Positive formularies

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Questions and Answers

What is one advantage of using a hospital formulary system regarding cost management?

  • Standardized treatment protocols (correct)
  • Reduced inventory control needs
  • Increased treatment options for patients
  • Increased prices for medications

Which of the following is a disadvantage of a hospital formulary system?

  • Enhanced patient safety protocols
  • Limited treatment options available to physicians (correct)
  • Improved clinical practice of health care professionals
  • Streamlined decision-making process

What is included in the procedure for compiling a positive list in formulary development?

  • List of inactive substances for reference
  • Introduction of new medications without review
  • Creation of a manual for the use of the positive list (correct)
  • Expanded access to all available drugs

How does a hospital formulary system contribute to patient safety?

<p>By monitoring drug interactions and reducing medication errors (C)</p> Signup and view all the answers

What benefit does a pharmacy's positive list provide?

<p>Better pricing through preferred purchasing (D)</p> Signup and view all the answers

What is one of the primary purposes of a drug formulary?

<p>To promote safe, effective, and affordable medications (C)</p> Signup and view all the answers

What were doctors in the Netherlands struggling with in the 1980s regarding prescriptions?

<p>Recalling a sufficient number of medications for various conditions (C)</p> Signup and view all the answers

What does a formulary system typically include beyond just a list of medications?

<p>Additional prescribing guidelines and clinical information (C)</p> Signup and view all the answers

How do formularies help in the reduction of medication errors?

<p>By limiting the number of substances and enhancing evidence-based choices (D)</p> Signup and view all the answers

What do positive lists/formularies provide to insurance companies?

<p>A list of medications that are covered (D)</p> Signup and view all the answers

What was one of the main reasons for the introduction of formularies in the Netherlands?

<p>An increase in prescription errors due to lack of medication knowledge (D)</p> Signup and view all the answers

What is indicated as a benefit of formularies in improving the quality of care?

<p>Simplifying the medication process and preventing errors (C)</p> Signup and view all the answers

What is one advantage of outpatient formularies?

<p>Reduction in the cost of prescription drugs (B)</p> Signup and view all the answers

What is the primary role of a hospital formulary?

<p>To guide physicians and pharmacists on available medicinal substances (A)</p> Signup and view all the answers

How are essential medicines selected by the World Health Organization?

<p>Regarding prevalence of diseases and evidence of efficacy (B)</p> Signup and view all the answers

What code is assigned to each medicinal product in hospital formularies?

<p>ATC code (C)</p> Signup and view all the answers

What distinguishes partially-closed formularies from open formularies?

<p>Partially-closed formularies restrict access to certain medications. (B)</p> Signup and view all the answers

What is typically included in hospital formularies?

<p>Medicines listed alphabetically and by ATC groups (D)</p> Signup and view all the answers

What guides the selection of medicines in hospital formularies?

<p>A team of medical professionals including doctors and pharmacists (B)</p> Signup and view all the answers

What is a characteristic of lists of medicines created by insurance companies?

<p>Medicines used in hospital care are fully reimbursed (D)</p> Signup and view all the answers

What is the significance of having a national list of essential medicines?

<p>Hospital positive lists should reflect this national list. (D)</p> Signup and view all the answers

Which committee is NOT part of the system of organization and management of the formulary?

<p>The finance committee (B)</p> Signup and view all the answers

Flashcards

Hospital Formulary

A comprehensive list of medications approved for use within a hospital, including information on prescribing, dispensing, and administration.

Formulary Development

The process of creating and maintaining a hospital formulary.

Positive List Approach

A method of creating a formulary by starting with a list of approved active substances.

Pharmacy Positive List

A type of formulary used by pharmacies to list preferred medications, often from a single company.

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Generic Substitution

A list of medications that can be substituted for another, often with the goal of cost savings.

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Formulary (insurance)

A list of medicines covered by insurance companies in a specific country.

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Formulary (healthcare facility)

A continuously updated list of medicines used in a specific healthcare facility or community, based on cost and evidence-based medicine.

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Drug Formulary

A list of medications that have been carefully evaluated and deemed safe, effective, and affordable for use in a specific healthcare setting.

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Formulary System

A system that goes beyond a simple list of approved medications, providing additional guidelines and information to assist healthcare professionals in promoting high quality, affordable care.

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Formulary Management

The practice of using a standardized list of medications in a healthcare setting.

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Effects of Standardized Formulary

The use of a standardized list of medications can reduce costs, improve quality of care, and minimize medication errors.

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Why are formularies used?

Formularies are used to minimize costs, improve the quality of care, and reduce medication errors by limiting the number of medications used and focusing on evidence-based medicine.

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Drug Committee

A team of doctors and pharmacists who select medicines for the hospital formulary.

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List of Essential Medicines

A list of essential medicines that are considered the most important for treating common conditions.

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National List of Medicines

A list of medicines that are fully reimbursed by insurance companies under the Public Health Insurance Act.

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List by ATC Groups

A list of medicines that are organized by their therapeutic groups, and also include the name of the company that produces them.

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ATC Code

A unique code assigned to each medicine that categorizes it into a specific therapeutic group.

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Outpatient Formularies

Formularies that allow the prescription of cheaper generic versions of branded drugs, saving money for insurance companies.

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Closed Formularies

Formularies that limit the choice of medicines to only those on the approved list.

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Partially Closed Formularies

Formularies that allow the use of a limited range of medicines beyond the approved list.

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Open Formularies

Formularies that allow the use of any medicine, regardless of whether it is on the approved list.

