E-DRUG: Myths about hospital formularies persist (1)
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This article [the one referred to in previous posting. KM] has not mentioned other techniques for getting drugs accepted.
There are three types of Evidence.
1. The Evidence Based Medicine as most of us know it.
2. The Eminence Based Evidence (the Senior ..... ologist wants it
and so it must be available)
3. The Eloquence Based Evidence (talk about it for 45 minutes and
the committee gets tired and allows it).
Also other techniques for making a Formulary - GOBSAT (Good Old Boys
Sitting Around a Table). OK What do you use in your Cardiology Clinic -
can we have the list and that will take care of the Cardiology and now
for Gastroenterology .....
Sadly this does take place even in drug registration where the decision
affects the whole population of the country.
KW
Dr Krisantha Weerasuriya
Essential Drugs and Medicines Policy (EDM)
WHO South-East Asia Regional Office (SEARO),
World Health House, New Delhi, 110 002, India
Phone +91 11 2330 9314
Mobile +91 98104 16366
Fax +91 11 2337 8510
Email: weerasuriyak@whosea.org
(Email sent in my personal capacity)
E-DRUG: Myths about hospital formularies persist (3)
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Dear Krisantha,
In the Hospital I am associated with, Kenyatta
National Hospital, the need for a Hospital Formulary
was perceived as an additional tool to the Essential
Drug List in improving rational use of drugs and
availability of certain drugs at this tertiary &
national Hospital. However, certain weaknesses have
become apparent.
(1)The Pharmaceutical industry have
used its availability to push for the presence of
certain drugs at this tertiary level through
consultants and have in this way overshadowed the
crucial role of the country's Essential Drugs which
addresses most of these drug needs. The senior
specialists, i.e cardiologist,nephrologists and
oncologists have always claimed that their patients
required urgent and newer and more potent drugs than
the general physicians who handle malaria, pneumonias
and septicaemias which are regarded life-threatening.
Perhaps therapeutic committees could be of a great
help. I appreciate a great deal your concern in this
area which is currently ambiguous in most health care.
Prof. Francis D. Juma MD., PhD.
Department of Clinical Pharmacology & Internal
Medicine
University of Nairobi & Kenyatta National Hospital
fdjuma@yahoo.com
E-DRUG: Myths about hospital formularies persist (4)
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Dear Francis
Having worked at Kenyatta National Hospital (KNH), I can attest to your views. However, I believe that things can be better. I have shared with KNH my experience in running a Therapeutics committee in a private Hospital environment in Kenya and the basic facts are that there must be a focus for a win-win situation and it is feasible. The fight is against irrational use of medicines and high costs that go with it, including potential loss of life, not individual patients, their caregivers or the providers of the much needed medicines.
Atieno Ojoo
Boston University School of Public Health, USA
atisojoo@yahoo.co.uk
E-DRUG: Myths about hospital formularies persist (5)
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Atieno Hi!
I appreciate your sentiments. The WHO together with
INRUD have made useful efforts in the recent years to
identify and rationalize strategies in the promotion
of Essential Drugs which means; the choice a critical
number of drugs for most countries' needs in their
medical interventions. Their rational use has been
verified by several studies including indicator
studies and this approach was found cost-effective for
low resource countries which are also burdened with
HIV/AIDS. We insist that this is the way forward and
recommend that countries should adhere to their
Essential Drug Lists introduced by living Clinical
Guidelines. Hospital formularies could be important
additions, but will require allot of integrity &
transparency in the formulation of therapeutic
Committees. These arrangement must be seen to be done
and require some efforts from regulatory authorities
as they have both human survival and cost implications
for many countries.
Kind regards
Prof Francis D. Juma MD., PHD.
Department of Clinical Pharmacology & Internal
Medicine,
College of Health Science,
University Nairobi Kenya East Africa
E-DRUG: Myths about hospital formularies persist (6)
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Dear E-druggers
This remains an interesting discussion. At this late stage still a few
remarks: My experience here in Holland has been that in the first instance
a hospital formulary aims at rationalizing drug treatment, and is not
primarily introduced to decrease cost. I have assisted with the composition
of two formularies for large community hospitals, and during the first two
years expenses actually increased; only after some time physicians really
understood what the meaning was, and expenses slowly went down. It was
therefore very clever that the South African authorities started developing
treatment guidelines, and formularies were only at a later stage derived
from such guidelines by selecting the drugs which were judged appropriate
for those treatment modules. If introduced in this way outside influence is
automatically neutralized. One should not start with a formulary and then
wait what happens.
Good luck and best wishes,
Leo Offerhaus
offerhausl@euronet.nl
[I very much agree! KM]