2. 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

3. 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?

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

5. 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

6. 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.

7. 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

8. 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

9. 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.

10. 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

11. 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.

12. 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

13. Terima kasih (thank you)