Cross-sectoral pharmacotherapeutic coherence in the Netherlands

Abstract

Objectives - To measure the extent of pharmacotherapeutic coherence across sectors of Dutch health care from the hospitals' perspective, and to identify perceived markers of coherence and barriers to improvement. Methods - Telephone interviews were carried out with hospital pharmacists (76), community pharmacists (5), and clinical pharmacologists (9) affiliated to pharmacies serving 120 Dutch general hospitals. Coherence between (a) hospital and general practice, (b) hospital and nursing home practice, (c) hospitals, and (d) hospital inpatient and outpatient practice was reported and assessed against a set of indicators. Results - Almost all hospitals (93 per cent) had formulary agreements or prescribing policies in place and 86 per cent of these had a printed hospital drug formulary (HDF). Over 50 per cent of hospitals reported that they had established coherence with nursing home practice and/or with other hospitals. Less than half of the hospitals had established coherence with general practice. Few hospitals reported activities to review outpatient prescribing and its implications for follow-on prescribing in primary care. Reported barriers to increasing coherence could be classed into three categories: economic, organisational and social. Suggestions to enhance coherence included influencing professionals' practice through training, and greater use of regional and national policies on prescribing. Conclusion - Therapeutic coherence within Dutch health care is far from ideal. The discrepancy between the actual and desired extent of coherence arises from organisational and economic barriers. To date, activities in this area have relied on professional preactivity rather than a structured approach. To move forward, (dis)incentives should be created for health care providers and professionals across all sectors, including pharmacists and prescribers.