Drug and therapeutics committees in Jordanian hospitals: a nation-wide survey of organization, activities, and drug selection procedures

Main Article Content

Keywords

Pharmacy and Therapeutics Committee, Hospitals, Formularies, Hospital, Pharmacy Service, Hospital, Pharmacists, Surveys and Questionnaires, Jordan

Abstract

Background: Drug and Therapeutics Committees (DTCs) were founded about a century ago as a guide for dealing with drugs in hospitals. Since then, it has shown a vital role in rational drug use in terms of regulatory and educational activities.


Objective: To describe structures, functions, and activities of hospital DTCs. 


Methods: A questionnaire was developed based on previous studies. Questions consisted of information on respondents’ demographics; structures, functions, and activities of DTCs; drug selection process and resources used, and factors and criteria used in drug selection.


Results: The overall response rate was 95%. DTCs were mainly present in most large hospitals (45%). All DTCs had hospital pharmacists in their structure and most of them (66%) met monthly. The main responsibilities of DTCs were related to general prescribing policies. The number, frequency, and severity of adverse drug reactions were the most reported criteria for the drug selection process. Legal implications for practical, economic, and organizational factors were the most important factors that were reported for drug selection. 


Conclusions: DTCs are mainly present in most large hospitals. The main responsibilities of the DTC in Jordanian hospitals are general prescribing policies, drug selection, hospital formulary editing, and reporting of ADR to external authorities.

