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PubMed1984

Improvement in drug utilization in an ambulatory care setting by the use of drug profiles for physicians.

The purpose of this study was to determine if the use of drug profiles could improve drug utilization in an ambulatory care setting. Four clinics were provided drug profiles on each patient for a 6- to 9-month period. Evaluation of drug utilization and physician response to using the profiles was performed. The data indicated that, after the profiles were introduced, there was a reduction in the total number of medications and duplications in a majority of patients studied. In addition, physician time spent in reviewing the drug history was significantly reduced. Overall, the physicians who were surveyed felt that the profile helped them and improved patient care. These data support the conclusions that the integration of drug profiles within an ambulatory care setting can improve patient care and help the hospital with large outpatient workloads to realize significant savings.

Analysis of Variance↗
PubMed1990

Drug use in pregnancy: an overview of epidemiological (drug utilization) studies.

The need for further information on drug utilization patterns during pregnancy in different countries was assessed by reviewing literature obtained by hand and computer searches for the years 1960-1988. The 13 identified studies showed that pregnant women used an average of 4.7 drugs. The most commonly ingested medications were vitamins and iron preparations (almost all women), analgesics, antiemetics and antacids. However, the important variables taken into account differently in each study, such as date of surveillance, country, size of population, personal habits, and physiopathological and demographic characteristics, may it impossible to construct a comprehensive, detailed, up-to-date picture of drug utilization during pregnancy. The evaluation confirmed the need for systematic permanent surveillance of drug utilization in pregnancy, so as to avoid the use of data based on widely differing contexts, times and methods, in a field where knowledge is often derived from scanty information.

Drug Utilization↗
PubMed1986

Drug utilization research in clinical practice.

This report describes the use of drug utilization studies in clinical practice, with special emphasis on future developments. It has been shown that pharmacy services affect prescribing patterns, have great potential for reducing health care costs, and are in a position to produce financial savings in drug therapy and drug use. However, it is essential to balance the drug utilization figures against the resulting outcome, and attention should be focused on the assessment of therapeutic results. To make therapeutic result assessment possible, end points need to be defined. Several examples of such end points are given and include incidence of nosocomial infections and postoperative wound infections. New parameters have been established to assess the severity of the illness and to follow the effect of drugs on the disease process in the form of an Index of Disease Activity (IDA). IDAs have been prepared for Crohn's disease, rheumatoid arthritis, and ankylosing spondylitis. It then becomes possible to link drug utilization data with a drug's influence on a disease, making drug utilization research a recognized discipline within the medical field.

Anti-Infective Agents↗
PubMed1998

Socioeconomic factors, morbidity and drug utilization--an ecological study.

The aim of the present study was to elucidate the relations between demographic and socioeconomic factors, morbidity and the utilization of major drug groups in an urban Swedish population. The study was performed as an ecological analysis during November 1991 in the 17 different districts of Malmö, the third largest Swedish city (235,000 inhabitants). The material comprised 86,228 ACT-coded drug items which corresponded to 76% of all prescriptions dispensed during the study month. Of these, 43,032, dispensed to patients aged 15-64 years, were analysed in the present work. Age standardized drug utilization was expressed as the number of dispensed Defined Daily Doses per 1000 inhabitants per day. Morbidity was measured in terms of reimbursed days on sick leave. The sociodemographic parameters used were socioeconomic status (SES), employment rate, median income per family, households on social allowance, and ethnicity. For four of the five major pharmacological groups (ATC-groups A, C, J, N and R, i.e. alimentation, circulation, infectious diseases, nervous system and respiration), most pronouncedly group N and least so group R, utilization correlated positively with not only the extent of morbidity but also with an unfavourable socioeconomic situation, high proportion of immigrants, and households on social allowance or with low income and/or with a low employment rate. The utilization of antibiotics (group J), however, instead correlated negatively with these parameters. For all five drug groups, these trends were similar among men and women, albeit with varying strength. In conclusion, socioeconomic factors may have a profound influence on the utilization of several major drug groups. At least in the case of antibiotics, the consequence of this influence is irrational drug use.

Journal Article↗
PubMedDate not supplied

[Prevalence of drug utilization in the adult population of Catalonia, Spain].

