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PubMed1994

[Criteria for the development of a formulary of drugs in a basic health area and impact on prescription].

OBJECTIVE: To promote rational prescription in Primary Care by elaborating a restricted list of medicines in a PC, the implementation of the list and the evaluation of its influence. DESIGN: Controlled intervention study. SETTING: Intervention group: Castelldefels Health Centre. CONTROL GROUP: Molí Nou HC in same health sector. PARTICIPANTS: Doctors from the PC teams of both centres. INTERVENTIONS: Initially the prescription for 1992 of the intervention group was analysed. The main therapeutic groups prescribed for on the initiative of the General Practitioners (GP) of the Castelldefels HC were identified and the intervention was then carried out on them. The PC team from the intervention group, chose the drugs by consensus, on the basis of pharmaceutical advice. MEASUREMENTS AND MAIN RESULTS: Castelldefels HD presented worse indicators than the rest of the Sector's. It was observed that the GPs decided 63.4% +/- 3.9% of their therapeutic prescriptions. The groups most prescribed for on GP initiative were systemic (J) and respiratory apparatus (R) anti-infection therapies. The intervention was verified with Macrolids, Beta-lactamics (excluding Cephalosporins) and Quinolones. In neither of the two HDs were statistically significant differences (p < 0.05) in the consumption of the selected antibiotics between the two periods observed. CONCLUSIONS: This process is aimed at altering GPs' attitudes, it is essential that they participate in the choice of medicines in order to keep them involved; and that the ongoing records of the chosen drugs are verified, with the evaluation of their influence then being just one more tool in this process.

Catchment Area, Health↗
PubMed1994

Attitudes of primary care physicians towards the use of a drug formulary--preliminary results of a study in Germany.

Although the concept of a drug formulary in primary health care is known for more than 10 years it was only recently that the drug budget of the new German Health Legislation has drawn doctors' attention to the use of such formularies. The loose-leaf form "Göttingen formulary" has been specifically compiled for the need of primary care doctors. It contains less than 300 drugs and drug combinations (including pseudo-placebos). This formulary was ordered by 830 colleagues from November 1992 until the end of May. In June 1993 we sent a semi-structured questionnaire to the users to learn about their experience with and attitude towards the formulary and about changes in their prescribing habits. Until the end of August 223 questionnaires have been returned. Seventy-four % of the respondents were general practitioners with considerable experience (more than 10 years in practice: 77%). The majority were satisfied or very satisfied with the drugs selected for the formulary and found the list helpful or very helpful (68%). Sixty-seven % indicated that the use of the formulary changed their prescribing habits; 70% appreciated an official (governmental) positive list. Although this study did not use a representative sample and the response rate was rather low until the cut-off point, it is noteworthy that the overall appreciation of a drug formulary for primary health care was very positive. The great majority of the respondents were convinced that an individual drug formulary does not render an official positive list superfluous.

Attitude of Health Personnel↗
PubMed1994

Quality control of drug prescriptions by positive lists--the European Formulary.

The overall quality of drug prescription is based on three elements: structural, procedural and result quality. In order to improve the clinical outcome (= result quality) of a patient, only drugs with a proven efficacy and a well known risk/benefit-relation should be prescribed. However, in 1992 in Germany, 31.1% of the ambulatory drug prescriptions were for drugs with questionable efficacy or dubious combination preparations. These expenditures therefore cannot be justified, neither from a pharmacological point of view nor from an economic standpoint. One of the main reasons for this poor prescribing quality is a poor structural quality, i.e. too many drugs and lack of transparency on the market and a producer-oriented drug information. In order to improve this structural quality, a drug list will be established by a group of 33 pharmacologists, physicians and pharmacists from 15 European countries. This list aims at 66 diseases, which are thought to be the most common for the general practitioners everyday routine. For these illnesses drug therapies are recommended including information on drug side-effects, possible interactions and contra-indications. Furthermore, basing on published literature, all possible drugs for the 66 indications will be discussed explaining and underlining the choice of the European Formulary Group. However, even a comprehensive drug list may not rule out insufficient procedural quality, i.e. too lengthy prescriptions of benzodiazepines, but may hopefully facilitate the rational choice of drugs and therefore improve patients outcome.

