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PubMed1988

Approaches to assessing the rationality of drug usage in a developed country.

The prerequisites for analyses of the medical, social and economic consequences of drug usage are in part available in Sweden. Hard data, though, are still fragmentary. Examples are given where various data sources and methods have been applied. It is suggested that feedback of drug utilization data should increase to create a more questioning attitude among prescribers. The concept of medical audit has to be better explained including the fact that individual-based registers are necessary tools in trying to assess the rationality of drug treatment. In the future such analyses should focus on everyday treatment of common disease entities such as hypertension, diabetes, dyspepsia and asthma. Long term medical and economical consequences of optimized pharmacological versus non-pharmacological treatment should be studied.

Drug Utilization↗
PubMed1990

Improving drug usage evaluation with microcomputer database software.

The use of microcomputer database software can help overcome many of the potential weaknesses of criteria-based drug usage evaluation (DUE) through the collection and assessment of drug use statistics on a broad basis. By allowing for more systematic and comprehensive data analyses, database software can target the selection of the most appropriate DUE topics; improve the accuracy, efficiency, and acceptance of DUE reports; and enhance the overall therapeutic- and cost-effectiveness of drug use in the institutional setting. The development of antibiotic use statistics in the area of surgical prophylaxis is presented as an example, with recommendations for similar applications in other therapeutic areas.

Anti-Bacterial Agents↗
PubMed1978

Contribution of the consultant pharmacist to rational drug usage in the long-term care facility.

In a rural 116-bed skilled nursing facility, a study was made of the influence of a Consultant Pharmacist on drug usage over a one-year period. Lines of communication were established with the six attending physicians by means of work rounds, telephone calls, and both official and unofficial memoranda. Daily pharmacy rounds were conducted with health-care students and the nursing supervisor, who facilitated physician-pharmacist communication. The physician-nurse-pharmacist team studied each patient's problems, the status of the therapeutic endpoint, and the need of and usage of each regularly scheduled or pro re nata (PRN) drug. Stop-order and standing-order protocols were developed. During the one-year period, the number of regularly scheduled drugs per patient was reduced from 3.30 to 2.66 (19.4 percent decrease), and of PRN drugs from 3.92 to 2.12 (45.9 percent decrease). The overall significant reduction was associated with the protocol and stop-order discontinuances of routinely scheduled drugs, and with the duplicated orders for drugs to relieve pain, nausea, vomiting, diarrhea, colds and cough. Implications for optimal care of the patients, and for the economics of this federally-mandated system of consultant pharmacists are discussed.

Drug Therapy↗
PubMed1992

Drug usage evaluation of warfarin sodium: the need for improved patient education.

Due to documented problems encountered during therapy, the potential for drug-drug interactions, and possible readmissions due to therapy complications, the Ohio State University Department of Pharmacy decided to conduct a drug usage evaluation (DUE) of warfarin sodium. The results of their DUE are presented below.

Clinical Protocols↗
PubMed1994

Pattern of drug usage in bronchiolitis.

Bronchiolitis is a common viral respiratory infection in infants and young children. The objective of this study was to assess the pattern of drug usage in paediatric patients with bronchiolitis. One hundred patients (aged 2 weeks to 22 months) were evaluated. Of these, 64% had a respiratory syncytial virus infection. The drug therapy included albuterol in 99%, corticosteroids in 36%, aminophylline in 12% and ribavirin in 2% of the patients. The drug doses and frequencies, and durations of therapy varied substantially among patients. This emphasizes the need for well-designed research to develop optimal dosage regimens in paediatric patients with bronchiolitis.

Albuterol↗
PubMed1985

Drug usage and outstanding performance among young adolescents.

In this study, 1,008 ninth grade boys and 1,040 ninth grade girls completed questionnaires concerning: (a) drug usage (alcohol, tobacco, marijuana, psychedelics, etc.) over the previous 6 months; and (b) outstanding performance in art, school subjects, music, leadership, performing arts, athletics, and writing. In general, the outstanding performer is rather more likely to be an abstainer and less likely to fall into the high-user category than is a nonoutstanding performer. The strongest support for this appears to come from use of tobacco. Differences between outstanding and nonoutstanding students are, however, often quite small.

Achievement↗
PubMed1991

Developing a drug usage evaluation program.

One of the goals of the University of Illinois Hospital and Clinic's Pharmacy and Therapeutic Agent Review Program is to monitor and evaluate prescribing practices for drugs used in their facilities and to comply with Joint Commission standards with regard to conducting drug usage evaluations (DUE). Presented below is an overview of each step taken in the DUE process at the University of Illinois. The process described here can be adopted by other institutions that wish to improve their own DUE program.

