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PubMed1990

Impact of a drug bulletin on the knowledge, perception of drug utility, and prescribing behavior of physicians.

The impact of a drug bulletin was tested in a randomized controlled trial that included 186 family physicians. The length of the trial was six months. It was hypothesized that printed information, such as in drug bulletins, influences physician prescribing behavior by changing their knowledge of drug efficacy and adverse effects and their perceptions of drug utility. Therefore, the impact of a drug bulletin was evaluated on these domains of influence. Interview data were used to assess changes in knowledge, perceived drug utility, and stated prescribing. Health insurance funds' records were used to collect actual prescribing data. Information in the bulletin on the treatment of renal colic changed physicians' knowledge as well as perceived utility of drugs used for renal colic (p less than 0.05). Significant changes in stated prescribing were also found. On the other hand, advice in the same bulletin on the treatment of the irritable bowel syndrome (IBS) had no impact at all. It did not even improve the knowledge of the physicians about the drugs used for IBS. Apparently, the message about the treatment of IBS failed to gain the attention of the physicians. It is suggested that some messages are sufficiently transmitted through written information, and others that are seen as less relevant or too difficult to implement need more intensive strategies.

Adult↗
PubMed1994

Individualized drug utilization statistics. Analysing a population's drug use from the perspective of individual users.

The Danish retail pharmacies' drug subsidy system is completely computerized. The data are person-identifiable, making it possible to chart the population's drug use from the perspective of individual users. We decided to explore the potential of this data source and to analyse heavy drug users specifically. The analysis encompassed all 890,352 prescriptions presented by citizens of Odense in 1991. There was a total sales volume of 32 million defined daily doses consumed by 113,468 adult drug users, corresponding to 65.1% of the adult population. We found 2388 heavy drug users, defined by an annual purchase of more than 2000 defined daily doses. Heavy drug users accounted for 1.4% of the adult population and 22.9% of drug sales. They were remarkably well characterized by their main therapeutic class, which constituted a median of 47% of their drug use. A median of 97% of each heavy user's drugs were issued by one main prescriber. We conclude that heavy drug use can generally be ascribed to severe disease rather than to irresponsible prescribing. For the most important drug classes, we present various epidemiological measures of drug use, including 1-year prevalence, incidence, duration of therapy and some measures of skewness in utilization. If analysed regularly these measures can disclose subtle trends in clinical drug use that would not be evident from the wholesale figures.

Age Distribution↗
PubMed1987

Drug utilization study methodologies: national and international perspectives.

This paper in the series on pharmacoepidemiology describes the history, development, and present status of drug utilization activities. The various methodologies employed in drug utilization studies are evaluated and presented along with a listing of the principal drug databases available for drug utilization research. An analysis is presented comparing the validity of drug consumption rates based on individual patient usage or drug cost data as adopted in North America and the defined daily dose unit as developed in Europe. Drug utilization derives its importance in pharmacoepidemiology from the fact that it provides the methodological rigor for defining the denominator data needed in pharmacoepidemiological research.

Ambulatory Care↗
PubMed1984

Relation between drug utilization and morbidity pattern.

Do drug utilization data, versus other health care data--such as causes of death and sick reports, discharge diagnoses, and number of days on the sick list--give a similar picture of the health status in Sweden? Though a number of discrepancies exist between these sources of information, analyses show that the similarities between the pictures they give of the health status are considerable, provided due consideration is given the facts that--for self-evident reasons--certain illnesses and injuries are not to be found in all the sources.

Adult↗
PubMed1988

Problems in assessing rationality of drug utilization in less developed countries.

