1. 1 Session 14. Getting Started Drug and Therapeutics Committee

2. 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

3. 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

4. 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.

5. 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

6. 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

7. 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)

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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