Chicago↗
PubMed1991

Human albumin solutions: an audit of use in three major metropolitan hospitals. Subcommittee of the Victorian Drug Usage Advisory Committee.

OBJECTIVE: To evaluate the volume used and the indications for use of the human albumin solutions, stable plasma protein solution and normal serum albumin, in Victorian metropolitan teaching hospitals. DESIGN: The Victorian Drug Usage Advisory Committee conducted a prospective audit by means of a questionnaire in three major Melbourne teaching hospitals over a three-month period. All bottles of the human albumin solutions issued were numbered and a questionnaire regarding indications for use was completed for each patient treated with either product. OUTCOME MEASURES: The results were compared with the recommendations of the Australasian Society of Blood Transfusion to determine whether usage was appropriate, and the number of bottles used was analysed for each hospital and each major indication. RESULTS: The survey was comprehensive (84% of the forms were returned) and demonstrated that these products are used for appropriate clinical categories, for example, hypovolaemia, hypoalbuminaemia, and not for inappropriate indications, such as nutritional support or wound healing. There was however a marked variation in the level of usage for a given indication between the three hospitals. CONCLUSIONS: This variation reflected a considerable difference in unit policy regarding the use of these products in preference to crystalloid or synthetic colloid solutions. The variation suggests the need for more specific guidelines for the use of these products in defined clinical settings.

Albumins↗
PubMed1988

Drug usage in chest diseases.

A survey of prescribing trends was carried out on 70 admitted patients and 210 outpatients presenting themselves for treatment at the chest disease unit of the Nehru Hospital attached to the Postgraduate Institute of Medical Education and Research. Drug usage was found to be very rational and scientific, other findings are discussed.

Adolescent↗
PubMed1994

Price stickers do not alter drug usage.

Anaesthetists choose daily among wide varieties of neuromuscular blocking drugs and rapidly acting hypnotic agents. This study sought to determine whether definitive, immediate knowledge of drug cost might influence clinician choices, ultimately reducing the cost of anaesthesia care. Faculty anaesthetists, residents in training, and nurse anaesthetists served as subjects in this prospective, sequential, blinded study of prescribing habits. Weekly inventories of selected neuromuscular blocking and rapidly acting hypnotic agents were performed over 24 wk at a tertiary-care hospital. Supermarket style price stickers plainly indicating the hospital cost of each unit of drug appeared continually for 13 wk following an initial 11 wk control period. Both actual usage data in priced units as well as data normalized by total anaesthesia duration underwent comparison between control and priced periods. The usage of pancuronium, vecuronium, atracurium, mivacurium, succinylcholine, thiopentone, etomidate, and propofol did not differ in the control from the priced periods. Pipecuronium decreased after sticker placement (2 vs 1 vials.wk-1 median, P < 0.05), as did methohexitone (39 +/- 9.0 [SD] vs 29 +/- 11 syringes.wk-1, P < 0.05). Ketamine usage normalized by total anaesthesia duration increased (P < 0.05) following sticker placement. The weekly cost of all drugs inventoried normalized for caseload did not differ during the measurement periods. Immediate cost awareness, implemented simply as price stickers on drug units, had minimal impact on clinicians' drug usage in a tertiary care setting.

Anesthesia, General↗
PubMed1992

A drug usage review of omeprazole.

A drug use review of omeprazole was carried out at two centres in the Yorkshire Region from December 1990 to April 1991. Data collection documents were used and 66 patients in total were audited. Thirteen patients (19.7%) were treated for indications outside the product licence and 18 patients (27.3%) were treated for longer than 8 weeks. Twenty-eight patients (42.4%) received 40 mg daily. Fifty-one patients (77.3%) had received previous therapy with H2-receptor antagonists and in 33% of these patients it was at an inadequate dose or for an inadequate period of dosing or both. The results indicate a need for a prescribing policy for omeprazole.

Dose-Response Relationship, Drug↗
PubMed2002

Distribution of risk factors and prophylactic drug usage in Turkish patients with angiographically established coronary artery disease.