Less developed countries are facing various difficulties in assessing rationality of drug utilization. The problems are essentially related to four major areas; (a) Policies, administration and management, (b) Practice and services, (c) Education and training, (d) Monitoring and research. Drug policies have often failed to recognise the importance of identifying the levels of rationality of the various components of drug utilization. Consequently, neither the need nor the mechanisms to assess rationality were considered. Drug utilization data and records have been poorly developed and maintained, e.g. mal-managed, inaccurate, and without continuity with regard to collection, monitoring and evaluation. Provision and supply of drugs were handled by an unnecessary multiplicity of departments and state offices, none of which keeping complete records and/or information in relation to needs of drugs nor other health care requirements. Deficiencies and shortcomings associated with medical/pharmaceutical practice, services, education and training have as well contributed significantly to the failure of the less developed countries to assess and promote rationality of drug utilization.

Developing Countries↗
PubMed2004

[Drug utilization in adults: prevalence and individuals determinants].

OBJECTIVE: To study epidemiological patterns of drug utilization and its individual determinants and to classify drugs used into pharmacological groups. METHODS: In a population-based cross-sectional study, 3,182 subjects aged 20 years or more were selected from an urban area in Southern Brazil using a multi-stage sampling design. Data were collected through home interviews using a structured questionnaire. Drug use in the previous 15 days was recorded. Crude analysis was performed using the Chi-square test for heterogeneity and trend and t-test for means' comparison. The adjusted analysis was carried out using Poisson regression. RESULTS: The overall prevalence of drug utilization was 65.9%. The highest prevalences of drug use after adjusting for confounding were seen among elderly women in the upper economic class who had ill health self-perception. Analgesics, anti-inflammatory and anti-hypertensive drugs were the most frequently used drugs. CONCLUSIONS: The prevalence of drug use was found to be higher than in other national and international studies. Studies focusing on individual determinants of drug utilization can identify those groups with higher use. This knowledge might encourage specific strategies to decrease drug use and lead to restrictive policies concerning drug prescription and sale.

Adult↗
PubMed1984

Drug utilization review of parenteral clindamycin therapy.

A concurrent drug utilization review was conducted to evaluate the appropriateness of parenteral clindamycin use, the incidence of gastrointestinal side effects, and to implement, if necessary, corrective actions to improve parenteral clindamycin use. Criteria for the appropriate use of clindamycin were prepared, reviewed, and approved by the P & T Committee of the City of Memphis Hospital (CMH) and University of Tennessee Medical Center/William F. Bowld Hospital (UTMCH). Forty-five patients were included in the audit. Overall, in 43/45 (96%) of the patients audited, clindamycin use was deemed appropriate. This audit provided the opportunity for positive reinforcement of physician prescribing practices and helped to foster a cooperative, rather than an adversarial relationship, between pharmacists and physicians involved in drug utilization review.

Anti-Bacterial Agents↗
PubMed1991

A system for drug utilization review in ambulatory care.

BACKGROUND: It is more difficult to conduct drug utilization reviews in ambulatory care settings than in inpatient care settings. This is true for several reasons: it is harder to identify outpatients who are receiving specific medications; often there is less evidence on which to base clinical standards for drug use; and it is more difficult to ensure patient compliance with drug therapy. METHODS: This article describes a drug utilization review system designed to operate in ambulatory care clinics. The system consists of (1) a computerized database for efficient identification of patients who receive prescriptions for a specific medication, (2) clinic-wide consensus guidelines, (3) reminders in the medical record, (4) regular chart audits, and (5) feedback to physicians. RESULTS: Experience in monitoring the use of serum theophylline assays illustrates how this system can be used in an ambulatory care clinic. According to guidelines adopted in our clinic, overuse of assays is not a problem. The system of physician reminders and chart audits can help prevent underuse. CONCLUSIONS: Despite the difficulties in conducting drug utilization reviews in the ambulatory setting, a system based on clinic-wide guidelines is feasible and should be an integral part of quality assurance programs.

Adolescent↗
PubMed1999

A framework for drug utilization evaluation in depression: insights from outcomes research.

