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PubMed2004

Drug evolution concept in drug design: 1. Hybridization method.

A novel concept, "drug evolution", is proposed to develop chemical libraries that have a high probability of finding drugs or drug candidates. It converts biological evolution into chemical evolution. In this paper, we present "hybridization" drug evolution, which is the equivalent of sexual recombination of parental genomes in biological evolution. The hybridization essentially shuffles the building blocks of the parent drugs and ought to drug(s); no drug evolution can otherwise occur. We hybridized two drugs, benzocaine and metoclopramide and generated 16 molecules that include the parent drugs, four known drugs, and two molecules whose therapeutic activities are reported. The unusually high number of drugs and drug candidates in the library encourages high expectations of finding new drug(s) or drug candidate(s) within the remaining eight compounds. Interestingly, the therapeutic applications of the eight drugs or drug candidates in the library are fairly diverse as 38 therapeutic applications and 25 molecular targets are counted. Therefore, the library fits as a general chemical library for unspecified therapeutic activities. The hybridization of other two drugs, aspirin and cresotamide, is also described to demonstrate the generality of the method.

4-Aminobenzoic Acid↗
PubMedDate not supplied

[The effect of implementation of a unit dose drug distribution system on drug consumption].

As an important drug consumer in Dubrava University Hospital, Department of Cardiac Surgery has been chosen for testing a new model of drug distribution system known as unit dose drug distribution system. During the first 39 weeks in 1996--comparative period, drugs were delivered from the Pharmacy to the Department of Cardiac Surgery in traditional way, known as floor stock system. Next 65 weeks, until the end of 1997--pilot study period, drugs were delivered directly from the Pharmacy to the patients, using unit dose drug distribution system. Consumption of drugs was measured every week by statistical unit DDD/100 hospital days (Defined Daily Dose) according to Anatomic-Therapeutic-Chemistry (ATC) classification of drugs. For statistical measurements, beside common arithmetic means, geometric means were used which are less sensitive to extreme values of drug consumption. During comparative period drug consumption was chaotic with great oscillations around mean value, while in pilot study period that process was without great oscillations around lower mean value and did not exceed the limits of process. Drug consumption was completely under control, so it was a predictable process. In the pilot study period total drug consumption was 39% less, while consumption of drugs from group C was 30% less. During comparative period group C makes 34%, while in the pilot study period it makes 38% of the total drug consumption. This model of drug distribution in hospital leads to a rationalization of drug consumption and great savings. The pharmacist-physician interactive role began to emerge as a direct result of these changes in the drug distribution system. Hospital pharmacist has become a visible member of health care team who is responsible for Quality of all medication-related activities and thus has taken opportunity for clinical pharmacy practice.

Drug Utilization↗
PubMed1991

Drug related events and drug utilization in patients admitted to a geriatric hospital department.

Two hundred ninety-four consecutive admissions to a geriatric department were evaluated for drug events as cause of admission. The drug events considered were adverse drug reactions (ADRs) and dose-related therapeutic failures. In 39 cases (13.3%), a definite, probable or possible drug event was a dominant or contributing cause of the admission (11.2% ADRs and 2.0% dose-related therapeutic failures). Five of these cases (1.7%) were judged to be due to errors in prescription and a further seven (2.4%) were found to have been avoidable by efforts exceeding the obligatory. There were no statistically significant differences between drug-related and non-drug related admissions in terms of age, sex, number of drugs taken at the admission or duration of hospitalization. ADRs in the geriatric patients are difficult to recognize and may be interpreted as senile loss of function. Sixty-seven percent of the patients took drugs with a sedative action, 68% took drugs with a hypotensive action, 67% took drugs with a potential for confusional states, 15% took drugs with a potential for depression, and 64% took drugs with a potential for constipation. A reduction of the number of drug-related hospital admissions by means of a large-scale intervention would be a difficult task for several reasons: no particular class of drugs caused the drug events, no particular mechanism dominated, no particular group of doctors were responsible for the drug events, and only a part of the drug events were judged to be avoidable.

Aged↗
PubMed1989

Analysis of drug-drug interactions among nursing home residents.

