Drug Safety

, Volume 18, Issue 3, pp 153–159 | Cite as

The Application of Adverse Drug Reaction Data to Drug Choice Decisions Made by Pharmacy and Therapeutics Committees

An Australian Perspective
  • Lynn WeekesEmail author
  • Richard O. Day
Leading Article


Pharmacy and Therapeutics (P&T) committees undertake policy, regulatory and educational activities to promote rational use of medicines in their institutions with the aim of improving the quality of health and economic outcomes at these institutions. Formulary management is an important part of the P&T committees’ activities and making drug choices is one of the committees’ most difficult tasks.

The 3 types of information most commonly identified by P&T committees as necessary for making drug choices are effectiveness, safety and cost data; usually in this order of importance. There is some evidence, however, that safety data are not considered by all committees when they make decisions about adding a new drug to a formulary.

The role of adverse drug reaction (ADR) data in formulary decision-making (for registered drugs) occurs at several levels. First, ADR data obtained from pre-marketing studies of the drug are important and enable the committee to make an assessment of the risk of toxicity that should be anticipated for the drug. However, the limited nature of this information makes an absolute assessment impossible. Secondly, comparative safety information is necessary when deciding the place in therapy of a particular drug. Weighing up the comparative risks and benefits is a complex task which is a routine activity for most P&T committees whatever level of sophistication is applied. Thirdly, ADR data are an important ingredient of any economic assessment considered by a P&T committee. Calculation of the costs and consequences associated with the adverse effects of treatment demand careful assessment. Finally, aggregated adverse drug event reports which collate not only the consequences of adverse drug reactions but also medication incidents (medication errors) and which have been reported locally can be a useful quality assurance process for a P&T committee. This information will contribute to the identification of drugs for deletion from the formulary and less commonly in making decisions about additions to the formulary.

As formulary management forms only part of a P&T committee’s work, so the committee’s interest in ADR is broader than the use of these data in making drug choices. The P&T committee may also be involved in promoting ADR reporting to either a central database or primary carers.

Although often of limited availability, ADR information has an important role in the formulary management process of P&T committees.


Adis International Limited Adverse Drug Reaction Adverse Drug Event Medication Incident Adverse Drug Reaction Reporting 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Henriksen HH. A social scientific view on the development of Pharmacy and Therapeutics Committees. Soc Sci Med 1982; 16: 753–7PubMedCrossRefGoogle Scholar
  2. 2.
    Editor’s roundtable. Current formulas for P&T Committee success (Part 1). Hosp Formul 1987; 22: 288Google Scholar
  3. 3.
    Wilson JV, Hawkey CJ. Drug and Therapeutics Committees in the UK: 1981–1987. Br J Pharm Pract 1990; Jun: 198-205Google Scholar
  4. 4.
    Bochner F, Martin ED, Burgess NG, et al. Drug rationing in a teaching hospital: a method to assign priorities. BMJ 1994; 308: 901–5PubMedCrossRefGoogle Scholar
  5. 5.
    Weekes LM, Brooks C. Drug and Therapeutics Committees in Australia: expected and actual performance. Br J Clin Pharmacol 1996; 42: 551–7PubMedGoogle Scholar
  6. 6.
    Curtiss FR. Drug formularies provide a path to best care. Am J Health Syst 1996; 53: 2201–3Google Scholar
  7. 7.
    Rucker TD, Schiff G. Drug formularies: myths-in-formation. Hosp Pharm 1991; 26: 507–21Google Scholar
  8. 8.
    Anon. Current formulary decision-making strategies and new factor influencing the process: results of our national survey. Formulary 1995; 30: 462-71Google Scholar
  9. 9.
    Glaeske G. Quality control of drug prescriptions by positive lists — the European Formulary. Clin Pharmacol Ther 1994; 32: 403–8Google Scholar
  10. 10.
    Summers KH, Szeinbach SL. Formularies: the role of pharmacy-and-therapeutics (P&T) Committees. Clin Ther 1993; 15: 433–41PubMedGoogle Scholar
  11. 11.
    Dunford RW. Organisational behaviour: an organisational analysis perspective. Sydney: Addison-Wesley, 1992Google Scholar
  12. 12.
    Schumacher GE. Multiattribute evaluation in formulary decision making as applied to calcium channel blockers. Am J Hosp Pharm 1991; 48: 301–8PubMedGoogle Scholar
  13. 13.
    Denig P, Haaijer-Ruskamp FM, Wesseling H, et al. Drug expectations and drug choices of hospital physicians. J Intern Med 1993; 234: 155–63PubMedCrossRefGoogle Scholar
  14. 14.
    Asscher AW, Parr GD, Whitmarsh VB. Towards the safer use of medicines. BMJ 1995; 311: 1003–6PubMedCrossRefGoogle Scholar
  15. 15.
    Kresel JJ, Hutchings HC, MacKay DN, et al. Application of decision analysis to drug selection for formulary addition. Hosp Formul 1987; 22: 658–76PubMedGoogle Scholar
  16. 16.
    Eriksen S, Keller LR. A multivariate-utility-function approach to weighing the risks and benefits of pharmaceutical agents. Med Decis Making 1993; 13: 118–25PubMedCrossRefGoogle Scholar
  17. 17.
    Bates DW, Boyle DL, Van der Vliet MB, et al. Relationship between medication errors and adverse drug reactions. J Gen Intern Med 1995; 10: 199–205PubMedCrossRefGoogle Scholar
  18. 18.
    O’Hara DA, Carson NJ. Reporting of adverse events in hospitals in Victoria, 1994–1995. Med J Aust 1997; 166: 460–3PubMedGoogle Scholar
  19. 19.
    Weekes LM, Brooks C, Day RO, et al. Indicators for drug and therapeutics committees. Br J Clin Pharmacol 1998; 45: 1–6CrossRefGoogle Scholar

Copyright information

© Adis International Limited 1998

Authors and Affiliations

  1. 1.New South Wales Therapeutic Assessment Group Inc.DarlinghurstAustralia
  2. 2.St Vincent’s HospitalDarlinghurstAustralia

Personalised recommendations