Practical approach to grading evidence for formulary recommendations

Abstract

One important function of a pharmacy and therapeutics (P&T) committee is to provide judicious formulary review, with recommendations for management and selection of optimal treatment agents, and advice and strategies in therapeutic algorithms. The rapid pace of innovation (e.g., introduction of new drug technology) increases the demand for formulary reviews. In addition, the increased publication of outcomes research and supportive data provides impetus for ensuring patient safety and maintaining pharmaceutical costs and expenditures in the formulary decision-making process.1 The University of Pittsburgh Medical Center’s P&T committee is a multidisciplinary committee comprising 36 physicians, 14 pharmacists, 4 administrators and risk managers, and 2 nurses. The drug information center and drug use and disease state management program primarily support the functions of the committee, which is led by physician cochairs, and the executive director of pharmacy serves as the secretary. This committee has historically promoted evidence-based medical decisions and believes that decisions made by P&T committees should be driven by an evaluation of all evidence rather than a sole expert opinion or clinical anecdote. However, this committee previously did not have a process to systematically evaluate the evidence supporting formulary decisions. Evidence-based medicine incorporates both evidence (information learned from clinical research) and practice (role of clinical expertise and experience) and is defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”2 Our P&T committee felt that there was a need to consistently and systematically balance the importance of both in the clinical context of formulary decision-making.