Perceptions and Opinions of Canadian Hospital Executives: DISCUSSION part 2
The lack of variation in responses across the various regions of Canada was surprising. The only statistically significant difference in responses by geographic region was the higher average scores in Quebec than in British Columbia and Ontario for perceived importance of prior authorization requirements as a method to optimize the use of pharmaceuticals. This difference may be explained, in part, by Quebec’s Public Heath Act and related regulations requiring that heads of hospitals and pharmacy departments follow drug utilization rules, which can include a prior authorization mechanism (i.e., a drug can be prescribed and dispensed once approved by an infectious disease specialist, a pharmacist, or other health care professional).
The qualitative findings presented here identify individual opinions about “value for money” in terms of pharmaceuticals and an indication of access to information sources to determine this value. However, the opinions and experiences of respondents who answered the open-ended survey questions are not necessarily typical or widespread; as such, the findings are not generalizable and do not provide an estimate of the prevalence of certain opinions.
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Interestingly, there was remarkable consistency in responses in relation to the demographic variables. Other than the few cases highlighted previously, the responses did not differ by region, job title, sex, or other variables. This is somewhat surprising, given differences in drug policies across Canada and differences in the expected level of medication management competencies of individuals at different stages of their careers (supervisors or CEOs) or in different health care settings (hospitals or long-term care).
The results of this study also suggest directions for future research in this area. First, further work is needed to determine the types of education related to medication management that executives and managers need, suitable methods for providing that education, and the career stages at which it is appropriate to do so. Second, the perceptions identified in this survey regarding the methods most important to optimize pharmaceutical use should be compared with the scientific evidence. Although respondents believed that clinical practice guidelines represent the best method to optimize the use of pharmaceuticals, the effectiveness and cost-effectiveness of such guidelines relative to other methods such as tiered formularies (identified as the least important method of optimizing the use of pharmaceuticals) must be determined and communicated.
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This study had some limitations. First, nonresponders were not surveyed to determine why they were unwilling to complete the survey. However, the similarity in demographic characteristics between the general membership of CCHSE and the respondents suggests that the results reported here are generalizable to other health care managers and executives. Second, some respondents might not have been knowledgeable about issues related to pharmaceuticals. Presumably, those with no interest or expertise in pharmaceuticals would not have responded to the survey, but this cannot be known for certain. Third, there may have been some confusion over the terms used in the survey (e.g., patient copayments, tiered formularies), although the inclusion of a glossary of terms in the survey instrument was intended to minimize any potential confusion of this type. Fourth, we did not validate the responses provided with the actions of respondents; as such, it is possible that respondents simply told us what they thought we wanted to hear or what they perceived as “politically correct” answers. Finally, certain health care executives and managers in the private sector (e.g., community pharmacy managers, private drug plan managers) are unlikely to be CCHSE members and hence would have been underrepresented in the survey population. Nevertheless, the CCHSE membership of approximately 3000 captures a significant proportion of the approximately 5000 senior health care managers in Canada. The results of this survey should therefore be generalizable to other Canadian health care managers.
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This study has provided insight into the perceptions of Canadian hospital executives and managers about one of the most important issues facing them today—medication management. Interestingly, there was remarkable consistency in the responses across all demographic variables in the survey. Further work is needed to determine the educational needs of executives and managers related to medication management, to ensure the implementation of appropriate strategies to optimize the cost-effectiveness of drug utilization and to reduce the burden imposed by inappropriate use.