The extent of clinically important drug-drug interactions in the patient population of a nursing home was studied. The administration of medications to all 138 residents of two wards of the hospital-affiliated facility was monitored for 15 days through a review of nurses' medication-administration records and patients' charts. Information on the nature and timing of administered drug combinations was compared with published information to identify potential drug interactions. If a serious drug interaction was suspected, the recorded information was verified through the nurse in charge of that patient. Few of the drug interactions commonly reported to occur in nursing homes were observed at the facility, where drug therapy is monitored by a team of geriatric practitioners that includes two pharmacists. Of the 24 suspected interactions that were identified, 11 had potential clinical importance, and all 11 involved drug combinations that could alter the metabolism or action of one of the drugs. However, only two patients were exposed to any substantial degree of risk, and dosages of the drugs involved were adjusted. An additional 13 patients were taking a combination of drugs that could have altered the intestinal absorption of one of the drugs. Careful timing of drug administration avoided this potential problem. With proper education of the nursing staff, immediate clarification of medication orders, and optimal timing of drug administration, many clinically important drug-drug and drug-food interactions can be avoided in nursing home patients.

Adult↗
PubMed2004

Effects of changes in patient cost sharing and drug sample policies on prescription drug costs and utilization in a safety-net-provider setting.

PURPOSE: The impact of cost-containment strategies on prescription drug utilization and costs in an ambulatory care safety-net-provider setting was studied, along with the impact of these strategies on patient out-of-pocket expenditures. METHODS: Aggregate monthly prescription drug cost and utilization data were obtained from a health system's outpatient pharmacy computer system for the targeted clinic. The data represented approximately 42,000 patient visits over 38 months. Univariate and multivariate statistics were used to evaluate the influence of copayment increases and changes in prescription drug sample policies on prescription drug costs, prescription drug utilization, and patient expenditures. RESULTS: Prescription drug copayment increases were associated with significant decreases in prescription drug utilization and costs. An average per visit prescription drug copayment increase of $5 was associated with a significant reduction in prescription drug utilization per visit and a $26.07 reduction in prescription drug expenditures per visit per month. Removal of samples from the clinic did not result in a significant decrease in either prescription drug costs or utilization. The presence of samples, however, was associated with a significant reduction in per visit patient expenditures by an amount similar to the copayment for one brand-name prescription drug per visit. CONCLUSION: An increase in patient copayments was associated with reductions in a clinic's drug expenditures and prescription drug utilization per visit. Removal of prescription drug samples had no effect except increasing patients' out-of-pocket drug costs.

Cost Sharing↗
PubMed2006

Formulation of drugs in block copolymer micelles: drug loading and release.

Block copolymer micelles have become accepted as a viable strategy for drug formulation and delivery. Block copolymer micelles may serve as solubilizers and/or true drug carriers depending on their drug retention properties in vivo. Indeed the formulation of hydrophobic drugs in these micelle systems has been shown to provide up to a 30,000 fold increase in the water solubility of some compounds. In addition, the administration of drugs in copolymer micelles has been shown to reduce their toxicity and improve their therapeutic efficacy. The present review is focused on the drug loading and release properties of block copolymer micelles. Specifically, the properties of the drug, properties of the micelle core and the presence of interactions between the drug and the core-forming block are discussed in terms of their influence on the drug loading and release properties of the micelles. The various methods employed to prepare drug-loaded micelles are reviewed and the in vitro release assays used to predict the in vivo release characteristics of the formulations are discussed. The balance between drug loading and micelle stability is highlighted as a critical factor in the optimization of micelle-based formulations. The in vivo performance of micelles as delivery systems is evaluated by comparing the pharmacokinetics of free drug and drug administered in micelle-based formulations. Overall, the composition-property and property-performance relationships outlined in this review may aid in guiding the rational design of block copolymer micelles for drug delivery. In addition, suggestions for future research in this area are provided as a means to assist in furthering block copolymer micelles as one of the leading advanced drug delivery technologies for the systemic administration of drugs.

