Stakeholder Perspectives on the Adaptability of Hospital Drug Formularies to Disease Patterns: A Modified Q-Methodology Study in Vietnam.

Abstract

Background: Hospital drug formularies function within Complex Adaptive Systems (CAS), where the alignment between drug supply and disease patterns is critical for patient care and cost-effectiveness. However, measuring this responsiveness is challenging due to conflicting stakeholder priorities and a lack of standardized assessment tools.

Objective: This study aims to analyze the perspectives of three key stakeholder groups - clinical providers, non-clinical service providers, and policymakers - to develop a consensus-based set of indicators for monitoring the adaptability of drug formularies in Vietnam.

Methods: We employed a modified Q-methodology approach involving 69 experts (20 non-clinical, 28 clinical, and 21 policymakers). A Q-set of 92 indicators across 9 criteria was developed. Participants evaluated these indicators using a 5-point Likert scale to determine levels of consensus and discordance, rather than a orced-distribution sort, to assess the absolute importance of adaptability metrics.

Results: Most criteria achieved consensus with a Mean > 4.0, particularly for "Usage" and "Storage" adaptations. However, significant discordance was observed regarding "Drug availability", "Procurement", and "Outputs and outcomes". Notably, the correlation for "Outputs and outcomes" between non-clinical and policy stakeholders was statistically weak (r=0.09, p=0.356), highlighting a profound strategic gap.

Conclusion: The study proposes a management framework that monitors drug list adaptability across four levels: non-adaptive, passive, active, and advanced adaptive. Success requires enhanced collaboration between specialized teams and a shift from efficiency-based to resilience-based performance metrics.