Drug And Therapeutics Committees Research Articles

Understanding how a non-National Institute for Health and Care Excellence technology appraisal drug is added to the hospital drug formulary

Abstract Introduction In England, only medications listed in a hospital formulary can be used to treat patients in a National Health Service (NHS) hospital. Medications approved by the National Institute for Health and Care Excellence (NICE) via technology appraisal (TA)1 are included in hospital formularies.[1] Non-NICE TA medications need to be reviewed by the hospital’s drug and therapeutics committee (DTC) for inclusion in the hospital formulary. Research shows that different DTCs make contrary decisions concerning the same non-NICE TA drug request for inclusion in the hospital formulary, contributing to postcode prescribing and inequality in medication access.[2] To understand how and why different DTCs make different decisions, it is vital to understand how a non-NICE TA drug is added to a hospital formulary. Aim To identify the process and variations when adding a non-NICE TA drug to a hospital formulary. Methods As part of a larger study, the DTC of a tertiary centre where this research was based developed and sent a questionnaire exploring DTC processes to Chief Pharmacists (via Microsoft Forms) of ten large tertiary centres in England. After completing the questionnaire, a semi-structured interview was conducted with each Chief Pharmacist to clarify ambiguity in the questionnaire responses. Only data regarding how a non-NICE TA is added to the hospital formulary was used in this study. A hierarchical task analysis (HTA) was developed; data were analysed using inductive thematic analysis to identify subgoals, tasks and subtasks required to add a non-NICE TA drug to the hospital formulary. The HTA was developed iteratively. Results A total of ten Chief Pharmacists (100% of those approached) completed both the questionnaire and interview. Adding a non-NICE TA drug starts with the applicant requesting and completing an application package, followed by obtaining approval to submit the application package for review. Once approval is granted, the application package goes through three review levels: initial, preliminary, and final review. The non-NICE TA drug is added to the formulary once the application package is clinically and financially approved. This process involves over 100 tasks and subtasks. The process described varied from one centre to another with the following main variations: 1. application package components, 2. how the application package is submitted for approval, 3. the depth of review the application package receives, and 4. how the final review is conducted. Conclusion Adding a non-NICE TA drug to a hospital formulary is complex and varied across each centre, indicating a lack of national standardisation in the process. The variations identified could contribute to health inequalities as all patients may not have equal access to the same medications. Therefore, further research is required to study the impact of these variations on patient access to medication via the NHS. Currently, there are no studies in the literature that described the process of adding a non-NICE TA drug to the hospital formulary across the tertiary centres in England. The study only included tertiary centres in England and there should be caution when considering the transferability of the findings to other types of hospitals.

Drug and Therapeutics Committee Structure and Roles in Hospitals: A Scoping Review

Drug and Therapeutics Committees (DTCs) have been identified and promoted as a fundamental model in advancing the rational management and use of essential medicines and health supplies in hospitals since the 1970s. However, there is still a scarcity of comprehensive literature on their current structure and actual roles performed in various countries. We conducted a scoping review using the Pubmed and ResearchGate databases and included eligible articles published between 2010 and 2023, to assess the structure and roles performed by hospital DTCs. The database search yielded 47 potential records, but only seven of these were eligible for inclusion. Studies included were from both high-income and low- and middle-income countries. The structure of DTCs is generally similar across these countries, with minor contextual variations. All DTCs are heterogeneous in composition and contain both medical and non-medical staff. The DTC leadership comprises a chairperson who is usually a senior clinician, and a secretary who is usually a pharmacist. The majority of the DTCs have at least one sub-committee, and antimicrobial stewardship is the most common. The DTCs still perform their customary roles, although their role scope is expanding. In some countries, the DTCs have taken on additional roles due to the evolving medicines management and use problems, and technologies. There is however still a dearth of recent primary data on the structure and roles of DTCs in many countries. We recommend more primary research to understand the status of DTCs in various countries and to provide more insights into the existence and functionality of the DTC sub-committees. Keywords: Drug and Therapeutics Committee; DTC; Irrational Use; P&T Committee; Review; Hospital.

