A Survey of Therapeutic Substitution Programs in Ten Boston Area Hospitals

To generate descriptive data about the process of therapeutic substitution, a survey was conducted in 10 hospitals in the Boston area. Interviews were conducted with 10 Pharmacy and Therapeutics (P&T) Committee Chairpersons and 10 Pharmacy Directors. Questionnaires were mailed to 416 physicians and 78 staff pharmacists in the 10 hospitals. Three policies emerged with respect to contacting the prescribing physician to obtain immediate prior approval for the dispensing of a therapeutic alternate: “no contact,” “variable contact,” and “full contact.” Of 230 responding physicians, 172 (74.8%) rated themselves as either somewhat or not informed about the prescription drug policies and procedures in their hospital. Of the 166 physicians working in the “no contact” and “variable contact” settings, 93 (56%) stated they were unaware or uncertain whether therapeutic substitution was being practiced in their work setting. The selection of specific therapeutic alternates appeared to involve a thoughtful and balanced investigation at the P&T level; however, a significant gap in the process was evidenced by the absence of a legal opinion or risk management guideline on therapeutic substitution. For the hospitals surveyed, the data suggest a need to reexamine the implementation phase of such programs and to consider an increased emphasis on in-house education on pharmacy policies and procedures in general and on therapeutic substitution in particular