Pharmacy database for tracking drug costs and utilization.

A pharmacy database for tracking drug costs and physician prescribing trends is described. Accuracy problems plagued data systems used to make drug-use-policy decisions at a tertiary care teaching hospital because of structural deficiencies within the systems and their nonclinical orientation. To resolve these problems, a programmer analyst, a clinical supervisor, and a clinical pharmacist developed a hierarchical database of drug costs. The database was designed to be valid for tracking drug costs according to patterns of clinical use. Internal controls were created that could identify and correct cost-tabulation errors arising within the ordering, order-entry, and billing processes. The database was able to tabulate drug costs according to the clinical service on which the patient was being treated at the time so that reports could compare aggregate prescribing trends from one time period to another for the same service. Similarly, the database could track and report drug use by disease or financial classification. Flagging elements were introduced to the database for cancer chemotherapy and antimicrobial drug products to enable reporting by these categories and by therapeutic subcategories within the antimicrobial category. Routine monthly reports were distributed to end users. Development of a database for tracking drug costs and utilization allowed a teaching hospital to derive the cost of medications from billing-charge information and to report data to health care professionals on the basis of important factors like clinical services.

Selecting a pharmacy computer system for the future.

Major advances are occurring in the field of computer science that have placed us at the threshold of a significant revolution in the management and application of clinical data. These advances will have a profound effect on the practice of pharmacy and are occurring at a time when many hospital pharmacies are deciding whether to enhance or replace their current systems. To best position your department for the future, it is essential that you are knowledgeable of the advances being made, have a vision for how they will affect your practice, and undergo a well-organized and thorough selection process.

A commentary on high-cost drugs.

We are at the threshold of a time when new, ultra-expensive drugs will be brought to market. At present only a few agents have been successfully marketed. Their extraordinary acquisition costs will cause the budgets of pharmacy departments to expand as these new drugs are approved for use by pharmacy and therapeutics committees. These new agents should not be approved unless the department of pharmacy has ensured that their use and expense will be adequately controlled through inventory control procedures, protocol management, and drug-use evaluation, and that this control will be coupled with the education of prescribers and, perhaps more important, hospital administrators and financial managers. Further, there are costs associated with the new agents that are beyond the acquisition cost. These hidden costs include protocol management, drug-use evaluation, efforts made to secure reimbursement, and educational activities undertaken to ensure an understanding of the drug's therapeutic and financial implications. In addition to understanding the costs, similar efforts must be made to understand the cost offsets that go beyond savings in nursing or pharmacy time or supplies. These cost offsets may include early discharge of inpatients or analyses of lifetime medical costs per patient. To be sure, the ultra-expensive drugs will cause us to change the way we analyze costs and cost offsets.

Home parenteral nutrition: a hospital-based program with commercial logistic support.

Since home parenteral nutrition was introduced in the 1970's, a number of medical centers have formed successful home parenteral nutrition programs which have reduced expenses to the patient and third party payers by 50 to 73% over in hospital costs. However, the cost of maintaining these programs for training and follow-up has largely been absorbed by the hospital as a nonreimbursable teaching expense. To offset the costs of our growing program in these times of budget "caps," we have established an agreement between our hospital and commercial home care company which provides for patient instruction and follow-up by the hospital parenteral and enteral nutrition team and logistic support by the home care company. We used the average cost of our first five patients to establish a fee schedule which the commercial company agreed to pay the hospital parenteral and enteral nutrition team for its services. This agreement reduces the number of nurses and pharmacists that the commercial company would otherwise have to hire for teaching and follow-up of home care patients, and supports the concept of regional care in medical centers where parenteral and enteral nutrition teams maintain quality control, continuity of care, and efficient teaching programs for patients requiring home parenteral nutrition.

Patient-care unit system for measuring clinical and distributive pharmacy workload.

A time-weighted measurement of workload for distributive and clinical pharmaceutical services, the Patient-care Unit (PCU) System, is described. The Department of Pharmaceutical Services and the School of Pharmacy at the University of California, San Francisco, defines each patient-care pharmaceutical activity and assigns it a weighted value (WPCU) based on the time required to complete the activity. Manpower requirements are based on WPCUs and records of activities performed. Forty-two WPCUs have been defined. Based on these units, the PCU System permits (1) determination of pharmacy time devoted to distributive and clinical pharmaceutical services, (2) evaluation of staffing requirements for existing or proposed programs, (3) measurement of departmental productivity, and (4) comparison of pharmaceutical services offered in different hospitals. Applications and limitations of the PCU concept, which has been adopted by nine other hospitals, are discussed. The PCU System is a step toward development of a uniform workload reporting system for hospital pharmacies.