Drug Evaluation↗
PubMedDate not supplied

The role of pharmacoeconomic guidelines for formulary approval: the Australian experience.

This paper provides a review and critique of the recently introduced Australian Guidelines for the Presentation of Submissions to the Pharmaceutical Benefits Advisory Committee (Guidelines), which require pharmaceutical companies seeking recommendation for national formulary listing and subsidization to provide a detailed economic analysis to support their case. As Australia is the first country to mandate such a requirement, it is important not only to consider the details of the Guideline's requirements for economic analysis and the expectations of the authors, but also to consider, from both theoretical and practical perspectives, whether the Guidelines are appropriate for drug evaluation purposes. Although the Guidelines have raised the level of awareness of the need to integrate economic analysis into the formulary approval process, their contribution as a model for other jurisdictions must be qualified by the prescriptive and unduly narrow view that is taken of allowable analytical techniques. By forcing drug evaluations into a straightjacket, the Guidelines run the risk of undermining the credibility and contribution of economic analysis to formulary decisions.

Australia↗
PubMed1994

Impact of a formulary on personal care homes in Manitoba.

OBJECTIVE: To assess the impact of a formulary on drug expenditures and prescribing trends in personal care homes (nursing homes). DESIGN: Quasi-experimental analysis of a drug prescription database before and after implementation of the formulary. SETTING: Personal care homes in Manitoba. PATIENTS: Residents occupying the 6848 beds of the 88 personal care homes that did not already have a formulary. INTERVENTION: Formulary, introduced Apr. 1, 1987. MAIN OUTCOME MEASURES: Drug expenditures from Apr. 1, 1985, to Mar. 31, 1990; proportion of residents receiving a prescription by drug class and rate of prescriptions of nonformulary drugs in the year before and 2 years after the formulary was introduced. MAIN RESULTS: The total drug expenditures per bed remained constant during the first year after the formulary was implemented, even though the annual drug inflation rate was 9.8% on average during the study period. Expenditures 2 and 3 years after implementation rose by 9.4% and 5.8% respectively. Those for specific agents and drug classes targeted as being inappropriate for long-term care decreased greatly because of reduced prescribing. Expenditures for some other drug classes increased mainly because newer, more expensive agents were used. The mean drug expenditure per bed varied widely between homes; neither size nor location were found to correlate with drug expenditure, but adherence to the formulary did predict personal care homes with decreased expenditures. CONCLUSIONS: A formulary in personal care homes can improve therapeutic management. The impact on cost containment was not as strong after the first year, although expenditures remained less than the rate of inflation for drug costs.

Aged↗
PubMed1994

[Measuring quality of life. A new general and a new tumor specific formulary for evaluation and planning].

The generic measure, SF-36, was developed in the US. It covers both functioning and well-being and has proved suitable for clinical outcomes research, patient monitoring and health care planning. To protect the forms and scoring algorithms of the SF-36 and ensure comparability across studies and countries the copyright was placed with Medical Outcomes Trust, a non-profit making organization. Researchers are granted permission through a user agreement procedure. An international team of investigators is developing authorized translations of the SF-36 through the International Quality of Life Assessment (IQOLA) Project, sponsored by Glaxo Research Institute, Research Triangle Park, North Carolina, USA, and Schering-Plough Corporation, Kenilworth, New Jersey, USA. The Swedish test version is currently available on a case-by-case basis at the Health Care Research Unit. The tumor-specific measure, QLQ-C30, was developed and proved reliable in cross-cultural field studies, created by the Quality of Life Study Group within the European Organization for Research and Treatment of Cancer (EORTC). It includes questions on functioning, symptom burden and global quality of life across tumors, supplemented by diagnosis--or therapy-specific additional modules. The instrument is copyrighted and all translations are placed with the Quality of Life Unit at the EORTC Data Center, Brussels. Requests for permission to use the instrument and scoring instructions should be sent to the Center.

Formularies as Topic↗
PubMed1993

Antibiotic policies.

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Anti-Bacterial Agents↗