title: Management of Hospital Formularies in Ontario: Challenges within a Local Health Integration Network.
abstract: BACKGROUND
  Expenditures on drugs dispensed and administered to patients in Canadian hospitals have been estimated at $2.4 billion per year. Pharmacy and therapeutics (P&T) committees play a key role in the evaluation and management of drug therapies in this setting. Hospitals differ with respect to the composition of these committees, their members' expertise, and the processes used for making formulary decisions.
  
  
  OBJECTIVE
  To examine the current processes for formulary drug review from the perspective of P&T committees and their individual members, and to examine the needs and preferences of these stakeholders related to evidence review and potential collaborative drug review processes within a large Local Health Integration Network (LHIN) in Ontario.
  
  
  METHODS
  Twenty-three sites within 10 hospital corporations in LHIN 4 (Hamilton Niagara Haldimand Brant) were recruited. A 2-part questionnaire was developed and pretested for clarity and comprehensiveness. The institution profile section of the questionnaire was to be completed by pharmacy directors and the P&T section by committee members.
  
  
  RESULTS
  Ten pharmacy directors and 28 committee members representing 10 P&T committees responded. A mean of 6.4 new drug requests were reviewed annually by each P&T committee. Across the LHIN, the workload associated with reviewing submissions for new drugs to be added to the formulary represented 0.84 full-time equivalent. The quality of clinical evidence in the drug submissions was rated more favourably than the quality of economic evidence; furthermore, the use of economic evidence was limited by a lack of health economics expertise within the committees. A centralized review process for the LHIN was perceived as beneficial to improve efficiency, the quality of review, and standardization, and also to reduce costs.
  
  
  CONCLUSIONS
  Across the Hamilton Niagara Haldimand Brant LHIN, considerable time and resources are spent on the review of potential new drugs for addition to the hospitals' formularies. A standardized formulary review process, with greater use of provincial and national drug reviews, would likely benefit all LHINs.
authors.affiliation: MSc, is with McMaster University and St Joseph's Health-care Hamilton (Programs for Assessment of Technology in Health [PATH]), Hamilton, Ontario.
authors.forename: Natasha
authors.initials: N
authors.lastname: Burke
authors.affiliation: RPh, BScPhm, MSc, is with McMaster University and St Joseph's Healthcare Hamilton (Programs for Assessment of Technology in Health [PATH]), Hamilton, Ontario.
authors.forename: James M
authors.initials: JM
authors.lastname: Bowen
authors.affiliation: is with St Joseph's Healthcare Hamilton, Hamilton, Ontario.
authors.forename: Sue
authors.initials: S
authors.lastname: Troyan
authors.affiliation: MHEcon, was, at the time of this study, with McMaster University and St Joseph's Healthcare Hamilton (Programs for Assessment of Technology in Health [PATH]), Hamilton, Ontario.
authors.forename: Jathishinie
authors.initials: J
authors.lastname: Jegathisawaran
authors.affiliation: RPh, ACPR, PharmD, is with St Joseph's Healthcare Hamilton, Hamilton, Ontario.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Gosse
authors.affiliation: RPh, BScPhm, PharmD, ACPR, is with Hamilton Health Sciences, Hamilton, Ontario.
authors.forename: Marita
authors.initials: M
authors.lastname: Tonkin
authors.affiliation: DiplPharm, BScPharm, MBA/HCM, is with Brant Community Healthcare System, Brantford, Ontario.
authors.forename: Sandra
authors.initials: S
authors.lastname: Kagoma
authors.affiliation: MA, is with McMaster University, Hamilton, Ontario.
authors.forename: Ron
authors.initials: R
authors.lastname: Goeree
authors.affiliation: MD, PharmD, MSc, FRCPC, is with McMaster University and St Joseph's Healthcare Hamilton, Hamilton, Ontario.
authors.forename: Anne
authors.initials: A
authors.lastname: Holbrook
keywords: Canada; decision-making; hospital formulary; pharmacoeconomics; pharmacy and therapeutics committee; survey