Buenos Aires—A computerized decision-making tool that considers evidence-based medicine plus factors like social, legal and ethical concerns is helping one Canadian determine which perioperative drugs to stock in their formulary.
The program, called Know4Go, was designed about four years ago by Janet Martin, PharmD, who has a master’s in health technologies assessment, at London Health Sciences Centre University Hospital, affiliated with the University of Western Ontario. Know4Go incorporates a mathematical formula calculating the impact not only of evidence-based medicine but also of factors she calls SLEEPERs—the social, legal, environmental, ethical, political, entrepreneurial, research and stickiness/reversibility issues that often are to blame when someone or something goes against evidence-based medicine when making formulary decisions.
The analytical tool is designed as a graph, with budget impact (the cost of a new drug or device per patient in their setting) along the y axis and the benefit impact (the number of eligible patients divided by the number needed to treat to prevent a bad outcome) along the x axis. The results help make apparent whether formulary decisions should be a ‘go’ or a ‘no-go’ relative to the next best alternative.
In a recent study, Dr. Martin and colleagues identified high-stakes perioperative drugs for review based on their likely clinical, economic and risk impact. They used Know4Go to calculate the benefit index based on local patient characteristics and number likely to be helped or harmed; estimate local budget impact; perform a SLEEPERs assessment; and make informed decisions.
Dr. Martin and her colleagues have used the program to evaluate more than $6 million of drug therapies at their hospital, according to an abstract presented at the recent World Congress of Anaesthesiologists meeting. The program helped them reverse a trend from rising drug costs in the two years before Know4Go was implemented to a steep decline after implementation, with an estimated savings of $1.1 million both from preventing the uptake of some expensive drugs and from eliminating orders of medications that were no longer helpful.
“Once something is in practice, it’s much harder to take it out instead of preventing it in the first place,” Dr. Martin told Pharmacy Practice News. “When making decisions, we have to make trade-offs and decide what we’re going to do and not do, recognizing we can’t do it all or all at one time. Know4Go ensures we take the opportunities with the maximum benefit.”
The program has improved staff collaboration and reduced confusion between contrary evidence and opinions, Dr. Martin said. In addition, “when we put a decision on the table, if we say no, it’s not that the decision is permanently no, it’s just not right at this time, so that has made things more comfortable.”
Several hospitals have approached Dr. Martin about using Know4Go. She has started working on a new version of the program that could be adopted by other facilities. She also has been using Know4Go to evaluate whether the hospital should adopt other health technologies.
John Poikonen, PharmD, director of clinical informatics at the University of Massachusetts Memorial Medical Center in Worcester, called the technology “pretty cool and interesting” but said the process for evaluation would have to be made evident to stakeholders because “sometimes there is an overreliance on local opinion and culture over medical evidence.” Added Dr. Poikonen, “I’m excited to see this in the public domain or as an open-source product for people to use and adapt.”