Do Institutional Formulary Systems Conflict with the Provision of Pharmaceutical Care
Bibliographic record
Abstract
Almost all pharmacists working in Canadian hospitals and health-care institutions practice in a setting where a drug formulary specifies the medications available for treating patients. The drug formulary can be defined as a continually revised compilation of medications reflecting the current clinical judgement of local staff regarding the medications necessary to treat the local patient population. The formulary system is the method whereby physicians, pharmacists, and other members of the health-care team work to select the medications considered most useful for patient care and thereby ensure quality drug use while controlling costs. 1 “Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life. Pharmaceutical care involves the process through which a pharmacist cooperates with a patient and other professionals in designing, implementing, and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient.” 2 Yet restriction of the choice of drug therapy to a limited number of therapeutic options could theoretically conflict with optimal drug therapy for individual patients. Is it reasonable that we, as practitioners attempting to achieve specific therapeutic outcomes for individual patients, are limited in our choice of therapies because of a restrictive formulary? The “knee-jerk” response to this question would be that clinicians should not be limited in their therapeutic choices by a formulary, but a more holistic view of care lessens the potential for conflict between the formulary system and pharmaceutical care. The goals of the formulary system are consistent with the goals of pharmaceutical care. Formularies are established to ensure the availability of the drug therapies used to treat the conditions experienced by the patients served by the institution. The decision to add a drug to the institution’s formulary should be based on scientific data that have been evaluated impartially by clinicians familiar with anticipated therapeutic indications and alternative therapies. By assessing other available therapies, the formulary addition process minimizes redundant therapeutic options. This will reduce the costs of inventory management, drug storage and preparation, and staff education. The formulary evaluation process also prompts reevaluation of existing therapies in terms of more recent advances so that potentially outdated or toxic therapies can be
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.060 | 0.159 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.020 | 0.034 |
| Scholarly communication | 0.025 | 0.023 |
| Open science | 0.006 | 0.014 |
| Research integrity | 0.010 | 0.012 |
| Insufficient payload (model declined to judge) | 0.017 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".