Survey of formulary system policies and procedures.

A telephone survey was conducted to determine the policies and procedures of hospital formulary systems. Directors of pharmacy at a random sample of 150 community hospitals were interviewed, and letters were sent to each respondent requesting copies of the formulary and drug evaluation form. One hundred thirty hospitals completed the interview (gross response rate of 87%), and 35 evaluation forms and 49 printed formularies were received. Almost all hospitals had a formulary system and a printed formulary; the most frequently stated purposes were to decrease costs and to ensure appropriate therapy. Most formularies received were simple drug lists with no supporting information. The typical pharmacy and therapeutics committee consisted of 11 members, met every month, and reported to the executive committee. About 80% of the responding institutions had formal procedures for considering formulary additions. Less than half had standardized drug evaluation forms. Most hospitals have a formulary system and a printed version of the formulary; however, the formulary often serves primarily as a drug list, with no supporting information.     

The formulary decision-making process in a health maintenance organisation setting

The goal of a health maintenance organisation (HMO) is to provide high quality, cost-effective healthcare services and products which meet the needs of the membership. Providing and managing pharmaceutical products and services within the HMO is a major aspect of accomplishing this goal. Several decisions must be made in developing, implementing and maintaining a formulary system. The numbers of people seeking their healthcare from HMOs in the US has increased 4-fold in 10 years, and several model types of HMOs have developed, including network HMOs, group HMOs, independent practitioner associations and staff models. HMOs utilising formulary systems provided cover to 76% of enrollees in 1992. Formulary system management and decision making entails the use of open vs closed formularies and the role of the pharmacy and therapeutics (P & T) committee. Product selection takes into account efficacy, safety, costs, patient acceptance, ease of use, dosage forms, preparation requirements, stability and storage requirements and the reputation of the manufacturer and the service it provides. We list and describe various policy decisions which HMO pharmaceutical decision makers must address if the formulary system is to become an efficient tool for the HMO.     

Formulary-control procedures in a staff-model health maintenance organization

Efforts to promote cost-effective drug prescribing in a health maintenance organization (HMO) through (1) revision of the formulary, (2) education, and (3) drug-use evaluations (DUEs) are described. New programs and procedures to promote more cost-effective prescribing were implemented in 1987 at a staff-model HMO with seven health-care centers and 40,000 members. Support to the pharmacy and therapeutics committee in developing formulary recommendations was enhanced, the formulary was revised and the number of listed drugs reduced by half, the focus of pharmacists was changed from purchasing and inventory control to education of physicians about cost-effective prescribing, and the most expensive drug categories were identified and educational efforts instituted. During the next two years substantial changes in the prescribing of oral contraceptives, nonsteroidal anti-inflammatory drugs, antiulcer agents, and anti-infectives, but not antihypertensive drugs, were identified through DUEs. Evaluation of cost savings was limited by the lack of an automated, integrated patient database, and it was difficult to assess the effect of changes in patient population. Revision of the formulary coordinated with enhanced educational efforts and DUEs resulted in more cost-effective prescribing in an HMO without placing severe restrictions on physicians or patients.     

Effect of patient notification of formulary change on formulary adherence

OBJECTIVE: To evaluate the impact of patient notification of impending formulary changes on formulary adherence. METHODS: This pilot program in a large, Midwest-based health insurer utilized a randomized controlled trial research design. A list of 30 chronic-use medications that were to change formulary status were selected for the pilot. A review of adjudicated pharmacy claims records was performed to identify patients receiving one or more of the formulary change medications on the list. Members of 112 individual health plans of this large health insurer, all of whom were subject to the same drug formulary, were randomized to either the intervention (letter) or control arm. Patients in the intervention arm were sent a targeted communication that described the patient.s formulary change medication(s) and provided therapeutic option(s) for the formulary change medication(s). Pharmacy claims for patients in both arms were examined at 110 days after the date of the mailing to determine if there was a switch to a formulary alternative. Multivariate regression modeling was performed to adjust for baseline differences between the arms. RESULTS: A total of 7,247 unique formulary change medication regimens were identified (3,817 in the control arm and 3,430 in the letter arm) for 6,518 subjects (3,387 in the control arm and 3,131 in the letter arm). A higher proportion of formulary change medication regimens in the intervention arm were switched to a formulary alternative compared with the control arm (19.2% vs. 12.0%, P<0.001). After adjustment for baseline differences, regression modeling indicated that subjects in the intervention arm were 1.33 times more likely to switch to a formulary alternative (P<0.001). CONCLUSION: A letter-based, formulary change notification program is a pragmatic and effective strategy to increase drug formulary adherence. Such a program does not restrict access to medications but, rather, provides education and personalized information that may allow patients to participate more actively in their pharmacotherapy decision making.     