Medicines Wastage and Its Contributing Factors in Public Health Facilities of South Gondar Zone, Amhara Regional State, Ethiopia.

In developing countries like Ethiopia, medicines wastage becomes a major healthcare system challenge. However, data that displayed the type, extent, and contributing factors of medicines wastage were limited. A health facility-based explanatory sequential mixed study was conducted from December 2021 to February 2022. One drug and therapeutics committee (DTC) and one store man per health facility, working during the study period were included for their perception of medicines wastage and possible causes. As key informants, 1 Chief Executive Officer (CEO) and 1pharmacy head were also included per facility. In total, 80 participants were included in this study. The quantitative data to determine the magnitude of medicine wastage were collected using a structured interviewer-administered questionnaire and analyzed using SPSS version 25. The overall medicines wastage in the three consecutive years was 6.3%. The trend over the three years indicated that medicines wastage is 6.5%, 5.9%, and 6.5% in 2011, 2012, and 2013 Ethiopian Fiscal Year (EFY), respectively. The medicine wastage rate has been increasing nearly by 3% between 2011/2012 and 2012/2013. The main sources of wastage of medicines were expiry (99.3%). The perceived reasons for such medicine's wastage were near-expiry medicines (<6 months) being delivered to the health facilities by suppliers, poor communication and coordination with key stakeholders, and the presence of overstocked medicines due to improper forecasting of need in the facilities. There is an excessive rate of medicines wastage which needs immediate mitigation by exchanging nearly expired medicines with other health facilities, communicating with suppliers and even prescribers, using auditable pharmaceutical transactions and services (APTS), providing continuous training, pursuing quality and safetymedicines reuse scheme, implementation of pharmacist waste-reducing activities in all stages of the pharmaceutical supply chain, reducing medication amounts in stock, and through the use of electronic stock management tools.

Knowledge support for environmental information on pharmaceuticals: experiences among Swedish Drug and Therapeutics Committees

BackgroundTwo publicly available Swedish knowledge support systems, “Pharmaceuticals and Environment” on Janusinfo.se and Fass.se, provide environmental information on pharmaceuticals. Janusinfo is provided by the public healthcare system in Stockholm and Fass is provided by the pharmaceutical industry. The objectives of this study were to investigate the experiences among Swedish Drug and Therapeutics Committees (DTCs) with using the databases, retrieve development proposals for these, and investigate the DTCs’ challenges with working with pharmaceuticals in the environment.MethodsA cross-sectional survey with 21 questions, both closed and open-ended, was distributed electronically in March 2022 to Sweden’s 21 DTCs. Descriptive statistics and inductive categorization were used for the analysis.ResultsA total of 132 respondents from 18 regions filled out the survey. The average regional response rate was 42%. The DTCs used the knowledge supports to consider environmental aspects of pharmaceuticals in their formularies and in education. Respondents were more familiar with Janusinfo compared to Fass but appreciated the availability of both. The DTCs especially valued the concrete proposals for certain active pharmaceutical ingredients on Janusinfo. Respondents requested that all medicinal products have environmental information on Fass. Challenges included lack of data, lack of transparency from the pharmaceutical industry and difficulties considering the environmental aspect of pharmaceuticals in their healthcare practice. Respondents wanted more knowledge, clear messages, and legislation to support their work to reduce the negative environmental impact of pharmaceuticals.ConclusionsThis study demonstrates that knowledge supports for environmental information on pharmaceuticals are valuable for the DTCs in Sweden, but the respondents experienced challenges in their work in this field. The study can provide insights to those in other countries interested in considering environmental aspects in their formulary decision-making.

Drug and Therapeutics Committee (DTC) evolvement and expanded scope in Ethiopia.

