Promoting Drug and Therapeutics Committees in the Developing World

Promoting Drug and Therapeutics

Committees in the Developing World

Terry Green

John Chalker

Kathleen Holloway

Rational Pharmaceutical Management Plus

World Health Organization

March 2004

RPM + is supported by the U.S. Agency for

International Development

What is a DTC?Drug & Therapeutics Committees The committee designated to ensure the safe &

effective use of medicines in health facilities develops policies for managing drug use administers and manages the formulary system evaluates the clinical use of drugs

DTCs are important because there is widespread inappropriate use of medicines Polypharmacy, antibiotic overuse, injection overuse and

non-sterile injections, non-compliance with guidelines… leading to increased antimicrobial resistance, spread of

hepatitis B/C & HIV, waste of resources, increased adverse drug reactions and poor patient outcome

Responsibilities of a DTC

Regular Assessment(1) ABC/VEN(2) Indicator Studies(3) Drug use evaluation(4) Regular review of reports of medication errors and ADRs

Establishing Standards(1) EML & STG development(2) Evaluating drugs(3) Drug Use Evaluation criteria

Correcting problems to achieve standards(1) Interventions to promote rational drug use(2) Interventions to prevent medication errors, quality problems, stock-outs & ADRs

Investigating reported problems(1) Investigation of medication errors, drug quality problems, stock-outs and ADRs(2) Qualitative investigation why a drug use problem exists

DTC’s role to ensure quality of therapeutic care

Objectives of the MSH/WHO DTC Project

To promote DTCs in the developing world

DTCs have been shown to be effective in promoting rational drug use in developed countries, but there has been minimal use of these committees in developing countries

Interventions during 2000-3 DTC training materials were developed by MSH

and WHO

“Drug and Therapeutics Committees: a practical guide” developed by WHO and MSH and published in 2004

4 international and 8 national courses conducted in Asia, Africa, Latin America, E.Europe & aimed at doctors, pharmacists, hospital administrators & MOH officials

Follow-up workshop for participants

Structure & content of training course 16 half -day modules and a field trip to

hospitals Formulary management

Drug Selection Determining efficacy, safety, cost, quality Adding and deleting drugs

Identifying drug use problems Qualitative and quantitative methods

Strategies to improve drug use Educational, managerial, and regulatory

strategies

Training follow-up activities

E-mail correspondence with participants

DTC Web site Workplans displayed and progress reported Discussion boards Announcements Links to resources

Follow-up workshop in Africa

Training results 361 people trained from 56 countries

87 (24%) responded to follow-up e-mail request

57 (16%) participants had undertaken 152 DTC related activities

24 (7%) participants from 10 countries attended the follow-up workshop for active participants

Post-course country DTC activities

29 training courses organized by DTC participants 72 DTCs in 14 countries created/restructured 9 new drug selection processes in 6 countries STGs developed in 12 institutions in 6 countries 7 DUEs undertaken in 4 countries 8 ABC/VEN analyses undertaken in 5 countries 7 ADR reporting systems developed in 5 countries 8 training programmes on rational use of drugs in 6

countries

Major problems identified by participants to implement DTCs Lack resources and institutional support

Non-compliance with essential drug list (formularies)

Non-compliance with STGs

Pharmaceutical company influences

Decreasing revenues with improved drug use

Solutions proposed by participants Use locally collected evidence on irrational drug

use to convince officials Provide incentives to DTC members e.g. training,

recognition by administration for DTC work Develop specific Terms of Reference approved by

healthcare administrators Link procurement to STGs and formularies Provide training to DTC members & administrators Build a critical mass of activity to show

administration the value of the committee and demonstrate that DTC activities can save money

Link procurement to DTC’s formulary/EDL

Conclusions Key Lessons DTCs can be promoted and implemented in

developing countries through a combination of training and active follow-up support

Increased follow-up support increased the productivity of many DTC course participants

Policy Implications Promotion of DTCs is possible in resource poor

settings and can result in improved use of medicines but requires institutional support and investment from government and donors

Future Research Rigorous evaluation of the impact of DTCs on drug

use and costs saved from improved use