EVALUATION OF TYPE C HOSPITAL FORMULARY IN YOGYAKARTA Anggriani Y, Pudjaningsih D, Suryawati S Department of Clinical Pharmacology, Faculty of Medicine, Gadjah Mada University, Yogyakarta

Background Quality of hospital formulary? Many pharmaceutical products on the market are new and non-essential. Strong hospital drug policy and instruments is needed to manage the hospital formulary list, due to increasing number of new drugs being introduced to medical doctors. Hospital formulary list is often developed without adequate process Even if there is a guideline, the decision is often based on individual interest. Quality of hospital formulary?

Objectives To evaluate and to compare the quality of 7 hospital formularies. To determine the processes used to maintain the formulary in each hospital

Methods Descriptive-analytical, explorative case study 5 Public and 2 Private Hospitals Seven Hospital Formulary Lists were evaluated Quantitative data: total number of drugs on the list, number of drugs in brand name, number of drugs in generic name, number of essential drugs, number of drugs supported by primary literature, number of generic drugs available, and the number of non-formulary drug procured and kept in stock. Qualitative data: In-depth interviews with Drug and Therapeutic Committee (DTC) members and representative doctors from 4 wards (Obstetrics and Gynecology, Pediatrics, Surgery, and Internal Medicine). Observation on minutes of DTC meetings

Outcome Measures The quality of hospital formulary was measured by looking at some indicators, i.e.,: Number of brand-name products Percentages of generic drugs on the list Percentages of essential drugs (drug from NEDL) Percentages of drugs supported with the primary literature Percentages of drugs with a single ingredient Percentages of generic drugs kept in stock The process of maintaining a formulary was measured by: The frequency of revision formulary list Percentage of non-formulary drugs procured and kept in stock Observation on minutes of DTC meetings.

Results 1: The values of each indicator in 7 hospitals Indicators Public Hospitals Private Hospitals A B C D E F G No. Active ingredients 525 441 382 532 296 513 1575 No. Brand-name products 619 570 388 686 308 1002 2153 % Generic drugs on the list 37 35 26 34 50 17 18 % Drugs from NEDL 61 41 49 71 28 20 % Drugs with primary literature % Drugs with single ingredient 90 77 73 80 67 % Generic drugs kept in stock 31 29 27 48 16 13 Hospital E shows relatively better performance compared to the other hospitals Hospital G shows the worst performance among 7 hospitals

Results 2: Number of non-formulary drugs vs frequency of revision Indicators Public Hospitals Private Hospitals A B C D E F G % Non-formulary drugs procured 31 34 24 7 1 65 3 % Non-formulary drugs in stock 41 27 36 28 64 9 Frequency of revision 4 Year of the newest edition 1995 2000 1999 2001 1996 Hospital E, which has better quality of formulary is among the most frequently revised

Results 3: Step in developing hospital formulary list Listing all drugs available in stock Distributing the existing drug list and drug request forms to medical doctors Establishing criteria for drug selection and revise formulary in DTC meeting. Parties involved : DTC members and Doctors Discussing the requests request is discussed only if attended by doctors who request the new drug Official announcement of the new formulary by the hospital director.

Results 4: Mechanisms of new drug additions into formulary Hospital B, C, D and E Fill in the drug request form Submit to pharmacy department Discuss drug requests in DTC meeting Distribute supplementary formulary Procured by the pharmacy department Hospital A, F, G Fill in the drug request form Submit to pharmacy department Procured by the pharmacy department

DISCUSSION This study found the method was easy to use. Therefore, its use in routine hospital evaluation is promising, e.g., for accreditation system. Although still far from the ideal, this method is sensitive enough to show the difference between hospitals. Such instruments can also be used as indicators in improving the quality of hospital formulary. Hospital formulary list should ideally develop from hospital standard treatment guidelines (STGs). An indicator should be added to evaluate the percentage of active ingredients which are not in the STGs.

CONCLUSIONS Although no hospital showed ideal formulary list, the quality of public hospital formularies was relatively better than that of private hospitals formularies, due to: Tendency of DTC in private hospitals to accommodate the doctors request Doctors’ general perception that essential and generic drugs are not sufficient to clinical needs The mechanism to manage hospital formulary is not well established, mostly because regular meetings for formulary revision in not yet established

Terima kasih (thank you)