BACKGROUND: Coronary artery disease (CAD) is the leading cause of adult deaths in our country. In clinical practice, an adequate level of secondary prevention towards CAD primarily requires full recognition of the distribution of risk factors. The aim of our study was to determine the prevalence of coronary risk factors and the use of prophylactic drugs among patients who have an angiographically proven CAD in our centre, and to compare it with those of the EUROASPIRE I and II studies. DESIGN: Cross-sectional, observational study. METHODS: Our patients comprise 617 subjects (516 male, mean age 57.2 +/- 10.8 years) who underwent an angiography between January 2000 and May 2000 for the first time and in whom significant coronary lesions were detected. Age, gender, family history of premature CAD (FH), diabetes mellitus (DM), hypertension (HT), lipid profile, smoking, body mass index, waist circumference, hip circumference and physical activity data were recorded prior to angiography. The medical treatments received by these cases at discharge from hospital were investigated. Data thus obtained were compared with the results of the EUROASPIRE I and II trials, which studied the frequency of existing risk factors and prophylactic drug use among CAD patients in European countries. RESULTS: Hyperlipidaemia, FH, DM, HT, smoking, obesity, central obesity were found in 52, 26, 20, 41, 65, 18 and 29% of patients, respectively. The use of antiplatelets, beta-blockers, ACE inhibitors, statins and calcium antagonists were 99, 86, 40, 63 and 16%, respectively. CONCLUSION: Upon comparison of the risk factors, prevalence of obesity and DM was found to be similar to the average of nine European countries among our subjects. Smoking was found to be considerably higher, whereas HT, hyperlipidaemia and family history of premature CAD were lower than the European average within our subjects. In our cases the frequency of prophylactic drug usage at discharge was higher than the European means.

Adult↗
PubMedDate not supplied

Factors associated with psychotropic drug usage among nursing home residents with dementia.

BACKGROUND: Although federal regulations hold nursing homes responsible for monitoring psychotropic drug (PD) usage, there is a high prevalence of PD usage and significant variation in use across nursing homes. OBJECTIVES: The aims of study were to (a) describe current PD usage in nursing homes and (b) examine resident and nursing home factors associated with PD usage in nursing home residents with dementia. METHODS: A multivariate, multisite, cross-sectional descriptive study was used on data from 107 dementia patients residing in nine randomly selected nursing homes in southeastern Michigan. The PD usage of interest included antipsychotics, antidepressants, anxiolytics or sedatives, and mood stabilizers. Regression analysis tested resident factors, including cognitive ability, functional ability, presence of depressive symptoms, and demographic characteristics, and three facility factors (nursing home size, type of ownership, and level of registered nurse [RN] staffing) in comparison with PD usage. RESULTS: In this study, 67.3% of the participants received at least one PD. The most frequently prescribed PDs were antidepressants (41.1%) and antipsychotics (37.4%). Newly developed antipsychotics such as risperidone were given more frequently to residents than were conventional drugs such as haloperidol. Regression analysis suggests that the presence of depressive symptoms (odds ratio [OR]= 3.5, p < .01) and low levels of RN staffing (OR = 1.0, p < .01) were associated with the use of PD. DISCUSSION: Psychotropic drugs are prescribed frequently for nursing home residents, although such usage is variable. Behavioral symptoms were not an independent predictive factor for PD use. Rather, combined resident and facility characteristics best predicted the use of PDs in nursing home residents. The evaluation of nursing home systems for these characteristics as predictive factors for PD usage in nursing home patients with dementia is suggested by the results. Likewise, attention to new drugs such as selective serotonin reuptake inhibitors and their appropriate use is recommended.

Aged↗
PubMed1996

Drugs usage of drivers suspected of driving under the influence of alcohol and/or drugs. A study of one week's samples in 1979 and 1993 in Finland.

The extent of drug use among drivers suspected of driving under the influence of alcohol and/or drugs in Finland was studied. All blood samples submitted to the laboratory during 1 week in two study periods, in 1979 (n = 298) and 1993 (n = 332), were analyzed for alcohol and psychotropic drugs. Drugs classified as hazardous to traffic safety were detected in 7.0% of the samples in 1979 and 26.8% in 1993. Benzodiazepines were the most frequently found drugs in both years: 6.0% of the cases in 1979 and 22.9% in 1993. Illegal drugs were found in 4% of the cases in 1993. Of the samples tested, 296 in 1979 and 317 in 1993 were from drivers suspected of driving under the influence of alcohol only. In 1979 every fourteenth and in 1993 every fourth of these suspected drunken drivers had drugs in their blood. Drugs, other than alcohol, were found six times more often than expected by the police. The results indicate that the trend of drug use, multidrug use and drug abuse is increasing among cases suspected of driving under the influence of alcohol/drugs.

Accidents, Traffic↗