Impact of a formulary on personal care homes in Manitoba.
OBJECTIVE
To assess the impact of a formulary on drug expenditures and prescribing trends in personal care homes (nursing homes).


METHODS
Quasi-experimental analysis of a drug prescription database before and after implementation of the formulary.


METHODS
Personal care homes in Manitoba.


METHODS
Residents occupying the 6848 beds of the 88 personal care homes that did not already have a formulary.


METHODS
Formulary, introduced Apr. 1, 1987.


METHODS
Drug expenditures from Apr. 1, 1985, to Mar. 31, 1990; proportion of residents receiving a prescription by drug class and rate of prescriptions of nonformulary drugs in the year before and 2 years after the formulary was introduced.


RESULTS
The total drug expenditures per bed remained constant during the first year after the formulary was implemented, even though the annual drug inflation rate was 9.8% on average during the study period. Expenditures 2 and 3 years after implementation rose by 9.4% and 5.8% respectively. Those for specific agents and drug classes targeted as being inappropriate for long-term care decreased greatly because of reduced prescribing. Expenditures for some other drug classes increased mainly because newer, more expensive agents were used. The mean drug expenditure per bed varied widely between homes; neither size nor location were found to correlate with drug expenditure, but adherence to the formulary did predict personal care homes with decreased expenditures.


CONCLUSIONS
A formulary in personal care homes can improve therapeutic management. The impact on cost containment was not as strong after the first year, although expenditures remained less than the rate of inflation for drug costs.
Yakabowich
M R
MR
Faculty of Pharmacy, University of Manitoba, Winnipeg.
Keeley
G
G
Montgomery
P R
PR
D000368:Aged; D003363:Cost Control; D016527:Drug Costs / Q000639:trends; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005569:Formularies as Topic; D006801:Humans; D008350:Manitoba; D009735:Nursing Homes