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Study Notes

Positive Lists (Formularies)

  • A positive list, or formulary, is a list of medicines. It has two meanings:
    • A list of medicines covered by insurance companies in a specific country.
    • A continuously updated list of medicines preferable for use in a health facility or by outpatient practitioners, potentially due to cost or evidence-based medicine (EBM).

What is a Formulary?

  • A formulary is a continually updated list of medications and related products.
  • It's supported by current evidence-based medicine, physician/pharmacist judgment, and expert knowledge in disease diagnosis and treatment.
  • The primary goal is to encourage the use of safe, effective, and affordable medications.
  • A formulary is more than a list of approved medications; it encompasses prescribing guidelines and clinical information to improve care quality and affordability.

History of Formularies

  • In the 1980s, Dutch doctors struggled with low knowledge of medications.
  • Doctors could only recall 2-5 medicines for a given patient diagnosis, remembering a total of 150-200 medicine names.
  • Dutch doctors and pharmacists collaborated to create medicine lists as guidelines, reducing duplication and improving prescribing.
  • This approach spread to other countries like the UK, Sweden, and other Nordic nations.

Formulary Management: Standardized vs. Non-Standardized

  • Standardized:
    • Improved quality of care due to streamlined workflows and reduced errors.
    • Reduced medication errors when using a limited set of medications.
    • Increased efficiency in determining and administering care.
    • Reduced costs by needing fewer medications on-site.
  • Non-Standardized:
    • Higher risk of errors due to choosing from many medications.
    • More time determining appropriate medications.
    • Higher costs due to maintaining a wider range of medications.
    • More confusion and prescribing errors due to a larger number of options.

Why are Formularies Used?

  • Reduced Costs: Limiting medicines reduces the overall costs.
  • Improved Quality of Care: Frequent medication errors are avoided.
  • Enhanced Quality of Care (EBM): Choosing medications based on EBM is another way to improve the patient's care.
  • Improved Availability of Requested Medicines: Easier to stock and make ready needed medicines.

Types of Formularies

  • Hospital formularies
  • Outpatient formularies
  • Open, Partially-Closed, and Closed formularies
  • Lists of Essential Medicines (national)
  • Lists of Medicines created by Insurance Companies

Hospital Formularies

  • Organized by ATC (Anatomical Therapeutic Chemical) groups and generic names.
  • Include company names.
  • Listed alphabetically (typically).
  • Selected by a team of doctors and pharmacists.
  • Minimal co-payments (often none).
  • Available from the hospital pharmacy.
  • Include ATC codes for proper categorization.

Outpatient Formularies

  • Prescription of cheaper generic products.
  • Savings for patients through lower co-payments.
  • Better orientation of prescribers to medicines, lessening prescribing errors

Open, Partially-Closed, and Closed Formularies

  • Open: No limitations on access to any medicine by a practitioner.
  • Closed: Limits access to certain medicines, restricting drugs for specific physicians, patient care areas, or specific disease states.
  • Partially Closed: A middle ground, restricting access to certain medications.

List of Essential Medicines, National Lists

  • Selected by the World Health Organization based on prevalence of diseases, evidence of efficacy/safety, and cost-effectiveness.
  • Often categorized by generic names within therapeutic groups.
  • Some European countries (e.g. Sweden and England) have national lists.
  • Hospital positive lists should align with national essential medicine lists if available.

Lists of Medicines Created by Insurance Companies

  • In the Czech Republic, insurance reimburses for the least costly medicinal products used in hospitals.

System of Organization and Management of a Formulary

  • Drug committee
  • Expert committee
  • Institutional pharmacy
  • Antibiotic centre

Advantages of Hospital Formularies

  • Cost control (budget management, generic substitution)
  • Quality assurance (standardized treatment protocols and therapeutic guidelines)
  • Patient safety (reduced medication errors, drug interaction monitoring)
  • Streamlined decision-making (simplified drug selection, quick access to information)
  • Optimized patient outcomes (evidence-based selection, consistent care)
  • Efficient resource utilization (inventory management, formulary review committees)
  • Improved clinical practice (convenient to use and complete)
  • Better inventory control in hospital pharmacy.
  • Controlling variability in treatments.
  • Reduction in drug costs.

Disadvantages of Hospital Formularies

  • Limited treatment options (restricted choices)
  • Access/equity concerns (patient variability, access issues)
  • Cost-containment pressures (focus on cost savings)
  • Clinical rigidity (lack of flexibility)
  • Physician frustration (administrative burden from management)
  • Patient compliance issues
  • Supply chain risks
  • Influence of pharmaceutical industry

Formulary Development: Hospital Formulary System

  • Stages in preparing and managing a formulary:

    • Formation of a physician-pharmacist team (PTC).
    • Creating a drug formulary list.
    • Creating a formulary manual.
    • Ongoing maintenance and monitoring.

Procedure for Compiling a Positive List

  • Compile a list of active substances.
  • Assign medical products to medicinal substances.
  • Implement the final positive list.
  • Create a manual for using the positive list.
  • Continuously update the positive list.

Pharmacy Formularies

  • Pharmacy Positive List (preferred medicines, often from a single contract).
  • Benefits of preferred purchasing (better prices).
  • Substitution pressure (substitution to positive list-medicines, and financial incentives for doing so)
  • Competition amongst pharmacies (standards, economic profit)

Health Ethics

  • Provides the context for how medical professionals approach legal and ethical considerations in the pharmacy.

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