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PubMed2005

Drug utilization: using objective data to achieve cost-efficiency.

By grading pharmacy benefit managers' (PBMs') performance using an objective evaluation process, employers can identify specific opportunities and establish measurable goals to define efficient drug utilization. Many employers come away from the grading process with a similar conclusion--Increased generic dispensing is a must for achieving delivery of an affordable prescription drug benefit. By focusing on the conditions that affect their population, employers are ensuring that PBMs implement practical programs that make it easy for physicians to prescribe affordable high-value drugs.

Cost Savings↗
PubMed2005

Drug utilization in the pediatric intensive care unit: monitoring prescribing trends and establishing prioritization of pharmacotherapeutic evaluation of critically ill children.

The primary objective of this study was to characterize the drug exposure for children hospitalized in the authors' institution's pediatric intensive care unit for the year 2002. Secondary objectives included the examination of drug utilization differences among various age criteria and the suitability of the most prevalent resources for pediatric dosing guidance. Many of the most commonly prescribed agents in the pediatric intensive care unit fall into the broad categories of pain management/sedation and anti-infectives. Based on the generally narrow windows afforded by each of these drug classes, it is obvious that more, well-defined investigations in critically ill children are warranted. The existing dosing guidance for many of these agents is neither generalizable nor sufficient to accommodate the diversity in pediatric intensive care unit patients, and the current drug monographs fall short of any practical dosing information.

Adolescent↗
PubMedDate not supplied

[PHOLY: a pilot study of drug utilization in civil hospitals in Lyon. Results].

As shown in many studies, up-to-date knowledge is not reflected in prescribing behaviours. The aim of pilot study PHOLY (Prescription aux Hospices civils de LYon) was to study methodological and technical conditions of a drug utilization study in a large university medical centre and to evaluate the discrepancy between drug prescribing and up-to-date knowledge. Data of 1115 in-patients of Hospices Civils de Lyon were collected. We have shown the feasibility of such a study in spite of many difficulties (52.15 per cent of questionnaires received, missing data...). Reference treatments such as ACE inhibitors in heart failure treatment or betablockers for high blood pressure represent respectively only 14.6 per cent and 6.7 per cent of the prescriptions in these indications. Within the framework of quality of care improvement, the study of the appropriateness of the treatments enables identification of domains where better therapeutic information is necessary.

Adrenergic beta-Antagonists↗
PubMed2006

Drug utilization pattern during pregnancy in North India.

BACKGROUND: Pregnancy is a special physiological condition, where drug treatment presents a special concern. AIMS: To evaluate the drug utilization pattern during pregnancy and to evaluate the effect of the educational and economic status on it.. DESIGN: The retrospective cross-sectional study. SETTING: The postgraduate Department of Pharmacology and Therapeutics of a medical college. and the antenatal clinic of the institution. MATERIALS AND METHODS: Medical students filled 405 questionnaires after interviewing pregnant women (243 primigravida and 152 multigravida). All the collected questionnaires were analysed for various study parameters. STATISTICAL ANALYSIS USED: Inter-group comparison was done using chi-square test. P value < 0.05 was considered statistically significant. RESULTS: A total of 700, 1086 and 686 drugs, with an average of 1.73, 2.89 and 2.49 drugs per pregnant women, were used during first, second and third trimester of pregnancy, respectively. A majority of the drugs used, were from category-A, followed by category-B and category-D. However, category C and X drugs constituted 2.90 (20) and 5.71% (40) of drugs used during the third trimester and first trimester, respectively. Herbal/homeopathic drugs constituted 6.42 (45), 3.68 (40) and 1.46% (10) of the drugs used in the first, second and third trimester of pregnancy, respectively (P=649). 33.33% (135) women believed that drug use during pregnancy is dangerous to both mother and child and 37.03% (150) believed that drugs are dangerous throughout pregnancy. 55.55% (225) females advocated the use of iron/folic acid during pregnancy. 24.69% (100) of women had knowledge about barrier contraceptives. Self-medication and homeopathic/ herbal drugs use was found more in graduates than in undergraduates; as well as, it was more in the higher socioeconomic group than the lower socioeconomic group. CONCLUSION: There is a need to educate and counsel women of child-bearing age, regarding the advantages and disadvantages of drug use during pregnancies, with special reference to alternative therapies and self-medication.

Adolescent↗
PubMed2006

Drug utilization of ezetimibe in rehabilitation centres: registry analysis of factors influencing prescription and effectiveness of treatment.

