EVALUATION OF TYPE C HOSPITAL FORMULARY EVALUATION OF TYPE C HOSPITAL FORMULARY IN YOGYAKARTAIN YOGYAKARTA

Anggriani Y, Pudjaningsih D, Suryawati S Anggriani Y, Pudjaningsih D, Suryawati S Department of Clinical Pharmacology, Faculty of Medicine, Department of Clinical Pharmacology, Faculty of Medicine,

Gadjah Mada University, YogyakartaGadjah Mada University, Yogyakarta

Background Many pharmaceutical products on the market are new

and non-essential. Strong hospital drug policy and instruments is needed

to manage the hospital formulary list, due to increasing number of new drugs being introduced to medical doctors.

Hospital formulary list is often developed without adequate process

Even if there is a guideline, the decision is often based on individual interest.

Quality of hospital formulary?

Objectives To evaluate and to compare the quality of 7

hospital formularies. To determine the processes used to maintain the

formulary in each hospital

Methods Descriptive-analytical, explorative case study 5 Public and 2 Private Hospitals Seven Hospital Formulary Lists were evaluated Quantitative data: total number of drugs on the list, number of

drugs in brand name, number of drugs in generic name, number of essential drugs, number of drugs supported by primary literature, number of generic drugs available, and the number of non-formulary drug procured and kept in stock.

Qualitative data: In-depth interviews with Drug and Therapeutic Committee

(DTC) members and representative doctors from 4 wards (Obstetrics and Gynecology, Pediatrics, Surgery, and Internal Medicine).

Observation on minutes of DTC meetings

Outcome Measures The quality of hospital formulary was measured by looking at

some indicators, i.e.,: • Number of brand-name products• Percentages of generic drugs on the list • Percentages of essential drugs (drug from NEDL)• Percentages of drugs supported with the primary

literature• Percentages of drugs with a single ingredient• Percentages of generic drugs kept in stock

The process of maintaining a formulary was measured by:• The frequency of revision formulary list• Percentage of non-formulary drugs procured and kept in

stock• Observation on minutes of DTC meetings.

Results 1: The values of each indicator in 7 hospitals

IndicatorsPublic Hospitals Private Hospitals

A B C D E F G

No. Active ingredients 525 441 382 532 296 513 1575

No. Brand-name products 619 570 388 686 308 1002 2153

% Generic drugs on the list 37 35 26 34 50 17 18

% Drugs from NEDL 61 41 49 41 71 28 20

% Drugs with primary literature 61 41 49 41 71 28 20

% Drugs with single ingredient 90 77 73 80 90 67 73

% Generic drugs kept in stock 31 26 29 27 48 16 13

Hospital E shows relatively better performance compared to the other hospitals

Hospital G shows the worst performance among 7 hospitals

Results 2: Number of non-formulary drugs vs frequency of revision

Indicators

Public Hospitals Private Hospitals

A B C D E F G

% Non-formulary drugs procured

31 34 24 7 1 65 3

% Non-formulary drugs in stock

41 27 36 28 1 64 9

Frequency of revision 1 4 3 1 4 0 1

Year of the newest edition

1995 2000 1999 2001 2001 1996 2001

Hospital E, which has better quality of formulary is among the most frequently revised

Results 3: Step in developing hospital formulary list

1. Listing all drugs available in stock2. Distributing the existing drug list and drug request

forms to medical doctors3. Establishing criteria for drug selection and revise

formulary in DTC meeting. Parties involved : DTC members and Doctors

4. Discussing the requests request is discussed only if attended by doctors

who request the new drug5. Official announcement of the new formulary by the

hospital director.

Results 4: Mechanisms of new drug additions into formulary

Hospital B, C, D and E

Fill in the drug request formFill in the drug request form

Submit to pharmacy Submit to pharmacy departmentdepartment

Discuss drug requests in DTC Discuss drug requests in DTC meeting meeting

Distribute supplementary Distribute supplementary formularyformulary

Procured by the pharmacy Procured by the pharmacy departmentdepartment

Hospital A, F, GHospital A, F, G

Fill in the drug request Fill in the drug request formform

Submit to pharmacy Submit to pharmacy departmentdepartment

Procured by the Procured by the pharmacy departmentpharmacy department

DISCUSSION This study found the method was easy to use. Therefore,

its use in routine hospital evaluation is promising, e.g., for accreditation system.

Although still far from the ideal, this method is sensitive enough to show the difference between hospitals. Such instruments can also be used as indicators in improving the quality of hospital formulary.

Hospital formulary list should ideally develop from hospital standard treatment guidelines (STGs). An indicator should be added to evaluate the percentage of active ingredients which are not in the STGs.

CONCLUSIONS1. Although no hospital showed ideal formulary list, the

quality of public hospital formularies was relatively better than that of private hospitals formularies, due to:

Tendency of DTC in private hospitals to accommodate the doctors request

Doctors’ general perception that essential and generic drugs are not sufficient to clinical needs

2. The mechanism to manage hospital formulary is not well established, mostly because regular meetings for formulary revision in not yet established

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