Pharmacy and Therapeutics Committees in Thai Hospitals under Health Reform

1
Pharmacy and Therapeutics Committees in Thai
Hospitals under Health Reform

• Sripairoj A, Liamputtong P, Harvey K
• La Trobe University, Australia

2
Outline of presentation

• Background
• Objectives
• Methods and Samples
• Results
• Summary
• Conclusion and Policy Implications

3
Background

• In Thailand, hospitals under the Office of the
  Permanent Secretary were first required to
  establish Pharmacy and Therapeutics Committees
  (PTCs) in 1987.
• A Manual of Drug Administration (1987) listed the
  expected structure, roles and responsibilities of
  PTCs.
• Since 1997, Thai hospitals have faced economic
  crisis, quality improvement and accreditation,
  universal coverage health reform and structural
  change in the Ministry of Public Health (MoPH).

4
Objectives

• To examine PTC performance during this period of
  change and reform.
• To determine the opinion of the PTC Chairpersons
  and the PTC Secretaries about defining good PTC
  performance, ways to improving PTC performance,
  and possible PTC performance indicators.
• To create a Manual that provides more practical
  help on rational drug use activities, including
  performance indicators.

5
Methods
6
Sample methods

• Seventeen hospitals (2 regional hospitals, 3
  provincial hospitals, and 12 district hospitals)
  in 4 regions of Thailand.
• Ten key informants who were the Chairperson, the
  Secretary or members of the PTC were interviewed.
• Fifteen key informants who involved with PTC or
  who are responsible for drug information centers
  were interviewed.
• Questionnaires were distributed to 452 PTC
  Chairpersons and Secretaries respectively in 25
  regional hospitals, 67 provincial hospitals and
  360 district hospitals.
• Eight key participants who were PTC stakeholders
  participated in a focus group.
• PTCs in 3 regional hospitals were observed.

7
Questionnaire results (1)

• The questionnaire response rate was 36 from PTC
  Chairpersons and 66 from Secretaries.
• Around 90 of PTC Chairpersons were Hospital
  Directors and 90 of Secretaries were Heads of
  Pharmacy Department.
• The average of the number of PTC members in
  regional, provincial and district hospitals was
  19, 20, and 10 members, respectively.
• There were only 2-3 PTC meetings in regional or
  provincial hospitals and only 1-2 PTC meetings in
  district hospitals during each fiscal year (from
  1996-2002).

8
Questionnaire results (2)

• The most important PTC performance indicators
  suggested by all PTC Chairpersons
• Is PTC responsible for considering and approving
  allocation of drug budget proposed by the
  Pharmacy section?
• Does PTC have a document providing criteria for
  addition and deletion of drug in the hospital
  drug list?
• Does PTC have a policy to develop or implement
  Clinical Practice Guidelines for common problems
  such as acute respiratory infection, diarrheal
  diseases, hypertension, diabetes, epilepsy, and
  antibiotic prophylaxis, etc.?
• Does the PTC monitor Pharmacy drug dispensing to
  ensure it follows written standards of pharmacy
  professional practice?
• Does PTC conduct satisfaction surveys on
  hospital staff to receive feedback on PTC
  performance?

9
Questionnaire results (3)

• The most important PTC performance indicators
  suggested by PTC Secretaries
• Does a document identifying goal, committee,
  objectives, and functions of PTC exists?
• Is PTC authorised to select drugs to be included
  and excluded in the hospital drug list?
• Does PTC monitor the percentage of drugs used
  outside hospital drug list?
• Does the PTC monitor Pharmacy drug dispensing to
  ensure it follows written standards of pharmacy
  professional practice?
• Does PTC have a policy to conduct satisfaction of
  patients/clients on the hospital treatment
  service?

10
Questionnaire results (4)

• When asked about the most important factor needed
  for the development of an effective PTC
• the Chairpersons said it was an effective PTC
  Secretary while
• the Secretaries said it was an effective PTC
  Chairperson.
• When asked about external factors that can
  contribute to improved performance of PTC both
  PTC Chairpersons and Secretaries in all hospitals
  agreed that the most important aspect was
• a national collaborative drug information center
  as a hub for information exchange between PTC for
  a decision making purpose.
• In addition, PTC Chairpersons and PTC Secretaries
  in regional hospitals noted that
• defining the function of PTC in the hospital
  accreditation criteria would be helpful.

11
Results (5)

• The retrospective document review, in-depth
  interviews, a focus group and participant
  observation noted that
• Under new structure of Ministry of Public Health,
  there was no distinctive responsible organization
  who support and monitor PTCs.
• Some hospitals had not updated information about
  new PTC members, functions or responsibilities.
• Most PTC activities still focused on drug
  selection and controlling drug budget.
  Activities on rational drug use were few.
• Many PTCs had not set their own specific goals,
  objectives, role and responsibilities.
• Often PTCs had no working plan and there was also
  no orientation about goal, objectives, role and
  responsibilities for PTC members.

12
Results (6)

• Many suggested the need for a responsible
  organization (perhaps under the Department of
  Health Service Support) that would assist PTCs
  by
• Updating Manual of PTC roles and
  responsibilities
• Providing opportunities for PTC networking e.g.
  by web site /or E-mail discussion groups
• Providing information for PTC to make decisions
• Supporting the incorporation of PTC performance
  indicators in hospital accreditation (Bureau of
  Inspection Evaluation /or The Institute of
  Hospital Quality Improvement Accreditation)
• Encouraging Universities to provide educational
  programs.

13
Summary

• PTCs at all levels of hospital focused their
  activities on drug selection and budget as this
  was the main focus of the 1987 Manual.
• There were limited numbers of meetings of PTCs
  (1-2 in district hospitals 2-3 in regional or
  provincial hospitals).
• The recommended PTC performance indicators were
  the number of PTC meetings and the number of drug
  items in hospital drug lists.
• Suggestions for improving PTC performance
• Setting a responsible organization
• Encouraging educational programs in universities
  and
• Providing national drug information center and
  PTC networking.

14
Conclusion Policy Implications

• There is a need for a responsible organization
  (perhaps under the Department of Health Service
  Support) that would assist PTCs by
• Updating a Manual regarding PTC roles and
  responsibilities
• Providing opportunities for PTC networking e.g.
  by web site /or E-mail discussion groups
• Providing information for PTC to make decisions
• Supporting the incorporation of PTC performance
  indicators in hospital accreditation monitored
  by
• Bureau of Inspection Evaluation /or
• The Institute of Hospital Quality Improvement
  Accreditation
• Encouraging Universities to provide PTC
  educational programs.

15
We cannot direct the wind but we can adjust the
sail.

• Learning to live, living to learn
• and have fun on improving Pharmacy and
  Therapeutics Committee performance.