International Journal of Clinical Pharmacy

, Volume 33, Issue 3, pp 475–483 | Cite as

Literature review on the structure and operation of Pharmacy and Therapeutics Committees

  • Esther Durán-GarcíaEmail author
  • Bernardo Santos-Ramos
  • Francesc Puigventos-Latorre
  • Ana Ortega
Review Article


Aim of the review To review the literature on the structure and operation of hospital Pharmacy and Therapeutics Committees from an international point of view and examine the factors that influence decision-making of these committees. Method We performed a literature search in the Medline and Embase databases from 1997 to January 2009 with the search terms: formulary system decision making, pharmacy and therapeutics committee, formularies hospital, drug formulary, survey, drug selection and outcome assessment health care. Inclusion criteria were the following: studies analyzing Pharmacy and Therapeutics Committees published in English or Spanish from 1997 to January 2009. Exclusion criteria were: publications which were editorials or opinion pieces, studies relating to one hospital, and studies where full text could not be attained. The analysis was divided into structural/organizational data and data on factors affecting the decision-making process. Results Seventeen studies met the inclusion criteria. Pharmacy and Therapeutics Committees and formularies were present in more than 90% of the hospitals in four of the five countries examined. Therapeutic interchange programs existed only in two of these countries. The mean number of committee members ranged between six and eight. More than 89% of the committees included a pharmacist. Standard operating procedures were implemented by 89% of the committees. The most influential factors in the decision-making were clinical trial results or drug costs rather than pharmacoeconomic studies. Other local organization-dependent factors were also important. Conclusions The structure and operating procedures of Hospital Pharmacy and Therapeutics Committees are similar in select Western countries. Information from clinical trials is the most influential factor in the decision-making process.


Decision-making Drug selection Formulary Formulary system Pharmacy and Therapeutics Committee PTC Survey 



The authors would like to thank the Research Group for Innovation Assessment, Standardisation and Research in the Selection of Drugs (GENESIS) of the Spanish Society of Hospital Pharmacy (SEFH), in particular T Requena-Caturla (Servicio Madrileño de Salud, Madrid), JP Ordovás-Baines (Hospital General Universitario de Alicante), MA Porta-Sánchez (Complejo Hospitalario Juan Canalejo, Coruña), and JM Recalde-Manrique (Andalusian Centre for Pharmaceutical Documentation and Information, Granada) for their contribution to the initial planning and development of this review. We also thank E Corpas-Nogales, L García-Mochón and M Moya-Garrido from the Research and Methodology Support Unit of the Andalusian School of Public Health (EASP) in Granada for their contribution to the literature search.


This review was funded by the Spanish Ministry of Health and Social Policy following the Ministry’s 2006 open call for proposals. Health Research Fund, Instituto de Salud Carlos III, Project PI061546.

