How to Develop a National Formulary Based on the WHO Model Formulary - A Practical Guide
(2004; 45 pages) View the PDF document
Table of Contents
View the documentAbbreviations
Open this folder and view contents1 INTRODUCTION
Open this folder and view contents2 OVERVIEW OF THE NATIONAL FORMULARY PROCESS
Open this folder and view contents3 DEVELOPING THE PRELIMINARY INFORMATION SECTION
Open this folder and view contents4 DEVELOPMENT OF THERAPEUTIC INFORMATION AND MONOGRAPHS USING THE WHO MODEL FORMULARY
Close this folder5 ADDITIONAL SOURCES OF INFORMATION
View the documentThe evidence-based approach in formulary development
View the documentInformation retrieval
Open this folder and view contentsTypes of source
Open this folder and view contentsSearching for the best evidence
Open this folder and view contentsAccessibility
View the documentCritical appraisal
Open this folder and view contents6 DEVELOPING SPECIFIC INFORMATION SECTIONS
Open this folder and view contents7 PRODUCTION, DISTRIBUTION AND IMPLEMENTATION
Open this folder and view contents8 EVALUATION
Open this folder and view contents9 REVIEW AND UPDATE
View the documentREFERENCES
 

Critical appraisal

Critical appraisal provides a systematic way of assessing the validity, results and usefulness of published literature. During critical appraisal we seek to answer the following questions:

1. Is this clinical trial (systematic review or guideline, etc.) valid? Several questions about methodology can be contained within this main query. Obviously, if the answers reveal significant flaws in the design of a clinical trial or consensus process of a clinical guideline that may lead to biased conclusions or recommendations, then this source should not be considered as a basis for making choices for drug therapies.

2. What are the valid results and are they important? If the evidence seems to be scientifically sound then we need to find out about the potential clinical benefits and adverse effects. To evaluate the clinical significance of the effects of a particular drug therapy we need to ask questions about the size of the effect and its relevance to clinical outcomes and the precision of the estimate. A statistically significant result may not actually bring clinically important benefits.

3. Will these results help locally? Questions should be asked about the transferability of the intervention, i.e. what are the differences between the study population and our patients, the potential benefits, adverse effects, cost-effectiveness and other possible outcomes in our local settings?


Sound evaluation of the primary and secondary literature about drug therapies requires good critical appraisal skills and sufficient time. For further information on how to develop appraisal skills and where to find appraisal tools for different types of study see the Critical Appraisal section of the major evidence-based practice gateway: Netting the Evidence.18

18http://www.shef.ac.uk/~scharr/ir/netting/


Table 5.1. Examples of the different types of sources and their accessibility in print or Online

TYPE OF SOURCE

ACCESSIBILITY

 

Print

Electronic products

Access to full text online

PRIMARY SOURCES

     

Annals of Internal Medicine

Internet version: <http://www.annals.org/>

via HINARI

British Medical Journal (BMJ)

Internet version: <http://bmj.com/>

Free for all

BioMed Central International Health and Human Rights

-

Internet version: <http://www.biomedcentral.com/bmcinthealthhumrights>

Free for all

New England Journal of Medicine

Internet version: <http://content.nejm.org/>

via HINARI

The Lancet

Internet version: <http://thelancet.com/>

via HINARI, certain articles free for all

SECONDARY SOURCES

     

Review type

     

ACP Journal Club

Internet version: <http://www.acpjc.org/?hp>

Subscription only

Evidence Based Medicine EBM

Internet version: <http://www.evidence-basedmedicine.com/>

Via HINARI

Clinical Evidence

Internet version: <http://www.clinicalevidence.com/>

Free for developing countries, see web site

The Cochrane Library

-

Desktop CD-ROM and Internet version: <http://www.cochranelibrary.net/cochrane/provisions.htm>

Several options for free access, see web site

Database of Reviews of Effectiveness

-

Internet version: <http://nhscrd.york.ac.uk/darehp.htm>

Free for all

Indexing type

     

Medline

-

Different platforms exist. Free Internet version: <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi/>

Free for all

CANCERLIT

 

Internet version: <http://www.cancer.gov/search/pubmed/>

Free for all

WHOLIS (WHO library database)

-

Internet version: <http://www.who.int/library/database/index.en.shtml>

Some free but not always full-text

African Journals online

-

Internet version: <http://www.inasp.info/ajol/index.html>

Free for all, abstracts only

TERTIARY SOURCES

     

American Hospital Formulary Service (AHFS)

Hand-held, desktop CD-ROM and Internet version: <http://www.ashp.org/ahfs/>

Single purchase for each edition

British national formulary (BNF)

Hand-held, desktop, Intranet and Internet version: <http://www.bnf.org/bnf/index.html>

Internet version free for all

Drug information handbook Ed. Lacy CF, Lexi-Comp, Hudson, US

-

Single purchase for each edition

Martindale: The complete drug reference

Desktop CD-ROM <http://www.micromedex.com/products/martindale/>

Single purchase for each edition

WHO model formulary

Internet version: <http://www.who.int/medicines/organization/par/formulary.shtml>

Internet version free for all

USP Drug information for the health care professional, Volume 1.

Desktop CD-ROM <http://micromedex.com/products/uspdi/v1/>

Single purchase for each edition

The Merck manual of diagnosis and therapy

Hand-held, desktop CD-ROM and Internet version: <http://www.merck.com/pubs/mmanual/sections.htm>

free Internet version

Via HINARI (Health InterNetwork Access to Research Initiative) provides free online access to more than 2200 high-quality biomedical journals and other sources for 69 low-income countries or access at a reduced rate of US$ 1000/annum for 43 middle-income countries. For more details on how to access these and to check your country’s eligibility see: http://www.healthinternetwork.org/src/eligibility.php

 

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