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Learning Objectives
After completing this chapter, the reader will be able to:
Describe the pharmacy and therapeutics (P&T) committee.
Define the functions of the P&T committee.
Describe attributes and structure of a P&T committee likely to promote its ability to function successfully.
Describe where and how the P&T committee fits into the organizational structure of a health care institution or other groups.
Describe how the pharmacy department participates in P&T committee activities.
Describe and explain the concepts of drug formularies and drug formulary systems, and how pharmacy participates in their establishment and maintenance.
Describe how P&T committee activities contribute to the quality improvement of medication use.
Describe how to develop policies and procedures for the process of medication use.
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Key Concepts
A pharmacy and therapeutics (P&T) committee, or its equivalent, oversees all aspects of medication use within an institution, health plan, or health care system.
While P&T committees have traditionally been associated with institutional pharmacy, other organizations (e.g., pharmacy benefit managers, outpatient infusion centers, specialty pharmacies) and governmental agencies (e.g., Indian Health Service, Veterans Affairs, and Department of Defense) are using P&T-type committees in an attempt to improve drug therapy while lowering costs.
More than one formulary may be necessary for an institution or health system.
Although it is common for pharmacists to downplay or misunderstand the importance of P&T committee support in comparison to other clinical activities, such support is vital for pharmacy to impact patient care.
A P&T committee may find it necessary to create ad hoc committees to address various issues, depending on their complexity and size.
Typically, P&T committee functions include determining what drugs are available on formulary, who can prescribe specific drugs, policies, and procedures regarding drug use (including pharmacy policies and procedures, clinical protocols, standard order sets, and clinical guidelines), what to do about counterfeit drugs or drug shortages, performance improvement, as well as quality assurance activities (e.g., drug utilization review/drug usage evaluation/medication-use evaluation, as well as compliance surveillance), adverse drug reactions/medication errors, dealing with product shortages, and education in drug use.
A variety of topics regarding the quality of medication use, inclusive of applicable medication metrics, are normally part of the activities of a P&T committee.
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When considering how a clinician can have an impact on a patient’s drug therapy, it is common to consider the individual practitioner caring for a specific patient or, perhaps, a small group of patients. Certainly, the clinician can have a deep impact this way, but he or she does have the disadvantage of dealing with a very limited number of patients. In order to efficiently impact a population of patients, a different approach is necessary. Fortunately, there is the opportunity to participate in the activities of a P&T committee or its equivalent, which generally oversees all aspects of medication use in an institution, health plan, or ...