美沙酮维持治疗门诊的综合管理

美沙酮维持治疗（MMT）是以生物、心理和社会医学为基础模式的综合治疗，通过这种综合治疗来改变患者的高危险行为，恢复患者的个人、家庭和社会功能。该治疗方法在我国开展的时间比较短，自开诊以来，完善的综合管理是每一个从事这项工作的门诊努力的方向。云南省药物依赖防治研究所大树营维持门诊作为国家美沙酮维持治疗培训中心的教学和科研基地，自开诊以来，利用自身的人员和资源优势，针对我国美沙酮维持治疗的基本体系和治疗目的，对美沙酮维持治疗门诊的综合管理模式进行了探讨，取得了一些经验，形成了一套较完善的综合管坪模式．现将该管坪模式介绍如下：     

Results of our national survey. Current formulary decision-making strategies and new factors influencing the process

Formulary recently conducted a survey of 2,000 of its readers to uncover what forces are at play in their formulary decision-making processes. Topics included general philosophies toward formulary decision making, philosophies toward adding and deleting products, influences on the process, trends related to product reviews, formulary management strategies, drug information educational strategies, and new approaches to the formulary decision-making process. Some 295 surveys (14.75%) were returned. Highlights and analyses of the survey findings are presented for your review and comparison with your practice setting's approaches.     

A psychoeducational approach to methadone maintenance treatment: a survey of client reactions

STAR, a methadone clinic in Portland, Oregon employs a psychoeducational approach in an attempt to provide coherent, comprehensive treatment in meeting diverse client needs. Two hundred and thirty-eight STAR clients completed a 133 item survey as part of an evaluative review of the efficacy of the psychoeducational model. Clients were asked about their perceived treatment needs and expectations, drug use, criminality, mental and physical health, social and economic stability, and their sense of self-worth and life satisfaction. Respondents reported that receiving methadone was the most useful and best liked aspect of treatment, followed by individual counseling, and education and skill classes. Clients indicated low rates of criminal behavior and drug use, but acknowledged high rates of psychological symptoms including depression, anxiety, and irritability, and rated as very important the need to reduce drug use and to improve health, to achieve a sense of life satisfaction, to enhance feelings about self and relationships, especially those with their children. A majority of the respondents had less than adequate income, and a substantial minority had less than a high school education. Longer time in treatment at STAR was associated with reduced heroin and cocaine use and improvements in social, economic and legal realms. The discussion focuses on implications for methadone treatment in general and possible modifications of the STAR program.     

Long-term citalopram maintenance in mice: selective reduction of alcohol-heightened aggression

Background Selective serotonin reuptake inhibitors (SSRIs) alleviate many affective disturbances in human clinical populations and are used in animal models to study the influence of serotonin (5-HT) on aggressive behavior and impulsivity. Objective We hypothesized that long-term SSRI treatment may reduce aggressive behavior escalated by alcohol consumption in mice. Therefore, aggression was tested in male CFW mice to determine whether repeated citalopram (CIT) administration reduces alcohol-heightened aggression. Materials and methods Resident male mice self-administered alcohol by performing an operant response on a panel placed in their home cage that delivered a 6% alcohol solution. Mice repeatedly confronted an intruder 15 min after self-administration of either 1 g/kg alcohol (EtOH) or water (H₂O). Aggressive behaviors were higher in most mice when tests occurred after EtOH intake relative to H₂O. Once baseline aggression was established, animals were injected (i.p.) twice daily with 10 mg/kg CIT or saline (SAL) for 32 days. Every 4 days throughout the CIT treatment period, aggressive encounters occurred 6 h after CIT injections, with testing conditions alternating between EtOH and H₂O intake. Results Aggression was only modestly affected by CIT in the first 2 weeks of treatment. However, by day 17 of CIT treatment, alcohol-heightened aggressive behavior was abolished, while baseline aggression remained stable. These data lend support for the role of the 5-HT transporter in the control of alcohol-related aggressive behavior, and the time course of effects suggests that a change in density of 5HT_1A autoreceptors is necessary before antidepressant drugs produce beneficial outcomes.     

