At what level are DTCs formed-the national level or the hospital level?
DTCs may be established at both national and hospital levels. National level committees address issues with nationwide implications, such as national formulary lists, national standard treatment guidelines, group purchasing decisions, and adverse drug reactions that may warrant market withdrawal. Many countries now have national committees that maintain essential drug lists for the public sector. Where possible, these committees can take on the functions of a DTC, promoting effective and efficient pharmaceutical management, including appropriate drug use, as recommended by WHO.

Hospital committees address issues specific to the local setting, such as defining and implementing facility level policies, formulary lists, and standard treatment guidelines; identifying problems with pharmaceutical management and use; and supporting effective interventions that improve the quality and use of medicines. Because problems with pharmaceutical management and utilization vary from hospital to hospital, DTCs make their most direct contribution when established at the local level. In countries with national DTCs, it's essential to establish effective coordination mechanisms between the national and local committees. This will help ensure development and implementation of consistent policies, formulary lists, and procedures.

Who should be a member of a DTC?
The complexity of drug management issues-such as selection, procurement, distribution, storage, and use-requires broad, multidisciplinary involvement. At the same time, the committee should be sufficiently small and manageable, in order to conduct business efficiently. If needed, ad hoc subcommittees can be formed for in-depth analysis of particular issues.

DTC members should have relevant technical backgrounds or previous DTC experience and should include representatives from the medical staff (with representation from each department), the pharmacy (the chief pharmacist often serves as the secretary), the nursing staff, the hospital administration, and the quality assurance coordinator.

Another goal in selecting committee members is minimizing the opportunity for private interests to adversely influence DTC decisions. Committee members should be known for their integrity, honesty, and dedication. Ideally, they should not have relationships with pharmaceutical manufacturers or distributors, which may create a conflict of interest. Any members who do have a potential for conflict of interest must disclose this information to their colleagues, so that any potential bias can be considered during the decision-making process.