National Survey of Pharmacy and Therapeutic Committees in Saudi Arabia : Scope , Structure and Responsibilities

Yousef Ahmed Alomi* , General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia. Sultan Mohammed Al-Jarallah, Ambulatory Care Pharmacy, Oncology and Hematology Clinical Pharmacist, Pharmaceutical Care Department, Security Forces Hospital, Riyadh, SAUDI ARABIA. Rasha Abdelsalam Elshenawy, Ministry of Health, Makkah, SAUDI ARABIA. Faiz A. Bahadig Rph, Informatics Pharmacist, Pharmaceutical Care Department, King Abdulaziz Medical, City-WR-Jeddah, Ministry of National Guard, Saudi Arabia


INTRODUCTION
In every hospital, medications and medical supplies are critical to the delivery of services. However, according to the WHO, the availability of the drugs in the hospital depends not only on good supplies but also on their efficient management of medication. One of the most critical approaches has been to improve medication management and use in various health settings. In a hospital setting, Hospital Pharmacy and Therapeutics Committees "PTC Committee" is a practical approach in ensuring that medicines are used in a safe, appropriate and cost-effective manner. [1,2] The Pharmacy and Therapeutics Committee (PTC), sometimes aptly named the Formulary Committee. Formularies have been used by a broad spectrum of organizations in the USA. [3] PTC used to determine the hospital for-mulary and addition and deletion of new pharmacotherapeutic and diagnostic agents for the hospital. This committee typically consists of a multidisciplinary team of pharmacy, physician, nursing and hospital clinical and administrative leadership. [1,2] Several studies had been done around the world discussed the scope and activities of PTC. [4] For instant; The Structure and procedures of the pharmacy and therapeutics committees in Spanish hospitals reveals that PTC Committees have looked like a structure and function with multidisciplinary professional composition. They addition or deletion drugs is similar in different types of hospital. [5] In the study of the Structure and activities of hospital drug committees in Germany. At 53.2% of drug committees, a phar-macist holds the position of chairman, followed by medical specialists (32%); clinical pharmacologists hold this position in only 7.7% of the general hospitals. The number of members in between 5-40 with a median 12. [6] In the local study of the characteristics of the Pharmacy and Therapeutic Committees in Saudi Hospitals, reveals that of 30 hospital pharmacies, 23 (76.6%) pharmacy managers responded. The average total number of the PTC committee members is (13.5) and dominated by physicians (6.9), pharmacists (2.7) and nurses (1.4) and the pharmacist coordinated all surveyed committee. [7] In the Ministry of Health of Saudi Arabia, the PTC well established before than 30 years ago with peripheral regional PTCs. They had a systemic way of formulary system and addition and deletion medication from the MOH drug formulary. [8,9] Besides, the PTC has proven to be effective in improving prescribing, dispensing and resource allocation and management, according to the Saudi Central Board for Accreditation of Healthcare Institutions "CBAHI" Standards; as the hospital establishes a multidisciplinary team of the pharmacy and therapeutics committee for oversight of the hospital formulary and medication use. [10] However, in practice, the central or regional PTCs scopes, structure and responsibilities should be the same and there is very few excised studies based of the best knowledge to explore those parameters in local country or Gulf and Arab countries. [7] This study aims to assess the Therapeutic Committee at MOH hospitals in the Kingdom of Saudi Arabia: Scope, structure and responsibilities.

METHODS
It is a 4-month cross-sectional survey of National Survey of Pharmacy and Therapeutics Committee at MOH hospitals in Saudi Arabia The survey consisted of 93 questions divided in two parts: The first part collects the demographic information, the second part contains questions on 4 domains: (1) scope, structure and responsibilities, that is including questions about the pharmacy and therapeutic committee membership, clear mission, vision and values of the pharmacy and therapeutic committee, the responsibilities of the PTC committee and the Sub-committees of Pharmacy and Therapeutic Committee, (2) formulary management system, (3) evaluation of drug formulary and decision-making, (4) committee meetings organization and management. The survey drives from previous literature and local regulation and American Society of Health-System Pharmacists (ASHP) standards of PTC and Formulary system. [1,2,8,9,11,12] All Pharmacoepidemiology or review investigates of PTC included the study and any comparative of PTC studies or perception excluded from the study. The 5-point Likert response scale system closed and ended questions used. The survey was distributed to fifty Drug Information Center at the Ministry of Health hospitals. All size capacity or type of specialty hospital was included in the study. The survey was in an electronic format and it analyzed scope, structure and responsibilities through survey monkey system.

