{"title":"How to develop critical paths and prepare for other formulary management changes.","authors":"S McCaffrey, C H Nightingale","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Changes occurring in the health care marketplace are changing the way clinicians are managing patients. Cost, quality, and efficiency of care are increasingly being focused upon. One patient care management strategy that keeps these three factors in mind and is growing in popularity is the use of critical paths. This article describes the 7-step critical path development process followed by clinicians at Hartford Hospital. Additionally, the effect of health care marketplace changes on the formulary decision-making process, P & T Committee structure and function, and new drug development is also presented.</p>","PeriodicalId":76912,"journal":{"name":"Hospital formulary","volume":"29 9","pages":"628-32, 635"},"PeriodicalIF":0.0,"publicationDate":"1994-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21010129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Educational effort and CQI program improves ordering of serum digoxin levels.","authors":"W E Wade, C Y McCall","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In a 289-bed, acute-care, non-tertiary-care regional referral center, a continuous quality improvement educational effort successfully improved ordering of serum digoxin levels. Following a determination that physicians were not requesting serum digoxin levels correctly, the P & T Committee issued a letter describing appropriate wording of orders for serum digoxin levels. The number of incorrectly ordered serum digoxin levels requested dropped significantly over a 49-month period as a result of the intervention described below, which also resulted in cost savings.</p>","PeriodicalId":76912,"journal":{"name":"Hospital formulary","volume":"29 9","pages":"657-9"},"PeriodicalIF":0.0,"publicationDate":"1994-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21009842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"How to tie a drug therapy improvement program to physician credentialing.","authors":"C S Tse, W Roecker, M Benitez, M Musabji","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The pharmacy staff and the management information system specialist at St. James Hospital and Health Centers, a 472-bed community medical center located in Chicago Heights, Illinois, developed a computer program for documenting the drug use patterns of physicians. This program was not only helpful in improving the appropriate use of medications within the institution, it was also tied to the prescriber credentialing process. How the program evolved as well as the cost savings/cost avoidance achieved as a result of the drug therapy improvement process is presented.</p>","PeriodicalId":76912,"journal":{"name":"Hospital formulary","volume":"29 9","pages":"646-50, 656"},"PeriodicalIF":0.0,"publicationDate":"1994-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21009841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Managing high cost and biotech drugs: two institutions' perspectives.","authors":"W J Dana, B McWhinney","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A proactive and multidisciplinary approach is used at The University of Texas MD Anderson Cancer Center to forecast the effect of new biotechnology and other high-cost agents prior to their commercial availability. Protocols, practice guidelines, and drug-use policies are developed to promote cost-effective use of these agents. To promote optimal utilization, two pharmacoeconomic strategies are used: cost reduction and drug performance. An economic impact analysis is performed on pending drug protocols, which includes hospital cost, patient billing, and estimates of insurance reimbursement denial risk. The management of biotechnology drug usage at the University of Pittsburgh Medical Center is through the drug advisory program (DAP). DAP is an organized, multidisciplinary program comprising numerous drug usage review functions including drug information, therapeutic evaluation and modification, drug morbidity and surveillance, and an investigational drug service. The objective of DAP is therapeutic efficiency, which has as its key elements efficacy, low toxicity, and low cost. The actual work of DAP takes place via multiple subcommittees and task forces whose recommendations are forwarded to the P & T Committee. These multidisciplinary groups ensure the involvement of the appropriate specialists in therapeutic decisions and, therefore, successful implementation of the recommendations.</p>","PeriodicalId":76912,"journal":{"name":"Hospital formulary","volume":"29 9","pages":"638-45"},"PeriodicalIF":0.0,"publicationDate":"1994-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21010130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Antibiotic therapy in 1994: mechanisms of resistance.","authors":"N Barg","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Drug-resistant organisms are appearing with increasing frequency. Of particular concern are drug-resistant strains of enterococci, streptococci, and pneumococci. Bacteria use several adaptive mechanisms to thwart the actions of antimicrobials, including enzymes, alterations in cell membrane permeability, export of antibiotics from the cell, alteration of molecular structures, and transfer of resistance to other species. Countering the effects of resistance requires judicious use of antibiotic therapy and a clear understanding of the biologic mechanisms involved.</p>","PeriodicalId":76912,"journal":{"name":"Hospital formulary","volume":"29 Suppl 3 ","pages":"S13-7"},"PeriodicalIF":0.0,"publicationDate":"1994-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21008464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pharmacoeconomic factors in the treatment of acute hypertension.","authors":"D J Shulkin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Strategies to minimize drug costs include physician education, restrictions on non-cost-effective agents, cost-awareness programs, benchmarking with other institutions, and increased physician-pharmacist collaboration. These measures are particularly adaptable to the treatment of acute hypertension, which is often associated with additional avoidable expenditures depending on management decisions. This article reviews the factors affecting the cost-effectiveness of the various agents used in treating acute hypertension, including dosage changes, adverse events, ancillary services, methods of administration, and dosage computation.</p>","PeriodicalId":76912,"journal":{"name":"Hospital formulary","volume":"29 Suppl 2 ","pages":"S15-20"},"PeriodicalIF":0.0,"publicationDate":"1994-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21007728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Current issues in the selection and use of broad-spectrum antibiotics. Roundtable discussion.","authors":"L M Cortez, C Dempsey, J Simelaro, R Wilson","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76912,"journal":{"name":"Hospital formulary","volume":"29 Suppl 3 ","pages":"S4-12"},"PeriodicalIF":0.0,"publicationDate":"1994-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21008466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"DUEs for the '90s: multicentered, outcome-oriented.","authors":"K A Swanson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The likely development of healthcare alliances and affiliations will create a logical role for multicentered DUEs that study treatment regimens or indications in a healthcare system made up of several institutions. Such a study is under way in New Jersey, involving 15 hospitals. The DUE is evaluating usage patterns of ticarcillin/clavulanate and two other broad-spectrum antibiotics. A multicenter DUE presents challenges, such as the need for additional resources and for consensus among disparate elements; but this methodology also opens up expanded roles for pharmacists, including participation in quality assurance activities.</p>","PeriodicalId":76912,"journal":{"name":"Hospital formulary","volume":"29 Suppl 3 ","pages":"S26-31"},"PeriodicalIF":0.0,"publicationDate":"1994-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21008465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Universal prescription drug coverage would increase Rx expenditures by 4 to 6%, CBO says.","authors":"B Gatty","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76912,"journal":{"name":"Hospital formulary","volume":"29 8","pages":"598, 597"},"PeriodicalIF":0.0,"publicationDate":"1994-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21007727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}