THE THERAPEUTIC DRUG MANAGEMENT PROGRAM: A COLLABORATIVE INITIATIVE OF TEACHING HOSPITALS

McGill University Health Center (MUHC) • Centre hospitalier universitaire de Sherbrooke (CHUS) • CHU de QuébecCentre hospitalier universitaire Sainte-Justine (CHU Sainte-Justine) • Centre hospitalier de l’Université de Montréal (CHUM)

PURPOSE

The Therapeutic Drug Management Program (TDMP) is an innovative joint venture initiated in January 2004 by the �ve university teaching hospitals (UTH) in Quebec, Canada (CHUM, CHU de Québec, CHUS, MUHC, CHU Sainte-Justine). The TDMP is a voluntary collaborative initiative of these �ve centers to allow for a sharing of expertise and to enable clinicians to provide inputs from their clinical practice experiences. It also serves to better address the challenges of new drug evaluations, management of hospital formularies, drug utilization reviews (DUR), increased drug costs, and limited quali�ed resources in each center.

DEFINITIONTherapeutic Drug Management is a systematic way of evaluating drugs, from their introduction onto the hospital formulary to their administration to the patient. It integrates systematic reviews of the literature, evaluative and outcomes research and assessments of economic impact.

PROGRAM’S MANDATEThe TDMP is aiming to achieve optimal drug utilization by supporting UTH in their mission: patient care, teaching, researchand technology assessment.

These major concepts have been included in the program’s mandate:

• Collaboration between independent centers

• Scientific validity

• Transparency

• Relevance

• Publications and conferences

• Systematic method for prospective evaluations

• Respect for ethics

DESCRIPTION OF CONCEPT The TDMP created an executive committee composed of the Directors of Professional Services and the Heads of department of Pharmacy of each center. The executive committee ensures a coordinated and common approach of the �ve UTH regarding TDMP’s evaluations and makes recommendations on the use of drugs. This committee is also responsible for setting priorities, overseeing administrative and legal matters, and public/media or external agencies relationships.

The TDMP also includes a scienti�c committee composed of pharmacists and physiciansfrom each center. Its mandates are:

• To develop and share methodological and clinical expertise;

• To revise and approve TDMP scientific evaluations with the collaboration of external reviewers;

• Promote and maintain TDMP methodological’s Guide to ensure a uniform methodology.

Each center is responsible for completing or reviewing studies, multiple literature reviews and DUR (in consultation with experts, revision by peers and approval by the scienti�c committee).

RESULTSSince 2004, the TDMP completed over:36 Drug evaluations17 Descriptive analyses9 Drug utilization reviews2 Treatment reviews (heparin-induced thrombocytopenia, methicillin-resistant Staphylococcus aureus)

All these documents can be consulted on the TDMP’s web site www.pgtm.qc.ca.

Local, national and international presentations were given and scienti�c papers have been written.

A methodological guide was published and is available on the TDMP’s web site.

A systematic review of interventions to change behaviour of prescribers and to facilitate knowledge transfer in hospital settings has been completed. A clinical intervention model (CIM) can now be developed for each TDMP evaluation using the criteria issued from this review.

For many studies, a follow-up is done to evaluate the dissemination and the impact of the recommendations.

CONCLUSIONThe TDMP allows clinicians to access quality and evidence-based information to optimize drug utilization in their centers. The TDMP converts research into innovative tools for clinicians and in doing so, facilitates the transfer of theory into every day practice and therapeutic decision-making.

In times of scarcity for professional resources and increasing drug costs, sharing information and expertise is imperative. The university teaching hospitals of Quebec have decided to work together to optimize the pharmacotherapy of patients in Quebec. After nearly ten years of operation, the success of the program is well established.

ExecutiveCommittee

Scienti�cCommittee

Evaluation

Teaching

Evaluationstatement

Descriptiveanalysis

Follow-upstudies

Disseminationand

Interventionstrategies

Utilizationinformation/rules

DrugutilizationReviews

CHUSCentre hospitalier

Universitairede Sherbrooke

CHUSainte-Justine

Centre hospitalierUniversitaire

de Ste-Justine

CHUde Québec

MUHCMcGill University

Health Center

CHUMCentre hospitalier

de l’Universitéde Montréal

MSSS

INESSS

APES

Health NetworkOther Hospitals

ENVIRONMENTTDMP

ENVIRONMENTTDMP

1st

2nd

STEP

3rd

STEP

1st

STEP

2nd

STEP

3rd

STEP

Before hospital formulary addition, literature review with recommendations and druguse criteria.

CIM: academic detailing, educational outreach visits, local consensus process, preprinted form.

Descriptive analysis and Drug utilization review with audit and feedback

1- Dexmedetomidine

Impact: optimal drug utilization and cost control

1st1st

2nd2nd

3rd3rd

Baseline analysis: evaluate how opioids areprescribed in the UTH (Phase 1 - 2006)

Evaluate the impact of the recommendations (Phase 2 - 2008)

Identify if discrepancies are still present(Phase 3 - 2011)

2 - Opioids (all steps through descriptive analysis)

Impact: improved safety

STEPSTEPSTEP

STEPSTEP

STEPSTEP

EXAMPLES

Ministère de la santé etdes services sociaux

Institut national d’excellenceen santé et services sociaux

Association des pharmaciensdes établissements de santé

du Québec