Animals↗
PubMed2005

Adverse drug event surveillance and drug withdrawals in the United States, 1969-2002: the importance of reporting suspected reactions.

BACKGROUND: The Adverse Event Reporting System is the primary surveillance database used by the Food and Drug Administration for identifying postmarketing drug safety problems. METHODS: We analyzed all reports of suspected adverse drug reactions submitted to the Food and Drug Administration from the inception of the Adverse Event Reporting System database in 1969 through December 2002. We documented drug withdrawals and restricted distribution programs based on safety concerns. RESULTS: During the 33-year period from 1969 when adverse drug event reporting was initiated through 2002, about 2.3 million case reports of adverse events for the cumulative number of approximately 6000 marketed drugs were entered in the database. Most reports were for female patients. During this period, numerous drug reactions have been identified and added to the product labeling as boxed warnings, warnings, precautions, contraindications, and adverse reactions. More than 75 drugs/drug products have been removed from the market due to safety problems. In addition, 11 drugs have special requirements for prescriptions or have restricted distribution programs. Drugs withdrawn or restricted represent a small proportion (about 1%) of marketed drugs. CONCLUSIONS: The Food and Drug Administration's Adverse Event Reporting System is the primary surveillance database used for the identification of safety problems of marketed drugs. Despite the limitations of underreporting, differential reporting, and uneven quality, submitted reports often allow the identification of serious adverse events that are added to the product labeling information. In rare instances, additional regulations, up to and including market removal, have been required. We encourage physicians, pharmacists, other health care professionals, and patients to continue to report serious suspected and known adverse drug reactions to manufacturers and the Food and Drug Administration.

Adolescent↗
PubMed2001

Regular outpatient medical and drug abuse care and subsequent hospitalization of persons who use illicit drugs.

CONTEXT: Patients and the public could benefit from identification of factors that prevent drug users' heavy reliance on inpatient care; however, optimal health care delivery models for illicit drug users remain ill-defined. OBJECTIVE: To evaluate associations of outpatient medical and drug abuse care with drug users' subsequent hospitalization rates. DESIGN AND SETTING: Retrospective cohort study of data from longitudinally linked claims for all ambulatory physician/clinic services and drug abuse services covered by the New York State Medicaid program. SUBJECTS: A total of 11 556 human immunodeficiency virus (HIV)-positive and 46 687 HIV-negative drug users. MAIN OUTCOME MEASURES: Hospitalization in federal fiscal year (FFY) 1997 compared by 4 patterns of care in FFY 1996: regular drug abuse care (>/=6 months in 1 program), regular medical care (>35% of care from 1 clinic, group practice, or individual physician), both, or neither. RESULTS: Hospitalization occurred in 55.6% of HIV-positive and 37.5% of HIV-negative drug users, with a mean of 27.5 and 24.5 inpatient days, respectively. In HIV-positive drug users, the adjusted odds ratio (AOR) for hospitalization was lowest among those with both regular medical and drug abuse care (AOR, 0.76; 95% confidence interval [CI], 0.67-0.85) followed by those with regular medical care alone (AOR, 0.82; 95% CI, 0.74-0.91) and regular drug abuse care alone (AOR, 0.85; 95% CI, 0.76-0.96) vs those with neither. In HIV-negative drug users, the AOR of hospitalization was lower for those with regular medical and drug abuse care (AOR, 0.73; 95% CI, 0.68-0.79), regular drug abuse care alone (AOR, 0.71; 95% CI, 0.66-0.76), and regular medical care (AOR, 0.91; 95% CI, 0.86-0.95) vs those with neither. Both types of care showed favorable effects for all but drug abuse-related hospitalizations. CONCLUSION: Our data indicate that regular drug abuse care with regular medical care for drug users is associated with less subsequent hospitalization.

Adult↗
PubMed1995

A theoretical basis for a biopharmaceutic drug classification: the correlation of in vitro drug product dissolution and in vivo bioavailability.