DISCUSSION
The Ministry of health updated all healthcare systems, administration and committee related issues based on MOH strategic plan 2010-2020. [13,14] The pharmacy and Therapeutic committee are new names after updating of old updating MOH drug formulary. The committee head by assistant minister, deputy for medical supply and logistic and membership of directors of medical supply general administration, Pharmaceutical Care general administration, national drug information center, a clinical pharmacist from the hospital, Pharmaceutical planning of medical supply, Pharmacoeconomic pharmacist, the meet on a monthly basis. During the period of membership as director of general administration of Pharmaceutical Care, the committee made significant reductions as follows, but not lim-ited to, for instants; the committee updated and added more five hundred new line items. The committee updated primary care medical list, updated Cardiopulmonary Resuscitation (CPR) medication list for adults and pediatric. The committee added a ready-made, fixed standard concentration of some CPR medication. The committee supports the Implementation of the medicines safety program. Also, the updated some pharmacy services including intravenous admixture services at more thirty hospitals. [8,9] In the study, the authors utilized drug information center pharmacy because the PTC part of the drug information center duties and expected drug information pharmacists should be an active member of the PTC. The study finding should most of the drug information pharmacist were Saudi and that is expected because of the Saudization policy in KSA. Most drug information pharmacists had a bachelor's degree because of the new system of Pharm D in college of pharmacies. The findings of the study showed the head of the pharmacy department, medical directors, medical physicians and drug information pharmacist most active members in the PTC similar to previous study. [7,15,16] That is expected because the old regulations of PTC which composed of those members while the medication safety officer or pharmacy informatics or critical care departments and emergency or nursing not commonly had members not part of the old regulation. The update regulation of PTC is required to activate the role of other essential pharmacy or medical departments. Despite the local standers of pharmacy accredited emphasized of PTC; still, some hospital did not have some primary elements of PTC, including vision or mission and objective and functions similar to the previous study. [7] That may lead to PTC not function well in practice and subsequent not accredited by local or international institutions. Besides, some functions of PTC not implemented, especially in the medication's safety and similar to what it should in the current study. The results should drug accepted or reject of drug hospital formulary the primary function while drug monitory or evaluation system and off labeled or therapeutic interchange not fully implemented and functioning well as most the hospital. That may lead several discrepancies in the medication safety and additional economic burden on the healthcare system at MOH institutions. The most subcommittee functioning in the surveyed hospital was antibiotics and medications, safety subcommittee, while one-quarter of the hospital had not any functioning subcommittee. According to the ASHP Guidelines on the pharmacy and therapeutics committee and the Formulary System. The PTC committee may find subcommittees that address specific therapeutic areas  to be beneficial (e.g., antimicrobial, cancer chemotherapy, cardiovascular, adverse-drugreaction, or biotechnology subcommittees). [1,2] Despite the antimicrobial stewardship and medication safety program established at MOH, [17,18] it seemed antibiotics or medications safety subcommittee not functioning well because the main scopes or functions not implemented well in practice. Besides, the drug utilization and therapeutic guidelines subcommittee was not active at more than eighty percent of the hospitals. Some very important subcommittee was not existed at most of the hospitals nutrition support committees for adults and pediatrics or pain management or anticoagulants subcommittee. Those necessary subcommittees were essential to run some national clinical and pharmacy practice programs at that are times. [19,20] The scopes or functions and responsibilities of PTC was not active well at most of the hospitals. An education course about PTC is required for all MOH hospitals and close monitoring of the implementation of the update PTC system is highly recommended at all MOH hospital in the Kingdom of Saudi Arabia.

CONCLUSION
The scopes and functions of PTC at MOH hospitals are not adequately implemented. The PTC membership regulation is old and should be updated. The subcommittees of PTC were few and should expand in quantity and quality manner. Targeting of education and training of PTC members is required with an annual survey of PTC scopes and responsibilities is highly recommended in the Kingdom of Saudi Arabia.

CONFLICTS OF INTEREST
The authors declare no conflicts of interest.