Drug and Therapeutics Committee Structure and Roles in Hospitals: A Scoping Review
Abstract:
Drug and Therapeutics
Committees (DTCs) have been identified and promoted as a fundamental model in advancing
the rational management and use of essential medicines and health supplies in hospitals
since the 1970s. However, there is still a scarcity of comprehensive literature
on their current structure and actual roles performed in various countries. We conducted
a scoping review using the Pubmed and ResearchGate databases and included eligible
articles published between 2010 and 2023, to assess the structure and roles performed
by hospital DTCs. The database search yielded 47 potential records, but only seven
of these were eligible for inclusion. Studies included were from both high-income
and low- and middle-income countries. The structure of DTCs is generally similar
across these countries, with minor contextual variations. All DTCs are heterogeneous
in composition and contain both medical and non-medical staff. The DTC leadership
comprises a chairperson who is usually a senior clinician, and a secretary who is
usually a pharmacist. The majority of the DTCs have at least one sub-committee,
and antimicrobial stewardship is the most common. The DTCs still perform their customary
roles, although their role scope is expanding. In some countries, the DTCs have
taken on additional roles due to the evolving medicines management and use problems,
and technologies. There is however still a dearth of recent primary data on the
structure and roles of DTCs in many countries. We recommend more primary research
to understand the status of DTCs in various countries and to provide more insights
into the existence and functionality of the DTC sub-committees.
References:
[1] Religioni
U, Pakulska T. Rational drug use in hospital settings – areas that can be
changed. J Med Econ [Internet]. 2020;23(10):1205–8. Available from: https://doi.org/10.1080/13696998.2020.1801455.
[2] Tan EL,
Pharm B, Hons BP, Ph D, Day RO, P FRAC, et al. Perspectives on Drug and
Therapeutics Committee policy implementation. 2010;1(2005):526–45.
[3] World
Health Organization. Drug and Therapeutics Committees. A practical Guide.
Holloway K, Terry G, editors. Geneva: World Health Organization; 2003.
[4] Tan EL,
Day RO, Brien J anne E. Drug and therapeutics committees — are they fulfilling
their potential to improve the quality use of medicines? Int J Pharm Pract. 2010;11(3):175–81.
[5] Fadare
JO, Ogunleye O, Obiako R, Orubu S, Enwere O, Ajemigbitse AA, et al. Expert
Review of Clinical Pharmacology Drug and therapeutics committees in Nigeria:
evaluation of scope and functionality. Expert Rev Clin Pharmacol [Internet].
2018;11(12):1255–62. Available from: https://doi.org/10.1080/17512433.2018.1549488.
[6] Res M.
Rational use of medicines: Cost consideration & way forward.
2016;(October):502–5.
[7] Shankar
PR, Humagain ÆB, Nisha RMPÆ, Bidur JÆ. Establishing and strengthening a
medicine and therapeutics committee in a medical college in Nepal: initial
experiences. 2009;241–5.
[8] Seyoum
H, Feleke Z, Bikila D, Yaregal A, Demisie A, Ali S, et al. Drug and
Therapeutics Committee (DTC) evolvement and expanded scope in Ethiopia. Gates
Open Res. 2023; 5:70.
[9] Vogenberg
FR, Gomes J. The Changing Roles of P & T Committees A Look Back at the Last
Decade and a Look Forward to 2020. 2020;39(11).
[10] Mashaba
TP, Matlala M, Godman B, Meyer JC, Mashaba TP, Matlala M, et al. Expert Review
of Clinical Pharmacology Implementation and monitoring of decisions by pharmacy
and therapeutics committees in South African public sector hospitals
Implementation and monitoring of decisions by pharmacy and therapeutics. Expert
Rev Clin Pharmacol [Internet]. 2018;00(00):1–10. Available from: https://doi.org/10.1080/17512433.2018.1545572.
[11] Yang J,
Yu- LZMS. Evaluating the effectiveness of drug and therapeutics committees (DTCs)
in controlling irrational drug use: A retrospective analysis. 2022;(December
2021):995–1001.
[12] Perrone
J, Nelson LS. Pharmacy and Therapeutics Committees: Leadership Opportunities in
Medication Safety for Medical Toxicologists. 2011;99–102.
[13] Matlala
M, Gous AGS, Godman B, Meyer JC, Matlala M, Gous AGS, et al. Expert Review of
Clinical Pharmacology Structure and activities of pharmacy and therapeutics
committees among public hospitals in South Africa; findings and implications.
