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PubMed1981

Therapeutic substitution and the hospital formulary system.

Physicians consent and statutory regulations relating to therapeutic substitution are discussed. Some hospitals have adopted policies allowing the interchange of a chemically inequivalent product deemed therapeutically identical by the P & T committee. In the absence of statutory regulation, hospital pharmacists usually refer to (1) the physician's agreement to abide by hospital bylaws (including the formulary system) when joining the hospital staff, or (2) prescription blanks and order sheets preprinted with the statement "substitution permitted unless otherwise indicated" as the legal authority for therapeutic substitution. Only two states have addressed the legality of therapeutic substitution. An opinion of the Oregon Attorney General and a Washington state statute both authorize therapeutic substitution under certain circumstances if the prescriber has given prior consent. Neither of the states specifies, however, whether the agreement of prescribers to abide by hospital bylaws constitutes authorization of therapeutic substitution. It is proposed that state boards of pharmacy and state legislatures draft laws that address therapeutic substitution and specify acceptable methods of consent.

Formularies, Hospital as Topic↗
PubMed1995

[Guidelines for investigating clusters of health events].

Clusters of health events, such as chronic diseases, injuries, and birth defects, are often reported to health agencies. In many instances, the health agency will not be able to demonstrate an excess of the condition in question or establish an etiologic linkage to an exposure. Nevertheless, a systematic, integrated approach is needed for responding to reports of clusters. In addition to having epidemiologic and statistical expertise, health agencies should recognize the social dimensions of a cluster and should develop an approach for investigating clusters that best maintains critical community relationships and that does not excessively deplete resources. Health agencies should understand the potential legal ramifications of reported clusters, how risks are perceived by the community, and the influence of the media on that perception. Organizationally, each agency should have an internal management system to assure prompt attention to reports of clusters. Such a system requires the establishment of a locus of responsibility and control within the agency and of a process for involving concerned groups and citizens, such as an officially constituted advisory committee. Written operating procedures and dedicated resources may be of particular value. Although a systematic approach is vital, health agencies should be flexible in their method of analysis and tests of statistical significance. The recommended approach is a four-stage process: initial response, assessment, major feasibility study, and etiologic investigation. Each step provides opportunities for collecting data and making decisions. Although this approach may not always be followed sequentially, it provides a systematic plan with points at which the decision may be made to terminate or continue the investigation.

Cluster Analysis↗
PubMed1977

Antisubstitution law changes and the hospital formulary system.

The effects of amendments to state antisubstitution laws on the hospital formulary system are discussed. The approaches of four states--California, Michigan, Minnesota and Delaware--are reviewed. It is concluded that the legal basis of the hospital formulary system remains intact regardless of the changes in state antisubstitution laws.

California↗
PubMed1993

Effect of generic drug competition on the price of prescription drugs in Ontario.

OBJECTIVE: To analyse the potential effect of generic drug competition on prices in Ontario to assess the costs and benefits associated with Bill C-22 (An Act to amend the Patent Act). DESIGN: Comparison of the cost of the least and most expensive versions of all products sold by more than one manufacturer in 1991. The number of brand-name and generic drug companies marketing each of the products was recorded. RESULTS: Of 1599 products 437 (27.3%) were made by more than one company. Almost half (44.6%) of the 437 were sold by two companies. The more companies that sold a drug the greater the difference in price between the least and most expensive versions. Similarly, as the proportion of generic drug companies in competition increased, the greater the price difference. When competition was between generic drug companies only, the price spread was smaller than when it was between brand-name drug companies only. CONCLUSIONS: Generic drug competition can result in savings to the Ontario Drug Benefit Plan. A more in-depth analysis of the potential savings is necessary to fully assess the costs and benefits associated with Bill C-22.

Drug Industry↗
PubMed1993

Adolescent abortion: views of the membership of the American Academy of Pediatrics.

To identify the positions held by the American Academy of Pediatrics (AAP) membership on a number of issues that may be topics of legislation regarding abortion, the AAP carried out a survey based on a random sample of 1000 active US members. A total of 785 usable questionnaires were returned. The majority of members surveyed (56.7%) favored access to abortion for adolescents for all the reasons identified in the questionnaire; 35.4% believed abortion should clearly be restricted in some circumstances, and 7.0% believed adolescents should not have access to abortion under any circumstances. For each individual reason for abortion, at least 60% of the membership believed adolescents should have access to abortion services. In addition, most pediatricians supported legal positions that would facilitate access to abortion services for adolescents. Urban, female, and non-self-employed pediatricians were slightly more likely to support access to abortion by adolescents than comparison groups. Discussion focuses on the extent to which pediatricians' views reflect medical concerns, the extent to which their views are reflected in the current laws, and implications for practice and for AAP policy.

Abortion, Legal↗
PubMed1996

[Professional profile of primary health care personnel. A Delphi study].

OBJECTIVE: To determine the professional profile of health staff (doctors, paediatricians and nurses) in primary care (PC). DESIGN: Three simultaneous Delphi techniques (consensus method). SETTING: Primary care. PARTICIPANTS: 55 doctors, 45 nurses and 23 paediatricians from the whole of Spain and different fields of activity. INTERVENTION: The filling in of three questionnaires, using the Delphi methodology. RESULTS: The overall percentage of replies was 69.1% (first questionnaire), 70.7% (2nd) and 60.16% (3th). The PC doctor should guide in a suitable way his/her community's health problems, using the relevant diagnostic and therapeutic methods, caring for patients' all-round health, controlling the doctor-patient interview, all in collaboration with other professionals, with a planning, programming and evaluation of his/her activity and a basically community-oriented approach. The nursing professional should provide all-round care for patients, using nursing diagnostic and therapeutic methods, within a multidisciplinary team and carrying out planning, programming and evaluation of the community's health problems. The PC paediatrician should be concerned with the prevention and treatment of the most common pathologies. He/she has a vital role to play in childrens' health education, should have the training to resolve the most common paediatric emergencies and organise his/her work within a multidisciplinary team. CONCLUSIONS: The Delphi method is a useful technique for determining professional profiles. Paediatricians have a more sharply defined profile than doctors and nursing staff.

Delivery of Health Care↗