BACKGROUND: While randomized controlled trials (RCTs) generate informative data about clinical outcomes, by their nature they cannot provide information about drug utilization and factors influencing prescribing decisions. In the secondary prevention of patients with cardiac events, lipid lowering therapy with statins and other agents, such as cholesterol absorption inhibitors (CAI, e.g. ezetimibe) plays a pivotal role and is often initiated or modified in rehabilitation centres. The aims of the present study were to analyse factors that influence the prescribing decisions of physicians, and to investigate success rates of lipid lowering therapy with ezetimibe after adjustment for covariates. METHODS: Ninety-three rehabilitation centres throughout Germany documented a total of 17029 patients in cardiac rehabilitation, of which 6976 (41.6%) were prescribed a CAI. A logistic regression model with forward selection based on 31 potential regressors for ezetimibe prescription (demographics, diagnosis, risk factors etc.) was used to construct a propensity score, which reflects the inclination of physicians to prescribe CAI. This score was subsequently used for bias reduction in the comparison of co-medications and success rates. RESULTS: Nineteen variables were associated with ezetimibe prescriptions, the most important ones being total cholesterol, level of education, unstable angina pectoris and arterial hypertension. Ezetimibe was more frequently prescribed together with simvastatin and pravastatin than with other statins, and frequently together with aspirin or beta blockers, respectively. After adjustment for baseline lipid values and covariates, the probability of target level achievement appears to be substantially higher for patients on ezetimibe than for those without ezetimibe. CONCLUSIONS: Other factors than conventional risk factors contribute to the CAI prescription habits of physicians. Additional lipid level reductions due to ezetimibe are seen in routine health care corresponding to findings from randomized studies.

Aged↗
PubMed1994

Prescription drug utilization review in the private sector.

With increased coverage of prescription drugs by health insurance plans, utilization data are now becoming available and there is renewed interest in drug utilization review (DUR) programs. This article describes the DUR programs now being conducted by private sector firms for health insurance plans. The programs were found to be highly automated and very efficient. Most firms estimate at least two to three dollar direct savings for each dollar invested in DUR. Much of this results from controlling overutilization and gaining compliance with drug formulary guidelines. In addition, the firms report finding drug therapy problems in about two to three percent of the enrollees receiving prescriptions.

Chemistry, Pharmaceutical↗
PubMed1988

Total parenteral nutrition: a concurrent drug utilization review.

University Hospital, a 428-bed tertiary care teaching hospital, treats approximately 150 patients annually with TPN. Currently used are three standard TPN base formulae which are ordered by physicians using preprinted TPN order forms. A concurrent Drug Utilization Review (DUR) was conducted on TPN treatment of 30 patients, to examine adherence to the current TPN protocol. Criteria for evaluation included ruling out enteral feeding, indications for TPN use, duration of therapy, monitoring of laboratory values, and caloric delivery. Physician and dietician estimation of caloric needs were compared to calories actually ordered by the physician. The number of pharmacist interventions and TPN bags wasted were also determined. Results could not be obtained with respect to ruling out enteral feeding and indications for TPN therapy due to inadequate information. The five-day minimum for duration of TPN therapy established in the DUR criteria was not attained in 23 percent (7/30) of patients. Seventy-seven percent of laboratory monitoring tests were completed. Results indicate wide disparities in caloric calculation and delivery; only 45 percent (10/22) of the patients who were ordered TPN met the physician's caloric goal. A number of recommendations were made to improve the TPN protocol and TPN therapy.

Adult↗
PubMed1998

[Evaluation of drug treatment of myocardial infarction in public hospitals of Andalusia. GAUME (Andalusian Group for performance of Studies on Drug Utilization)].

BACKGROUND: The management of patients with acute myocardial infarction (AMI) has changed over the last decade. The aim of this study was to evaluate the pharmacologic treatment of AMI in the clinical practice, with special emphasis in thrombolytic therapy. MATERIAL AND METHODS: Prospective drug utilization survey, collecting data from 26 hospitals belonging to the Andalusian Health Service, Spain, during one month period. Pharmacologic treatment in the first 24 h was obtained. RESULTS: Out of 379 patients recruited, 52.8% received thrombolytic therapy, although another 19% could have obtained some benefit from that therapy. Alteplase was the most frequently used thrombolytic (65.5%). The regimen prescribed was mainly that followed in GUSTO Study (45.8%) or double bolus (43.5%). In a high percentage of patients the thrombolytic selection was not made according to the results of the literature. Women and patients older than 75 years were less likely to receive thrombolytic therapy. There was a high utilization of aspirin (89.7%), nitrates (84.4%) and heparin (83.6%). CONCLUSIONS: Thrombolytic therapy was prescribed in a higher percentage of patients than is reported in other trials. In spite of that, thrombolytics should have been used in more patients. As alteplase does not have a definitive benefit over streptokinase, protocol is needed when selecting a thrombolytic agent.