A biopharmaceutics drug classification scheme for correlating in vitro drug product dissolution and in vivo bioavailability is proposed based on recognizing that drug dissolution and gastrointestinal permeability are the fundamental parameters controlling rate and extent of drug absorption. This analysis uses a transport model and human permeability results for estimating in vivo drug absorption to illustrate the primary importance of solubility and permeability on drug absorption. The fundamental parameters which define oral drug absorption in humans resulting from this analysis are discussed and used as a basis for this classification scheme. These Biopharmaceutic Drug Classes are defined as: Case 1. High solubility-high permeability drugs, Case 2. Low solubility-high permeability drugs, Case 3. High solubility-low permeability drugs, and Case 4. Low solubility-low permeability drugs. Based on this classification scheme, suggestions are made for setting standards for in vitro drug dissolution testing methodology which will correlate with the in vivo process. This methodology must be based on the physiological and physical chemical properties controlling drug absorption. This analysis points out conditions under which no in vitro-in vivo correlation may be expected e.g. rapidly dissolving low permeability drugs. Furthermore, it is suggested for example that for very rapidly dissolving high solubility drugs, e.g. 85% dissolution in less than 15 minutes, a simple one point dissolution test, is all that may be needed to insure bioavailability. For slowly dissolving drugs a dissolution profile is required with multiple time points in systems which would include low pH, physiological pH, and surfactants and the in vitro conditions should mimic the in vivo processes.(ABSTRACT TRUNCATED AT 250 WORDS)

Biological Availability↗
PubMed2006

Prevalence of problematic and injecting drug use for Drug Action Team areas in England.

BACKGROUND: National and local monitoring of policies on illicit drug use requires information on the number of problematic drug users in a country. This article reports the findings from a study that estimated the number of problematic and injecting drug users for all Drug Action Teams (DATs) in England for 2001. METHODS: The Multiple Indicator Method (MIM) is a statistical technique for using aggregated data to estimate numbers of drug users across a large number of areas. The MIM was used to combine eight indicators available for all DATs, with prevalence estimates available from a small number of DATs. The indicators were drug possession and supply offences, arrest referrals, people recorded in drug treatment databases, methadone prescriptions, drug-related hospital episodes, drug-related deaths and DATs' Townsend score. The latter is a measure of material deprivation. A three-stage process involved, (i) factor analysis of the drug indicators, (ii) regression linking factor scores to known prevalence estimates and (iii) imputation of estimates to all other DATs. RESULTS: Factor analysis yielded two statistically significant factors underlying the drug indicators in 150 DATs in England. The estimated prevalence rate of problematic drug use in the DATs varied from 0.2 to 1.5 per cent of the population. The estimated average number of problematic drug users per DAT was 1943 (standard deviation = 1300). The estimated average number of injecting drug users per DAT was 627 (standard deviation = 572). The estimates for England in 2001 were 287,670 (population rate = 0.64 per cent) problem drug users, and 93,185 (population rate = 0.23 per cent) injecting drug users. CONCLUSIONS: Although the model cannot take account of specific local factors, the results are likely to be accurate in areas that do not have these idiosyncrasies. The estimated prevalence figures provide a basis for all DATs to assess their contact rates with problematic and injecting drug users.

Adolescent↗
PubMed2005

Strut position, blood flow, and drug deposition: implications for single and overlapping drug-eluting stents.

BACKGROUND: The intricacies of stent design, local pharmacology, tissue biology, and rheology preclude an intuitive understanding of drug distribution and deposition from drug-eluting stents (DES). METHODS AND RESULTS: A coupled computational fluid dynamics and mass transfer model was applied to predict drug deposition for single and overlapping DES. Drug deposition appeared not only beneath regions of arterial contact with the strut but surprisingly also beneath standing drug pools created by strut disruption of flow. These regions correlated with areas of drug-induced fibrin deposition surrounding DES struts in porcine coronary arteries. Fibrin deposition immediately distal to individual isolated drug-eluting struts was twice as great as in the proximal area and for the stent as a whole was greater in distal segments than proximal segments. Adjacent and overlapping stent struts increased computed arterial drug deposition by far less than the sum of their combined drug load. In addition, drug eluted from the abluminal stent strut surface accounted for only 11% of total deposition, whereas, remarkably, drug eluted from the adluminal surface accounted for 43% of total deposition. Thus, local blood flow alterations and location of drug elution on the strut were far more important in determining arterial wall drug deposition and distribution than were drug load or arterial wall contact with coated strut surfaces. CONCLUSIONS: Simulations that coupled strut configurations with flow dynamics correlated with in vivo effects and revealed that drug deposition occurs less via contact between drug coating and the arterial wall than via flow-mediated deposition of blood-solubilized drug.

