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?

By monitoring drug interactions and reducing medication errors Signup and view all the answers

What benefit does a pharmacy's positive list provide?

Better pricing through preferred purchasing Signup and view all the answers

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

To promote safe, effective, and affordable medications Signup and view all the answers

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

Recalling a sufficient number of medications for various conditions Signup and view all the answers

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

Additional prescribing guidelines and clinical information Signup and view all the answers

How do formularies help in the reduction of medication errors?

By limiting the number of substances and enhancing evidence-based choices Signup and view all the answers

What do positive lists/formularies provide to insurance companies?

A list of medications that are covered Signup and view all the answers

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

An increase in prescription errors due to lack of medication knowledge Signup and view all the answers

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

Simplifying the medication process and preventing errors Signup and view all the answers

What is one advantage of outpatient formularies?

Reduction in the cost of prescription drugs Signup and view all the answers

What is the primary role of a hospital formulary?

To guide physicians and pharmacists on available medicinal substances Signup and view all the answers

How are essential medicines selected by the World Health Organization?

Regarding prevalence of diseases and evidence of efficacy Signup and view all the answers

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

ATC code Signup and view all the answers

What distinguishes partially-closed formularies from open formularies?

Partially-closed formularies restrict access to certain medications. Signup and view all the answers

What is typically included in hospital formularies?

Medicines listed alphabetically and by ATC groups Signup and view all the answers

What guides the selection of medicines in hospital formularies?

A team of medical professionals including doctors and pharmacists Signup and view all the answers

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

Medicines used in hospital care are fully reimbursed Signup and view all the answers

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

Hospital positive lists should reflect this national list. Signup and view all the answers

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

The finance committee Signup and view all the answers

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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Description

Explore the concept of formularies, which are essential lists of medications used in healthcare. This quiz covers the definitions, purposes, and historical context of formularies, emphasizing the importance of evidence-based medicine in prescribing. Test your knowledge on how formularies can enhance patient care and medication management.