Expert Rev Clin Pharmacol [Internet]. 2017;00(00):1–8. Available from: https://doi.org/10.1080/17512433.2017.1364625.
[14] Marcos-rodríguez
JA, Cordero-ramos J, Alvarado-fernández MD. Policy Multi-criteria Decision
Analysis as a Decision-Support Tool for Drug Evaluation: A Pilot Study in
Pharmacy. 2018.
[15] Santos-ramos
B, Dura E. Literature review on the structure and operation of Pharmacy and
Therapeutics Committees. 2011;475–83.
[16] Hoffmann
M. The right drug, but from whose perspective? A framework for analysing the
structure and activities of drug and therapeutics committees. 2013; 69:79–87.
[17] Page
MJ, Mckenzie JE, Bossuyt PM, Boutron I, Hoffmann C, Mulrow CD, et al. The
PRISMA 2020 statement: an updated guideline for reporting systematic reviews
Systematic reviews and Meta-Analyses. 2021.
[18] Tricco
AC, Lillie E, Zarin W, Brien KKO, Colquhoun H, Levac D, et al. R ESEARCH AND R
EPORTING M ETHODS PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist
and Explanation. 2018;(August 2016).
[19] Mak S,
Thomas A. Steps for Conducting a Scoping Review. J Grad Med Educ.
2022;14(5):565–7.
[20] Peters
MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for
conducting systematic scoping reviews. Int J Evid Based Healthc.
2015;13(3):141–6.
[21] Maros
H, Juniar S. Beginer’s guide for systematic reviews. 2016;1–23.
[22] Almeida
CPB de, Goulart BNG de. How to avoid bias in systematic reviews of
observational studies. Rev CEFAC. 2017;19(4):551–5.
[23] THe
World Bank Group. Country classification by income [Internet]. [cited 2023 Aug
21]. Available from: https://datahelpdesk.worldbank.org/knowledgebase/topics/19280-country-classification.
[24] Alefan
Q, Alshareef S, Al-Shatnawi S. Drug, and therapeutics committees in jordanian
hospitals: A nation-wide survey of organization, activities, and drug selection
procedures. Pharm Pract (Granada). 2019;17(4):1–6.
[25] Plet
HT, Hallas J, Nielsen GS, Kjeldsen LJ. Drug and Therapeutics Committees in
Danish Hospitals: A Survey of Organization, Activities and Drug Selection
Procedures. Basic Clin Pharmacol Toxicol. 2013;112(4):264–9.
[26] Puigventós
F, Santos-Ramos B, Ortega A, Durán-García E. Structure and procedures of the
pharmacy and therapeutic committees in Spanish hospitals. Pharm World Sci.
2010;32(6):767–75.
[27] Kabba
JA, Koroma MM, James PB, Kitchen C, Xu S, Chang J, et al. Pilot drug, and
therapeutic committee programme in Sierra Leone: A descriptive mixed method
study. Br J Clin Pharmacol. 2023;89(1):20–33.
[28] Ministry
of Health. Medicine and Therapeutics Committees Manual. 2018;(December):173.
Available from: https://health.go.ug/sites/default/files/MTC Manual FINAL_print
copy_21st Jan_19 %281%29.pdf.
[29] Ministry
of Health Kenya. Guidelines for the Establishment and Operationalization of
Medicines and Therapeutics Committees. 2020;(October).
[30] Management
Sciences for Health. Treatment Guidelines and Formulary Manuals. MDS-3Managing
Access to Med Heal Technol. 2012;17.1-17.5.
[31] Ciccarello
C, Leber MB, Leonard MC, Nesbit T, Petrovskis MG, Pherson E, et al. ASHP
Guidelines on the Pharmacy and Therapeutics Committee and the Formulary System.
Am J Heal Pharm. 2021;78(10):907–18.
[32] 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 Heal Pharm. 1999;56(7):622–8.
[33] Björkman
IK, Bernsten CB, Schmidt IK, Holmström I. The role of drug and therapeutics
committees: Perceptions of chairs and information officers. Int J Health
Care Qual Assur. 2005;18(4):235–48.
[34] Ramli
A, Aljunid SM, Sulong S, Yusof FA. Structures and activities of Drug and
Therapeutic Committees in formulary management: findings from a national survey
and key informant interviews. 2014;14(Suppl 1):2458.