The evaluation and selection of medicines is one of the main tools of medicines policy in hospitals. Therapeutic developments of interest are studied to determine whether they should be included in the center’s Pharmacotherapeutic Guide (GFT). The decision-making process is carried out by the Pharmacy and Therapeutics Committees, which have been in operation for many years in almost all Spanish hospital networks.
Hospital pharmacy promotes and participates in the implementation and development of medicines selection processes. Their activities focus on knowledge management in the areas of information retrieval, critical review of the literature, comparative analysis of therapeutic alternatives, safety evaluation and pharmacoeconomics. Hospital pharmacy has developed evaluation and selection systems and procedures to perform these functions.
In recent years, in addition to increasing scientific and methodological rigor, the complex nature of hospital pharmacy has also increased, as selection is not limited to deciding on the inclusion of the new medicine in a formulary, but also to defining its therapeutic positioning and ensuring its suitability for the appropriate clinical indication and conditions of use.
The adoption of health economics criteria to the selection process to prioritize indications and identify the place of the new medicine in therapy is causally related to the efficient use of available resources.
In terms of selection, it should be noted that there is now a strong relationship and integration between specialized care and primary care leading to medicines selection activities and editing of the Pharmacotherapeutic Guide that encompass both areas.
Therapeutic Exchange Programs (PITs) is a new hospital concept. These are prescription assistance programs, which help the hospital doctor to select the most appropriate medicine from among those included in the Pharmacotherapeutic Guide. For each medicine described, advice is given on the therapeutic approach to be followed: continue treatment, discontinue treatment or replace it with an equivalent medicine.
The evaluation also makes it possible to determine when two or more medicinal products are considered to be homologous medicines a public procurement competitive tender process will determine which specific medicine will be made available in a facility. This makes procurement management easier for hospital pharmacy.
Finally, the selection of medicines is critical to ensuring that medicines are used with the highest guarantees of patient safety and to avoid medication errors. First, the very fact that selection limits the number of medicines and facilitates their correct handling and use. Second, because it incorporates safety criteria and risk detection and prevention systems into the selection process.
Traditionally, the medicines selection process has been carried out independently in each hospital center, with little collaboration and coordination experience among centers. Today, all aspects of health information and decision-making are increasingly interrelated. This is all taking place within the context of great dynamism and changes in the role of regulatory agencies and administrative actors, which will undoubtedly lead to major shifts in the coming years.
Hence the need for greater coordination and collaboration among hospitals and the expediency of promoting the GENESIS (Grupo de Evaluación de Novedades, EStandardización e Investigación en Selección de Medicamentos = New Product Evaluation, Standardization and Medicines Selection Research Group) working group within the SEFH (Spanish Society of Hospital Pharmacy).