Over the past several years, it has been virtually impossible to practice in an office or hospital without encountering formularies. While they initially were met with skepticism and felt like barriers to freedom of choice in care, eventually most physicians came to see them as necessary evils, then as reflections of the realities of practice of medicine in a world of expensive choices. Many doctors now see formularies as what they have become – a list of thoughtful choices about drugs in classes made by pharmacy and therapeutics committees. These choices ultimately have become evidence-based clinical decisions about what medications are best, and for drugs with equivalent proof of efficacy, medications that reflected best negotiated prices by hospitals or insurance organizations.
While at this point Golden Living is not instituting a closed formulary, the clinical, pharmacy, and medical leaders have developed a preferred drug list. This list does not cover all drug classes, but does have some preferred medications in some of the most commonly prescribed classes. Unlike some drug lists, there won’t be complicated tiers, or pages or pages of medications. It will be able to fit on two sides of one sheet of paper.
At Golden Living, guides will be available to help you make some of these decisions regarding medications. While you are free to make your own choices about what is best for your patients, I ask that you take a look at the list to see some of our recommended medication substitutions for several classes of drugs. Some will have an equivalent therapeutic effect but at a significantly reduced cost. Others simply will be the best medication in their class. For those facilities with automated drug dispensing units (ADUs), the list also will help you prescribe medications which are most readily available to the patient because they are already in the facility.
We will do our best to get these lists to you via e-mail and in print, which will be available to you at the nursing stations. We also will make sure that the nursing supervisor has extra copies. If you have questions, comments, or suggestions about the list, please feel free to discuss the items with your consultant pharmacist.
Down the road, it may be possible to have an automated list, which will prompt nurses entering initial orders to request substitutions or alternative medications. Ultimately (in states where this is permitted), you may even be able to sign a list ahead of time which allows for automatic substitutions of medications. Until then, please help us right now with your own prescription activity.
If your patient comes from the hospital with some medications which are of dubious value or unclear indication, I hope that when clinically appropriate you will be willing to consider discontinuation or a gradual dosage reduction. If not, then consulting the list ultimately may result in a safer, more efficacious, and cost-effective regimen for your patients. It may even save you from some phone calls and fax requests down the road.