BACKGROUND: Drug utilization evaluation (DUE) offers the prospect of improving the quality of care in depression by focusing on drug-related problems (DRPs). Outcomes research in depression can provide a basis on which to address difficulties in implementing DUE programs in the outpatient environment of managed care. OBJECTIVE: The purpose of this paper is to facilitate the development of a drug utilization evaluation program for depressed patients receiving care in an outpatient environment. METHODS: The literature was reviewed in the area of depression treatment, drug-related problems, and current outcomes research. This information was synthesized into a framework with potential DUE criteria. CONCLUSION: The quality of care for depression can be improved if these efforts are focused on solving DRPs. Outcomes research findings may be used as the basis for developing DUE criteria and as a first step in selecting and targeting interventions.

Ambulatory Care↗
PubMed1997

The waiting time distribution as a graphical approach to epidemiologic measures of drug utilization.

The emergence of large, computerized pharmacoepidemiologic databases has enabled us to study drug utilization with the individual user as the statistical unit. A recurrent problem in such analyses, however, is the overwhelming volume and complexity of data. We here describe a graphical approach that effectively conveys some essential utilization parameters for a drug. The waiting time distribution for a group of drug users is a charting of their first prescription presentations within a specified time window. For a drug used for chronic treatment, most current users will be captured at the beginning of the window. After a few months, the graph will be dominated by new, incident users. As examples, we present waiting time distributions for insulin, ulcer drugs, systemic corticosteroids, antidepressants, and disulfiram. Appropriately analyzed and interpreted, the waiting time distributions can provide information about the period prevalence, point prevalence, incidence, duration of use, seasonality, and rate of prescription renewal or relapse for specific drugs. Each of these parameters has a visual correlate. The waiting time distributions may be an informative supplement to conventional drug utilization statistics, and possibly also a useful screening tool for unusual prescribing patterns.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Inter- and intrarater reliability of retrospective drug utilization reviewers.

OBJECTIVE: To assess inter- and intrarater reliability among 23 pharmacist and physician retrospective drug utilization reviewers and to assess interrater reliability after a reviewer training session. DESIGN: Exploratory study. SETTING: Maryland Medicaid's retrospective drug utilization review (DUR) program. PARTICIPANTS: 23 physician and pharmacist retrospective drug utilization reviewers. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Profiles rated as "intervention indicated" or "intervention not indicated." Cochran's Q test, overall percent agreement, and the unweighted kappa statistic were used in the analysis of review consistency. RESULTS: Intrarater reliability showed substantial consistency among the 23 reviewers; the percent agreement was 82.9% with kappa = 0.66. Interrater reliability, however, was poor, with an overall agreement of 69.6% and kappa = 0.16. Interrater reliability was also poor after a one-hour reviewer training session (agreement 81.8%, kappa = -0.19). CONCLUSION: The implicit review process used in the retrospective DUR program that we evaluated was unreliable. Since reliability is a necessary but not sufficient condition for validity of an indicator of inappropriate drug use, the validity of the DUR implicit review process is in question.

Data Interpretation, Statistical↗
PubMed1979

Examining the annual drug utilization of a cohort of low income health plan members.

Changes in the annual drug utilization of a cohort of 828 low income Kaiser Foundation Health Plan members in the Oregon region over a four-year period are examined. The study also attempts to identify relationships between consistency in the levels of annual drug utilization and characteristics of the cohort, prescriptions received and doctor office visits (DOVs). The results show no change in the: 1) annual prescription rate; 2) types of drugs received each year; 3) annual DOV rates; and 4) annual prescribing rate by physician specialties. There was consistency in the annual drug and DOV utilization rate among the cohort through time. Consistency in the level of drug utilization was not always directly related to consistency in the level of DOV utilization. Consistent high users of drugs, while few in number (4.6 per cent), received a large proportion (37.3 per cent) of all prescriptions. A substantial proportion (15.8 per cent) of the cohort were consistent nonusers of drugs. Consistency in the level of drug use was related to: sex and age, purpose (disease classification) of the DOVs, the types (new or refill) of prescriptions received, the therapeutic classes of drug received, the number of prescribing physicians and the number of pharmacies patronized.

