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At least 1,243 records · Page 69Linked to original sources
PubMed1990

The Royal Naval Medical Stores for Service Afloat: a prospective quantitative study.

The contents of the scale of Medical Stores for Service Afloat must provide adequate quantities of drugs to allow proper patient care in a variety of situations often remote from specialist support. The overall make up of the scale is difficult to envisage outside the context for which it was conceived. This study was designed to assess the accuracy of the make up of the scale in three RN ships over a six-month period during a detached deployment. During this time the usage of all consumable items was specifically recorded and the outcome subjected to rigorous analysis in relation to the present scale. The results of the study indicate that in the case of both HMS Ark Royal (AR) and the two smaller ships HMS Edinburgh and HMS Sirius (ES) the quantities of drugs in the majority of cases are in excess of requirements. Of the 290 (AR) and 266 (ES) individual drugs 68% and 40% respectively could safely be reduced by varying amounts, whereas only 7.6% and 4.9% respectively needed to be increased. Furthermore, when these changes are costed the savings that result are 7806 pounds for the AR scale and 1532 pounds for the ES scale. Extrapolation of these figures across the surface fleet produces an overall saving on the costs of drugs of over 87,000 pounds.

Cost Control↗
PubMed1990

Formulary-control procedures in a staff-model health maintenance organization.

Efforts to promote cost-effective drug prescribing in a health maintenance organization (HMO) through (1) revision of the formulary, (2) education, and (3) drug-use evaluations (DUEs) are described. New programs and procedures to promote more cost-effective prescribing were implemented in 1987 at a staff-model HMO with seven health-care centers and 40,000 members. Support to the pharmacy and therapeutics committee in developing formulary recommendations was enhanced, the formulary was revised and the number of listed drugs reduced by half, the focus of pharmacists was changed from purchasing and inventory control to education of physicians about cost-effective prescribing, and the most expensive drug categories were identified and educational efforts instituted. During the next two years substantial changes in the prescribing of oral contraceptives, nonsteroidal anti-inflammatory drugs, antiulcer agents, and anti-infectives, but not antihypertensive drugs, were identified through DUEs. Evaluation of cost savings was limited by the lack of an automated, integrated patient database, and it was difficult to assess the effect of changes in patient population. Revision of the formulary coordinated with enhanced educational efforts and DUEs resulted in more cost-effective prescribing in an HMO without placing severe restrictions on physicians or patients.

Cost-Benefit Analysis↗
PubMed1990

Containing medicines costs in the private sector--the example of a medical benefit scheme.

Despite a pre-existing cost-containment programme, expenditure on medicines was identified as a source of further cost savings in a medical benefit scheme faced with increasing divergence between income and benefit expenditure. Analysis of medicines utilisation trends showed that a relatively small number of pharmaceutical products accounted for a high percentage of total medicines expenditure, and that a small number of pharmacies were dispensing a very high proportion of prescriptions. On the basis of these findings, a revised cost-containment programme for medicines was implemented. It consisted of a recommended medicines list, designed to rationalise selection and utilisation of medicines, and a 'preferred provider pharmacy' network that allowed further savings to be achieved. In its first 12 months, the programme allowed for savings of R305,000, or 37% of anticipated expenditure on medicines for that year. This represents a decrease over 1988 expenditure notwithstanding an increase in membership and medicine prices over the same period. There are therefore significant savings to be obtained by medical schemes through implementation of cost-containment programmes for medicines.

Cost Control↗
PubMed1990

State Medicaid officials battle drug firms in war to cut costs.

As state Medicaid agencies struggle to cut costs for prescription drugs, their main tool has been the use of drug formularies--a state-approved list of thousands of drugs that the agencies will reimburse for the treatment of Medicaid patients. Now, states are trying to use a second method that could reap big savings: requiring drug companies to bid to be included in the formulary. However, both cost-containment strategies have attracted the pharmaceutical industry's attention--and their lobbyists.

Competitive Bidding↗
PubMed1990

Practice formularies.

Explore the source record for details and available documents.

Drug Information Services↗
PubMed1989

Pharmaceutical services at the Tenth Pan American Games.

