Charles Perkins Centre, School of Pharmacy, Faculty of Medicine & Health, The University of Sydney, Australia.
New South UK Therapeutics Advisory Group, Sydney, Australia.
Br J Clin Pharmacol. 2021 May;87(5):2341-2353. doi: 10.1111/bcp.14636. Epub 2020 Nov 26.
One tool for protecting quality use of medicines in hospitals is a drug and therapeutics committee (DTC) that oversees medicines availability. Pharmaceutical industry marketing to prescribers is associated with less appropriate prescribing and increased costs. There is little data on decision-making practices of DTCs so it is unknown whether or how they might be vulnerable to pharmaceutical industry influence. This project explores DTC decision-making with a focus on how pharmaceutical industry influence on access and use of medicines is identified and managed.
We used a qualitative methodology with individual interviews of 29 participants who were current or recent members of public hospital DTCs across New South Wales, Australia. Participants included medical, pharmacy and nursing staff and 1 citizen. Committees were linked to specific hospitals or regions, and some were affiliated with paediatric, neonatal, rural or mental health services.
Drug committee processes for oversight of medicines in public hospitals are vulnerable to pharmaceutical industry influence at several points. Applications for formulary additions are sometimes initiated and completed by company representatives. Conflict of interest disclosures among applicants and committee members may be incomplete. In some institutions, medicines are available from pharmaceutical companies without committee review, including through free samples and industry-supported medicines access programmes. Participants noticed the presence and impact of pharmaceutical company marketing activities to local clinicians, resulting in increased prescriber demand for products.
Improved DTC practices and review of hospital policies concerning pharmaceutical marketing activities might preserve the independence of evidence-based decision-making for safe, cost-effective prescribing.
医院药品和治疗委员会（DTC）是监管药品供应的工具，它可用于保障药品的合理使用。制药行业向处方医生进行药品营销与不适当的处方行为和增加成本有关。关于 DTC 的决策实践的数据很少，因此尚不清楚它们是否容易受到制药行业的影响，以及可能受到何种影响。本项目重点探讨 DTC 的决策制定，以了解制药行业对药品准入和使用的影响是如何被识别和管理的。
我们采用定性方法，对澳大利亚新南威尔士州的 29 名现任或前任公立医院 DTC 成员进行了个人访谈。参与者包括医疗、药学和护理人员以及 1 名公民。委员会与特定医院或地区相关联，其中一些与儿科、新生儿、农村或精神卫生服务有关。
公立医院药品监督的药物委员会流程在几个方面容易受到制药行业的影响。药品目录增补的申请有时由公司代表发起和完成。申请人和委员会成员的利益冲突披露可能不完整。在一些机构中，药品可不经委员会审查从制药公司获得，包括通过免费样品和行业支持的药品准入计划。参与者注意到制药公司向当地临床医生进行营销活动的存在及其影响，导致产品的处方需求增加。
改进 DTC 实践和审查医院有关制药营销活动的政策，可能有助于维护基于证据的决策制定的独立性，以确保安全、具有成本效益的处方。
