1 Session 14. Getting Started Drug and Therapeutics Committee

Objectives  Understand the basics of starting a DTC where none exists  Understand how to improve the functioning of an existing DTC  Identify and solve management and medicine use problems in establishing and maintaining a DTC

Addressing the Problem  The way to get started will depend on local circumstances, including the health care system and hospital  DTCs have to deal with many issues but cannot do everything all at once – so concentrate on only 1-2 issues at a time especially in the beginning  The first step is for YOU to realize there is a problem and that the DTC can provide a framework for solutions  Thereafter, you must convince others of the need to address the problem and work with them on solutions

Step 1. Do the Groundwork Build evidence for advocacy by determining —  Whether data on medicine use problems is available. If so, collect it.  Whether senior health staff think medicine use problems exist. If so—  What kind of problems?  How serious are they?  How can the most serious problems be addressed?  Document what they say.

Step 2. Gain a Friend in Authority  Share the findings of your initial groundwork with the most senior medical authority  Present any useful data and discuss how it might negatively affect patient outcome or increase hospital budget  Plan a course of action with the senior medical authority

Step 3. Meet Relevant Stakeholders  With the approval of senior management, meet all senior health staff to discuss medicine use problems  Present your groundwork findings  Present medicine use data (e.g., ABC analysis, indicators)  If all agree that medicine use problems are a serious issue, take the opportunity to discuss establishing a DTC

Step 4. Measure Your Medicine Use Problem  Involve senior staff in these important activities—  VEN analysis  ABC analysis  Compare VEN and ABC  Medicine use indicator studies (health facility and hospital indicators)

Step 5. Present Findings, and Plan the Next Steps with your Stakeholders  Analyze potential medicines use problems and obtain consensus on how to solve them  Use this opportunity to discuss establishing a DTC  If causes are well understood, then solutions can be found by stakeholders  Stakeholders’ meeting is an opportunity to demonstrate how a DTC can function

Step 6. Undertake a Detailed Medicine Use Investigation A DUE of one or two medicines may be done according to whether the medicine—  Has the highest value  Has serious side-effects  Is nonessential  Has more consumption than expected from morbidity patterns

Step 7. Present Your Detailed Findings to Stakeholders, and Plan an Intervention  Present your results and analysis  Mention how much time it took, and thank all those who participated  Discuss and agree with stakeholders and senior prescribers a plan of action which may include—  Targeted intervention based on the detailed findings and involving the senior prescribers  Initiating a formulary process or other general means to improve medicine use  Use the opportunity to discuss having a DTC  Record minutes of the meeting

Step 8. Implement and Evaluate the Agreed-upon Intervention  Type of intervention(s) will depend on the type of medicine use problem and the underlying reasons for it that have been identified  Educational, managerial, or regulatory  Implement and evaluate interventions with the full cooperation and involvement of stakeholders and senior prescribers.  Measure the cost of the intervention and any savings in terms of less drug used or different medicines used

Step 9. Present the Results of Your Interventions to Senior Prescribers  Present the results of your findings to senior management and prescribers  If they have been properly involved they will already know some of the results  Emphasize during the presentation  Benefits in terms of better health care and reduced costs  Need for time and resources to achieve an improved result  Need for a sustainable mechanism to conduct such work and how a DTC could provide this

Step 10. Plan the Start of a DTC  Plan the start of a DTC  If you have followed the previous steps administration and senior staff, whom you have kept fully informed, should support you  Develop terms of reference (TOR)  Select members  Representing key stakeholders  Get approval and buy-in from hospital administration and senior physicians

Revitalizing Nonfunctioning DTCs  Probe for reasons why the DTC is nonfunctional  If staff are unaware of medicine use problems, demonstrate the problems and their underlying causes  Examine why DTC members are not active and determine what can be done to improve participation  If the DTC has ceased to function because a specific issue cannot be resolved, seek senior medical authority involvement

Activity Each group should work on an assigned DTC- related problem and develop solutions Develop a presentation to include—  A succinct description of the problem and the reasons underlying the problem  A practical plan of action to solve the problem

Summary In conclusion, getting a DTC started or making it more functional will require a strategy based on—  Local conditions  Local data  Starting small and then scaling up  Choosing a problem that can easily be addressed  Transparent decision making  Political and administrative support