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PubMed2002

Drug utilization pattern of anti-epileptic drugs: a pharmacoepidemiologic study in Oman.

PURPOSE: To get an insight into the type and aetiology of epileptic seizures; to describe the drug utilization pattern of anti-epileptic drugs (AEDs) for the treatment of various forms of epileptic seizures in this tertiary referral centre in Oman; and to compare our drug utilization pattern with that from other countries. In addition, the tolerability of AEDs and the use of therapeutic drug monitoring (TDM) were evaluated. METHODS: In a 6-month study, all epileptic patients aged 14 and above who were prescribed an AED were considered for analysis. Demographic data, type and aetiology of epileptic seizures, AED data, tests performed and adverse drug reaction (ADR) data were collected. RESULTS: A total of 1039 prescriptions originated from 488 epileptic patients. The age ranged from 14 to 77 years (median, 24 years). Generalized tonic-clonic seizures (51%) of idiopathic/cryptogenic origin (83%) were the most common type and aetiology of epileptic seizures, respectively. An average of 1.34 AEDs per patient was prescribed with 78% of patients being on monotherapy. Sodium valproate (49%) was the most frequently prescribed AED, followed by carbamazepine (44%), phenytoin (12%) and lamotrigine (11%). Ten patients suffered an ADR and phenobarbital followed by carbamazepine were most commonly the subject of TDM. CONCLUSIONS: Unlike the results in most other studies, generalized seizures represented the majority of epileptic seizures. The selection of the AEDs corresponded well with their known efficacy profiles for specific epileptic seizure types. Monotherapy was the type of therapy most frequently used, and sodium valproate and carbamazepine were the most commonly used AEDs.

Adolescent↗
PubMed1989

Studies on drug utilization: bilateral case study in Poland and Sweden.

The utilization of drugs in Poland and Sweden was compared by two means: the defined daily doses (DDD) and the price-adjusted sales figures (PASF). Obtained results imply that the total pharmaceutical consumption in the countries under study is almost equal: in Poland-US $114.47 and in Sweden-US $109.77 per inhabitant. However, in particular groups and subgroups of drugs, significant differences in prescribing exist (Tables 1 and 2). Awareness of these may help doctors to improve their prescribing of drugs, and may prompt further studies on drug utilization where irrational use of drugs is not evident but suspected.

Case-Control Studies↗
PubMedDate not supplied

Comparison of drug utilization of most commonly used drugs in Poland and Czech Republic.

Utilization of drugs from the following groups: antibacterial, cardiovascular, gastrointestinal and respiratory tract diseases in Poland and Czech Republic was analyzed. The most commonly sold drugs were among antibacterial drugs, viz., doxycycline (4.5DDD/1000 inh./day in Poland; 3.3 in Czech Republic), co-trimoxazole (Poland-2.9; Czech Republic 2.5), ampicilline and amoxicilline; among gastrointestinal drugs, ascorbic acid (Poland 42.2; Czech Republic 59.3), among respiratory drugs, sodium cromoglicate in Poland and bromhexine in Czech Republic, and among cardiovascular drugs, enalapril in Poland and diuretics with potasium sparing drug in Czech Republic. In general, the leading drugs in Poland and Czech Republic, were the same. All drugs with highest utilization were on the Essential Drug List. Some differences in drug utilization between these two countries could result from the prevalence of particular diseases in each population and physician's prescribing patterns.

Czech Republic↗
PubMed2005

[Data sources on drug utilization in Croatia and Europe].

The costs for drugs account for a significant proportion of total health care cost in every country. This is especially pronounced in welfare states and less developed countries. Therefore, each government has to take protective measures against uncontrolled rise in drug expenses and tend to the ideal, rational drug utilization. One of these measures is systematic monitoring of drug utilization. The data on drug utilization thus obtained provide a basis for appropriate interventional measures and their evaluation. In Croatia, no systematic measures in the field of drug utilization have yet been employed. In this brief survey, the methodology of drug utilization monitoring is critically reviewed, emphasizing the need of implementing the World Health Organization (WHO) Anatomical-Therapeutic-Chemical (ATC) system of drug classification and drug utilization monitoring by use of WHO Defined Daily Doses (DDD). The use of ATC/DDD system and other methods of drug utilization monitoring in Scandinavian countries is then presented. The third section deals with the current situation concerning data sources on drug utilization in Croatia. In Croatia, the ATC/DDD system has to date been only used by researchers and Zagreb Institute of Public Health in the work on the project entitled Drug Utilization in the City of Zagreb, launched in 2002.

Croatia↗
PubMed1996

The Drug Utilization Review Network of Quebec.

