Pharmacy and Therapeutics Committees in Thai Hospitals under Health Reform Sripairoj A, Liamputtong P, Harvey K La Trobe University, Australia

Outline of presentation Background Objectives Methods and Samples Results Summary Conclusion and Policy Implications

Background In Thailand, hospitals under the Office of the Permanent Secretary were first required to establish Pharmacy and Therapeutics Committees (PTCs) in 1987. A Manual of Drug Administration (1987) listed the expected structure, roles and responsibilities of PTCs. Since 1997, Thai hospitals have faced economic crisis, quality improvement and accreditation, universal coverage health reform and structural change in the Ministry of Public Health (MoPH).

Objectives To examine PTC performance during this period of change and reform. To determine the opinion of the PTC Chairpersons and the PTC Secretaries about defining good PTC performance, ways to improving PTC performance, and possible PTC performance indicators. To create a Manual that provides more practical help on rational drug use activities, including performance indicators.

Methods Retrospective document review In-depth interviews Questionnaire survey A focus group Participant observation

Sample & methods Seventeen hospitals (2 regional hospitals, 3 provincial hospitals, and 12 district hospitals) in 4 regions of Thailand. Ten key informants who were the Chairperson, the Secretary or members of the PTC were interviewed. Fifteen key informants who involved with PTC or who are responsible for drug information centers were interviewed. Questionnaires were distributed to 452 PTC Chairpersons and Secretaries respectively in 25 regional hospitals, 67 provincial hospitals and 360 district hospitals. Eight key participants who were PTC stakeholders participated in a focus group. PTCs in 3 regional hospitals were observed.

Questionnaire results (1) The questionnaire response rate was 36% from PTC Chairpersons and 66% from Secretaries. Around 90% of PTC Chairpersons were Hospital Directors and 90% of Secretaries were Heads of Pharmacy Department. The average of the number of PTC members in regional, provincial and district hospitals was 19, 20, and 10 members, respectively. There were only 2-3 PTC meetings in regional or provincial hospitals and only 1-2 PTC meetings in district hospitals during each fiscal year (from 1996-2002).

Questionnaire results (2) The most important PTC performance indicators suggested by all PTC Chairpersons: Is PTC responsible for considering and approving allocation of drug budget proposed by the Pharmacy section? Does PTC have a document providing criteria for addition and deletion of drug in the hospital drug list? Does PTC have a policy to develop or implement Clinical Practice Guidelines for common problems such as acute respiratory infection, diarrheal diseases, hypertension, diabetes, epilepsy, and antibiotic prophylaxis, etc.? Does the PTC monitor Pharmacy drug dispensing to ensure it follows written standards of pharmacy professional practice? Does PTC conduct satisfaction surveys on hospital staff to receive feedback on PTC performance?

Questionnaire results (3) The most important PTC performance indicators suggested by PTC Secretaries: Does a document identifying goal, committee, objectives, and functions of PTC exists? Is PTC authorised to select drugs to be included and excluded in the hospital drug list? Does PTC monitor the percentage of drugs used outside hospital drug list? Does the PTC monitor Pharmacy drug dispensing to ensure it follows written standards of pharmacy professional practice? Does PTC have a policy to conduct satisfaction of patients/clients on the hospital treatment service?

Questionnaire results (4) When asked about the most important factor needed for the development of an effective PTC: the Chairpersons said it was an effective PTC Secretary; while the Secretaries said it was an effective PTC Chairperson. When asked about external factors that can contribute to improved performance of PTC both PTC Chairpersons and Secretaries in all hospitals agreed that the most important aspect was: a national collaborative drug information center as a hub for information exchange between PTC for a decision making purpose. In addition, PTC Chairpersons and PTC Secretaries in regional hospitals noted that: defining the function of PTC in the hospital accreditation criteria would be helpful.

Results (5) The retrospective document review, in-depth interviews, a focus group and participant observation noted that: Under new structure of Ministry of Public Health, there was no distinctive responsible organization who support and monitor PTCs. Some hospitals had not updated information about new PTC members, functions or responsibilities. Most PTC activities still focused on drug selection and controlling drug budget. Activities on rational drug use were few. Many PTCs had not set their own specific goals, objectives, role and responsibilities. Often PTCs had no working plan and there was also no orientation about goal, objectives, role and responsibilities for PTC members.

Results (6) Many suggested the need for a responsible organization (perhaps under the Department of Health Service Support) that would assist PTCs by: Updating Manual of PTC roles and responsibilities; Providing opportunities for PTC networking e.g. by web site &/or E-mail discussion groups; Providing information for PTC to make decisions; Supporting the incorporation of PTC performance indicators in hospital accreditation (Bureau of Inspection & Evaluation &/or The Institute of Hospital Quality Improvement& Accreditation); Encouraging Universities to provide educational programs.

Summary PTCs at all levels of hospital focused their activities on drug selection and budget as this was the main focus of the 1987 “Manual”. There were limited numbers of meetings of PTCs (1-2 in district hospitals; 2-3 in regional or provincial hospitals). The recommended PTC performance indicators were the number of PTC meetings and the number of drug items in hospital drug lists. Suggestions for improving PTC performance: Setting a responsible organization; Encouraging educational programs in universities; and Providing national drug information center and PTC networking.

Conclusion & Policy Implications There is a need for a responsible organization (perhaps under the Department of Health Service Support) that would assist PTCs by: Updating a Manual regarding PTC roles and responsibilities; Providing opportunities for PTC networking e.g. by web site &/or E-mail discussion groups; Providing information for PTC to make decisions; Supporting the incorporation of PTC performance indicators in hospital accreditation monitored by: Bureau of Inspection & Evaluation &/or The Institute of Hospital Quality Improvement & Accreditation; Encouraging Universities to provide PTC educational programs.

“We cannot direct the wind but we can adjust the sail.” “Learning to live, living to learn and have fun on improving Pharmacy and Therapeutics Committee performance.”