Yakabowich M R, Keeley G, Montgomery P R
Faculty of Pharmacy, University of Manitoba, Winnipeg.
CMAJ. 1994 May 15;150(10):1601-7.
To assess the impact of a formulary on drug expenditures and prescribing trends in personal care homes (nursing homes).
Quasi-experimental analysis of a drug prescription database before and after implementation of the formulary.
Personal care homes in Manitoba.
Residents occupying the 6848 beds of the 88 personal care homes that did not already have a formulary.
Formulary, introduced Apr. 1, 1987.
Drug expenditures from Apr. 1, 1985, to Mar. 31, 1990; proportion of residents receiving a prescription by drug class and rate of prescriptions of nonformulary drugs in the year before and 2 years after the formulary was introduced.
The total drug expenditures per bed remained constant during the first year after the formulary was implemented, even though the annual drug inflation rate was 9.8% on average during the study period. Expenditures 2 and 3 years after implementation rose by 9.4% and 5.8% respectively. Those for specific agents and drug classes targeted as being inappropriate for long-term care decreased greatly because of reduced prescribing. Expenditures for some other drug classes increased mainly because newer, more expensive agents were used. The mean drug expenditure per bed varied widely between homes; neither size nor location were found to correlate with drug expenditure, but adherence to the formulary did predict personal care homes with decreased expenditures.
A formulary in personal care homes can improve therapeutic management. The impact on cost containment was not as strong after the first year, although expenditures remained less than the rate of inflation for drug costs.
评估药品处方集对个人护理院（疗养院）药品支出及处方开具趋势的影响。
对实施药品处方集前后的药品处方数据库进行准实验分析。
曼尼托巴省的个人护理院。
居住在88家尚无药品处方集的个人护理院的6848张床位的居民。
1987年4月1日引入药品处方集。
1985年4月1日至1990年3月31日的药品支出；引入药品处方集前一年及后两年按药物类别划分的接受处方居民比例及非处方集药物的处方开具率。
在实施药品处方集后的第一年，每张床位的药品总支出保持不变，尽管在研究期间药品年平均通胀率为9.8%。实施后2年和3年的支出分别增长了9.4%和5.8%。因处方开具减少，那些被认为不适用于长期护理的特定药物及药物类别的支出大幅下降。其他一些药物类别的支出增加主要是因为使用了更新、更昂贵的药物。各护理院每张床位的平均药品支出差异很大；未发现规模和位置与药品支出相关，但遵守处方集确实能预测药品支出降低的个人护理院。
个人护理院的药品处方集可改善治疗管理。尽管支出仍低于药品成本的通胀率，但对成本控制的影响在第一年之后没有那么显著。
