E-DRUG: Hospital drug and therapeutic committees (2)
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I have for the last 3 years together with colleagues at the
Karolinska Institute in Stockholm been helping the Ministry of Health
in Zambia with its National Drug Policy Development. During the last
year I have been developing a new instrument that their District
Drugs and Therapeutics Committees can use when deciding on the choice
of drugs and how to arrive at this choice. This is after a
fascinating grass-roots upwards exercise when every district in the
country has carried out field exercises to identify the major causes
of mortality, morbidity and disability in their district (from
existing statistics, focus group discussions in the community, key
informant interviews etc). This has helped to identify the most
important diseases that need drug intervention. My recent exercise has
been how to identify the drugs needed for these and a few other major
diseases.
I am call my model "Titrating Pharmaceutical Choices", the idea
being that it is a flexible model that can be modified as time goes on
and that is based on the most recent consensus thinking, (if possible
using Cochrane reviews where they have looked at the subject). It
gives 6 levels of drug therapy for each disease, 3 of which are
acceptable and can be recommended and 3 which are not recommended
(experimental or yet under development, obsolete and contraindicated
in this disease). The 3 recommended levels have one a low-cost, one
a medium cost and one a high cost. As you are aware in many diseases
the difference in clinical efficacy between these three is often
quite small and the main difference is in minor side-effects and of
course in cost. I have developed this model now for 37 diseases and
am now working on a similair model for Diagnostic pathways: one a
low-cost which may not be the best but in certain settings of severe
constraint may be the only one available, one a medium cost and one
a high cost.
If you are interested I can give examples of the model and we can
have further contact.
Gunnar Holmgren
Director of Studies
Unit for International Child Health
University of Uppsala
Entrance 11,University Hospital
751 85 Uppsala, Sweden
Email: Gunnar.Holmgren@ich.uu.se
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