Development of High Cost Chemotherapy Drugs Management Systems

Abstract

This participatory action research (PAR) study aimed to develop the pharmaceutical management system and reduce the financial impact from high cost chemotherapy drugs. It was conducted from October 2015 – August 2016 at Surin Hospital. Participants were purposely selected, including 5 pharmacists and 7 medical service personnel from multidisciplinary cancer team. The study was divided into 3 phases: (1) problem analysis (2) development, and (3) outcome evaluation. Data were collected through interviews and documentation records; and were analyzed by content analysis, descriptive statistics, and paired t-test. The results showed that ineffective communication was the major problem of the pharmaceutical manage-ment system. It was improved by adding a regular report by the pharmaceutical product preparing unit on drug utilization status for 8 high cost chemotherapy drugs. As a result, there were no nearly-expired drugs and out-of stock event after the development. Regarding the reduction of financial impact for service providers, it was found that the practitioners still lacked of understanding about the process of the national health compensation funds. The improvement was performed through 3 measures: (1) revision of the guidelines for approved of non-protocol medicines, (2) completion of cancer patients’ registration, and (3) reduction of drug prices. Such developemnt had resulted in the significant increase of fund compen-sation compared to the earlier period (p<0.05). As for the reduction of impact on the patients, it was found that service providers did not understand the drug supply conditions set by pharmaceutical companies, resulting in the missing opppotunities of the patients to gain the agreed benefits from the companies. To address this issue, a special care pathway was developed leading to the reduction of the drug cost up to 436,560 baht in one patient. Therefore, it is recommended that tertiary hospitals should analyze and improve the process of high cost chemotherapy drug management system which would not only increase management efficiency but also reduce the negative financial impact.