Cost containment through P & T committee drug utilization review

Provoked by changes that are occurring in health care, hospitals are currently formulating and implementing strategies to identify and control costs while maintaining the highest quality of care. Because drug costs account for a significant proportion of the hospital supply budget (5 to 10%), there is an increased need for the P & T Committee to become involved in the cost containment effort. This article will demonstrate how an existing program of drug utilization review (DUR) has reduced drug expenses without sacrificing the quality of care or imposing unnecessary restrictions on formulary items. Furthermore, implementation of the DUR program has not resulted in conflict between pharmacy, medical, nursing or administrative staffs within the institution.     

Effect of a P & T committee newsletter on anti-infective prescribing habits

P & T newsletters are commonly employed as a way in which to educate the medical staff. However, studies suggest that a newsletter is an ineffective method of education. This study describes the effects of a newsletter and direct in-service education on altering prescribing habits of physicians in a university-based teaching hospital. The newsletter and in-service recommended that physicians switch from a commonly used anti-infective to a more cost-effective alternative that had recently been added to the formulary. Prescribing patterns were altered and sustained for at least 3 months. The newsletter was at least as effective as direct in-service education.     

P & T Committee formulary requests: criteria for admission

The criteria for P & T Committee members to consider when adding or deleting a product to the formulary are discussed. Although each institution will require and develop different standards that reflect the characteristics of the patient population they serve, two general sets of factors should be studied. The anticipated needs of the institution and the therapeutic application of the medication in consideration must be identified. Furthermore, the characteristics of the drug, including pharmacokinetics, biopharmaceutics, and cost must be clearly defined. The P & T Committee formulary decisions are critical in ensuring high-quality, cost-effective health care.     

The P & T committee: descriptive survey of activities and time requirements.

Hospitals in the St. Louis area were surveyed to identify the activities of their P & T Committees and to determine the time commitment required of various hospital personnel for P & T functions. The acceptance of the P & T Committee within the hospital and committee membership were also studied. The data gathered were reviewed according to hospital size to determine the effect of size on P & T Committee activities. After analyzing results from the survey, suggestions on effective use of time for P & T functions are presented.     

Preparing for the new millennium

Since being introduced to the field of drug discovery at Zeneca Pharmaceuticals in 1991, it has become apparent to me that a blizzard of revolutionary novel approaches has swept through the pharmaceutical industry. Now, the discovery process has become completely transformed and the race to develop commercially successful drugs is now taking place in a very different realm. Rapid advances in automation, combinatorial chemistry, high-throughput screening (HTS), genomics, proteomics and bioinformatics appear to be principally responsible for driving such a rapidly evolving discovery process. In these exciting times for pharmaceutical R&D, it is a delight for me to take over the Editor's reins of Drug Discovery Today.     

蛋白质、多肽类药物新型释药系统的研究

现代生物技术的飞速发展,使蛋白质、多肽类药物在临床上的应用越来越广泛。与此同时,蛋白质、多肽类药物递送系统的研究也日益成为现代药剂学的热点之一。本文综述了近年来国内外蛋白质、多肽类药物新型释药系统的发展概况,为蛋白质、多肽类药物制剂的研究和临床应用、开发提供借鉴。     

External quality assurance committee for drug information services

Use of an external quality assurance committee to assess the performance of a drug information service is described. At the St. John's University Drug Information Center, responses to requests for drug information are provided via telephone, with written consultations or bibliographies provided on request. All telephone queries and responses are tape-recorded so that the oral responses to requests can be evaluated. In September 1986, the center initiated a quality assurance program that involved a 10-member external review committee composed of local pharmacists representing eight practice areas. A standardized evaluation form containing performance criteria was used. Performance with respect to each criterion, excluding timeliness and consistency of the response, was rated according to a four-point scale. Mean scores for all drug information skills were determined on the basis of the difficulty rating of the request. A total of 25 consultations were evaluated during a six-month pilot period. The most accurately answered requests were those pertaining to adverse drug reactions, teratogenicity, injectable drug compatibility, and drug-drug interactions. The least accurately answered questions pertained to product identification. Mean scores for the low-difficulty and intermediate-difficulty questions were much lower than those for the high-difficulty questions for all performance areas except oral communication. Use of an external quality assurance committee proved to be an objective, valid way of ensuring the accuracy and completeness of drug information consultations.     

Revival of the regulatory T cell: new targets for drug development

Compelling new evidence supports the idea that regulatory T cells play a major role in our immune system. Several subsets of these regulators have been identified recently. Differences in the phenotypical and functional characteristics of these subsets have immunological implications. From our growing knowledge of the field of immunology, we could potentially generate a new class of therapeutic agents that target immune-related diseases.     

Potential extension of strict products liability to hospitals: P & T committee liability

Members of Pharmacy and Therapeutics (P & T) Committees and materials managers should be aware of the current trend of court decisions to extend strict products liability or liability without the showing of fault, to hospitals and providers of health care services in favor of innocent consumer-patients. Traditionally, a hospital's defense if charged with strict liability (in tort) was that its primary business is to provide services and not sell products. Recent Texas strict products liability judicial decisions have questioned, but not resolved, whether or not a hospital does sell or legally introduce a product into the stream of commerce. Since it is the function of materials managers, or in the case of pharmaceuticals the P & T Committee, to make the decisions on products that will be used in the hospital, the precedence established by the Texas cases portend further judicial extension of strict liability to providers of health care services.     

P & T Committee role in advocating rational therapeutics.

In this P & T Committee interview with Richard Borreson, MD, issues concerning rational therapeutics in a VA Medical Center setting are identified. Dr. Borreson discusses the frustrations the Houston VA Medical Center P & T Committee encounters in promoting prescribing practices that are therapeutically sound and yet cost-effective. Although their P & T Committee is very active and productive, Dr. Borreson suggests that more effort is needed to educate staff in the cost-effective selection of drugs. The process that the Houston VA has adopted for adding drugs to the formulary and the reporting of adverse reactions as required by the Joint Commission on Accreditation of Hospitals (JCAH) are also discussed.