Matlala Moliehi, Gous Andries G S, Meyer Johanna C, Godman Brian
School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-rankuwa, South Africa.
Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.
Front Pharmacol. 2020 Aug 18;11:1267. doi: 10.3389/fphar.2020.01267. eCollection 2020.
The World Health Organization identified Pharmaceutical and Therapeutics Committees (PTCs) at district and hospital levels as one of the pivotal models to promote rational use of medicines (RUM). This is endorsed by the Government in South Africa. Formulary development and management is one of the main functions of PTCs. This study aimed to describe the formulary management activities among PTCs in public hospitals in Gauteng Province, South Africa, following initiatives to promote RUM in South Africa.
Qualitative, nonparticipatory, observational study, observing 26 PTC meetings. Data were coded and categorized using NVivo9 qualitative data analysis software. Themes and sub-themes were developed. The themes and sub-themes on formulary management are the principal focus of this paper.
More than half of the observed PTCs reviewed their formulary lists. There was variation in the review process among institutions providing different levels of care. Various aspects were considered for formulary management especially requests for medicines to be added. These included cost considerations (mainly focusing on acquisition costs), evidence-based evaluation of clinical trials, patient safety, clinical experience and changes in the National Essential Medicines List (NEML). The tertiary PTCs mostly dealt with applications for new non-EML medicines, while PTCs in the other hospitals mainly requested removal or addition of EML medicines to the list.
This is the first study from Gauteng Province, South Africa, reporting on how decisions are actually taken to include or exclude medicines onto formularies within public sector hospitals providing different levels of care. Various approaches are adopted at different levels of care when adding to- or removing medicines from the formulary lists. Future programs should strengthen PTCs in specialized aspects of formulary management. A more structured approach to formulary review at the local PTC level should be encouraged in line with the national approach when reviewing possible additions to the NEML.
世界卫生组织将地区和医院层面的药品与治疗委员会（PTCs）确定为促进合理用药（RUM）的关键模式之一。这一模式得到了南非政府的认可。药品处方集的制定和管理是PTCs的主要职能之一。本研究旨在描述在南非豪登省公立医院的PTCs中，在南非促进合理用药的举措之后的药品处方集管理活动。
采用定性、非参与性观察研究，观察26次PTC会议。使用NVivo9定性数据分析软件对数据进行编码和分类。确定了主题和子主题。本文主要关注药品处方集管理的主题和子主题。
超过一半的被观察PTCs对其药品处方集列表进行了审查。提供不同护理水平的机构在审查过程中存在差异。药品处方集管理考虑了多个方面，特别是添加药品的请求。这些方面包括成本考量（主要关注采购成本）、临床试验的循证评估、患者安全、临床经验以及国家基本药物清单（NEML）的变化。三级医院的PTCs主要处理新的非基本药物的申请，而其他医院的PTCs主要请求从清单中删除或添加基本药物。
这是南非豪登省的第一项研究，报告了在提供不同护理水平的公共部门医院中，实际如何做出将药品纳入或排除在药品处方集内的决策。在从药品处方集列表中添加或删除药品时，不同护理水平采用了不同的方法。未来的项目应在药品处方集管理的专门方面加强PTCs。在审查可能添加到NEML的药物时，应鼓励地方PTC层面采用更结构化的药品处方集审查方法，与国家方法保持一致。
