|Treatment Guidelines and Formulary Manuals. (MDS-3: Managing Access to Medicines and Health Technologies, Chapter 17)
(2012; 17 pages)
Treatment guidelines are disease oriented and reflect a
consensus on the treatments of first choice for a range of
medical conditions. A formulary manual is drug oriented
and contains summary drug information on a selected
number of medicines, sometimes combined with practical
prescribing and dispensing information. They can
both be developed for various levels of health care.
The process of developing these publications (the formulary
process) is a continual effort, not limited to the
one-time production of a set of treatment guidelines
or a formulary manual. The process includes gaining
acceptance of the concept, preparing a text on the basis of
wide consultation and consensus building, implementing
an introductory campaign and training activities, and
undertaking regular reviews and updates.
Treatment guidelines can be made for one institution,
such as a hospital; for one level of care, such as all health
centers; or for a region or nation. Treatment guidelines
are powerful tools to promote rational prescribing, provided
they are based on extensive involvement of the
end users. Their development is a good opportunity to
integrate technical advice from various disease programs
into an overall training program. Treatment guidelines
should be used as the basis for undergraduate medical
and paramedical training, for in-service training, for
supervision, and for medical audit. The range of medicines
included should be limited to those on the national
list of essential medicines.
A formulary manual, whether at a national or facility
level, should be developed by a formulary subcommittee
of the national drug committee or the facility’s drug and
therapeutics committee. Both committees should ensure
the full participation of prominent specialists and health
opinion leaders in the process. One or two editors should
be commissioned to draft and edit the formulary manual.
To maintain the credibility of the information, a system
for regular updates and for incorporation of accepted
amendments into the next edition is essential for both
formularies and treatment guidelines.
This chapter builds on concepts introduced in Chapter
16, which should be read first.