Resumen de Clinical and financial effects of the application of a therapeutic equivalence program in a tertiary hospital
Carmen García Muñoz, Carolina Alarcón Payer, Irene Cañamares Orbis, Mª Jesús Jiménez Cerezo, Miguel Angel Calleja Hernández
Objective: Therapeutic Equivalence Program contains clinically equivalent drugs and defines the best therapeutic alternative included in the hospital's Pharmaco-therapeutic Guide for drugs not included. The main objective of this study is to assess the clinical and economic impact of the application of a Therapeutic Equivalence Program in a tertiary hospital. Method: Descriptive observational study conducted between November 2011 and January 2012. During the transcription and validation of the prescriptions of clinical units with unit dose drug distribution system, pharmacists applied the Therapeutic Equivalence Program and submitted the substitution to the physician in writing. The prescription of drugs not included only happened if there was a clinical justification that made the substitution not possible. The main outcome measures were: rate of substitution proposals accepted and rejected, justifications for not performing the substitution, cost of the drug not included, cost of the therapeutic equivalent per hospital stay and percentage of therapeutic equivalents prescribed at discharge. Results: One hundred and ninety-nine substitution proposals were sent to the physicians. In the 51.8% of the cases, the physician accepted the substitution of the drug not included proposed by the Pharmacy Department. In the 24.1% of the cases, the physician did not accept the substitution. In those cases of rejection, a clinical justification was needed so that the Pharmacy Department acquired the DNI in PTG, for the patient. In the 17.1% of cases, the physician considered the substitution was not necessary because the patient brought the medication from home and, therefore, the Pharmacy Department did not perform the substitution. In the 7% of the cases, the physician preferred to discontinue that medication. The most common clinical justification received (eight cases) was leg edema caused by amlodipine (maintenance of manidipine). The second one was anaerobic infection where levofioxacin is less active (moxifioxacin was kept). The drugs not included global price within two months of study was euros 1,148.78. In two months, euros 472.63 was saved with 51.8% of substitutions accepted. If all substitutions had been accepted, the therapeutic equivalent prescription would have saved euros 632.29. In 17% of cases therapeutic equivalents were prescribed at discharge. Conclusion: The substitution proposals have been accepted in more than half of cases. However, the prescription of therapeutic equivalents at discharge was not as it was expected. The adjustment of medical prescriptions to the hospital's Pharmacotherapeutic Guide prevailed over the economic saving, that was insignificant
