Formulary最新文献

To facilitate the long-term storage, retrieval, and analysis of adverse drug reaction (ADR) data, the drug information service at the University of Texas Health Science Center at San Antonio selected a computer software program with the capability to compile sets of relational databases. Five subsets were created to form the ADR database--patient demographics, medications, American Hospital Formulary Service classifications, adverse reactions, and case reports. This computerized system allows for quick information retrieval as well as the generation of monthly ADR reports. With such information, trends in ADRs can be identified and targeted for intervention programs to improve patient care and to comply with JCAHO requirements.

Despite the potential of modern pharmacotherapy to control disease and enhance quality of life, two out of five patients fail to take their prescribed medication correctly. Research indicates that the two primary influencers of adherence are the patient's beliefs in the value of the regimen and the patient's ability to overcome practical barriers to adherence. The patient's perception of value--ie, the risks, benefits, and efficacy of therapy--influences his or her commitment to the medication regimen. Barriers to adherence include side effects, number and frequency of dosages, and cost. Communication between health care providers and patients is crucial to enhancing patient adherence to medication regimens.

Health care costs as a percentage of the gross national product have been increasing in most industrialized countries. As part of the trend, pharmaceutical expenditures also have been rising. In many countries, pharmaceutical costs are the largest single health care expenditure. In an effort to contain rising costs, governments are exploring a variety of pharmaceutical management strategies. These include price controls, restrictive formularies, budget caps, profit controls, and practitioner education.

The goal of pharmacoeconomics is to define the cost and value of different treatment strategies. The cost-effectiveness analysis, one model used in the study of pharmacoeconomics, considers not only the cost of the drug itself, but also the labor costs associated with physician and pharmacy visits, and expenses for laboratory testing. Drugs that require more intensive medical surveillance, either for dose adjustments or overall management of treatment-related side effects, can escalate costs. In the case of antidepressant drugs, various cost-effectiveness analyses have shown that the total cost of disease management is similar for generic tricyclics and the more expensive selective serotonin reuptake inhibitors. This outcome is due to the higher labor costs associated with tricyclics that offset their acquisition cost advantage. The application of cost-effectiveness studies in formulary decision-making and clinical practice guidelines, will maximize the use of health care resources.

Development of institutional guidelines for use of high-cost biotechnology drugs, such as antithrombin III, is a valuable tool in formulary management. This article describes the process by which the University of California Davis Medical Center used an ad hoc committee to the P & T Committee to develop guidelines for antithrombin III use. Performing an objective analysis of available literature to address the appropriate role of a biotechnology agent is necessary to develop consensus guidelines. Approval of use guidelines by the P & T Committee provides the necessary structure for optimal use of biotechnology agents, such as antithrombin III.

Women with large uterine leiomyomas traditionally have had just one choice for therapy--abdominal hysterectomy. Recently, gonadotropin-releasing hormone (GnRH) agonist therapy has been introduced as an option to shrink tumors before surgery. When administered preoperatively, usually for 2 months, GnRH therapy has been shown to reduce tumor size enough to permit an endoscopic myomectomy or a vaginal hysterectomy. It has also been shown to reduce blood loss associated with the tumors and increase hemoglobin levels. When assessed for its economic impact, preoperative GnRH therapy reduces both direct and indirect costs associated with a hysterectomy.