BMJ  2005;331:515 (3 September), doi:10.1136/bmj.331.7515.515-b

Letter

Hospital formularies restrict evidence based practice

The first 150 words of the full text of this article appear below.

EDITOR—I agree with Maxwell that evidence based prescribing is complex and requires clinical experience, common sense, and some knowledge of clinical pharmacology.1 The drugs that I can prescribe are governed primarily by a strict hospital formulary and, in some cases, the primary care trust formulary. The formulary often has a limited number of drugs (often only one) that can be prescribed for each class, and the choice is often determined not by evidence but cost per tablet (and not even longer term cost effectiveness). This kind of restriction is often defended by policy-makers using the "class effect" argument. The hospital's necessity to slash the drug budget has led to some good drugs being excluded from the formulary, despite their use being supported by class A evidence and national clinical guidelines.

As clinicians, we are encouraged to practice evidence based medicine, and many of us spend hours every week . . . [Full text of this article]

Joseph Kwan, specialist registrar in geriatric medicine

Elderly Care Research Unit, Southampton General Hospital, Southampton SO16 6YD jk@1to1.org


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