce resistance rates [7,33,34]. However, there are concerns with current adherence to recommended antibiotic treatments and doses for infectious diseases across countries [27,[33][34][35] although not universal [36], as well as a lack of formularies and associated activities in hospitals in Africa to improve future antibiotic use [37][38][39]. In Kenya, currently only 4 in 10 public hospitals were complying with the National treatment guidelines when their prescribing was analyzed raising concerns with increasing AMR rates [40].…”

Availability and Use of Therapeutic Interchange Policies in Managing Antimicrobial Shortages among South African Public Sector Hospitals; Findings and Implications

“…Encouragingly, the majority of the respondents said that their hospitals had active PTCs and AMSCs. This is welcomed, especially as one of the aims and objectives of the South African National Drug Policy is to establish and strengthen PTCs in all hospitals [23,24,36]. However, of concern was that less than half of the respondents (42.4%) stated their hospitals had therapeutic interchange policies.…”

“…Where shortages of antimicrobials exist, therapeutic interchange policies can potentially help ensure that substitution is not haphazard or inappropriate [22]. Pharmacists can play a crucial role in the development and implementation of therapeutic interchange policies in hospitals combined with other key stakeholder groups, building on activities within Pharmacy and Therapeutic Committees (PTCs) as well as AMSPs [8,23,24]. Whilst the effective functioning of PTCs is improving in South Africa and AMSPs are evolving [23,24], there are concerns regarding the extent of therapeutic interchange policies among public sector hospitals in South Africa, especially regarding antimicrobials.…”