The pharmaceutical services provided by volunteers, including more than 100 pharmacists, at the 1987 Pan American Games in Indianapolis, Indiana, are described. Pharmacists at a local hospital were given responsibility for doping control and operation of the medical clinic pharmacy at the games. Barracks at a U.S. Army facility within the games' boundaries were converted into the clinic; an area on the second floor was equipped as the pharmacy. The pharmacy secured the necessary licensure and obtained drug products and supplies. Volunteer pharmacists were recruited and instructed about responsibilities, procedures, and security. The formulary was based on the 1983 Pan American Games formulary, the 1988 Olympic Games formulary, and requests from the Pan American Sports Organization. In the 26 days that the pharmacy was open, 968 prescriptions were filled. The drugs most commonly prescribed were ibuprofen, terfenadine, acetaminophen, penicillin V potassium, clotrimazole cream, and naproxen. A doping control center located at each competition venue was staffed by a physician, pharmacists, nurses, medical technologists, and nonmedical personnel. After an event, selected athletes were escorted to a doping control center, where a medical history and urine sample were obtained. The urine was tested for pH and specific gravity, and the coded specimen bottles were sealed for transport to the laboratory. Each step was documented on special forms. A total of 981 athletes were tested; six athletes had positive test results. The 1987 Pan American Games provided a unique opportunity for pharmacists to assist in providing medical services at a large athletic event and to become involved in doping control.

Americas↗
PubMed1989

Evaluating an enteral nutrition formulary.

Two hundred registered dietitians in health care facilities in the United States were surveyed to ascertain practices in enteral nutrition formulary management. A random selection of members of the Clinical Nutrition Management Dietetic Practice Group of The American Dietetic Association comprised the sample population. The response rate was 74%. The facilities were typically private, nonprofit, acute-care, with a capacity of 201 to 500 beds. Dietetic departments were primarily responsible for procuring, preparing, and distributing enteral nutrition formulas, Physicians, however, primarily initiated orders for formulas. Approximately 15% of hospitalized patients required enteral nutrition formulas, yet modular formulas were rarely used. More than 75% of the facilities utilized enteral nutrition formularies. Ninety-five percent of dietitians believed that establishing objective criteria for evaluating enteral nutrition formulas was important. Cost-containment through decreased product duplication, staff education, inventory management, and quantity ordering advantages were cited as motivating factors in criteria development. Osmolarity, lactose content, and product availability were identified as being the most important criteria in enteral product evaluation. The costs of enteral formulas were included in the standard room rate when the dietetics department was responsible for procuring and supplying enteral formulas. Patients were billed directly when the pharmacy department was responsible for purchasing or supplying enteral products. This study provides data from which a model may be developed to guide health care professionals in enteral formulary decision making.

Dietetics↗
PubMed1988

Implementation of an outpatient prescription drug formulary in a managed-care system.

The development and implementation of an outpatient prescription formulary in an independent-practice model health maintenance organization (HMO) and the role of the pharmacy and therapeutics (P&T) committee in the process are described. Approximately 600 physicians provide medical care and control the operation of this independent practice association (IPA); of approximately 45,000 members, 95% are eligible for outpatient prescription services provided by one of 188 local pharmacies. The formulary, which is restricted to noninjectable medications, was developed by a P&T committee composed of eight IPA physicians, a representative of the local pharmaceutical association, and three staff members of the IPA's pharmacy department. The printed version of the formulary indexed almost 1800 items and included only commonly used medications to limit its size. Requests for additions or deletions of drugs were evaluated monthly. After a four-month period during which physicians were asked to comply with the formulary, mandatory compliance was imposed, with a limit of 16 nonformulary prescriptions per physician per month being allowed. Based on the results of an informal survey, the physicians indicated that the formulary was relatively easy to adjust to (44.1%), somewhat difficult to work with (43.6%), and somewhat disruptive to their prescribing practices (55.3%). When asked about quality of patient care, 74.3% indicated there was no change. Physician compliance with the formulary system increased from 88.0% to 96.1% after the formulary was mandated by the IPA. Under the direction of the P&T committee, a formulary was implemented effectively in this HMO outpatient prescription drug program.

Delivery of Health Care↗