Galician Health Service (Servicio Gallego de Salud - SERGAS), Galicia Regional Authority, Administrativo San Lázaro s/n, 15703, Santiago de Compostela, Galicia, Spain.
Santiago de Compostela Health Area Authority, Galician Health Service, Rúa da Choupana, s/n, 15706 Santiago de Compostela, A Coruña, Galicia, Spain.
Implement Sci. 2020 May 14;15(1):33. doi: 10.1186/s13012-020-00996-y.
Hospital drug formularies are reduced lists of drugs designed to optimise inpatient care. Adherence to the drugs included in such formularies is not always 100% but is generally very high. Little research has targeted the impact of a change in these formularies on outpatient drug prescriptions. This study therefore sought to evaluate the impact of a change affecting bronchodilator medications in a hospital drug formulary on intra- and out-of-hospital drug prescriptions in a region in north-western Spain. Two new drugs belonging to this same class were brought onto the out-of-hospital market, overlapping with the intervention.
We used a natural before-after quasi-experimental design with control group based on monthly data. The intervention evaluated was the modification of a hospital drug formulary, which involved withdrawing salmeterol/fluticasone in order to retain formoterol/budesonide as the sole inhaled corticosteroid and long-acting beta-agonist (ICS/LABA). Using official data sources, we extracted the following dependent variables: defined daily doses (DDD) per 1000 inhabitants per day, DDD per 100 bed-days, and cost per DDD.
Intra-hospital use showed a 173.2% rise (95% CI 47.3-299.0%) in the medication retained in the formulary, formoterol/budesonide, and a 94.9% drop (95% CI 77.9-111.9%) in the medication withdrawn from the formulary, salmeterol/fluticasone. This intervention led to an immediate reduction of 75.9% (95% CI 82.8-68.9%) in the intra-hospital cost per DDD of ICS/LABA. No significant changes were observed in out-of-hospital use.
Although this intervention was cost-effective in the intra-hospital setting, the out-of-hospital impact of a change in the drug formulary cannot be generalised to all types of medications and situations.
医院药品处方集是优化住院患者治疗的药物清单。对这类处方集所包含药物的依从性并非 100%，但通常非常高。很少有研究针对这些处方集的变化对门诊药物处方的影响。因此，本研究旨在评估西班牙西北部一个地区的医院药品处方集改变影响支气管扩张药物对院内和院外药物处方的影响。属于同一类别的两种新药进入了院外市场，与干预措施重叠。
我们使用了自然前后准实验设计，基于对照组的每月数据。评估的干预措施是修改医院药品处方集，即停用沙美特罗/氟替卡松，保留福莫特罗/布地奈德作为唯一的吸入性皮质类固醇和长效β-激动剂（ICS/LABA）。我们使用官方数据来源，提取以下依赖变量：每 1000 居民每日的定义日剂量（DDD）、每 100 张病床的 DDD 和每 DDD 的成本。
院内使用显示，保留在处方集内的药物福莫特罗/布地奈德增加了 173.2%（95%置信区间 47.3-299.0%），而从处方集内撤出的药物沙美特罗/氟替卡松则下降了 94.9%（95%置信区间 77.9-111.9%）。这一干预措施导致院内 ICS/LABA 每 DDD 的成本立即降低了 75.9%（95%置信区间 82.8-68.9%）。院外使用未观察到显著变化。
尽管该干预措施在院内环境中具有成本效益，但不能将药品处方集变化对院外的影响推广到所有类型的药物和情况。
