Preparation of Phayao’s Drug Formulary

Abstract

Objective: To prepare Phayao’s drug formulary that was hierarchical according to the levels of health service facilities. Method: This study was a participatory action research with the involvement from pharmacists in every hospital in Phayao. The researchers played the roles as coordinators and participants in the preparation of drug formulary of the province. The provincial working group for group purchasing of medications, with pharmacists responsible for drug purchasing in all hospitals in the province as members, prepared drug formulary of the province. Moreover, there was an appointment of the provincial committee for management of drug and non-drug medical supplies presided by the provincial chief medical officers with the directors of general hospital, representatives of the directors of community hospitals and head of pharmacy departments as members. This committee approved the proposed drug formulary of the province. Results: The selection of drug items to be included in the formulary followed the process outlined in the guideline to increase the efficiency of management of medical supplies of the Ministry of Public Health in 1999. Factors affecting the preparation of drug formulary were financial status and policy of the hospital directors on the substitution of original drugs with generic drugs to lower drug expenditures. The drug formulary approved by the committee for management of drug and non-drug medical supplies was hierarchical by the levels of hospitals (general or community hospitals). Even though, there were 24 items of medication available only in community hospitals, they were medications with the same generic name as those available in general hospitals but with a lower strength. Moreover, some of these medications were compounded by general hospitals, thus, did not appear in the purchasing plan of general hospitals. The scope of drug items of 2 general hospitals was not hierarchical either. The majority of item difference involved those medications with prescribing authority restricted to specialists. The decisions on drug to be included in the formulary should consider the information on comparative cost effectiveness among drugs with indicators on the same symptoms or diseases, patient compliance and financial status of the hospitals. Conclusion: The preparation of hierarchical drug formulary according to the levels of health service facilities needs the participation of hospital directors, prescribers and pharmacists through multiple rounds of meetings and discussion with the clear supporting data such as pharmacoeconomics data in order to make an appropriate judgment on drug selection.