慢性肾功能衰竭维持性血液透析患者配偶生活质量调查分析

目的探讨慢性肾功能衰竭（肾衰）维持性血液透析患者配偶的生活质量,以更好地配合患者治疗。方法94例慢性肾衰维持性血液透析患者配偶为研究组,60例健康人群的配偶为对照组。应用生活质量综合评定问卷（GQOLI）对2组受试人群进行生活质量调查评估。结果研究组的GQOLI总分及躯体功能、情感功能、心理功能、社会功能、精神状态、物质生活维度得分均较对照组低,差异有统计学意义（P〈0．01或P〈0．05）。研究组中女性配偶GQOLI总分及情感功能、心理功能、社会功能、精神状态维度得分较男性配偶低,差异有统计学意义（P〈0．01或P〈0．05）;物质生活维度、躯体功能维度得分与男性配偶比较,差异无统计学意义（P〉0．05）。结论慢性肾衰维持性血液透析患者配偶的生活质量较正常人下降,女性配偶生活质量下降更明显。应关注这部分人群,积极进行心理干预,提高其生活质量。     

Decision analysis in formulary decision making

Although decision making about what drugs to include in an institutional formulary appears to lend itself readily to quantitative techniques such as decision analysis and cost-benefit analysis, a review of the literature reveals that very little has been published in this area. Several of the published decision analyses use non-standard techniques that are, at best, of unproved validity, and may seriously distort the underlying issues through covert under-counting or double-counting of various drug attributes. Well executed decision analyses have contributed to establishing that drug acquisition costs are not an adequate measure of the total economic impact of formulary decisions and that costs of labour and materials associated with drug administration must be calculated on an institution-specific basis to reflect unique staffing patterns, bulk purchasing practices, and the availability of surplus capacity within the institution which might be mobilised at little marginal cost. Clinical studies of newly introduced drugs frequently fail to answer the questions that weigh most heavily on the structuring of a formal assessment of a proposed formulary acquisition. Studies comparing a full spectrum of therapeutically equivalent drugs are rarely done, and individual studies of particular pairs of drugs can rarely be used together because of differences in methodology or patient populations studied. Gathering of institution-specific economic and clinical data is a daunting, labour-intensive task. In many institutions, incentive and reward structures discourage behaviour that takes the broad institutional perspective that is intrinsic to a good decision analysis.(ABSTRACT TRUNCATED AT 250 WORDS)     

我院儿科应用抗菌药物的调查

抗菌药物是医院应用最广泛的药物之一,其使用的合理性与患者的康复及医院医疗质量有密切关系。为了解抗菌药物在儿科的使用情况,以督促临床合理应用,对我院抗菌药物的使用进行调查,结果如下。     

The National Criminal Justice Treatment Practices survey: multilevel survey methods and procedures

The National Criminal Justice Treatment Practices (NCJTP) survey provides a comprehensive inquiry into the nature of programs and services provided to adult and juvenile offenders involved in the justice system in the United States. The multilevel survey design covers topics such as the mission and goals of correctional and treatment programs; organizational climate and culture for providing services; organizational capacity and needs; opinions of administrators and staff regarding rehabilitation, punishment, and services provided to offenders; treatment policies and procedures; and working relationships between correctional and other agencies. The methodology generates national estimates of the availability of programs and services for offenders. This article details the methodology and sampling frame for the NCJTP survey, response rates, and survey procedures. Prevalence estimates of juvenile and adult offenders under correctional control are provided with externally validated comparisons to illustrate the veracity of the methodology. Limitations of the survey methods are also discussed.     

维持性血液透析患者隐性结核病患病率和有关预测因子的调查研究

目的笔者通过调查维持性血液透析(hemodialysis,HD)患者的隐性结核菌感染患病率,以明确隐性结核菌感染和干扰素γ释放试验(Gamma interferon release assay,IGRA)结果不确定的患者的预测因子。方法选择2013年3月—2015年2月于济南军区总医院血液净化中心接受血液透析3月以上的患者。排除活动性结核患者后,IGRA测试阳性作为隐性结核感染的诊断方法。通过对隐性结核感染患病率研究,获得隐性结核感染和IGRA测试结果可疑的患者的预测因子。结果 97例被纳入研究对象,23例(23.7%)IGRA测试阳性,61例(62.9%)测试阴性,13例(13.4%)IGRA结果可疑。隐性结核感染的独立预测因子包括:高龄、结核病史、吸烟。IGRA测试结果可疑的高危因素包括透析时间、贫血、人血白蛋白水平。结论高龄、结核病史、吸烟的透析患者中患病率显著增高,这些患者需要长期随访。营养不良的长期血液透析患者有必要定期接受IGRA测试。