Conflicts of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Apolone G, Joppi R, Bértele V, Garattini S. Ten years of marketing approvals of anticancer drugs in Europe: regulatory policy and guidance documents need to find a balance between different pressures. Br J Cancer. 2005;93:504–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Joppi R, Bertelé V, Garattini S. Disappointing biotech. BMJ. 2005;331:895–7.PubMedCrossRefGoogle Scholar
  3. 3.
    American Society of Hospital Pharmacists, American Hospital Association. Statement of guiding principles on the operation of hospital formularies. Am J Hosp Pharm. 1960;17:609–10.Google Scholar
  4. 4.
    Anonymous. ASHP guidelines on the pharmacy and therapeutics committee and the formulary system. Am J Health-Syst Pharm. 2008;65:1272–83.CrossRefGoogle Scholar
  5. 5.
    Cooke J, Mason AR, Drummond MF, Towse AK. Medication management in English National Health Service hospitals. Am J Health-Syst Pharm. 2005;62:189–95.PubMedGoogle Scholar
  6. 6.
    Willems L, Raymakers A, Sermeus W, Vleugels A, Laekeman G. Survey of hospital pharmacy practice in Flemish-speaking Belgium. Am J Health-Syst Pharm. 2005;62:321–4.PubMedGoogle Scholar
  7. 7.
    Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing–2004. Am J Health-Syst Pharm. 2005;62:378–90.PubMedGoogle Scholar
  8. 8.
    Pedersen CA, Schneider PJ, Santell JP. ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing–2001. Am J Health-Syst Pharm. 2001;58:2251–66.PubMedGoogle Scholar
  9. 9.
    Mannebach MA, Ascione FJ, Gaither CA, Bagozzi RP, Cohen IA, Ryan ML. Activities, functions, and structure of pharmacy and therapeutics committees in large teaching hospitals. Am J Health-Syst Pharm. 1999;56:622–8.PubMedGoogle Scholar
  10. 10.
    Shalansky SJ, Virk R, Ackman M, Jackevicius C, Kertland H, Tsuyuki R, et al. Access to new cardiovascular therapies in Canadian hospitals: a national survey of the formulary process. Can J Cardiol. 2003;19:173–9.PubMedGoogle Scholar
  11. 11.
    Fijn R, Brouwers JR, Knaap RJ, De Jong-Van Den Berg LT. Drug and Therapeutics (D & T) committees in Dutch hospitals: a nation-wide survey of structure, activities, and drug selection procedures. Br J Clin Pharmacol. 1999;48:239–46.PubMedCrossRefGoogle Scholar
  12. 12.
    Fijn R, den Berg LT, Brouwers JR. Rational pharmacotherapy in The Netherlands: formulary management in Dutch hospitals. Pharm World Sci. 1999;21:74–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Thürmann PA, Harder S, Steioff A. Structure and activities of hospital drug committees in Germany. Eur J Clin Pharmacol. 1997;52:429–35.PubMedCrossRefGoogle Scholar
  14. 14.
    Björkman IK, Schmidt IK, Holmstrom I, Bernsten CB. Developing the role of the drug and therapeutics committees: perceptions of chairs. Int J Health Care Qual Assur. 2007;20:161–78.PubMedCrossRefGoogle Scholar
  15. 15.
    Anell A, Svarvar P. Pharmacoeconomics and clinical practice guidelines. A survey of attitudes in Swedish formulary committees. Pharmacoeconomics. 2000;17:175–85.Google Scholar
  16. 16.
    Tan EL, Day RO, Brien JA. Prioritising drug and therapeutics committee (DTC) decisions: a national survey. Pharm World Sci. 2007;29:90–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Hasle-Pham E, Arnould B, Spath HM, Follet A, Duru G, Marquis P, et al. Role of clinical, patient-reported outcome and medico-economic studies in the public hospital drug formulary decision-making process: results of a European survey. Health Policy. 2005;71:205–12.PubMedCrossRefGoogle Scholar
  18. 18.
    Späth HM, Charavel M, Morelle M, Carrere MO. A qualitative approach to the use of economic data in the selection of medicines for hospital formularies: a French survey. Pharm World Sci. 2003;25:269–75.PubMedCrossRefGoogle Scholar
  19. 19.
    Jenkings KN, Barber N. What constitutes evidence in hospital new drug decision making? Soc Sci Med. 2004;58:1757–66.PubMedCrossRefGoogle Scholar
  20. 20.
    Schumock GT, Walton SM, Park HY, Nutescu EA, Blackburn JC, Finley JM, et al. Factors that influence prescribing decisions. Ann Pharmacother. 2004;38:557–62.PubMedCrossRefGoogle Scholar
  21. 21.
    Odedina FT, Sullivan J, Nash R, Clemmons CD. Use of pharmacoeconomic data in making hospital formulary decisions. Am J Health-Syst Pharm. 2002;59:1441–4.PubMedGoogle Scholar
  22. 22.
    Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing–2007. Am J Health-Syst Pharm. 2008;65:827–43.PubMedCrossRefGoogle Scholar
  23. 23.
    Devenport C. Pharmacy and therapeutics committee ‘virtual’ meetings. Am J Health-Syst Pharm. 1999;56:1132. Letter.PubMedGoogle Scholar
  24. 24.
    Sears EL. Development and maintenance of an online formulary for a large health system. Am J Health-Syst Pharm. 2008;65:510–2.PubMedCrossRefGoogle Scholar
  25. 25.
    Verhagen CC, Niezink AG, Engels YY, Hekster YY, Doornebal JJ, Vissers KC. Off-label use of drugs in pain medicine and palliative care: an algorithm for the assessment of its safe and legal prescription. Pain Pract. 2008;8:157–63.PubMedCrossRefGoogle Scholar
  26. 26.
    Lehmann DF, Guharoy R, Page N, Hirschman K, Ploutz-Snyder R, Medicis J. Formulary management as a tool to improve medication use and gain physician support. Am J Health-Syst Pharm. 2007;64:464–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Schachtner JM, Guharoy R, Medicis JJ, Newman N. Speizer R. Prevalence and cost savings of therapeutic interchange among U.S. hospitals. Am J Health-Syst Pharm. 2002;59:529–33.Google Scholar
  28. 28.
    Mittmann N, Knowles S. A survey of Pharmacy and Therapeutic committees across Canada: scope and responsibilities. Can J Clin Pharmacol. 2009;16:e171–7.PubMedGoogle Scholar
  29. 29.
    Gafni A, Birch S. Inclusion of drugs in provincial drug benefit programs: Should “reasonable decisions” lead to uncontrolled growth in expenditures? CMAJ. 2003;168:849–51.PubMedGoogle Scholar
  30. 30.
    Tordoff JM, Murphy JE, Norris PT, Reith DM. Use of centrally developed pharmacoeconomic assessments for local formulary decisions. Am J Health-Syst Pharm. 2006;63:1613–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Esther Durán-García
    • 1
    Email author
  • Bernardo Santos-Ramos
    • 2
  • Francesc Puigventos-Latorre
    • 3
  • Ana Ortega
    • 4
  1. 1.Pharmacy Department (Servicio de Farmacia)Hospital General Universitario Gregorio MarañónMadridSpain
  2. 2.Pharmacy DepartmentHospital Universitario Virgen del RocíoSevilleSpain
  3. 3.Pharmacy DepartmentHospital Universitario Son DuretaPalma de MallorcaSpain
  4. 4.Pharmacy DepartmentClínica Universidad de NavarraPamplonaSpain

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