As a key partner of Ministry of Health (MOH) Ethiopia, The Clinton Health Access Initiative (CHAI) had been implementing the Child Survival Project (CSP) since October 2015. Strengthening DTC was one of its focuses to improve overall supply chain management (SCM).The objective of this study are to review the evolution of DTCs in Ethiopia from their early years to current practice and identify the major driving and hindering factors for their functionality. A descriptive mixed study design was employed. The study made use of qualitative data supplemented with quantitative data, generated from both primary and secondary sources through key informant interviews and desk review methods. DTCs were introduced in Ethiopia in the early 1980s. The mandate of DTCs has been given to four different government organizations during that time. As a result, due to a lack of coordination among these organizations, its implementation was lagging. Recently, the government and its partners have given attention to DTCs. More than 5847 professionals underwent DTC training from 2016 onwards. DTC establishment in health facilities improved from 85% to 98% between 2015 and 2019 during baseline and end-line assessments carried out by CHAI/CSP. Similarly, DTC functionality in HFs improved from 20% to 63%. The CHAI/CSP regular supervision data analysis revealed that DTC establishment improved from 83% to 100% of HFs, while its functionality improved from 5% to 72% between 2016 and 2019, respectively. A chi-square test of independence examining the relationship between facility and pharmacy head training on DTCs and functionality of DTC in the same facility revealed a significant association between the two variables at p<0.0001. Conclusions: Providing consistent capacity building and availing strong monitoring and evaluation system improves functionality of DTCs. Moreover, national coordinating bodies for DTCs and similar structures at Regional Health Bureaus and woreda health offices should be established.

ANALYSIS OF THE STRUCTURE OF THE LIST OF ANTIBIOTICS USED IN PHONG DIEN DISTRICT HEALTH CENTER IN 2019

Background: Antibiotics administered incorrectly may result in detrimental consequences, such as prolonging treatment duration, causing adverse effects, or even increasing mortality. Similar to surrounding underprivileged urban medical institutions, the Drug and Therapeutics Committee (DTC) at Phong Dien district's health center (PDHC) is still struggling to attain rationality in keeping track of and evaluating hospital medication formularies. It is commonly believed that these lists directly impact the DTC's decisions on drug selection, distribution, and order for supply, as well as other inventory issues such as assuring quality and minimizing extra expenses. Objectives: The research aimed to examine the characteristics of the antibiotics list utilized at PDHC in 2019. Methods: From January to December 2019, we investigated 99 different medicines from 8 different antibiotic families in retrospective research. The acquired data were analyzed statistically using descriptive analysis. Results: Foreign medications accounted for 19.3% of pharmaceutical expenditure, whereas domestic medicine accounted for 80.7%. Regarding route of administration, ratios of oral medicines dominated others in quantity and cost (67.67% and 82.73%, respectively). It also revealed that 97.27% of the inventory budget was spent on generic medications compared to under 3% of brand-name ones. Additionally, single-component products (78.79% of items and 71.65% of total expense) were used more often than those with multicomponents. β-lactam was the most widely utilized group among the 8 studied groups, which accounted for 72.61% of the monetary allocation. Conclusion: The results of this study showed that the use of antibiotics at the center was relatively adequate and followed the principle of drug consumption by the Ministry of Health (MOH) in drug utilization and prescription of antibiotics.

Drug and therapeutics committee interventions in managing irrational drug use and antimicrobial stewardship in China.

Aim: This study aimed to investigate the key points in the transformation of the functions of the Drug and Therapeutics Committee (DTC) of the Shandong Provincial Third Hospital and how to provide full authority to its role in the control of rational drug use, especially in the management of antibiotic use. Method: A prescription review management group, antimicrobial stewardship group, and rational drug use service group were established under the DTC. From January 2016 to December 2021, each group played a role in promoting rational drug use and antimicrobial stewardship. In addition, we performed statistics on typical management cases, irrational drug use, bacterial resistance rate, and drug costs from 2015 to 2021 to evaluate the effect of management by the DTC. Results: Intervention by the DTC led to a significant reduction in prescribing errors (71.43%, p < 0.05), the intervention acceptance rate increased by 16.03%, and the problem solved rate increased by 32.41% (p < 0.05). Resistance rates of general spectrum antibiotics were reduced remarkably after the intervention. The quality of drug treatment was improved and patient drug expenses was continuously reduced. Conclusion: Giving full play to the functions of the DTC can significantly improve the level of drug treatment and reduce unreasonable drug use to save unnecessary drug expenses and slow the development of drug resistance.

Evaluating the effectiveness of drug and therapeutics committees (DTCs) in controlling irrational drug use: Aretrospective analysis.

