Dear coleagues,
Colombia's Ministry of health is sponsoring the creation of
ADR monitoring and drug use evaluation programs both for teaching and
non-teaching hospitals. Any success stories on self-sustainable programs
in developing countries? we have found recent experiences , but specially
for US hospitals, sponsored by JCAHO.
Sincerely,
Rodolfo Dennis
Clinical Epidemiology Unit
Universidad Javeriana.
Many hospitals in Canada would have "non-systematic" ADR monitoring, ie -
spontaneous reports go in , generally reported by pharmacists, some by
physicians. The more successful but much more costly example that you may
be referring to is Brian Strom's model at HUP in Philadelphia (written up
in CPT, I believe). Since hospitals here are in the business of actively
closing beds, even whole hospitals, new moneys for programs are not easy
to find. The only angle that has worked and continues to work is
relatively good evidence that, for instance to use the ADR program as an
example, by hiring someone (pharmacist/PHarmD, or other) to vigilantly
monitor for and implement methods of preventing adverse reactions, the
hospital in the end will still save money.
If you currently do not have pharmacist or physician implementing the
simple things (heparin nomograms, INR monitoring of warfarin, allergy
recording on the chart, etc) then such to justify such a program, indeed,
would be relatively easy I would think. The difficulty is for many
including ourselves, those programs have been in place for some time as
regular pharmacy/pharmacy and therapeutics initiatives and are considered
a regular part of pharmacists' activities (even if they are not really
given enough time to devote to them...). A comprehensive ADR program or
further focussed ADR monitoring becomes more difficult without a
well-linked hospital computer system or some way of linking labs and
diagnoses with drugs ordered...
If I remember correctly from a past collaboration in Brazil, antibiotic
prescribing would be a good DUR/ADR monitoring focus area there.
Hope this helps a little,