Impact of removal and restriction of me-too medicines in a hospital drug formulary on in- and outpatient drug prescriptions: interrupted time series design with comparison group
Abstract Background The study covered in- and out-of-hospital care in a region in north-western Spain. The intervention evaluated took the form of a change in the hospital drugs formulary. Before the intervention, the formulary contained four of the five low molecular weight heparins (LMWHs) markete...
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13012-019-0924-0 |
| _version_ | 1828852306506940416 |
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| author | Raquel Vázquez-Mourelle Eduardo Carracedo-Martínez Adolfo Figueiras |
| author_facet | Raquel Vázquez-Mourelle Eduardo Carracedo-Martínez Adolfo Figueiras |
| author_sort | Raquel Vázquez-Mourelle |
| collection | DOAJ |
| description | Abstract Background The study covered in- and out-of-hospital care in a region in north-western Spain. The intervention evaluated took the form of a change in the hospital drugs formulary. Before the intervention, the formulary contained four of the five low molecular weight heparins (LMWHs) marketed in Spain. The intervention consisted of withdrawing two LMWHs (bemiparin and dalteparin) from the formulary and restricting the use of another (tinzaparin), leaving only enoxaparin as an unrestricted prescription LMWH. Accordingly, the aim of this study was to evaluate the effect on in- and outpatient drug prescriptions of removing and restricting the use of several LMWHs in a hospital drugs formulary. Methods We used a natural, before-after, quasi-experimental design with a control group and monthly data from January 2011 to December 2016. Based on data drawn from official Public Health Service sources, the following dependent variables were extracted: defined daily doses (DDD) per 1000 inhabitants per day (DDD/TID), DDD per 100 stays per day, and expenditure per DDD. Results The two compounds that were removed from the formulary registered an immediate decrease at both an intra- and out-of-hospital level (66.6% and 55.6% for bemiparin and 73.0% and 92.2% for dalteparin, respectively); similarly, the compound that was restricted also registered an immediate decrease (36.1% and 9.0% at the in- and outpatient levels, respectively); in contrast, the remaining LMWH (enoxaparin) registered an immediate, significant increase at both levels (44.9% and 32.6%, respectively). The intervention led to an immediate reduction of 6.8% and a change in trend in out-of-hospital cost/DDD; it also avoided an expenditure of €477,317.1 in the 21 months following the intervention. Conclusions The results indicate that changes made in a hospital drugs formulary towards more efficient medications may lead to better use of pharmacotherapeutic resources in its health catchment area. |
| first_indexed | 2024-12-12T23:50:35Z |
| format | Article |
| id | doaj.art-760cf4eb7b21473896c719da91d93cb0 |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-12-12T23:50:35Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-760cf4eb7b21473896c719da91d93cb02022-12-22T00:06:42ZengBMCImplementation Science1748-59082019-07-0114111110.1186/s13012-019-0924-0Impact of removal and restriction of me-too medicines in a hospital drug formulary on in- and outpatient drug prescriptions: interrupted time series design with comparison groupRaquel Vázquez-Mourelle0Eduardo Carracedo-Martínez1Adolfo Figueiras2Sub-Directorate-General, Galician Health Service (Servicio Gallego de Salud - SERGAS), Galicia Regional AuthoritySantiago de Compostela Health Area Authority, Galician Health ServiceDepartment of Preventive Medicine and Public Health, Faculty of Medicine, University of Santiago de Compostela and Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP)Abstract Background The study covered in- and out-of-hospital care in a region in north-western Spain. The intervention evaluated took the form of a change in the hospital drugs formulary. Before the intervention, the formulary contained four of the five low molecular weight heparins (LMWHs) marketed in Spain. The intervention consisted of withdrawing two LMWHs (bemiparin and dalteparin) from the formulary and restricting the use of another (tinzaparin), leaving only enoxaparin as an unrestricted prescription LMWH. Accordingly, the aim of this study was to evaluate the effect on in- and outpatient drug prescriptions of removing and restricting the use of several LMWHs in a hospital drugs formulary. Methods We used a natural, before-after, quasi-experimental design with a control group and monthly data from January 2011 to December 2016. Based on data drawn from official Public Health Service sources, the following dependent variables were extracted: defined daily doses (DDD) per 1000 inhabitants per day (DDD/TID), DDD per 100 stays per day, and expenditure per DDD. Results The two compounds that were removed from the formulary registered an immediate decrease at both an intra- and out-of-hospital level (66.6% and 55.6% for bemiparin and 73.0% and 92.2% for dalteparin, respectively); similarly, the compound that was restricted also registered an immediate decrease (36.1% and 9.0% at the in- and outpatient levels, respectively); in contrast, the remaining LMWH (enoxaparin) registered an immediate, significant increase at both levels (44.9% and 32.6%, respectively). The intervention led to an immediate reduction of 6.8% and a change in trend in out-of-hospital cost/DDD; it also avoided an expenditure of €477,317.1 in the 21 months following the intervention. Conclusions The results indicate that changes made in a hospital drugs formulary towards more efficient medications may lead to better use of pharmacotherapeutic resources in its health catchment area.http://link.springer.com/article/10.1186/s13012-019-0924-0Hospital formularyLow molecular weight heparinLMWHProgramme efficiencyPharmacy and therapeutics committeePrescription drugs |
| spellingShingle | Raquel Vázquez-Mourelle Eduardo Carracedo-Martínez Adolfo Figueiras Impact of removal and restriction of me-too medicines in a hospital drug formulary on in- and outpatient drug prescriptions: interrupted time series design with comparison group Implementation Science Hospital formulary Low molecular weight heparin LMWH Programme efficiency Pharmacy and therapeutics committee Prescription drugs |
| title | Impact of removal and restriction of me-too medicines in a hospital drug formulary on in- and outpatient drug prescriptions: interrupted time series design with comparison group |
| title_full | Impact of removal and restriction of me-too medicines in a hospital drug formulary on in- and outpatient drug prescriptions: interrupted time series design with comparison group |
| title_fullStr | Impact of removal and restriction of me-too medicines in a hospital drug formulary on in- and outpatient drug prescriptions: interrupted time series design with comparison group |
| title_full_unstemmed | Impact of removal and restriction of me-too medicines in a hospital drug formulary on in- and outpatient drug prescriptions: interrupted time series design with comparison group |
| title_short | Impact of removal and restriction of me-too medicines in a hospital drug formulary on in- and outpatient drug prescriptions: interrupted time series design with comparison group |
| title_sort | impact of removal and restriction of me too medicines in a hospital drug formulary on in and outpatient drug prescriptions interrupted time series design with comparison group |
| topic | Hospital formulary Low molecular weight heparin LMWH Programme efficiency Pharmacy and therapeutics committee Prescription drugs |
| url | http://link.springer.com/article/10.1186/s13012-019-0924-0 |
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