Drug Funding Decision-Making in Hospital Formulary Committees in Germany

Rübesam, Tim (2015) Drug Funding Decision-Making in Hospital Formulary Committees in Germany. DBA thesis, University of Gloucestershire.

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Abstract

BACKGROUND: Hospital formularies are usually the gatekeepers for pharmaceutical drugs. Typical majority members of hospital formularies are physicians, although most of the time the formulary is chaired by a pharmacist. As German hospitals are struggling with a difficult economic environment the question arises: what kind of decision-making criteria are applied when pharmaceutical drugs should be added to the formulary list? Information regarding this topic is scarce due to the sensitive topic of decision-making. OBJECTIVES: Build a single decision-making framework which will be created to explain hospital drug funding decision-making and identify underlying mechanisms which explain processes and structures. The results can be used by hospitals to initiate knowledge sharing and provide a basis to analyse local formulary committee decision-making practice. Additionally, they can be used by the pharmaceutical industry to better adapt to the specific needs of the hospital decision-makers. METHODS: In this study, a mixed-methods approach has been used to confirm and further detail a preliminary hospital formulary decision-making framework derived from literature. An online survey was used to get insights on the structure of German hospital formularies and the relative importance of different decision-criteria. Additional semi-structured expert interviews were used to get in-depth information on the underlying mechanisms which influence decision-making on drug funding. RESULTS: Decisions for or against a pharmaceutical drug are influenced by a variety of perceived objective and specifically subjective criteria. Despite a consistency in a dominant, high impact role of pharmacists and lead physicians every hospital formulary member has different relative weighting of decision criteria. Drug funding decision-making in German hospital formularies is highly individual but usually starts with a quasi-rational preference influenced by a mixture of analytic and intuitive criteria. The decision to use more analytic or more intuitive criteria is influenced by a variety of factors. The two most important ones are uncertainty and power. The resulting individual preference is then challenged and adapted in a group decision-making process.

Item Type: Thesis (DBA)
Thesis Advisors:
Thesis AdvisorEmailURL
Pioch, Elkeepioch@glos.ac.ukUNSPECIFIED
Jain, Mohitmjain@glos.ac.ukUNSPECIFIED
Uncontrolled Keywords: Pharmaceutical drugs; Decision-making model; Hospital formularies; Pharmaceutical treatment, economic factors; Germany
Subjects: R Medicine > RM Therapeutics. Pharmacology
Divisions: Schools and Research Institutes > Business School > Business and Human Resource Management
Depositing User: Susan Turner
Date Deposited: 26 Apr 2016 09:51
Last Modified: 22 Sep 2016 11:23
URI: http://eprints.glos.ac.uk/id/eprint/3432

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