Changing Roles of Pharmacy and Therapeutic Committees

1
Changing Roles of Pharmacy and Therapeutic
Committees

• Richard Laing
• Department of
• International Health
• Boston University
• School of Public Health

2
Drug and Therapeutic or Pharmacy and Therapeutic
Committees

• Around for a long time, various functions in
  developed countries
• Hardly exist or function effectively in
  developing countries
• NDPs support PTCs but in practice often meetings
  become drug shortage confrontations

3
Why interest in PTCs

• Almost complete absence of data on improving drug
  use in hospitals in developing countries
• Cost and quality conflicts increasing everywhere
• Australian models seem useful
• Recognition that quality of care determines
  willingness to pay

4
Justification for PTCs

• Cost control
• As technology develops, populations transform
  AIDS affects health services, pressures mount to
  control costs while maintaining services
• Quality of Care
• Quality is determined by more than structures and
  resources. Need processes and people to produce
  outputs
• Efficiency
• As health systems become more complex, efficiency
  requires effective communication and collaboration

5
Essential Function of PTCs

• Meeting ground between clinicians, pharmacists
  and financial managers to negotiate the balance
  between cost and quality.
• The pharmacist often has to play the role of an
  expert referee!

6
Membership

• Staff from medicine, surgery, pharmacy, nursing,
  quality management, hospital administration,
  information systems, and infection control. In
  Australia community members!
• The number of members range from eight to twelve
  in the United States, with Australia averaging
  nine members.
• The chairperson is chosen usually from clinical
  members while secretary a pharmacist. But not in
  Germany!

7
Meetings Frequency and Duration

• Most committees meet monthly, usually for 60 to
  90 minutes
• Best times in US mornings (breakfast meeting) or
  noon (Lunchtime meeting)
• In Boston providing food was directly related to
  attendance!

8
Terms of Reference

• Includes
• Selection
• Standard Treatment Guidelines
• Drug Utilization Review
• Production of Drug bulletin

• Providing objective information including DICs
• Adverse Drug Reactions
• Medication errors
• Control of Drug Reps
• ????

9
Functioning in Practice

• Selection
• Hospital Formulary or Hospital drug lists e.g.
  Emergency, Surgical, Medical, Pediatrics etc
• Review of Applications for additions, deletions,
  buying out, special requests, ABC Analysis
• Defining drug priority VEN analysis
• Producing and Reviewing STGs
• Disease or Drug based Examples Cerebral Malaria,
  OP hypertension OR blood, ciprofloxacin or
  ceftriaxone
• Defining levels of use
• Specialist only, counter signatures,
• Distribution controls

10
Functioning in Practice (2)

• Educational Activities
• Printed Materials
• Large Group teaching
• Small group teaching
• Individual detailing
• Teaching Nurses, medical students, new appointees
• Opinion leaders

11
Drug Utilization Review / Evaluation

• Effective but not that frequently done
• Steps
• Problem Identification (Condition or drug)
• Define criteria
• Measure performance
• Compare performance with criteria
• Feedback results
• See MDS2 or McGuire article for details

12
Other Functions

• ADR Monitoring
• Medication Errors
• Controlling drug reps (Achieving the impossible!)
• Appointments
• Prior review of materials
• Equal time for presentations
• Patients have priority!

13
Evaluation of Interventions

• Structural and Process evaluation needed annually
• Outcome evaluation of interventions
• Best method is time series ideally with a control
  hospital. Need at least 6 points before and at
  least 6 points after intervention. Better to have
  8 or 12 pre and post time points

14
Data Sources for Monitoring Evaluation

• Drug Stock records
• Prescribing records
• Dispensing records
• Case notes
• Registers of Expensive drugs
• Financial Records

15
Budgeting for PTC Activities

• Consider
• Staff time costs
• Meeting costs (Food, parking, duplication)
• DUR data collection costs
• Intervention costs
• Reporting costs

16
Difficult PTC Issues

• Conflict of Interest
• Lack of adherence to PTC decisions
• Role of Pharmaco-economics in decision making
• Lack of evidence based assessment in selecting
  drugs for formulary
• Appeal mechanisms and transparency

17
What makes a successful PTC?

• Chairman
• Members
• Quality and responsiveness of technical support
• Attendance and involvement at meetings
• Members carry decisions back to their departments

18
Why is it so difficult to get these committees to
function effectively?

• Personal View
• Clinicians, pharmacists and financial managers
  have different world views.
• For progress each group need to understand and
  respect the others world view

19
Importance of PTCs

• With technology development, changing patterns of
  disease and financial limits, critical that these
  committees function effectively
• Each committee will need to determine their own
  priorities, work plans and systems
• Without these committees decisions will be taken
  without regard for quality of care or cost
  efficacy of treatment