OBJECTIVES: To describe the prevalence of drug utilization according to sociodemographic factors and self-perceived health in the adult population. METHODS: Cross-sectional health survey of the CRONICAT/MONICA-Catalonia study carried out in 1994-96 in a random sample of the general population aged 25-64 years. A total of 3,421 participants (72% response rate) were interviewed about drug consumption in the previous two weeks with an open questionnaire. The participants were also asked about other health habits. Drugs were subsequently classified according to the ATC classification (1993 version). RESULTS: A higher proportion of women (38%) than men (26%) self-perceived poor health status (p < 0.001). Age-adjusted total drug utilization was 57% in men (95%CI: 55-59) and 76% in women (95%CI: 74-78). Excluding contraceptives, regular drug utilization was 35% in men (95%CI: 33-37) and 48% in women (95%CI: 46-51). Twenty-nine percent of men and 48% of women (p < 0.001) took more than one drug. Neither educational level nor marital status influenced drug utilization. Among men, drug consumption was higher in retired individuals and pensioners (68%; 95%CI: 62-74) than in active workers (54%; 95%CI: 52-57). The most frequently used drugs were those for the nervous system (35% men and 51% women; p < 0.001), alimentary tract (15%) and the cardiovascular system (9% and 13%; p < 0.001). Most drugs (40%) were prescribed by specialists and one quarter was self-prescribed. CONCLUSIONS: The prevalence of total drug utilization in the adult population of Catalonia is high, specially among women, who self-perceived worse health status. Policies of rationalization of drug expenditures should take the epidemiological pattern into account.

Adult↗
PubMed1990

Drug use in pregnancy: a preliminary report of the International co-operative Drug Utilization Study. Collaborative Group on Drug Use in Pregnancy.

In a field, such as drug use in pregnancy, where knowledge is often based on scanty information, and systematic permanent surveillance is needed, so as to avoid reliance on data obtained in widely differing contexts, an international co-operative network was set up, using a cheap and standardized interview technique. The study, originally European, can now be considered 'intercontinental', as the twenty-five countries where data is already being collected represent four of the five continents. Thirteen participating countries have already returned about ten thousand completed forms. Fifteen per cent of the 9714 enrolled women took no drugs at any state of pregnancy, while each taker received an average of 2.6 (range 1-13) prescriptions. Intracountry and intercountry differences were found in prescribing habits and in other characteristics of the population. Although the large amount of data collected is still being processed, preliminary findings indicate that this study seems to have been warranted.

Drug Utilization↗
PubMed2002

Sexually transmitted diseases in Manitoba: evaluation of physician treatment practices, STD drug utilization, and compliance with screening and treatment guidelines.

BACKGROUND AND GOAL: There is little information in Manitoba on the utilization of drugs for sexually transmitted disease (STD) treatment and the extent to which physicians comply with STD screening and treatment guidelines. This study was undertaken to provide such information to inform policy and program development. METHODS: Physicians providing STD care were asked to complete a simple record for each new STD index client or contact seen. This information was subsequently linked with data from provincial diagnostic and treatment databases. RESULTS: Between October 1997 and September 1998, there were 2535 reports of STD treatments. Only about 25% of drugs provided by the provincial health department to physicians for STD treatment could be accounted for on the basis of the treatment reports received. Seventy-four percent of all treatments provided were presumptive ones for urethral or cervical infection or pelvic inflammatory disease (PID), and 14.4% of these were associated with subsequent positive tests for Chlamydia trachomatis or Neisseria gonorrhoeae. About three quarters of presumptive treatments were in compliance with provincial guidelines, as were most etiology-based treatments for chlamydial infection and 72% of etiology-based treatments for gonorrhea. Noncompliance with guidelines was commonly due to presumptive treatment that covered only C trachomatis, nonrecommended treatment for N gonorrhoeae, and incorrect treatment of PID. Only about 25% of women and 4% of men aged 15 to 24 years who visited a physician in 1997 were tested for C trachomatis. CONCLUSION: Increased educational efforts are required to improve physician compliance with STD screening and treatment guidelines, as well as ensure the appropriate use of STD drugs provided. Opportunities are being missed for screening for C trachomatis among young people, the majority of whom are seen regularly by a physician.

Adolescent↗
PubMed1992

Drug utilization research in primary health care as exemplified by physicians' quality assessment groups.

