EVALUATION OF TYPE C HOSPITAL FORMULARY IN

YOGYAKARTA
Anggriani Y, Pudjaningsih D, Suryawati S
Department of Clinical Pharmacology, Faculty of Medicine,
Gadjah Mada University, Yogyakarta

Background
Many pharmaceutical products on the market are new
and non-essential.
Strong hospital drug policy and instruments is needed
to manage the hospital formulary list, due to increasing
number of new drugs being introduced to medical
doctors.
Hospital formulary list is often developed without
adequate process
Even if there is a guideline, the decision is often based
on individual interest.

Quality of hospital
formulary?

Objectives

To evaluate and to compare the quality of 7

hospital formularies.
To determine the processes used to maintain the
formulary in each hospital

Methods

Descriptive-analytical, explorative case study

5 Public and 2 Private Hospitals
Seven Hospital Formulary Lists were evaluated
Quantitative data: total number of drugs on the list, number of
drugs in brand name, number of drugs in generic name,
number of essential drugs, number of drugs supported by
primary literature, number of generic drugs available, and the
number of non-formulary drug procured and kept in stock.
Qualitative data:
In-depth interviews with Drug and Therapeutic Committee
(DTC) members and representative doctors from 4 wards
(Obstetrics and Gynecology, Pediatrics, Surgery, and
Internal Medicine).
Observation on minutes of DTC meetings

Outcome Measures
The quality of hospital formulary was measured by looking at
some indicators, i.e.,:
Number of brand-name products
Percentages of generic drugs on the list
Percentages of essential drugs (drug from NEDL)
Percentages of drugs supported with the primary literature
Percentages of drugs with a single ingredient
Percentages of generic drugs kept in stock
The process of maintaining a formulary was measured by:
The frequency of revision formulary list
Percentage of non-formulary drugs procured and kept in
stock
Observation on minutes of DTC meetings.

Results 1: The values of each indicator in 7

hospitals
Indicators

Public Hospitals

Private Hospitals

No. Active ingredients

525

441

382

532

296

513

1575

No. Brand-name
products

619

570

388

686

308

1002

2153

% Generic drugs on the

list

37

35

26

34

50

17

18

% Drugs from NEDL

61

41

49

41

71

28

20

% Drugs with primary

literature

61

41

49

41

71

28

20

% Drugs with single

ingredient

90

77

73

80

90

67

73

% Generic drugs kept in

stock

31

26

29

27

48

16

13

Hospital E shows relatively better performance compared to the other

hospitals
Hospital G shows the worst performance among 7 hospitals

Results 2: Number of non-formulary drugs

vs frequency of revision
Public Hospitals

Private
Hospitals

Indicators
A

% Non-formulary
drugs procured

31

34

24

65

% Non-formulary
drugs in stock

41

27

36

28

64

Frequency of revision

1995

2000

1999

2001

2001

1996

2001

Year of the newest

edition

Hospital E, which has better quality of formulary is among the

most frequently revised

Results 3: Step in developing hospital

formulary list
1.
2.
3.

4.

5.

Listing all drugs available in stock

Distributing the existing drug list and drug request
forms to medical doctors
Establishing criteria for drug selection and revise
formulary in DTC meeting.
Parties involved : DTC members and Doctors
Discussing the requests
request is discussed only if attended by doctors
who request the new drug
Official announcement of the new formulary by the
hospital director.

Results 4: Mechanisms of new drug

additions into formulary
Hospital B, C, D and E

Hospital A, F, G

Fill in the drug request form

Fill in the drug request

form

Submit to pharmacy
department
Discuss drug requests in DTC
meeting
Distribute supplementary
formulary
Procured by the pharmacy
department

Submit to pharmacy
department
Procured by the
pharmacy department

DISCUSSION

This study found the method was easy to use. Therefore,

its use in routine hospital evaluation is promising, e.g., for
accreditation system.

Although still far from the ideal, this method is sensitive

enough to show the difference between hospitals. Such
instruments can also be used as indicators in improving
the quality of hospital formulary.
Hospital formulary list should ideally develop from
hospital standard treatment guidelines (STGs). An
indicator should be added to evaluate the percentage
of active ingredients which are not in the STGs.

CONCLUSIONS
1. Although no hospital showed ideal formulary list, the
quality of public hospital formularies was relatively
better than that of private hospitals formularies, due to:
Tendency of DTC in private hospitals to
accommodate the doctors request
Doctors general perception that essential and
generic drugs are not sufficient to clinical needs
2. The mechanism to manage hospital formulary is not
well established, mostly because regular meetings for
formulary revision in not yet established

Terima kasih
(thank you)