Enhancing Appropriate Prescribing by Promoting the Tenets of a Long Term Care Formulary: Interim Analysis of a Formal Quality Improvement Initiative
Author(s): ,
Carla Beaton
Affiliations:
RPh
,
Lily Zhang
Affiliations:
PharmD
,
Hrishikesh Navare
Affiliations:
MSc
,
Sherman Chiu
Affiliations:
PharmD
,
Stephanie Farnham
Affiliations:
RPh
,
Dan Dalton
Affiliations:
RPh
,
Selim Hawa
Affiliations:
PharmD
,
Mark Goldstein
Affiliations:
MD
Ben Robert
Affiliations:
MD
Canadian Pharmacists Conference ePoster Library. O'Donnell D. Jun 3, 2017; 174262
Denis O'Donnell
Denis O'Donnell
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Abstract
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Objectives
In September 2016, the Ontario Long-Term-Care (LTC) Medication Management Demonstration Project was launched, a voluntary initiative developed by the MOHLTC Working Group to proactively address burgeoning provincial drug costs. The project consisted of a LTC formulary promoting fiscally responsible and therapeutically equivalent choices among 7 drug categories. The following 4-month interim analysis of a structured quality improvement initiative supporting the Demonstration Project involved 3 LTC facilities, totalling 995 beds. The objectives were to reduce drug costs by 20% at 6 months and measure the feasibility of a LTC formulary in clinical practice by evaluating clinical outcomes and the rationale of rejected recommendations.

Methods
Two approaches were observed; a traditional approach where a pharmacist provided written recommendations to physicians regarding potential substitutions, and afocused review where the physician and pharmacist met to discuss the pharmacists recommendations. Follow up costs and clinical outcomes were monitored on a weekly basis and compared to the baseline evaluation.

Results
There were 408 out of 995 residents at baseline with 1 active prescription for one of the targeted molecules identified in the LTC formulary with 502 recommendations generated. At 4 months, drug costs for the medications within the top 5 targeted drug categories were reduced by 25.7% with thefocused review and 7.2% using the traditional approach. Overall recommendation acceptance rate in two LTC homes was 60% using the focused review and 20% at a comparator LTC home using the traditional approach. Of the accepted recommendations, 95.3% of residents remained clinically stable.

Conclusion
The introduction of a LTC formulary is a feasible strategy to optimize cost effectiveness and maintain therapeutic equivalence. A dedicated focused review appears to be the most effective approach. The projected annual cost savings is $8.95M if used across all LTC homes in Ontario and possible greater savings if this process was legislated.

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