Impact of high-cost drugs for individual patient use

To document and describe the individual patient use (IPU) scheme at St Vincent's Hospital, Sydney in terms of submissions and approvals and assess the financial impact of the scheme on the hospital drug expenditure. Method: All submissions for IPU approvals received between January 1997 and December 2001 were reviewed. Submissions were collected on a calendar year basis. Data collection and analysis included identification of approved medication and indication, off- label or approved indication, prescriber, ward, outcome of therapy, person deciding the approval, approval date duration and expiry, amount of medication dispensed and the cost of therapy. The annual cost and proportion of overall drug expenditure for each approval was calculated. Results: The number of approvals had a trend to increase each year. 67.1% of the IPU approvals were for off-label indications. Requested feedback on clinical outcomes was provided only in 18% of cases. The drug acquisition cost of the IPU scheme more than doubled in the period between 1999 and 2001. Similarly the proportion of the drug expenditure on IPU drugs increased significantly (p<0.001) from 1.6% in 1999 to 3.6% in 2001. Conclusion: The results indicated that the number of approvals and submissions for IPU had a tendency to increase. The financial impact of the IPU scheme increased over the years reviewed

Access to high-cost drugs: Decision makers' perspectives

To explore the attitudes, perceptions and concerns among decision makers about equity of access to high-cost drugs in public hospitals. Method: 25 in-depth, semi-structured interviews were conducted with senior hospital administrators, directors of pharmacy and senior medical doctors. Topics included the decision-making process and associated problems, and solutions to issues of access to high-cost drugs. Interviews were audiotaped, transcribed verbatim and thematically analysed. Results: Healthcare funding models were perceived as obstacles to equity of access to high-cost drugs. Participants were concerned that there were inequities in decisions for individual patients according to public or private sector status. Tertiary public hospitals were seen to be at the 'cutting edge' and therefore were required to fund new and expensive drugs. This meant prioritising between patient groups and individuals. Participants had difficulty in identifying solutions. They suggested that ethical principles should be considered in addition to safety, efficacy and cost. Most wanted a transparent, accountable, evidence-based decision- making process. Conclusion: Decision makers were concerned about equity of access to high-cost drugs in public hospitals. They were also concerned about processes for decision making and the outcomes of these decisions

Electronic medication information sources : understanding the needs and preferences of health professionals

Background: To improve the accessibility and usability of local medication information, the pharmacy department at the study hospital consolidated the electronic medication information and restructured the manner in which it is presented to clinicians. Aim: To examine the electronic medication information needs of clinicians and to explore their preferences and views on the proposed 'new' medication information repository. Method: Doctors (n = 12), nurses (n = 15) and pharmacists (n = 8) from the study hospital participated either in a 30-minute focus group or semi-structured interview. Results: Doctors and nurses did not use the local medication information and viewed the new medication information repository as not very useful. Users identifi ed a range of issues related to the design and layout of the new repository. Clinicians are unlikely to use information if it is not visible during their work processes. Conclusion: Electronic medication information needs and preferences of clinicians were identifi ed as well as areas where redesign of electronic medication information sources is needed. It is not possible to meet the electronic medication information needs and preferences of all clinical users of a system or application.4 page(s

Error prone abbreviations in hospitals : is technology the answer?

1 page(s

Implementing electronic medication management at an Australian teaching hospital

5 page(s