Physician perceptions of a National Formulary

Objectives: To assess the perceptions of US Department of Veterans Affairs (VA) physicians regarding effects of a National Formulary (NF) on patient c are, access to drugs, physician workload, and resident training approximate ly 1 year after it was implemented. Study Design: Cross-sectional survey. Methods: A questionnaire was sent to attending physicians working within th e VA healthcare system. Participants included general internists (n = 2824) , neurologists.(n = 238), psychiatrists (n = 997), general surgeons (n = 42 9), and urologists (n = 152). The response rate was 45%. Results: Most physicians (63%) thought that they could prescribe needed dru gs; 65% agreed that patients could obtain needed nonformulary drugs. One th ird disagreed that access to prescription pharmaceuticals had increased; 29 % stated the NF impinged on providing quality care to their own patients, a nd 21% thought it did so to patients from other VA facilities. Thirty eight percent of physicians perceived the NF to be more restrictive than private sector formularies; 16% thought that the NF diminished the ability to trai n residents for managed care. Forty percent thought that the NF added to wo rkload. Generalists more often perceived that the NF improved their ability to provide care compared with neurologists (27% vs 18%, P=.046), psychiatr ists (27% vs 22%, P=.027), and internal medicine sub specialists (27% vs 18 %, P =.001). Physicians with more clinic time were more likely to perceive that the NF increased workload. Conclusion: Although differences of opinions among physicians were noted, m ost responding VA physicians did not perceive that the NF adversely affecte d patient care, access to pharmaceuticals, physician workload, or resident training.