This study aimed to explore methods to optimize the function of Drug and Therapeutics Committees (DTCs) in controlling irrational drug use. Clinical pharmacologists contribute their specific knowledge and skills to DTCs and help guide rational therapeutics. The DTC is the highest organization of hospital pharmacy management. From January 2016 to August 2021, the DTC promoted the optimization of clinical drug treatment schemes and reduced unreasonable drug use by improving the organizational framework, clarifying the division of functions, regularly monitoring drug use, organizing expert comments, scientific decision-making and functional intervention. During this time, we statistically analysed typical management cases, irrational drug use and drug cost to evaluate the effectiveness of the DTC's management. The DTC's intervention led to a significant reduction in prescribing errors (65.98%, p<0.05); the intervention acceptance rate increased by 16.37%; and the rate of problem resolution increased by 45.84% (p<0.05). The level of drug treatment was improved, and the proportion of patients' drug expenses was reduced. The DTC carried out a series of continuous improvement work that played a significant normative role in clinical drug use. Giving more power to the DTCs can significantly improve the level of drug treatment and reduce unreasonable drug use, which reduces unnecessary drug expenses.

Free-of-charge medicine schemes in the NHS: A local and regional drug and therapeutic committee's experience.

Free-of-charge (FoC) medicine schemes are increasingly available and allow access to investigational treatments outside clinical trials or in advance of licensing or NHS commissioning. We retrospectively reviewed FoC medicine schemes evaluated between 2013 and 2019 by a single NHS trust and a regional drug and therapeutics committee (DTC). The details of each locally reviewed FoC scheme, and any nationally available Medicines and Healthcare products Regulatory Agency Early Access to Medicines Scheme (MHRA EAMS) in the same period, were recorded and categorised. Most FoC schemes (95%) allowed access to medicines intended to address an unmet clinical need. Over 7years, 90% were company-FoC schemes and 10% were MHRA EAMS that were locally reviewed. Phase 3 clinical trial data were available for 44% of FoC schemes, 37% had phase 2 data and 19% were supported only by phase 1 data, retrospective observational studies or preclinical data. Utilisation of company-FoC schemes increased on average by 50% per year, while MHRA EAMS schemes showed little growth. Company-FoC medicine schemes are increasingly common. This may indicate a preference for pharmaceutical companies to independently co-ordinate schemes. Motivations for company-FoC schemes remain unclear and many provide access to treatments that are yet to be evaluated in appropriately conducted clinical trials, and whose efficacy and risk of harm remain uncertain. There is no standardisation of this practice and there is no regulatory oversight. Moreover, no standardised data collection framework is in place that could demonstrate the utility of such programmes in addressing unmet clinical need or to allow generation of further evidence.

The National Paediatric Medicines Forum: Who we are and what are we doing.

