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PubMed1987

Intravenous metronidazole: a drug utilization review in a community hospital.

The recent release, relatively high cost and extensive usage of intravenous metronidazole, in a 690-bed community hospital, prompted a drug utilization review of this antimicrobial agent. The review was retrospective and occurred over the period of October 25, 1984, to April 10, 1985. All patients started on intravenous metronidazole were assessed. The quality of use of intravenous metronidazole was determined on the basis of pre-established criteria, which were developed from the literature and in consultation with the hospital's Medical Microbiologist. These criteria were approved by a peer review committee of medical staff. Drug utilization was assessed as either appropriate or inappropriate. Appropriate therapy implied compliance with all of the criteria for appropriate intravenous metronidazole use with respect to indication, dose, dosage frequency, timing of perioperative prophylaxis, duration of use, and concurrent antimicrobial drug use, when metronidazole was prescribed for prophylaxis, empiric treatment or treatment of a documented infection (documented treatment). Inappropriate use implied non-compliance with one or more of the criteria. Fifty-four courses of intravenous metronidazole in fifty in-patients were reviewed. Of the total usage of intravenous metronidazole, 50%, was judged to be inappropriate. Although the Surgical Services accounted for 56% of the total usage, only 13% of the total intravenous metronidazole use was for surgical prophylaxis. Of these cases, 57% were inappropriate. Seventy percent of the total intravenous metronidazole use was for empiric treatment; 53% of these cases were considered inappropriate. The reasons cited most frequently for inappropriate prophylactic or empiric use were inappropriate indication and inappropriate dosage frequency.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMedDate not supplied

Drug utilization review of concomitant use of specific serotonin reuptake inhibitors or clomipramine with antianxiety/sleep medications.

Side effects of some antidepressants include anxiety and insomnia. A retrospective drug utilization review was conducted to determine the amount of concurrent use of an antidepressant with medication that may counteract these side effects. Texas Medicaid claims data for 1993 included more than 30,000 patients receiving a specific serotonin reuptake inhibitor (SSRI) or clomipramine. A total of 35.0% of these patients were also taking a medication that could be used to relieve anxiety or induce sleep, and 15.2% of the total were receiving once-daily dosing of the latter type of medication. Concomitant use of SSRIs or clomipramine with trazodone occurred in 7.7% of the patients.

Anti-Anxiety Agents↗
PubMed1993

Drug utilization review in ambulatory settings: state of the science and directions for outcomes research.

There are escalating national pressures to analyze pharmaceutical outcomes and to develop drug-related clinical guidelines. These interests coincide with passage of the Medicaid Rebate Law (OBRA, 1990), which mandates the implementation of prospective and retrospective drug utilization review (DUR) programs by Medicaid in 1993. This report investigates DUR programs that target outpatient drug therapies. The authors present a conceptual framework that identifies the factors influencing drug prescribing and the range of potential patient outcomes. Current types of DUR interventions and their applications are described, in addition to problems that hinder implementation or evaluation of DUR programs. DUR evaluation studies are reviewed, and a critique identifies the limitations of available DUR research. The authors recommend an expanded DUR policy research agenda, strongly suggesting that priority be given to studies in the following areas: DUR criteria development and validation; prevalence of prescribing problems and their association with patient outcomes; efficacy, toxicity and costs of therapeutic alternatives; and DUR program evaluation. The overall conclusion is that the state of the science pertaining to DUR is not well developed. The potential of DUR may not be realized due to the lack of resources needed to design, implement, and evaluate effective programs. Instead, DUR efforts may be limited to cost-containment issues without due consideration of quality-of-care outcomes. The authors call for rigorous evaluation efforts to inform DUR design and implementation, thereby assuring more rational prescribing and enhancing patient outcomes.

Ambulatory Care Facilities↗
PubMed1998

Treatment of Medicaid patients with asthma: comparison with treatment guidelines using disease-based drug utilization review methodology.