Age Factors↗
PubMed2004

A retrospective drug utilization evaluation of vancomycin usage in paediatric patients.

OBJECTIVE: To evaluate the appropriateness of use of vancomycin in paediatric patients at KK Women's and Children's Hospital, the major paediatric hospital in Singapore to identify potential problems in prescribing practices that may necessitate intervention to optimize vancomycin usage. METHODS: A retrospective drug utilization evaluation was performed for paediatric patients who received intravenous vancomycin from 1 June 1998 to 31 June 1999. The outcome measures were consistency of vancomycin indication with recommended guidelines, dosing regimens, microbiological data, monitoring of serum drug levels, renal function, clinical outcomes and adverse drug reactions (ADRs). RESULTS: A total of 96 cases was available for evaluation. Sixty-two (64.6%) courses of vancomycin were consistent with guidelines for indication of therapy. Eighty-six (89.6%) of the dosing regimen were consistent. All infusion times that were recorded (56.3%) were consistent with criteria. Of the patients treated with vancomycin for more than 1 day, peak and/or trough serum vancomycin levels were ordered for 70 cases. Of the 56 cases with paired levels ordered, 46 cases had at least one level that fell outside the therapeutic range. Nineteen (19.8%) cases of ADRs were documented. Fifty-eight (60.4%) cases received concurrent nephrotoxic drugs. However, a substantial portion of vancomycin courses were apparently not prescribed for appropriate indications, and there was poor recording of vancomycin administration information and sampling time. CONCLUSION: The majority of dosing regimens of vancomycin was consistent with guideline criteria. The most evident problem was the sub-optimal use of the monitoring of vancomycin serum levels. The information derived from this study may be used as a for further study and for the development of strategies for optimize vancomycin usage.

Adolescent↗
PubMed1987

Psychotropic drug utilization patterns in a metropolitan population.

Psychotropic drug intake by a random sample of citizens of the city of Munich aged 30-69 years has been assessed. A 1-week prevalence of 9.3% for all psychotropic drug users was found, benzodiazepines accounting for approximately two-thirds (6.6%) of the users. Two-thirds of drug users were women. Drug use in both sexes increased with age. The doses of benzodiazepines prescribed in most cases were less than 10 mg diazepam equivalent per day. Intake of benzodiazepines in combination with analgesics or alcohol (greater than or equal to 40 g/day) did not appear to represent a major problem. Multiple logistic regression analysis showed that the number of chronic diseases was the strongest predictor of benzodiazepine intake in men, whereas stress and age determined intake in women. Long-term use seemed to be relatively rare at 11% of all benzodiazepine users, so it was not considered to be a severe public health problem.

Adult↗
PubMed1993

Drug utilization and clinical pharmacology. Report on British Pharmacological Society Symposium at Trinity College Dublin on Thursday, 9th July, 1992.

The insatiable appetite for safer more effective, but increasingly more expensive, therapy in the face of increasing government reluctance to feed this demand has put the study of drug utilization and pharmacoeconomics centre stage. Clinical pharmacologists are uniquely positioned to determine the cost benefit and utility of modern therapy and give impartial advice on safe, effective and economic patient care. To mark the Quatercentenary Celebrations of Trinity College Dublin, eight speakers addressed this theme in a symposium held in conjunction with the British Pharmacological Society Meeting in July 1992.

Congresses as Topic↗
PubMed1999

Management of postoperative pain in abdominal surgery in Spain. A multicentre drug utilization study.

AIMS: Postoperative pain is common in hospital-admitted patients. Its management is determined by different therapeutic traditions and by the attitudes of health professionals in each hospital. The aim of this study was to describe the patterns of prescription and administration of analgesic drugs used for postoperative pain after abdominal surgery in Spanish hospitals, to know the prevalence and the severity of postoperative pain, and to determine the extent of variability in the management of postoperative pain among the participating centres. METHODS: The study was a multicentre descriptive cross-sectional drug utilization study in 12 Spanish hospitals. The subjects were an unselected sample of consecutive patients undergoing abdominal surgery, admitted between October 1994 and January 1995. For each patient, information about the surgical procedure and the use of analgesics was prospectively collected. The severity of postoperative pain was assessed during the first day after surgery by means of a six-category (none, mild, moderate, severe, very severe, and unbearable) rating scale and a visual analogue scale (VAS). RESULTS: Nine hundred and ninety-three patients (547 men) were included. The most common surgical procedures were inguinal hernia repair (315, 32%), cholecystectomy (268, 27%), appendectomy (140, 14%), bowel resection (137, 14%), and gastric surgery (58, 6%). Fifty-nine percent of patients (587) received nonopioid analgesics only, 9% (89) received opioid analgesics only, and 27% (263) received both opioid and nonopioid analgesics. The most frequently administered drugs were metamizole (667 patients) and pethidine (213 patients). Although in the majority of medical orders the administration of analgesics was scheduled at regular time intervals, the majority of actual doses were given 'as-needed'. The average administered daily doses of all analgesics were lower than those prescribed. Thirty-eight percent (371/967) of patients rated their maximum pain on the first day as severe to unbearable. Wide interhospital variability was recorded in the surgical procedures which had been performed, in the analgesics used, and also in the pain scores referred by patients. The percentage of patients in each centre who suffered severe to unbearable pain varied from 22 to 67%. CONCLUSIONS: In Spain many patients still suffer severe pain after abdominal surgery, and this seems to be due to an inadequate use of analgesics. Wide interhospital variability in the management of postoperative pain and in its prevalence was also recorded.