An increasing understanding of the pathophysiology of complex diseases has contributed to the explosion in availability of newer medications in recent years. Newer medications frequently have more specific mechanisms of action and improved clinical outcomes for their approved indications compared to standard care. This translation of research into practice is exciting because it reflects precision medicine principles and offers renewed hope for patients. Unfortunately, clinical decision-making is not always straight forward. Data are extremely limited in some patient groups, including those with rare conditions, or others not routinely included in clinical trials; paediatrics commonly feature in both scenarios.1 Newer medications are usually markedly more expensive than comparators. These factors complicate clinical decision-making in an individual patient. The Drug and Therapeutics Committees (DTCs) in each hospital are responsible for achieving effective medicines governance, equity of medicines access and quality use of medicines to underpin patient's therapy. The assessment of medication treatments has become an increasingly onerous workload for DTCs, reflecting the increase in newer medications often used for novel indications. In the context of limited high-quality evidence, there is substantial duplication of effort across tertiary paediatric institutions, with multiple paediatric DTCs considering similar applications with variability in processes and outcomes between DTCs.2 Furthermore, resources and training may be insufficient given the technical complexity of some submissions.2 In 2016, the Sydney Children's Hospitals Network (SCHN) proposed at the Children's Healthcare Australasia (CHA) Children's Hospitals CEOs Forum that a national approach for paediatric medication assessment should be developed. The National Paediatric Medicines Forum (NPMF) was established to identify shared issues and to develop and disseminate recommendations, including guidance for evaluating the clinical- and cost-effectiveness of high-cost medications. Through sharing experiences and skills, NPMF aimed to optimise consistency and quality in decision-making and equity of access. Tertiary paediatric services nominated members, including medical specialists and hospital pharmacists with expertise in clinical pharmacology, health economics, quality use of medicines and/or clinical ethics. Medications for evaluation were chosen via horizon scanning issues identified by regional DTCs, including high cost and/or novel drugs with limited evidence in paediatric patients. Since June 2019, 11 meetings with 16 members have been held by videoconference. Amongst a range of topics discussed, 10 drugs/classes have been reviewed in detail including vedolizumab, ranibizumab, burosumab, trametinib, canakinumab, eltrombopag, romiplostim, palivizumab, Glucagon-like peptide 1 (GLP-1) analogues and melatonin. Here, ‘medication summaries’ were developed, following a survey of their usage in paediatrics across Australia (including indications and local restrictions), systematic review of the literature and economic analysis modelling for financial implications. Consensus recommendations for the indications, dosage and endpoints for monitoring the effect were proposed and discussed. Guests with subspecialist expertise contributed as required, including the fields of neonatology, ophthalmology, gastroenterology and oncology. Feedback was also sought from other subspecialists utilising professional networks. The interplay and challenges with Medicines Access Programs for innovative therapies in paediatrics were explored.3 The purpose of the medication summaries is to support both clinician and DTC decision-making in individual patients, contributing to the stated goals of the NPMF. Plain language summaries have been developed for some medications to engage patients and parents with the findings. Looking forward, the NPMF will update medication summaries as new information is available and develop summaries for other drugs. We will increase NPMF membership and clinician input. Medication summaries will be submitted for publication in peer-reviewed journals to invite further discussions, and other methods to broaden their dissemination will be explored. Research to measure the impact of the medication summaries on decision-making in practice is under development. A systematic approach to multisite data collection is anticipated to provide valuable clinical information on trends, usage and outcomes from the drugs, further contributing to the published literature; collaborations with clinical researchers will be invaluable. This collective clinical experience also offers an opportunity to be a voice of paediatric advocacy, including for submissions to the Pharmaceutical Benefits Advisory Committee (PBAC). We hope that these collective activities will make significant improvements in outcomes for paediatric patients.

The economic impact of a clinical pharmacist's involvement in the hospital medicines policy in a rural area.

The evidence of the value of pharmaceutical care continues to grow, however, data on its effect in rural areas are still scarce. The aim of this article was to evaluate the economic impact of a clinical pharmacist's involvement in the hospital medicines policy design in a rural area, through the drug and therapeutics committee (DTC) and public procurement for medicines. An economic evaluation was conducted in the General Hospital Bjelovar which covers the Bjelovarsko-Bilogorska County in Croatia. It included costs from denial and approval decisions of the drug and therapeutics committee, during a 1-year period between June 1, 2019 and June 1, 2020, and costs for medicines in 2018 and 2019 that were intended for public procurement. The cost-benefit analysis and cost-minimisation analyses for the DTC and public procurement data have been conducted for the evaluation of the economic impact of a clinical pharmacist. The involvement of a clinical pharmacist in the hospital medicines policy design through the DTC and public procurement for medicines provides an economic benefit. This resulted in a cost-benefit ratio of 14.18:1 and 18.31% and 17.58% savings through the DTC and public procurement process, respectively. To put in a different perspective, around 14 yearly gross salaries can be paid out from savings achieved by the clinical pharmacist through a 1-year period. The involvement of a clinical pharmacist in the hospital medicines policy in a rural area hospital results with an optimisation of investment in medicines and leads to substantial cost savings for the healthcare system.

