P & T Committee interview: Establishing and maintaining a dynamic formulary.

In an exclusive interview with Hospital Formulary, Dr. Stephen Rostand and Mr. Herman Lazarus--the P & T Committee Chairman and Secretary of the University of Alabama Hospital--share their experiences in establishing an effective, functional formulary system. Discussed in this interview are the current activities of this Committee which include: reviewing adherence to an established Committee guideline on an effective antibiotic dosing regimen, creating a more effective adverse drug reaction reporting system, and establishing a computerized program to alert prescribers to the possibility of drug-drug interactions. By their willingness to cooperate, communicate, and remain flexible to medical staff requests, this 15-member Committee has been able to maintain a dynamic formulary.     

Editors' roundtable: current formulas for P & T Committee success. (Part 2).

In the second and final part of their recent roundtable discussion, the editors of Hospital Formulary express their views on numerous issues, including monitoring the use of approved drugs for unapproved indications, achieving and sustaining alterations in prescribing practices, and the establishment of guidelines for therapeutic substitution. All four editors--Arthur G. Lipman, PharmD, Harold C. Neu, MD, Bramah N. Singh, MD, PhD, and Michael Weintraub, MD--share the sentiment that most P & T Committees function as vital, effective bodies with responsibility for decision-making that has a significant impact on the day-to-day care of patients.     

Mission, role, and functions of the P & T Committee

This introductory article in a series on P & T Committees discusses the mission, role, and function of the committee in a hospital. With increasing complexity of drug therapy, the committee's mission has evolved into a multifaceted program related to promotion of rational and safe drug therapy within the institution. Components of the mission, the committee's responsibilities and functions, including formulary, policies and procedures, drug utilization review, drug administration, investigational drug studies, and education, are introduced and briefly discussed in terms of their role in the institution, accreditation standards, and published standards of practice. Future articles will provide fuller consideration of these topics.     

Editors' roundtable: Current formulas for P & T Committee success (Part 1).

In this roundtable discussion, the four editors of Hospital Formulary--Arthur G. Lipman, Pharm D, Harold C. Neu, MD, Bramah N. Singh, MD, PhD, and Michael Weintraub, MD--share their views on key issues that affect hospital P & T Committees. They agree that the P & T Committee is both highly visible and functions well, and they predict that its influence in the health care system wil heighten as prospective reimbursement continues. Challenges P & T Committees are confronted with today, such as therapeutic entities from new technologies, use of approved drugs for unapproved indications, and the need for educating and re-educating the medical staff are discussed. Cost containment continues to become a more and more important consideration with maintained patient care quality. Successful strategies for coping with and benefiting from these challenges are presented.     

The P & T Committee Part 2: involvement by pharmacy, medical, and nursing personnel

An active and enthusiastic participation by all members of the P & T Committee greatly improves committee effectiveness and productivity. Specific responsibilities for the physician, pharmacist, and nursing members of the committee are presented and discussed. In addition, the importance of open communication among committee members is reviewed. Examples of problems that may develop and suggested solutions are also presented.     

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.     

Challenges of a P & T Committee in a community teaching hospital

Lutheran General Hospital, a 650-bed, tertiary care and trauma center in Park Ridge, Illinois, has had a P & T Committee in place for 11 years. In this exclusive Hospital Formulary interview, David Cooke, MD, and Jackie Kessler, MS, the respective chairman and secretary of that committee, discuss the challenges their committee faces. Somewhat unique to a community hospital, this committee manages a relatively restricted formulary. They attribute their success to dedicated P & T Committee members and a committed pharmacy. Among the more difficult issues still to be resolved at Lutheran General are relationships between pharmaceutical companies and P & T members and the possible institution of a conflict-of-interest disclosure policy, as well as the never-ending battle of evaluating drug use in their institution.     

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.     

P & T Committee rises to challenges of the changing healthcare environment

The ever-increasing importance of the P & T Committee is well illustrated in this exclusive interview with members of a committee from a leading academic, private-practice, health-science center--Rush-Presbyterian-St. Luke's Medical Center. The participants detail the progress achieved in P & T Committee policy making, particularly in recent years. Unprecedented change in the healthcare environment has demanded a more aggressive P & T Committee, and theirs has responded appropriately. Because the medical staff at Rush constitute a unique blend of academicians and private practitioners, the mechanics of their decision making tends to be consensus-related, while the implementation of those decisions is education-oriented. Other P & T Committees can learn from their political and professional strategies in the management of drug therapy.     

The role of pharmacogenetics in cancer therapeutics

The variability in treatment responses and narrow therapeutic index of anticancer drugs are some of the key challenges oncologists face. The knowledge of pharmacogenetics can potentially aid in the discovery, development and ultimately individualization of anticancer drugs. The identification of genetic variations that predict for drug response is the first step towards the translation of pharmacogenetics into clinical practice. This review provides an update on the results of studies assessing the effects of germline polymorphisms and somatic mutations on therapeutic outcomes and highlights the potential applications and future challenges in pharmacogenetic research pertaining to cancer therapeutics.