Drugs in primary health care are often prescribed for nonrational reasons. Drug utilization research investigates the prescription of drugs with an eye to medical, social and economic causes and consequences of the prescribed drug's utilization. The results of this research show distinct differences in drug utilization in different age groups and between men and women. Indication and dosage appear irrational from a textbook point of view. This indicates nonpharmacological causes of drug utilization. To advice successfully changes for the better quality assessment groups of primary health care physicians get information about their established behavior by analysis of their prescriptions. The discussion and the comparisons in the group allow them to recognize their irrational prescribing and the social, psychological and economic reasons behind it. Guidelines for treatment are worked out which take into account the primary health care physician's situation. After a year with 6 meetings of the quality assessment groups the education process is evaluated by another drug utilization analysis on the basis of the physicians prescription. The evaluation shows a remarkable improvement of quality and cost effectiveness of the drug therapy of the participating physicians.

Cost-Benefit Analysis↗
PubMed2005

Drug utilization pattern of Chinese herbal medicines in a general hospital in Taiwan.

PURPOSE: Drug utilization studies are important for the optimization of drug therapy and have received a great attention in recent years. Most of the information on drug use patterns has been derived from studies in modern Western medicines; however, studies regarding the drug utilization of traditional Chinese medicine (CM) are few. The present study was the first clinical research to evaluate the drug utilization patterns of Chinese herbal medicines in a general hospital in Taiwan. METHODS: Data were collected prospectively from the patients attending the Traditional Medicine Center of Taipei Veteran General Hospital under CM drug treatments. The study was carried out over a period of 1 year, from January 2002 to December 2002. Core drug use indicators, such as the average number of drugs per prescriptions, the dosing frequency of prescriptions, and the most common prescribed CM herbs and formulae were evaluated. The primary diagnosis and the CM drugs prescribed for were also revealed. All data were analyzed by descriptive statistics. RESULTS: A total of 10 737 patients, representing 52 255 CM drugs, were screened during the study period. Regarding the prescriptions, the average number of drugs per prescription was 4.87 and 37.21% of prescriptions were composed by five drugs. Most of prescriptions (91.38%) were prescribed for three times a day. The most often prescribed Chinese herb was Hong-Hwa (5.76%) and the most common Chinese herbal formula was Jia-Wey-Shiau-Yau-San (3.80%). The most frequent main diagnosis was insomnia (15.58%), followed by menopause (5.22%) and constipation (5.09%). CONCLUSION: The survey revealed the drug use pattern of CMs in a general hospital. The majority of CM prescriptions were composed by 3-6 drugs and often prescribed for three times a day. Generally, the rational drug uses of CM drugs were provided with respect to the various diagnoses.

Adolescent↗
PubMed1998

Drug utilization 90%--a simple method for assessing the quality of drug prescribing.

OBJECTIVES: To describe a simple method for assessing the quality of drug prescribing. METHODS: We tested the idea that the number of drugs accounting for 90% of drug use--drug utilization 90% (DU90%)--may serve as an indicator of the quality of drug prescribing. We ranked the drugs by volume of defined daily doses (DDD) and determined how many drugs accounted for the DU90% segment. We also compared this segment with the pharmacotherapeutic guidelines issued by the Regional (local) Drug Committee to determine the adherence to its recommendations (index of adherence). The cost per DDD within the DU90% segment and for the remaining 10% was also calculated. The utilization of drugs based on prescriptions purchased during April 1995 was determined for 24 primary health care (PHC) centres in southwestern Stockholm. RESULTS: The number of different products, defined as all products marketed under a single brand name within an ATC (anatomic therapeutic chemical) category, in the DU90% segment varied twofold (81-164) between the 24 PHC centres. Differences in the number of GPs per PHC centre accounted for a third of this variation. The compliance with the Drug Committee recommendations varied between 54% and 78%. There was no relationship between the number of products accounting for the DU90% segment and the adherence to local prescription guidelines, i.e. prescribing more products did not increase the adherence. The costs for the DU90% drugs varied from 2.26 SEK/DDD in one PHC centre to 3.75 in another one, with an average cost of 2.87 SEK/DDD, while for the remaining 10% it was the double (6:54 SEK/DDD). In all, the DU90% drugs made up 80.8% of the total cost as compared with 19.2% for the remaining 10%. In the DU90% segment, there was no clear relationship between adherence to the guidelines and the cost/DDD, i.e. following the evidence-based guidelines appeared to provide a higher quality of prescribing rather than cheaper prescribing. CONCLUSIONS: The DU90% is an inexpensive, flexible, and simple method for assessing the quality of drug prescribing in routine health care. The number of products in the DU90% segment and adherence to prescription guidelines may serve as general quality indicators. The method may be adapted to provide comparative data between PHC centres, hospitals, regions etc. that may be cross-sectional and longitudinal. Other quality criteria, specific for each class of drugs, should complement these general indicators.