Drug and Therapeutics Committee (DTC) evolvement and expanded scope in Ethiopia

Background: As a key partner of Ministry of Health (MOH) Ethiopia, The Clinton Health Access Initiative (CHAI) had been implementing the Child Survival Project (CSP) since October 2015. Strengthening DTC was one of its focuses to improve overall supply chain management (SCM). The objectives of this study are to review the evolution of DTCs in Ethiopia from their early years to current practice and identify the major hindering factors for their functionality. Methods: A descriptive study design was employed with mainly qualitative data collection methods and analysis. The assessment made use of both qualitative and quantitative data, generated from primary sources through key informant interviews and from secondary sources through desk review methods. Results: DTCs were introduced in Ethiopia in the early 1980’s. The mandate of DTCs has been given to four different government organizations since this time. As a result, its implementation was lagging. Recently, the government and its partners have given attention to DTCs. More than 5847 professionals underwent DTC training from 2016 onwards. DTC establishment in health facilities (HFs) improved from 85% to 98% between 2015 and 2019 during baseline and endline assessments carried out by CHAI/CSP. Similarly, DTC functionality in HFs improved from 20% to 63%. The CHAI/CSP regular supervision data analysis revealed that DTC establishment improved from 83% to 100% of HFs, while its functionality improved from 5% to 72% between 2016 and 2019, respectively. A chi-square test of independence examining the relationship between facility and pharmacy head training on DTCs and functionality of DTC in the same facility revealed significant association between the two variables at p&lt;0.0001. Conclusions: Providing consistent capacity building and availing strong monitoring and evaluation system improves functionality of DTCs. Moreover, national coordinating bodies for DTCs and similar structures at Regional Health Bureaus and woreda health offices should be established.

Pilot drug and therapeutic committee programme in Sierra Leone: A descriptive mixed method study.

Irrational medicine use is a global crisis, but incidences are proportionately higher in low- and middle-income countries such as Sierra Leone. This study explores the structure, functions and challenges of drug and therapeutics committees (DTCs), an intervention towards irrational medicine use recently piloted in Sierra Leone. A 2-phase mixed-method study design was used in this study. Firstly, a cross-sectional survey was conducted on all pharmacists who have worked for at least 1 year in DTC-piloted hospitals, using an online questionnaire to assess DTCs' structure, indicators and challenges. In phase 2, all eligible pharmacists were invited for a semistructured online interview using the WhatsApp messaging application to get deeper insights into the key issues that emerged from the survey; however, only 5 of the 7 consented to participate. MS Excel 2019 and NVivo version 12 were respectively used for data management and analysis. A total of 6 survey responses and 5 interviews were included in the analysis. Participants are pharmacists from the 7 hospitals in Sierra Leone where DTC was piloted. Most DTCs are comprised of a minimum of 10 members consisting of both medical and hospital administrative staff. The main functions of DTCs are ensuring rational medicines use, monitoring and reporting adverse drug reactions. All 7 hospitals with established pilot DTCs have different subcommittees operating at varying functionality levels, ranging from effective to nonfunctional. The main challenges in DTC functions and maintenance are funding (n=6), DTC decision implementation (n=4), and unmotivated members (n=4). Strategies suggested to improve DTCs at public hospitals and nationwide include resource allocation, monitoring and evaluating DTC functions and its members' capacity building. DTCs present a compelling opportunity towards achieving rational medicines use at the hospital level in Sierra Leone. Nonetheless, the lack of funding and operational resources are significant limitations that must be noted by policymakers before expanding DTC programmes to other hospitals in Sierra Leone.

"There are ways … drug companies will get into DTC decisions": How Australian drug and therapeutics committees address pharmaceutical industry influence.

One tool for protecting quality use of medicines in hospitals is a drug and therapeutics committee (DTC) that oversees medicines availability. Pharmaceutical industry marketing to prescribers is associated with less appropriate prescribing and increased costs. There is little data on decision-making practices of DTCs so it is unknown whether or how they might be vulnerable to pharmaceutical industry influence. This project explores DTC decision-making with a focus on how pharmaceutical industry influence on access and use of medicines is identified and managed. We used a qualitative methodology with individual interviews of 29 participants who were current or recent members of public hospital DTCs across New South Wales, Australia. Participants included medical, pharmacy and nursing staff and 1 citizen. Committees were linked to specific hospitals or regions, and some were affiliated with paediatric, neonatal, rural or mental health services. Drug committee processes for oversight of medicines in public hospitals are vulnerable to pharmaceutical industry influence at several points. Applications for formulary additions are sometimes initiated and completed by company representatives. Conflict of interest disclosures among applicants and committee members may be incomplete. In some institutions, medicines are available from pharmaceutical companies without committee review, including through free samples and industry-supported medicines access programmes. Participants noticed the presence and impact of pharmaceutical company marketing activities to local clinicians, resulting in increased prescriber demand for products. Improved DTC practices and review of hospital policies concerning pharmaceutical marketing activities might preserve the independence of evidence-based decision-making for safe, cost-effective prescribing.