Animals↗
PubMed1999

In vivo microdialysis for the investigation of drug levels in the dermis and the effect of barrier perturbation on cutaneous drug penetration. Studies in hairless rats and human subjects.

The thesis opens with review chapters concerning theoretical and practical aspects of the investigation of drug contents in the skin. A discussion of the advantages and limitations of the established methods as well as the relatively new sampling method of microdialysis, which is employed in the experimental section, is given. Factors influencing the barrier function of the normal human skin are described as are the alterations in skin barrier function found in diseased and experimentally barrier perturbed skin. The microdialysis technique consists of introducing an ultra thin, semipermeable tube, a so-called probe, in the dermis. The tube is connected to a precision pump, which provides a steady flow of a tissue-compatible fluid through the probe at a very low flow. Smaller molecules in the tissue, among them the non-protein bound fraction of the drug content in the extracellular fluid, will passively diffuse across the surface of the membrane and thus enter the flow of the perfusate, which is sampled at regular intervals and analysed. Microdialysis is used for the determination of drug levels in the skin after topical as well as systemic drug delivery in the experimental part of the thesis. The method is not applicable to the investigation of all drugs or compounds, as we have shown that it is not feasible to sample highly protein-bound drugs or very lipophilic drugs by microdialysis without further development of the method. The investigation of topical drug administration consists of 2 studies of cutaneous penetration of a model drug, salicylic acid, initially investigated in hairless rats and subsequently in human volunteers. In both studies, barrier perturbation of the skin was undertaken by physical (removal of the stratum corneum by repeated tape stripping) or chemical (treatment with acetone) methods or by provocation of irritative dermatitis (by application of sodium lauryl sulphate, a detergent). Prior to the penetration experiment, the barrier damage inflicted was quantified by non-invasive measurements of transepidermal, water loss and erythema. The penetration of salicylic acid, applied in an ethanol solution in chambers glued to the skin in the barrier perturbed areas, was measured by microdialysis sampling of the drug level in the underlying dermis. At the end of the experiment, probe depth in the dermis and skin thickness were measured by ultrasound scanning. In humans and hairless rats alike, the cutaneous drug penetration was highly increased in tape stripped skin (157- and 170-fold increased, respectively, in comparison to the penetration in unmodified skin) and in skin with irritative dermatitis (46- and 80-fold increased). Delipidization by acetone led to a doubling of the penetration in humans but had no effect on penetration in hairless rats. In both studies a close correlation between the measurements of barrier perturbation by non-invasive methods and the cutaneous drug penetration in the same area was found. In the human study, the barrier perturbation in the acetone treated area was not measurable by non-invasive methods, whereas drug penetration, measured by microdialysis sampling, was significantly increased, indicating that the microdialysis method possesses high sensitivity in the detection and quantification of perturbed skin barrier function. In the human study, a dose-response relationship between the concentration of detergent used for the induction of irritant dermatitis and the ensuing increase in drug penetration across the skin could be demonstrated. In the hairless rat study a correlation between probe depth in the dermis and drug penetration was found, demonstrating that the more superficially a probe was placed, the earlier it would be reached by the influx of drug across the skin. Systemic drug distribution was studied in healthy volunteers following oral administration of 2 g acetylsalicylic acid. (ABSTRACT TRUNCATED)

Administration, Cutaneous↗
PubMed1997

Diagnostic value of specific T cell reactivity to drugs in 95 cases of drug induced liver injury.

