Cotter S M, McKee M
Health Services Research Unit, London School of Hygiene & Tropical Medicine, UK.
J Health Serv Res Policy. 1997 Jul;2(3):144-53. doi: 10.1177/135581969700200304.
Pharmacists in UK National Health Service (NHS) hospitals have a long tradition of involvement in the development of drug policy. This paper describes various approaches that have been employed in the development and implementation of drug policy in hospitals and examines the evidence for their effectiveness and acceptability in the context of a changing health service.
A series of focused interviews was conducted with a range of staff, including doctors, nurses, pharmacists and managers at eight hospitals. Interview sites were selected on the basis of a national survey of clinical pharmacy roles and were broadly representative of UK NHS hospitals. Interview data were analysed using constant comparison and analytic induction.
Three models used in the development of drug policy were identified: a 'traditional' model, in which a drug and therapeutics committee establishes a hospital-wide formulary which is implemented by pharmacists; a 'combined' model, in which there is much more emphasis on tailoring policies and feedback to specialties or clinical directorates; and a 'medical control' model, in which prescribing decisions are made by individual doctors without reference to explicit policies and with little active pharmacy involvement. Pharmacy involvement was seen as vital to the development of effective policies but hospital-specific factors influenced the choice of model at particular sites.
Hospitals may be moving towards the 'combined' model which could have advantages in the current internal market within the NHS. However, evaluations of the various approaches to drug policy should help inform this decision.
英国国民医疗服务体系（NHS）医院的药剂师长期以来一直参与药物政策的制定。本文描述了在医院药物政策制定和实施过程中采用的各种方法，并在不断变化的医疗服务背景下考察了这些方法的有效性和可接受性的证据。
对八家医院的一系列工作人员进行了聚焦访谈，包括医生、护士、药剂师和管理人员。访谈地点是根据对临床药学角色的全国性调查选定的，广泛代表了英国国民医疗服务体系医院。访谈数据采用持续比较和分析归纳法进行分析。
确定了药物政策制定中使用的三种模式：“传统”模式，即药物与治疗委员会制定全院范围的处方集，由药剂师实施；“联合”模式，即更加注重针对专科或临床科室量身定制政策和反馈；以及“医疗控制”模式，即由个别医生做出处方决定，不参考明确政策，药剂师很少积极参与。药剂师的参与被视为有效政策制定的关键，但医院特定因素影响了特定地点模式的选择。
医院可能正在向“联合”模式转变，这在国民医疗服务体系当前的内部市场中可能具有优势。然而，对药物政策各种方法的评估应有助于为这一决策提供参考。