Catchment Area, Health↗
PubMed2004

Exposure misclassification as a result of free sample drug utilization in automated claims databases and its effect on a pharmacoepidemiology study of selective COX-2 inhibitors.

PURPOSE: Free drug samples are widely used in clinical practice. We were concerned about free sample drug utilization as a source of misclassification in pharmacoepidemiology research using claims data that may result in biased effect estimates. METHODS: We investigated the magnitude of potential bias with sensitivity analyses based on a published study that examined cardiovascular risk associated with selective cyclooxygenase 2 (COX-2) inhibitors. We derived an estimate of free sample drug utilization with market data for rofexcoxib and calculated sensitivity of the exposure ascertainment method using claims data. We corrected the incidence rate ratio assuming the observed unexposed incidence rate was actually a weighted average rate of the truly unexposed and free sample drug users. The impact of exposure misclassification measured as the percentage change from a corrected to the reported crude incidence rate ratio was examined under a range of free sample drug utilization proportions and unexposed cohort sizes. RESULTS: The proportion of free sample drug utilization of all rofecoxib use in our base case scenario was 15.48%, resulting in sensitivity of 84.52% for exposure ascertainment. The magnitude of bias was an underestimation of the unadjusted incidence rate ratio by 0.03%. With a free sample drug utilization proportion of 1.48% and the same unexposed cohort size of 237 975 person-years, the underestimation was 0.003%. If the unexposed cohort were 975 person-years given a 15.48% proportion, the underestimation was 8.82%. CONCLUSIONS: In the pharmacoepidemiology study, we examined that uses claims data to ascertain drug exposure, our results suggest that adjustment for free sample drug utilization is probably not warranted.

Bias↗
PubMed1993

Drug-utilization study on Curaçao.

The drug use on Curaçao was evaluated with the help of the prescription forms of twelve community pharmacies at Curaçao over a period of three months. The emphasis of the study was on three therapeutic groups: the systemic antibiotics, the psycholeptics and the anti-inflammatory and antirheumatic drugs. Within the group of systemic antibiotics broad-spectrum antibiotics were very frequently prescribed compared with the small-spectrum penicillins. The consumption of psycholeptics, particularly benzodiazepines, on Curaçao is remarkably low in comparison with drug utilization data of Denmark and the Netherlands. In contrast, the number of defined daily doses per 1,000 persons per day of antirheumatic drugs is higher compared with data from these two countries. Within the analysed groups, large differences occur between the two most important kinds of insurance, i.c., the poor people (PP) and social insurance bank (SVB) insurance. The PP-insured patients consume in the case of antibiotics and antirheumatic drugs almost twice as many and in the case of psycholeptics even five times as many as the SVB-insured patients do. A few calculations of prices prove that the extra amount of drugs consumed by PP-insured has important financial consequences.

Adolescent↗
PubMed1999

Evaluation results from prospective drug utilization review: Medicaid demonstrations.

In 1992 HCFA awarded two cooperative agreements for demonstrations of prospective drug utilization review (PDUR). Iowa tested an on-line prospective drug utilization review (OPDUR) system. Washington tested payments to pharmacists for providing non-dispensing "cognitive services" (CS). In this article the authors report on an evaluation of these demonstrations and on three assessments of retrospective drug utilization review (RDUR) interventions. The evaluation failed to detect effects of either State PDUR demonstration on the frequency of drug problems, utilization of prescription drugs and other health services, and clinical outcomes. However, the State RDUR interventions had immediate effects on prescribing physicians.

Centers for Medicare and Medicaid Services, U.S.↗