Drug and therapeutics committees in Jordanian hospitals: a nation-wide survey of organization, activities, and drug selection procedures.

Background:Drug and Therapeutics Committees (DTCs) were founded about a century ago as a guide for dealing with drugs in hospitals. Since then, it has shown a vital role in rational drug use in terms of regulatory and educational activities.Objective:To describe structures, functions, and activities of hospital DTCs.Methods:A questionnaire was developed based on previous studies. Questions consisted of information on respondents’ demographics; structures, functions, and activities of DTCs; drug selection process and resources used, and factors and criteria used in drug selection.Results:The overall response rate was 95%. DTCs were mainly present in most large hospitals (45%). All DTCs had hospital pharmacists in their structure and most of them (66%) met monthly. The main responsibilities of DTCs were related to general prescribing policies. The number, frequency, and severity of adverse drug reactions were the most reported criteria for the drug selection process. Legal implications for practical, economic, and organizational factors were the most important factors that were reported for drug selection.Conclusions:DTCs are mainly present in most large hospitals. The main responsibilities of the DTC in Jordanian hospitals are general prescribing policies, drug selection, hospital formulary editing, and reporting of ADR to external authorities.

Drug and therapeutics committees in Nigeria: evaluation of scope and functionality

ABSTRACTIntroduction: Inappropriate use of medicines remains a problem, with consequences including increasing adverse drug reactions (ADRs) and prolonged hospitalizations. The Essential Medicines List and Drug and Therapeutics Committees (DTCs) are accepted initiatives to promote the rational use of medicines. However, little is known about DTC activities in Nigeria, the most populous African country.Areas covered: A cross-sectional questionnaire-based study was conducted among senior pharmacists, consultant physicians, and clinical pharmacologists in 12 leading tertiary health-care facilities across Nigeria.Expert commentary: Six (50%, 6/12) health-care facilities had existing DTCs with three (50%) having a subcommittee on antimicrobials. Seventy-five percent had infection control committees, with presence even in centers without DTCs. Chairpersons and secretaries of the DTCs were predominantly physicians (83.3%) and pharmacists (100%), respectively. Hospital formularies were available in five facilities with DTCs, while one facility without a DTC had an Essential Medicines Committee responsible for developing and updating the hospital formulary. The evaluation of ADRs was undertaken by pharmacovigilance units in nine facilities. Overall, DTCs were present in only half of the surveyed facilities and most were performing their statutory functions sub-optimally. The functioning of DTCs can be improved through government directives and mechanisms for continuous evaluation of activities.

Pharmaceutical management interventions through a Drug and Therapeutics Committee (DTC) in Kabul, Afghanistan: initial experience after decades of neglect

Pharmaceutical management interventions through a Drug and Therapeutics Committee (DTC) in Kabul, Afghanistan: initial experience after decades of neglect

Patients\u2019 knowledge and attitudes to the Wise List - a drug formulary from the Stockholm Drug and Therapeutic committee

