Abstract
Knowledge about evidence-based medicine selection and the role of the Drug and Therapeutics Committee (DTC) is an important topic in the literature but is scarcely discussed in Brazil. Our objective, using a qualitative design, was to analyze the medicine selection process performed in four large university hospitals in the state of Rio de Janeiro. Information was collected from documents, interviews with key informants and direct observations. Two dimensions were analyzed: the structural and organizational aspects of the selection process and the criteria and methods used in medicine selection. The findings showed that the DTC was active in two hospitals. The structure for decision-making was weak. DTC members had little experience in evidence-based selection, and their everyday functions did not influence their participation in DTC activities. The methods used to evaluate evidence were inadequate. The uncritical adoption of new medicines in these complex hospital facilities may be hampering pharmaceutical services, with consequences for the entire health system. Although the qualitative approach considerably limits the extent to which the results can be extrapolated, we believe that our findings may be relevant to other university hospitals in the country.
Highlights
The rational use of health technologies – medicines, equipment and devices, medical and surgical procedures, organization and support systems (Brasil, 2010) – implies that their selection must be satisfactory to justify financing decisions and requires the identification of the conditions in which they must be used (Krauss-Silva, 2003)
In the case of medicines, the World Health Organization states that activities linked to the selection process must be performed, either in institutions or in health systems, by the Drug and Therapeutics Committee (DTC), with the participation of health professionals with expertise in the assessment of scientific evidence (WHO, 2003)
This study aims to analyze the medicine selection process in four tertiary university hospitals in the state of Rio de Janeiro
Summary
The rational use of health technologies – medicines, equipment and devices, medical and surgical procedures, organization and support systems (Brasil, 2010) – implies that their selection must be satisfactory to justify financing decisions and requires the identification of the conditions in which they must be used (Krauss-Silva, 2003). In the case of medicines, the World Health Organization states that activities linked to the selection process must be performed, either in institutions or in health systems, by the Drug and Therapeutics Committee (DTC), with the participation of health professionals with expertise in the assessment of scientific evidence (WHO, 2003). The DTC must have clear goals, a firm mandate, support from institutional management or government, transparency in its procedures, wide representation, technical competence, multidisciplinary focus and sufficient resources to implement its decisions (WHO, 2003). A 2003 national assessment showed that a mere 29 (11%) of 250 investigated hospitals presented nominal DTCs, but operational DTCs were seen in only 3.6% of hospitals (Osorio-de-Castro, Castilho, 2004)
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