Drug utilization review programs have been recognized as an effective way to control health care spending while maintaining quality services. This article describes the structure, mandate and activities of Quebec's Drug Utilization Review Network. This 112-member network, which represents 45% of health care facilities in the province, was established to promote the optimal utilization of drugs through the provision of support to pharmacology committees, therapeutic committees and pharmacy departments. The network's main role is to coordinate multi-centre drug utilization studies. Future challenges include maintaining member interest and evaluating the clinical and economic impact of the network's efforts.

Cost Control↗
PubMed1982

An assessment of prescribing using drug utilization review criteria.

Drug utilization review screening criteria were applied to a sample of 30 000 prescriptions written by Iowa physicians. Characteristics of the physicians who had high percentages of prescriptions violating the explicit criteria were examined. It was found that the proportion of prescriptions failing the screening criteria did not differ significantly among physicians of differing board certification groups, medical school of graduation, year of graduation from medical school, age, or size of town where the physicians practiced. Regardless of the physicians' demographic characteristics, approximately 50 percent of their prescriptions violated the prescribing criteria. The three categories of screening criteria included irrational mixture, quantity prescribed, and daily dosage. An analysis of the relationship between physician ratings obtained for each of the categories revealed that no relationship existed between a physician's quantity prescribed rating and daily dosage rating, or between a physician's irrational mixture rating and daily dosage rating. A negative relationship was found between a physician's quantity prescribed rating and irrational mixture rating. This tends to indicate that the three categories measure different prescribing patterns and each warrants respective monitoring by pharmacists.

Drug Prescriptions↗
PubMed1984

Drug utilization data in risk/benefit analyses of drugs--benefit analysis.

For a benefit analysis of drug utilization data little reliable information is available. Benefit criteria have to be established for individual classes of drugs as well as for various types of diseases submitted to drug treatment. Antihypertensive therapy is taken as an example of how drug preferences vary from country to country and how prescribing patterns are affected by the appearance of new drugs. In the Federal Republic of Germany, fixed-ratio combinations of reserpine and diuretics are still the leading group of drugs in this field, whereas they have virtually disappeared in Great Britain and Sweden. In the latter two countries, beta-blockers are the most widely prescribed antihypertensives, and also in Germany they rank quite high in sales, but less so in the number of prescriptions. Extreme differences are found in the utilization of cardiac glycosides between Germany and Great Britain, but little is known about the consequences of risk/benefit analyses of either over- or underprescribing of these drugs. It is highly recommended to make further efforts in analyzing drug utilization data and developing studies in drug epidemiology.

Adrenergic beta-Antagonists↗
PubMed1983

Drug utilization studies and epidemiology.

Drug utilization studies have developed rapidly over the last ten years to become not only a new tool of investigation for clinical pharmacology but also a source of suggestive information for epidemiology. This paper begins by reviewing the general terms of reference, with special emphasis on the WHO-recommended methodology based on defined daily doses (D.D.D.), then focuses on antidiabetic treatment, and antihypertensive therapy, and on the use of drugs in psychiatry, in pregnancy, in elderly people and in cancer patients. These examples are given to show how drug utilization studies can be of use for epidemiological studies.

Adult↗
PubMed1984

Drug utilization data in benefit analysis of drugs.

The usefulness of drug utilization data from the medical point of view is closely related to possibilities for benefit analysis of drug treatment. In drug regulatory work this analysis may be facilitated by more recent evaluations in connection with reviews when granting marketing of new drugs. The general difficulties in benefit analysis have been especially noticed following observations on international differences in the utilization of certain groups of drugs. These difficulties are discussed and the importance of new attempts taken to assess the benefit of the treatment is emphasized.

Adult↗
PubMed1990

Drug-utilization studies in The Netherlands.

Drug-utilization research is a research area of increasing importance, both in the Netherlands and elsewhere. In this article an overview of the situation in the Netherlands is given. Three types of studies are distinguished: descriptive studies, studies of the determinants of drug use and studies of the impact of drug use. Descriptive studies are needed to understand the present situation and to detect problems. If these problems are to be solved it is important to understand the factors that determine drug use. In the Netherlands research in the latter area is focused on the influence of policy measures and of educational measures for physicians, as well as for the general public. The main body of research into the impact of drug use is the study of adverse effects, but increasingly attention is paid to the effect on quality of life in a broader sense. A number of data bases exist that enable drug-utilization research. At present one of the main problems concerning the data bases is the absence of adequate diagnosis-related drug-utilization data. Despite the existence of a number of shortcomings and problems, the general impression of drug-utilization research in the Netherlands is one of a flourishing field of study.

Drug Utilization↗
PubMed2003

Retrospective drug utilization review, prescribing errors, and clinical outcomes.