BackgroundInvolving patients in decisions about their pharmacotherapy is crucial for a satisfactory treatment outcome. Information and opinions about medicines are available from a variety of sources. The Wise List is the drug formulary of recommended essential medicines for the Stockholm healthcare region and is issued by the Drug and Therapeutics Committee (DTC). To inform the public about treatment for common diseases and the concept of recommended medicines, a patient edition of the Wise List was developed. The aim of this study was to explore patients’ knowledge, needs and attitudes to the Wise List, DTC and information about medicines in general.MethodsTo examine patient knowledge about recommended medicines a survey (n = 312) was carried out at four large primary healthcare centres in Stockholm, Sweden. To further elucidate the patients’ needs of the information on recommended medicines and medicines in general, three focus group discussions (FGDs) were performed.ResultsOf the respondents 57% did not recognise the Wise List, 26% recognised but did not use it and 17% used it. A total of 63% reported that they search for information about medicines. The most common information source was “asking their doctor” (36%) followed by searching the internet (31%). The FGDs revealed that the patients were not interested in medicines in general, only in the medicines they use themselves. They did not understand the aim of the Wise List or how they could benefit from information about recommended medicines. The patients expressed a wish to access all information they need about their own care as well as public healthcare information at one location.ConclusionThe intended aim of the DTC with providing information to the public was not achieved as the patients have difficulties to understand the information and how they should use it. The patients were not interested in medicines in general, they wanted information tailored to their specific needs. The findings highlight the importance of creating tools for patients in collaboration with them and evaluate the concept continuously.

The changing multiple sclerosis treatment landscape: impact of new drugs and treatment recommendations

PurposeThe purpose of this study is to describe the utilization of disease-modifying treatments (DMTs) in relapsing-remitting multiple sclerosis (MS) and assess the impact of both the introduction of new drugs and treatment recommendations (local recommendation on rituximab use issued at the largest MS clinic in Stockholm and regional Drug and Therapeutics Committee (DTC) recommendation on how dimethyl fumarate should be used).MethodsInterrupted time series analyses using monthly data on all MS patients treated with DMTs in the Stockholm County, Sweden, from January 2011 to December 2017.ResultsThere were 4765 individuals diagnosed with MS residing in the Stockholm County from 2011 to 2017. Of these, 2934 (62%) were treated with an MS DMT. Since 2011, fingolimod, alemtuzumab, teriflunomide, dimethyl fumarate, peginterferon beta-1a, and daclizumab were introduced. Only fingolimod and dimethyl fumarate significantly impacted MS DMT utilization. In parallel, the use of rituximab off-label increased steadily, reaching 58% of all DMT-treated MS patients by the end of the study period. The local recommendation on rituximab was associated with an increase in rituximab use. The regional DTC recommendation on dimethyl fumarate was associated with a decrease in dimethyl fumarate use.ConclusionsThree MS DMTs—fingolimod, dimethyl fumarate, and rituximab off-label—impacted MS DMT utilization in the Stockholm County. The associations between the treatment recommendations and the subsequent changes in MS DMT utilization indicate that such interventions can influence the uptake and utilization of new drugs used in the specialized care setting.

Total Quality Management Approach to Drug and Therapeutics Committee Guidelines in a Tertiary Care Government Hospital in Nepal

Background: Drug and Therapeutics Committee (DTC) is the principal policy making and recommending body for Civil Service Hospital (CSH). Condition of no functional DTC and guidelines based on the concept of total quality management (TQM) continuously presented inconsistencies health care delivery system at CSH. The present study was carried out at CSH from March 2012 to October 2015. Objective: The present guidelines were targeted to the prescribers, pharmacists, and nurses for providing rational health care and disseminating uniform and state-of-art medicine information at CSH. Methods: The present study was carried out at CSH from March 2012 to October 2015. The FOCUS-PDCA concept of TQM included following nine aspects: F: Find role of DTC for the improvement in the existing practice; O: Organize trained team knowledgeable of the process; C: Clarify operational definitions of DTC; U: Understand functions of DTC; S: Select rules and regulations for DTC members; P: Plan improvement procedures through the DTC meeting; D: Do improvement in DTC process; C: Check and analyze the results or outcomes obtained from the implementation of DTC guidelines; A: Act to explore the extent and scope of the guidelines. Results: The present guidelines were developed based on the FOCUS-PDCA concept of TQM. DTC also developed quality assurance criteria, medicine information provision, pharmacovigilance center, pharmacoeconomic evaluation criteria and defined roles and responsibilities of the members. Conclusions: DTC guidelines were developed at GoN CSH, based on FOCUS-PDCA model of TQM approach. The guidelines were based on rational pharmacotherapeutics concepts.