Nonformulary drug requests at an academic hospital in Germany – the role of general practitioners' long-term medication

Objective: To determine the influence of general practitioners' outpatient medication on nonformulary drug requests in university hospitals. Methods: During a period of 1 year every nonformulary drug request at the Göttingen University Hospital was analysed (reason for request, drug class). A second analysis examined whether the introduction of a new order form that allowed the prescribing physician to mark a box to declare that this request is due to general practitioner's outpatient therapy influenced the rate of requests. Results: During 12 months a total of 6,281 nonformulary drugs were ordered from the pharmacy, 1,077 (17.1%) of them because of outpatient medication. The percentage of requests according to general practitioners' outpatient medication was about 11% in both the medical and the surgical departments. The rate was rather high in the departments of psychiatry and orthopaedic surgery (39% and 60%, respectively). With the introduction of the new order form, there was a significant increase in the general practice based rate of nonformulary requests on the general surgical wards (from 10.8% to 19.9%). Only a minority of requests (14%) represented drugs of unproven efficacy. Conclusion: Since nonformulary requests attributable to previous outpatient medication accounts for less than 20% and since only a minor portion of them lack scientific proof of efficacy we suggest that hospital doctors and clinical pharmacologists should avoid a drug policy, which is too restrictive, and support maintenance of chronic medication initiated by general practitioners. Especially in the department of psychiatry, nonformulary requests seem to be justified by patient needs.