Adolescent↗
PubMed1991

VIDEOFAR: an epidemiologic tool for drug utilization studies.

VIDEOFAR is a computerized drug prescription monitoring system oriented to gain an epidemiological insight into the phenomenon of "drug prescription". The set of activities carried out within the VIDEOFAR project were focused to: define methods of analysis of prescription data, which could be transferred to the peripherical operating settings of the National Health Service (Local Health Units, Epidemiologic Observatories, Regional Pharmaceutical Services, etc.); implement a Drug Data Base to allow a flexible utilization of information; implement software systems in different computer environments.

Data Collection↗
PubMed1981

A multicenter study of ICU drug utilization.

As part of a view of hospital practice a sample of medical records of 15 intensive care units were analysed for the following items: reason for and origin of admission, age, sex, full pharmacological history, length of stay, clinical outcome, discharge diagnosis. Antibiotic therapy, steroid use for shock, problems of hemostasis, and cardiovascular drugs are areas where an active intervention appears to be specifically needed. Interhospital differences in diagnostic and general care criteria, documentation of inappropriate therapeutic practice, lack of reliable data registration gave occasion for an extensive discussion with clinicians leading to decisions on exclusion of drugs from hospital formularies, organization of information programs and of controlled clinical trials. The application of simple techniques of drug utilization review has proved a useful, inexpensive tool for creating favourable conditions for wide scale improvement of therapeutic practice.

Adolescent↗
PubMed1979

Computerized billing as a tool for drug utilization.

This article demonstrates a method of compiling and disseminating information on patterns of antibiotics usage. It is particularly appropriate for those institutions that use a computerized charge system. The author describes one method that has been effective in bringing trends in antibiotics usage to the attention of interested persons at his hospital. The information can then be used to assist in the selection of specific antibiotics for drug utilization review.

Accounting↗
PubMed1998

Improving prescribing patterns for the elderly through an online drug utilization review intervention: a system linking the physician, pharmacist, and computer.

CONTEXT: Pharmacotherapy is among the most powerful interventions to improve health outcomes in the elderly. However, since some medications are less appropriate for older patients, systems approaches to improving pharmacy care may be an effective way to reduce inappropriate medication use. OBJECTIVE: To determine whether a computerized drug utilization review (DUR) database linked to a telepharmacy intervention can improve suboptimal medication use in the elderly. DESIGN: Population-based cohort design, April 1, 1996, through March 31, 1997. SETTING: Ambulatory care. PATIENTS: A total of 23269 patients aged 65 years and older throughout the United States receiving prescription drug benefits from a large pharmaceutical benefits manager during a 12-month period. INTERVENTION: Evaluation of provider prescribing through a computerized online DUR database using explicit criteria to identify potentially inappropriate drug use in the elderly. Computer alerts triggered telephone calls to physicians by pharmacists with training in geriatrics, whereby principles of geriatric pharmacology were discussed along with therapeutic substitution options. MAIN OUTCOME MEASURES: Contact rate with physicians and change rate to suggested drug regimen. RESULTS: A total of 43007 alerts were triggered. From a total of 43007 telepharmacy calls generated by the alerts, we were able to reach 19368 physicians regarding 24 266 alerts (56%). Rate of change to a more appropriate therapeutic agent was 24% (5860), but ranged from 40% for long half-life benzodiazepines to 2% to 7% for drugs that theoretically were contraindicated by patients' self-reported history. Except for rate of change of beta-blockers in patients with chronic obstructive pulmonary disease, all rates of change were significantly greater than the expected baseline 2% rate of change. CONCLUSIONS: Using a system integrating computers, pharmacists, and physicians, our large-scale intervention improved prescribing patterns and quality of care and thus provides a population-based approach to advance geriatric clinical pharmacology. Future research should focus on the demonstration of improved health outcomes resulting from improved prescribing choices for the elderly.

Aged↗