BACKGROUND: Diagnosis of drug induced liver injury is usually based on a temporal relation between drug intake and clinical picture as well as on the exclusion of alternative causes. More precise diagnosis has been attempted by using in vitro specific T cell reactivity to drugs but the test has never reached general acceptability because of frequent negative results which could be explained, in part, by prostaglandin producing suppressor cells (PPSC). AIM: To analyse the diagnostic value of a modified test where lymphocyte responses to drugs are detected in the presence of a prostaglandin inhibitor. PATIENTS: Ninety five patients with a clinical diagnosis of drug induced liver injury, 106 healthy controls, 35 individuals with recent exposure to the same drugs without adverse effects, and 15 patients with liver disease unrelated to drugs. METHODS: Peripheral blood mononuclear cells (PBMC) were cultured in the presence of drugs alone and in the presence of drugs and a prostaglandin inhibitor. Responses were assessed by 3H-thymidine incorporation in lymphocytes. Results were expressed as counts per minute and as stimulation indexes (SI). RESULTS: When PBMC were stimulated with drugs alone, lymphocyte sensitisation to drugs (SI > 2) was detected in 26% of the cases. This was noticeably increased (56%) when a prostaglandin inhibitor was added to the cultures. No reactivity was found in controls. In patients with possible sensitivity to several drugs, lymphocyte reactivity was detected to only one drug. The severity of the lesions, as assessed by aminotransferase concentrations and disease duration, was lower in patients with evidence of PPSC. CONCLUSIONS: This new approach is useful for the diagnosis of drug induced liver injury, particularly in patients exposed to more than one drug; furthermore, the presence of putative PPSC is associated with less severe forms of drug induced hepatitis.

Adult↗
PubMed2005

Clinical relevance of drug-drug interactions : a structured assessment procedure.

INTRODUCTION: Computerised drug interaction surveillance systems (CIS) may be helpful in detecting clinically significant drug interactions. Experience with CIS reveals that they often yield alerts with questionable clinical significance, fail to provide relevant information on risk factors for the adverse reaction of the interaction and fail to detect all significant drug interactions. These problems highlight the importance of transparency and selectivity in choosing the drug interactions to be included in CIS. In The Netherlands, the Working Group on Pharmacotherapy and Drug Information is responsible for maintenance of the CIS of the Royal Dutch Association for the Advancement of Pharmacy (KNMP). METHODS: The Working Group developed an evidence-based procedure for structured assessment of drug-drug interactions and revised all drug interactions in the CIS accordingly. RESULTS: For every drug interaction four core parameters were assessed: (i) evidence on the interaction; (ii) clinical relevance of the potential adverse reaction resulting from the interaction; (iii) risk factors identifying patient, medication or disease characteristics for which the interaction is of special importance; and (iv) the incidence of the adverse reaction. On the basis of this assessment the drug-drug interactions for inclusion in the CIS were selected. After revision of the drug combinations in the KNMP-CIS, the Working Group judged 22% of the combinations to be not interacting and another 12% to be interacting but not requiring action. On the basis of this assessment the subset of drug combinations for which interaction alerts are generated and the information on management of a drug interaction alert for users of the CIS were adapted. When an alert is generated by the CIS, the user of the system is supplied with comprehensive information on the four core parameters, the mechanism of the interaction and critical information for management of the interaction for the individual patient. DISCUSSION: This structured procedure offers the possibility for transparent and reproducible assessment of the clinical relevance of drug interactions. CONCLUSION: A CIS selectively generating interaction alerts based on this assessment may help in realising the goal of good clinical practice and may offer a methodology to further increase drug safety.

Adverse Drug Reaction Reporting Systems↗
PubMed1997

Do increased levels of drug abuse treatment lead to fewer drug-related problems?

