This is just a short note to describe a new publication here in Canada called:
Drugs of Choice: A Formulary for General Practice. It is similar to the
forthcoming European General Practice Formulary for those who are familiar with
the endeavour. The book came out in mid August and is published by the Canadian
Medical Association. The Ministry of Health in the Province of Ontario has
purchased copies for each general practitioner in the province-about 10,000.
Our plan is to update the book every two years in hard copy, although a proposed
electronic version may be updated every 3-4 months.
What we (I am one of the editors) initially did was identify 130 common
conditions/diagnoses/problems for which general practitioners would initiate
therapy. Then we contacted specialists in each of these areas, who also had
some training in critical appraisal, and asked them to evaluate the existing
literature for each problem and come up with first and second line drug therapy
for each condition. We then took their recommendations to a panel of four
general practitioners to see if these GPs thought that the recommendations of
the consultants were realistic. Finally, the three editors (myself who is an
emergency physician, a clinical pharmacologist and a general practitioner)
assessed each entry. Besides listing the drugs, for each drug we give the usual
dosage, the length of time that therapy should be given and the cost of a
course of therapy. There are also important prescribing notes for each
condition, a list of the references that we used in arriving at our
recommendations and a rating of the evidence that we used.
Level A evidence is recommendations based primarily on evidence from RCTs,
objective and systematic literature reviews, consensus conference
recommendations and published practice guidelines. Level B evidence is
recommendations based on some published evidence and the opinions of experts in
the field. Level C evidence is recommendations based primarily on the opinions
of experts in the field.
We are now planning to evaluate the book in a couple of ways. Each copy of the
book has an evaluation form and a request for feedback. In addition, a
convenience sample of 40 GPs will be getting a more detailed evaluation form.
Finally, we are requesting funding to conduct a trial to see if providing the
book to GPs results in more appropriate prescribing.
Although the book is written for Canada and the prices are specific to Canada,
most of the information should be generalizable to other countries. Those in
North America who are interested can call the Canadian Medical Association to
order a copy. The phone number is 1-800-663-7336 X 2307. Outside of North
America either:
phone: +613-731-8610,
fax: +613-731-9013
or write to:
Membership Services
Canadian Medical Association
1867 Alta Vista Dr.
Ottawa, Ontario
CANADA K1G 3Y6
The cost is about Can $18.50.
Anybody who wants more information about the Formulary can get in touch with
me.
Sincerely,
Joel Lexchin MD
121 Walmer Rd.
Toronto, Ontario
CANADA M5R 2X8
Phone: +416-964-7186
Fax: +416-923-9515
E Mail: lexchin@utcc.utoronto.ca