Adolescent↗
PubMed2005

Treatment of type 2 diabetes in primary health care: a drug utilization study.

BACKGROUND: Metabolic control in type 2 diabetes depends on patient adherence to therapy. Quantitative consumption data do not supply information regarding the appropriate use of medicine. Drug utilization studies are useful to identify treatment adherence problems and, thus, design interventions to improve drug use. OBJECTIVE: To describe the treatment and outcome in terms of degree of metabolic control in these patients, assess the agreement between the doses of antidiabetic drugs reported by the patient and those written in the medical record, and describe the drug utilization characteristics in relation to the standards of care. METHODS: This drug utilization study was conducted in primary care centers in Barcelona, Spain. Consecutive patients with type 2 diabetes attending a follow-up visit were interviewed regarding lifestyle, diet, glycosylated hemoglobin level, and treatment. Concordance between the information obtained through medical records and patient interviews was analyzed. RESULTS: Metabolic control was deficient in 73 (40%), acceptable in 50 (28%), and good in 58 (32%) of the 181 patients with available information. For 38 (19%) patients, there was disagreement between the dose of the antidiabetic drug reported by the patient and that written in the medical record. For 83 (41%) patients, the treatment in the medical history was in agreement with published standards. CONCLUSIONS: Identification of disagreement between standards of care and clinical practice in type 2 diabetes management is the basis to improve drug utilization and achieve better metabolic control in these patients.

Aged↗
PubMed2006

Changing patterns of drug utilization in a neonatal intensive care population.

Newborns in the neonatal intensive care unit (NICU) typically are exposed to a large number of drugs and are especially vulnerable to adverse drug reactions. It is important to review changes in drug use patterns periodically in the NICU to identify newly introduced drugs as well as drugs with increasing use. The objective of this study was to determine the changes in drug utilization patterns over a 7-year period in an NICU population. Drug utilization of 2332 neonates treated at an intramural NICU between January 1, 1997 and December 31, 1998, and 2691 neonates between January 1, 2001 and June 30, 2004 was analyzed using chi-square tests, T tests, and linear regression. There was an increased utilization of antibiotics, central nervous system drugs, endocrine agents, cardiovascular and gastrointestinal drugs, and a decreased utilization of ophthalmic drugs. No changes in nutritional, biological, renal, and pulmonary drugs were observed. Some individual drug changes include an increased use of vancomycin, cefepime, caffeine, and a decreased use of morphine. Significant changes in drug utilization patterns in an NICU were observed during a 7-year period. These data are useful in monitoring drug resistance patterns, adverse drug reactions, and prioritizing areas of relevant therapeutic research and educational programs.

Drug Utilization↗
PubMed1984

Patterns in drug utilization--national and international aspects: psychoactive drugs 1966-80.

Although the press claimed there were dramatic increases in the use of tranquillizers in Northern Ireland after the outbreak of civil unrest in 1969, our data, based on the computerised pricing system for drugs prescribed in the province, showed average annual increases of about 20% from 1966 to 1969, and 10% from 1970 to 1975, thereafter tranquillizer prescribing levels reached a plateau and declined between 1979 and 1980. Total psychotropic drug use also reached a peak in 1975, when about 12.5% of the adult population were estimated to have been receiving such a drug, and declined in the following 5 years. Benzodiazepines accounted for three-quarters of all psychotropic drugs and 98% of tranquillizers prescribed in 1980. Benzodiazepine tranquillizer prescribing has consistently been 20-30% higher than the rest of the United Kingdom, in contrast to hypnotic and antidepressant prescribing which has been consistently lower. The rate of increase in benzodiazepine tranquillizer prescribing over the decade from 1966 was greater than in other European countries, overtaking the level in Norway in 1972 and has since remained third to Iceland and Denmark. Some possible demographic and socioeconomic determinants of these trends are discussed. The prescribing of benzodiazepine hypnotics was almost entirely explained by these variables.