Abstract 4244 | pdf Downloads 453

References

1. Gustafsson LL, Wettermark B, Godman B, Andersén-Karlsson E, Bergman U, Hasselström J, Hensjö LO, Hjemdahl P, Jägre I, Julander M, Ringertz B, Schmidt D, Sjöberg S, Sjöqvist F, Stiller CO, Törnqvist E, Tryselius R, Vitols S, von Bahr C; Regional Drug Expert Consortium. The 'wise list'- a comprehensive concept to select, communicate and achieve adherence to recommendations of essential drugs in ambulatory care in Stockholm. Basic Clin Pharmacol Toxicol. 2011;108(4):224-233. https://doi.org/10.1111/j.1742-7843.2011.00682.x
2. Fadare JO, Ogunleye O, Obiako R, Orubu S, Enwere O, Ajemigbitse AA, Meyer JC, Enato E, Massele A, Godman B, Gustafsson LL. Drug and therapeutics committees in Nigeria: evaluation of scope and functionality. Expert Rev Clin Pharmacol. 2018;11(12):1255-1262. https://doi.org/10.1080/17512433.2018.1549488
3. Matlala M, Gous AG, Godman B, Meyer JC. Structure and activities of pharmacy and therapeutics committees among public hospitals in South Africa; findings and implications. Expert Rev Clin Pharmacol. 2017;10(11):1273-1280. https://doi.org/10.1080/17512433.2017.1364625
4. Holloway K, Green T. Drug and therapeutics committees: A practical guide. World Health Organisation. Geneva. 2003. Available at: https://apps.who.int/iris/handle/10665/68553 (accessed on Sep 19, 2019).
5. Drug and Therapeutics Committees in Jordan. World Health Organization. 2014.. Available at: http://apps.who.int/medicinedocs/documents/s21606en/s21606en.pdf (accessed on Sep 19, 2019)
6. Andreski M. Development of the pharmacy and therapeutics committee to predict the level of prescriber adoption of its decisions. University of Iowa. USA. 2009. (accessed on Sep 19, 2019). Available at: https://ir.uiowa.edu/etd/329/ (accessed on Sep 19, 2019).
7. Mittmann N, Knowles S. A Survey of Pharmacy and Therapeutic Committees across Canada: Scope and Responsibilities. Can J Clin Pharmacol. 2009;16(1):e171-e177.
8. Hasle-Pham E, Arnould B, Späth HM, Follet A, Duru G, Marquis P; Advisory Panel. Role of clinical, patient-reported outcome and medico-economic studies in the public hospital drug formulary decision-making process: results of a European survey. Health Policy. 2005;71(2):205-212. https://doi.org/10.1016/j.healthpol.2004.08.007
9. Alsultan M. The role of pharmacoeconomics in formulary decision making in different hospitals in Riyadh, Saudi Arabia. Saudi Pharm J. 2011;19(1):51-56. https://doi.org/10.1016/j.jsps.2010.10.005
10. Weekes LM, Brooks C. Drug and therapeutics committees in Australia: expected and actual performance. Br J Clin Pharmacol. 1996;42(5):551-557. https://doi.org/10.1111/j.1365-2125.1996.tb00048.x
11. Durán-García E, Santos-Ramos B, Puigventos-Latorre F, Ortega A. Literature review on the structure and operation of Pharmacy and Therapeutics Committees. Int J Clin Pharm. 2011;33(3):475-483.
12. Mannebach MA, Ascione FJ, Gaither CA, Bagozzi RP, Cohen IA, Ryan ML. Activities, functions, and structure of pharmacy and therapeutics committees in large teaching hospitals. Am J Health Syst Pharm. 1999;56(7):622-628. https://doi.org/10.1093/ajhp/56.7.622
13. Gul WN. DTC is important for the betterment of the hospital pharmacy. Innovations in Pharmaceuticals and Pharmacotherapy. 2014;2(1):307-311.
14. Marques DC, Zucchi P. Pharmacy and therapeutics committees in Brazil: lagging behind international standards. Rev Panam Salud Publica. 2006;19(1):58-63. https://doi.org/10.1590/s1020-49892006000100014
15. Lima-Dellamora EC, Caetano R, Gustafsson LL, Godman BB, Patterson K, Osorio-de-Castro CG. An Analytical Framework For Assessing Drug And Therapeutics Committee Structure And Work Processes In Tertiary Brazilian Hospitals. Basic Clin Pharmacol Toxicol. 2014;115(3):268-276.
16. JFDA Law. Ministry of Health. Jordan. Available at: http://www.moh.gov.jo/Pages/viewpage.aspx?pageID=164 (accessed on Sep 19, 2019).
17. Vogenberg FR, Gomes J. The changing roles of P & T Committees: a look back at the last decade and a look forward to 2020. P T. 2014;39(11):760-772.
18. Perrone J, Nelson LS. Pharmacy and therapeutics committee: leadership opportunities in medication safety for medical toxicologists. J Med Toxicol. 2011;7(2):99-102. https://doi.org/10.1007/s13181-011-0147-5
19. Weekes LM, Day RO. The application of adverse drug reaction data to drug choice decisions made by pharmacy and therapeutics committees. An Australian Perspective. Drug Saf. 1998;18(3):153-159. https://doi.org/10.2165/00002018-199818030-00001
20. Hoffmann M. The right drug, but from whose perspective? A framework for analysing the structure and activities of drug and therapeutics committees. Eur J Clin Pharmacol. 2013;69(Suppl 1):79-87. https://doi.org/10.1007/s00228-013-1491-y
21. Mashaba TP, Matlala M, Godman B, Meyer JC. Implementation and monitoring of decisions by pharmacy and therapeutics committees in South African public sector hospitals. Expert Rev Clin Pharmacol. 2019;12(2):159-168. https://doi.org/10.1080/17512433.2018.1545572
22. Fijn R, Brouwers JR, Knaap R. De Jong-Van den Berg LT. Drug and Therapeutics (D&T) Committees in Dutch hospitals: a nation-wide survey of structure, activities, and drug selection procedures. Br J Clin Pharmacol. 1999;48(2):239-246. https://doi.org/10.1046/j.1365-2125.1999.00001.x
23. Tan EL, Day RO, Brien JA. Prioritizing Drug and Therapeutics Committee (DTC) Decisions: A National Survey. Pharm World Sci. 2007;29(2):90-96. https://doi.org/10.1007/s11096-006-9074-y
24. Shulkin D. Reinventing the Pharmacy and Therapeutics Committee. P T. 2012;37(11):623-649.
25. Godman B, Wettermark B, Hoffmann M, Andersson K, Haycox A, Gustafsson LL. Multifaceted national and regional drug reforms and initiatives in ambulatory care in Sweden: global relevance. Expert Rev Pharmacoecon Outcomes Res. 2009;9(1):65-83. https://doi.org/10.1586/14737167.9.1.65
26. Plet HT, Hallas J, Nielsen GS, Kjeldsen LJ. Drug and Therapeutics Committees in Danish Hospitals: A Survey of Organization, Activities and Drug Selection Procedures. Basic Clin Pharmacol Toxicol. 2013;112(4):264-269.
27. Terblanche A, Meyer JC, Godman B, Summers RS. Knowledge, attitudes and perspective on adverse drug reaction reporting in a public sector hospital in South Africa: baseline analysis. Hosp Pract (1995). 2017;45(5):238-245. https://doi.org/10.1080/21548331.2017.1381013
28. Tyler LS, Cole SW, May JR, Millares M, Valentino MA, Vermeulen LC Jr, Wilson AL; ASHP Expert Panel on Formulary Management. ASHP statement on the pharmacy and therapeutics committee and the formulary system. Am J Health Syst Pharm. 2008;65(13):1272-1283. https://doi.org/10.2146/ajhp080086
29. Armstong EP, Abarca J, Grizzle AJ. The role of pharmacoeconomic information from the pharmaceutical industry perspective. Drug Benefit Trends. 2001;13(3):39-45.
30. Academy of Managed Care Pharmacy. Format for formulary submissions: a format for submission of clinical and economic evicence in support of formulary consideration. 2016:(Version 4.0). Available at: http://www.amcp.org/sites/default/files/2019-03/AMCP-Format-V4.pdf (accessed on Sep 19, 2019)
31. Drummond MF, Sculpher MJ, Claxton K. Methods for the economic evaluation of health care programmes, 4th ed. Oxford: Oxford University Press; 2015.
32. Balu S, O'connor P, Vogenberg R. Contemporary issues affecting P & T committees, Part 1: the evolution. P T. 2004;29(11):709-711.
33. Fadare JO, Oshikoya KA, Ogunleye OO, Desalu OO, Ferrario A, Enwere OO, Adeoti A, Sunmonu TA, Massele A, Baker A, Godman B. Drug promotional activities in Nigeria: impact on the prescribing patterns and practices of medical practitioners and the implications. Hosp Pract (1995). 2018;46(2):77-87. https://doi.org/10.1080/21548331.2018.1437319