Burke Natasha, Bowen James M, Troyan Sue, Jegathisawaran Jathishinie, Gosse Carolyn, Tonkin Marita, Kagoma Sandra, Goeree Ron, Holbrook Anne
MSc, is with McMaster University and St Joseph's Health-care Hamilton (Programs for Assessment of Technology in Health [PATH]), Hamilton, Ontario.
RPh, BScPhm, MSc, is with McMaster University and St Joseph's Healthcare Hamilton (Programs for Assessment of Technology in Health [PATH]), Hamilton, Ontario.
Can J Hosp Pharm. 2016 May-Jun;69(3):187-93. doi: 10.4212/cjhp.v69i3.1554. Epub 2016 Jun 30.
Expenditures on drugs dispensed and administered to patients in Canadian hospitals have been estimated at $2.4 billion per year. Pharmacy and therapeutics (P&T) committees play a key role in the evaluation and management of drug therapies in this setting. Hospitals differ with respect to the composition of these committees, their members' expertise, and the processes used for making formulary decisions.
To examine the current processes for formulary drug review from the perspective of P&T committees and their individual members, and to examine the needs and preferences of these stakeholders related to evidence review and potential collaborative drug review processes within a large Local Health Integration Network (LHIN) in Ontario.
Twenty-three sites within 10 hospital corporations in LHIN 4 (Hamilton Niagara Haldimand Brant) were recruited. A 2-part questionnaire was developed and pretested for clarity and comprehensiveness. The institution profile section of the questionnaire was to be completed by pharmacy directors and the P&T section by committee members.
Ten pharmacy directors and 28 committee members representing 10 P&T committees responded. A mean of 6.4 new drug requests were reviewed annually by each P&T committee. Across the LHIN, the workload associated with reviewing submissions for new drugs to be added to the formulary represented 0.84 full-time equivalent. The quality of clinical evidence in the drug submissions was rated more favourably than the quality of economic evidence; furthermore, the use of economic evidence was limited by a lack of health economics expertise within the committees. A centralized review process for the LHIN was perceived as beneficial to improve efficiency, the quality of review, and standardization, and also to reduce costs.
Across the Hamilton Niagara Haldimand Brant LHIN, considerable time and resources are spent on the review of potential new drugs for addition to the hospitals' formularies. A standardized formulary review process, with greater use of provincial and national drug reviews, would likely benefit all LHINs.
据估计，加拿大医院为患者配药和给药的年度支出为24亿加元。药学与治疗学（P&T）委员会在这一背景下的药物治疗评估和管理中发挥着关键作用。不同医院的这些委员会组成、成员专业知识以及制定处方集决策所采用的流程各不相同。
从P&T委员会及其成员个人的角度审视当前的处方集药物审查流程，并研究安大略省一个大型地方卫生整合网络（LHIN）内这些利益相关者在证据审查以及潜在的合作药物审查流程方面的需求和偏好。
招募了LHIN 4（汉密尔顿尼亚加拉哈尔迪曼德布兰特）10家医院公司内的23个地点。设计了一份分为两部分的问卷，并针对清晰度和全面性进行了预测试。问卷的机构概况部分由药房主任填写，P&T部分由委员会成员填写。
来自10个P&T委员会的10位药房主任和28位委员会成员做出了回应。每个P&T委员会每年平均审查6.4项新药申请。在整个LHIN中，与审查提交的新药加入处方集相关的工作量相当于0.84个全职岗位。药物提交材料中的临床证据质量比经济证据质量得到更高评价；此外，委员会内部缺乏卫生经济学专业知识限制了经济证据的使用。LHIN的集中审查流程被认为有利于提高效率、审查质量和标准化，还能降低成本。
在汉密尔顿尼亚加拉哈尔迪曼德布兰特LHIN范围内，花费了大量时间和资源来审查可能添加到医院处方集的新药。采用标准化的处方集审查流程，更多地利用省级和国家级药物审查，可能会使所有LHIN受益。