It has been argued that increased levels of treatment for drug abuse are effective in reducing the levels of drug problems. During the 1980s in Ontario levels of treatment increased considerably. More treatment facilities were opened, and the number of drug abuse cases increased by a factor of about seven. It was expected that drug-related problems (mortality, morbidity, and convictions) would decrease, as happened for alcohol problems when alcohol treatment levels increased. However, the results were inconsistent. Hospital separations for drug problems decreased in the late 1970s and then increased in the 1980s. However, deaths from drug psychoses and drug dependency showed an opposite trend. Convictions for cocaine offences increased while those for narcotics, LSD, and hallucinogenic drugs showed a substantial decline from the early 1980s to the present. Significant negative correlations (suggestive of a beneficial impact) were found between treatment rates and three drug-problem measures (deaths rates from drug psychoses and drug dependence, other drug-related deaths, and convictions under the Food and Drug Act); however, a significant positive correlation was found between treatment rates and Narcotic Control Act convictions. Thus, although some of the predicted negative relationships between treatment rates and drug problems were observed, the correlations did not provide a consistent picture of the effects of increased drug treatment. More research is needed to identify better indicators of drug problems and monitor the factors that influence them.

Adult↗
PubMed2001

Prevalence and determinants of osteoporosis drug prescription among patients with high exposure to glucocorticoid drugs.

OBJECTIVE: To investigate use of osteoporosis drugs among patients with high exposure to glucocorticoid drugs. STUDY DESIGN: Retrospective review of pharmacy records. METHODS: We identified patients aged > or = 20 years who received prescriptions for > or = 2 g of prednisone (or equivalent) during any 12-month period between January 1, 1998, and December 31, 1999, and who initiated use of osteoporosis-specific drugs (alendronate sodium, etidronate disodium, and calcitonin) during that period. RESULTS: Among 8807 patients who met study criteria, 772 (8.8%) received prescriptions for osteoporosis drugs. Prevalence of osteoporosis drug prescriptions increased linearly during the study and differed markedly by patient sex, age, and exposure to glucocorticoid drugs. Osteoporosis drugs were prescribed for 16.3% of women aged > or = 65 years, for 6.1% of women aged < 50 years, for 6.5% of men aged > or = 65 years, and for 2.2% of men aged < 50 years. Higher glucocorticoid exposure was also associated with higher rate of osteoporosis drug prescription (11.2% of patients exposed to > 4 g/y and 5.6% exposed to 2 to 3 g/y received such therapies). Osteoporosis drugs were 50% more likely to be prescribed by clinicians who prescribed glucocorticoid drugs to > 18 patients than by providers who prescribed glucocorticoid drugs to < 4 patients. CONCLUSIONS: Despite ready availability of bone-specific osteoporosis drugs, few patients with high exposure to glucocorticoid drugs received such therapy. Likelihood of an osteoporosis drug being prescribed for such patients strongly depends on patient sex, age, and exposure to glucocorticoid drugs and on level of practitioner experience in prescribing glucocorticoid drugs.

Adult↗
PubMed1994

Hospital drug therapy cost containment through a preferred medicines list and drug utilisation review system.

AIM: To measure the economic impact of the introduction of a preferred medicines list and drug utilisation review process on drug therapy costs at the six Christchurch hospitals in the Canterbury Area Health Board. METHODS: The preferred medicines list, a consensus derived recommended drug list, was introduced along with a drug utilisation review process in December 1990. Detailed drug therapy costs were collected from the pharmacy computer for the 1990/1 and 1991/2 hospital financial years. Data was analysed under the 15 British National Formulary drug groups and also 14 other categories. National hospital drug costs based on sales to hospitals and local drug cost trends prior to the preferred medicine list system introduction were used as baseline measures. Hospital patient discharge numbers and patient days were also recorded. RESULTS: Prior to the preferred medicines list introduction local drug therapy costs had been rising on average 30% per year. Between 1990/1 and 1991/2 total drug costs fell by 2% from $12.16M to $11.86M while nationally, drug sales to hospitals increased by 15%. Included in the local expenditure were drugs external to the preferred medicine list/drug utilisation review system whose costs are reimbursed to the area health board. When these costs were deducted, inpatient drug costs fell by 11% from $8.76M to $7.7M. In the 29 categories reviewed, 17 had decreases, while the remaining areas increased. Total patient numbers during the period increased by 3% while total patient days decreased by 10%. CONCLUSION: The preferred medicines list and the associated drug utilisation review process played a major role in the reduction of inpatient drug therapy costs at the Christchurch hospitals. Other factors such as cost shifting or changes in community drug use may have also been responsible for some of the savings.

Cost Control↗