Professional Documents
Culture Documents
Also more prevalent in federal hospitals and those location in states with laws
allowing therapeutic interchange. Hospitals gave the following reasons for not
engaging in therapeutic interchange : lack of acceptance by physicians, interference
with physicians right to select the drug, unnecessary risk of civil liability, violation of
laws, and expected benefits do not justify the cost
Therapeutic interchange in managed care organizations
Many managed care oraganizations have embraced therapeutic interchange as a
means of promoting appropriate theraphy and containing cost. In 1992, 23 % of
managed care organizations allowed therapeutic interchange, with staff model
HMOs having the highest prevalence (46%) and independent prac tice associations
(IPAs) having the lowest (17%).
A survey of HMOs conducted by doering and colleagues found that approximately
30% of respondents allowed therapeutic interchange, with the practice being more
prevalent in staff or group model HMOs and less prevalent in IPAs. Policies allowing
therapeutic interchange were found more frequently in HMOs with in house
pharmacies then those using contracted pharmacy services. Physicians knowledge
of patien specific therapeutic interchange was not require by HMO policy in 30% of
the reporting HMOs that allowed the practice to occur.
The Role of the pharmacist in therapeutic interchange
Pharmacists are involved in therapeutic interchange programs at both of the policy
and the practice level. Through their involment in pharmacy and therapeutic
commitees, pharmacist participate in the selection of therapeutic alternatives and
the development of therapeutic interchange guidelines as practicioners,
pharmacists implement therapeutic interchange guidelines. This procces included
assessing patients individually to determine the health and economic impact of
performing therapheutic interchange, informing patients abount the dispensing and
use therapeutic alternatives, and monitoring patient response.
Establishing therapeutic interchange guidelines
In the 1980s, the concept of therapeutic interchange came under attack by the
medical profession. Many of arguments against therapeutic interchange were
based on concerns that interchange might occur without physicians knowledge or
authorization. Recent emphasis on the implementation of therapeutic interchange
guidelines has decreased organized medicines concerns about practice.
The procces use to select therapeutic alternatives is important to ensure quality
patient care, provider and patient acceptance, and positive economic outcome.
Factor to be considered in determining that two or more products are therapeutic
alternatives are listed in table 9.6. the development of a therapeutic interchange