Anti-Anxiety Agents↗
PubMedDate not supplied

Retrospective drug utilization review: incidence of clinically relevant potential drug-drug interactions in a large ambulatory population.

OBJECTIVE: To determine the incidence of clinically relevant potential drug-drug interactions (DDIs) in a large population of ambulatory patients utilizing a computerized, retrospective drug utilization review (DUR) program followed by clinical pharmacist audit. METHODS: The drug claims database included approximately 2.9 million patients with more than 30 million prescriptions dispensed in the 12-month period from September 2001 through August 2002. Cases were identified by a computerized, retrospective DUR program with embedded triggers to detect 69 prespecified potentially serious DDIs, with "serious" defined as an interaction that would likely require a change in therapy or use of additional clinical or laboratory monitoring. Two types of automated, computerized assessments were conducted: the first simply detected coprescribed drug pairs, and the second assessment used more sophisticated filters to reduce false positive alerts for coprescribed drug pairs. Clinical pharmacist audit then determined the final incidence of clinically relevant warnings; in this audit, coprescribed drug pairs were defined as clinically relevant if they could cause potentially serious DDIs. RESULTS: Eighteen drug pairs had insufficient cases for inclusion, leaving 51 drug pairs for evaluation. A total of 244,703 cases of potential DDIs were identified (0.8% of total prescription claims) by simple automated screens. More sophisticated DDI filters reduced the 244,703 potential DDIs by 70.8%, to a total of 65,544 pairs (0.2% of total prescription claims). Clinical pharmacist review reduced the number of potential DDIs by an additional 80.6%, to 12,722 drug pairs (0.04% of total prescription claims) deemed clinically relevant. The combination of sophisticated DDI filters and clinical pharmacist review reduced the incidence of potentially serious DDIs by 94.3%. CONCLUSION: The incidence of potentially serious DDIs is relatively low (less than 1%) among ambulatory patients; however, the incidence depends on the method of case finding. Retrospective DUR programs, especially those with additional automated filters or that utilize additional pharmacist review, appear to be important screening tools in determining true rates of coprescribed drug pairs that can lead to potentially serious DDIs.

Ambulatory Care↗
PubMedDate not supplied

Drug utilization: a regional approach.

A two-year Hospital Incentive Fund grant facilitated activities to improve drug utilization through a regional drug utilization evaluation involving 21 Ontario hospitals. While reporting on the development of a regional drug evaluation process, the authors identify areas where drug use, patient outcome and cost efficiency could be improved, and discuss the issues to be considered when developing such a process.

Anti-Infective Agents↗
PubMed2006

The history of the Drug Utilization Research Group in Europe.

Following the recommendations from a World Health Organization (WHO)/Euro symposium Consumption of drugs in 1969, a common classification system for drugs was developed, the Anatomical Therapeutic Chemical (ATC), and a technical unit of comparison, the Defined Daily Dose (DDD), as a comparative unit of drug use. This was found to be robust across therapeutic classifications, dosing forms and diverse populations. To maintain and develop the ATC/DDD system a WHO-Collaborating Centre was established in Oslo. As this was found to be of global interest the centre now reports to the WHO headquarters in Geneva. An informal WHO Drug Utilization Research Group (WHO-DURG), later the EuroDURG, has by now met 28 times in Europe. Since 1994 in Stockholm all these meetings have been with ISPE (International Society for Pharmacoepidemiology) when meeting in Europe. The main focus was initially to improve drug utilization through cross-national drug utilization studies based on the ATC/DDD methodology as they revealed large differences between and within countries that could not easily be explained by morbidity differences alone. These observed differences have led to the expansion of the area to include social, economic and qualitative methods with a more generalized public health focus. One of the most recent contributions was the development of drug use quality indicators.

Benchmarking↗