Topics in hospital pharmacy management最新文献

Pharmacists are encouraged to improve their knowledge and use of pharmacoeconomic data in formulary selection. The formulary selection process has changed significantly in recent years. Among its most significant uses is its potential for cost containment strategies. An overview is presented of the origin as well as the potential impact of pharmacoeconomic data. The need to balance the economic benefit with the clinical advantages for any proposed new drug for formulary inclusion remains the most critical decision to be made by pharmacists.

Establishing the value of a new medicine by applying the tools and methods of pharmacoeconomics has become an important third objective in many clinical trials. The pharmacoeconomic investigator conducting research in clinical trials must understand and conform to the rules and procedures governing the clinical trial process. This article addresses some of the vital yet often overlooked details associated with conducting pharmacoeconomic research in clinical trials. The protocol, the informed consent form, the data collection instruments, the study initiation, and the final study report are all discussed. Additionally, limitations of the study results are reviewed.

The article illustrates the process and techniques of obtaining or collecting pharmacoeconomic data in various health care organizations, focusing on hospitals, physicians' offices, and pharmacies as the research settings. The role that pharmacoeconomic data have in the decision-making process as well as the perspective of the decision maker are also discussed. The three primary components needed to conduct a complete pharmacoeconomic analysis (clinical outcomes, humanistic outcomes, and economic outcomes) are described in relation to the health care organization. The strengths, weaknesses, advantages, and disadvantages of such data are discussed. Various databases that are accessible within each organization are also outlined.

Cost analysis, cost containment, and cost reduction are realities in today's health care environment. Discussions of cost must also include an analysis of the consequences of economic decisions so that a balanced perspective can be presented to health care decision makers. The basic principles of pharmacoeconomics can be used to provide information about the cost and consequences of therapy. To ensure a high quality of pharmaceutical care, it will become necessary to use this scientific information to make therapeutic decisions and recommendations.

Pharmacy and therapeutics committees can use pharmacoeconomic and outcome studies as tools to evaluate and implement clinical guidelines for patient care. Results of studies help optimize the clinical effects and control the costs of drug therapy. Such data also assist in positioning products in competitive environments. A four-part classification of research studies is offered as an aid to strategic research planning.

Given the current cost-conscious health care environment, pharmacists must now be able to assess the effects of an agent from safety, efficacy, and value considerations. This article describes the various methodologies that may be used in performing pharmacoeconomic analyses and highlights the use and misuse of pharmacoeconomic terminology. Case studies relating the use of these methods to the pharmacy practice setting are presented. The technical nuances of the various methods are explained to promote a better understanding of the appropriate use of these techniques and the terminology used to describe them.

With the increased numbers of pharmacoeconomic trials being conducted and reported, the practicing pharmacist will need to apply this information in formulary decision making. The review provides suggestions about readily available pharmacoeconomic continuing education opportunities for the practitioner. Examples of printed materials, home study programs, and meeting presentations are discussed. A combination of approaches is recommended.

Managed care pharmacy organizations have the responsibility to promote high-quality cost-effective health care that provides value to their enrolled populations. Application of management interventions that reduce the inappropriate use of medications and enhance the appropriate use of medications that improve patient outcomes and the cost effectiveness of care can help meet these responsibilities. To accomplish these management objectives, managed care pharmacy organizations should aggressively apply the results of pharmacoeconomic studies and, where possible, participate in the conduct of these studies.

Decision analysis, a structured approach to decision making, is presented and applied to a typical management situation. Decision analysis is an explicit, quantitative, and prescriptive approach to choosing among alternative outcomes. It engenders in the decision maker an analytical viewpoint, the need to structure the various courses of action and the resultant consequences of the actions, to assess the degree of uncertainty of the actions occurring, and to value the preferences for the alternative outcomes. Literature examples of using pharmacy-related decision analysis are provided, including its use in formulary additions, cost-effectiveness analysis, drug therapy evaluation, therapeutic drug monitoring, and health policy issues.

We do not claim to have all the answers when it comes to implementing an ideal pharmaceutical care model. We are not even sure what all the characteristics of such a model should be. We have recognized, based on our interpretation of the model, that meeting the demands of pharmaceutical care will require changes and advanced skills in our staff. We continue to work in creating an environment where the concept of pharmaceutical care can flourish. Our department has focused on defining and then providing pharmaceutical care through individual practitioners and patient care teams. More employee empowerment with less management control was the key to facilitating initial phases in our pharmaceutical care model. A successful orientation process has further enhanced our abilities to hire new graduates and/or experienced practitioners for our open positions. We believe we have taken some significant first steps toward recruiting, training, and developing our staff to become competent and satisfied with their newly developing role as pharmaceutical care practitioners.