CONTEXT: Retrospective drug utilization review is required of all state Medicaid programs and is performed by most private-sector prescription programs. However, it has not been shown to improve clinical outcomes or reduce the rate of potential prescribing errors, known as "exceptions." OBJECTIVE: To look for an effect of retrospective drug utilization review on the rate of exceptions and of clinical outcomes in patients with an exception. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal ecologic study of the rate of exceptions, controlling for preintervention trends and calendar time; and a cohort study of all-cause and cause-specific hospitalizations in patients with an exception, controlling for potential individual-level confounders in 6 Medicaid programs using the same software in the mid-1990s. MAIN OUTCOME MEASURES: The rate of exceptions was examined as a function of retrospective drug utilization review implementation. In addition, before-after comparisons were made of the incidence of all-cause and cause-specific hospitalization in patients with exceptions. RESULTS: We found no reduction in the rate of exceptions coincident with retrospective drug utilization review implementation (rate increase, 0.064 exceptions per 1000 prescriptions per month; 95% confidence interval [CI], -0.006 to 0.133). We also found no effect of retrospective drug utilization review on the incidence of all-cause hospitalization (odds ratio, 0.99; 95% CI, 0.98-1.00) or cause-specific hospitalization. These results persisted in multiple subgroup analyses. Study states intervened using physician alerts in between 1% and 25% of exceptions. CONCLUSIONS: We were unable to identify an effect of retrospective drug utilization review on the rate of exceptions or on clinical outcomes. Given the lack of evidence for effectiveness, and suggestions from previous research of possible harm, policymakers should consider withdrawing the legislative mandate for retrospective drug utilization review.

Drug Utilization Review↗
PubMed1988

Quality control and drug utilization review.

The impact of drug utilization review on quality control is outlined. Special attention is given to a drug utilization review at the individual patient level for which the methodology for implementation and maintenance are described, with special emphasis on the cyclic character of the process.

Drug Utilization↗
PubMed1996

[Drug utilization studies].

Studies in drug utilization allow us to study different aspects of the use of drugs and to implement ways of improving therapeutic quality, bearing in mind the fact that health resources are limited. The aim of this work is to give a panoramic view of the various aspects of medicine use studies: origins, aims, methodology.

Drug Utilization↗
PubMed1988

Use of computerized databases to survey drug utilization in relation to diagnoses.

Many studies of drug utilization have suffered from the absence of information on the indications for therapy. A few data sets on drug utilization are available which include indication information. In addition, a number of computerized collections of medical billing data now exist in North America which can be used for such studies. These include data from the Kaiser Permanente Medical Plan; the Group Health Cooperative of Puget Sound; the Commission on Professional and Hospital Activities' Professional Activity Study; the U.S. state of Rhode Island; the Saskatchewan Health Plan in Canada; and Medicaid, the state run but federally financed health insurance plan for economically or medically needy individuals in the United States. These databases have a number of general advantages and disadvantages, which are reviewed. In addition, the differences among these databases are also explored. Finally, examples are presented demonstrating how these databases can be used for: 1) descriptive research on drug utilization, 2) evaluating the appropriateness of drug utilization, and 3) interventions designed to improve the appropriateness of prescribing.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1996

A primer on drug utilization review.

Many health care organizations evaluate drug utilization to improve the quality of patient care, reduce pharmaceutical expenditures, and enhance therapeutic outcomes. The Drug Regimen Review, instituted in 1974 as part of a quality assurance program for the care of Medicaid recipients, has reduced medication use, medication errors, adverse drug reactions, and drug-drug interactions. The Drug Usage Evaluation, a sophisticated analysis of drugs, their uses, and their contributions to various patient outcomes, is performed by member institutions of the Joint Commission on Accreditation of Healthcare Organizations. The 1990 Omnibus Budget Reconciliation Act (OBRA '90) established the Drug Utilization Review (DUR), which was implemented by state Medicaid outpatient prescription programs in 1993. Pharmacists performing DURs must review past patterns of drug misuse, monitor current therapy, and offer patient counseling. Drug utilization reviews have reduced inappropriate drug use and decreased drug costs.

Drug Utilization Review↗
PubMed1984

Patterns in drug utilization--national and international aspects: antihypertensive drugs.

There is a reasonable agreement between defined daily doses (DDDs) and prescribed daily doses (PDDs) of antihypertensive drugs, at least in Norway and Sweden. Sales and prescriptions of antihypertensive drugs in seven European countries (CSSR, Denmark, Finland, Iceland, Northern Ireland, Norway and Sweden) have increased 50 to 200% during the last 10 years. The drug statistics also illustrate marked qualitative and quantitative differences in the utilization of antihypertensive drugs between these seven European countries. Mortality in cardiovascular diseases also differs between these countries, particularly between Northern Ireland and Finland and the other countries. So do sales of alcohol and tobacco. However, none of these factors seem to co-vary with drug utilization.

Adrenergic beta-Antagonists↗