OBJECTIVE: To compare asthma drug therapy in the Iowa Medicaid population with international treatment guideline recommendations and relate differences to patient outcomes. METHODS: Data on asthma drug therapy and respiratory-related medical services (clinic visits, emergency visits, hospital admissions) were abstracted from prescription claims and diagnostic codes of adult Iowa Medicaid patients with asthma (n = 1029). RESULTS: About two-thirds of the population received a prescription for a short-acting beta 2-agonist during the study period. Patients with greater daily use of short-acting beta 2-agonists had more clinic visits (p = 0.004), likely related to illness severity. Almost one-third (29.3%) of 58 patients receiving a prescription of salmeterol did not receive the recommended prescription of a short-acting beta 2-agonist inhaler in the 6-month period. About one-half of patients who should have been prescribed inhaled corticosteroids according to the international guidelines did not receive such a prescription in the 6-month study period. Increased use of inhaled corticosteroids was associated with fewer (p = 0.04) emergency visits. CONCLUSIONS: Suboptimal asthma treatment in the Iowa Medicaid population, especially in regard to the use of inhaled corticosteroids as preventive therapy, was evident after comparison with treatment guidelines. Increased daily use of inhaled corticosteroids was associated with positive patient outcomes in accordance with guideline recommendations. Educational efforts to improve closer adherence to international guidelines both in prescribing practices and patient compliance with medication for asthma management should be undertaken.

Administration, Inhalation↗
PubMed1984

Cost containment through P & T committee drug utilization review.

Provoked by changes that are occurring in health care, hospitals are currently formulating and implementing strategies to identify and control costs while maintaining the highest quality of care. Because drug costs account for a significant proportion of the hospital supply budget (5 to 10%), there is an increased need for the P & T Committee to become involved in the cost containment effort. This article will demonstrate how an existing program of drug utilization review (DUR) has reduced drug expenses without sacrificing the quality of care or imposing unnecessary restrictions on formulary items. Furthermore, implementation of the DUR program has not resulted in conflict between pharmacy, medical, nursing or administrative staffs within the institution.

Cost Control↗
PubMed1985

Drug utilization review: dipyridamole plus aspirin antiplatelet therapy.

To assess whether dipyridamole was being used appropriately in providing antiplatelet therapy at the San Diego VAMC, a drug utilization review was conducted. Concomitant aspirin therapy was required for dipyridamole to be considered effective in the disease states reviewed. Seventy-three patients on antiplatelet therapy were evaluated, using dosing criteria established through a literature review. Our data indicated tht based on the criteria, only 11% of patients received dipyridamole in appropriate doses; it was underdosed in 89% of patients, and in 19% of patients, it was used when not indicated. In addition, 19% of patients did not receive concomitant aspirin therapy. Results suggest hat dipyridamole is not used optimally in providing antiplatelet therapy to patients in this institution.

Aspirin↗
PubMed1988

Total parenteral nutrition: a concurrent drug utilization review.

University Hospital, a 428-bed tertiary care teaching hospital, treats approximately 150 patients annually with TPN. Currently used are three standard TPN base formulae which are ordered by physicians using preprinted TPN order forms. A concurrent Drug Utilization Review (DUR) was conducted on TPN treatment of 30 patients, to examine adherence to the current TPN protocol. Criteria for evaluation included ruling out enteral feeding, indications for TPN use, duration of therapy, monitoring of laboratory values, and caloric delivery. Physician and dietician estimation of caloric needs were compared to calories actually ordered by the physician. The number of pharmacist interventions and TPN bags wasted were also determined. Results could not be obtained with respect to ruling out enteral feeding and indications for TPN therapy due to inadequate information. The five-day minimum for duration of TPN therapy established in the DUR criteria was not attained in 23 percent (7/30) of patients. Seventy-seven percent of laboratory monitoring tests were completed. Results indicate wide disparities in caloric calculation and delivery; only 45 percent (10/22) of the patients who were ordered TPN met the physician's caloric goal. A number of recommendations were made to improve the TPN protocol and TPN therapy.

Adult↗
PubMed1994

Drug utilization review on a surgical intensive care unit.

Drug use reviews (DUR) provide information about drug prescription patterns. At the surgical intensive care unit (SICU) of the University Hospital Frankfurt/Main we recorded the indication related administration of blood products and pharmaceuticals (which were responsible for 60% of the total costs at the SICU in the year before) over a 4-month investigation period. Data were recorded and analyzed using a notebook-PC. 207 Patients were included, and recorded total expenditures came to $551,592. The 10 leading substances, represented by antibiotics and blood-products, caused more than 70% of total costs. The usage of these high-cost substances and the most expensive complications are identified and discussed. We concluded that DURs are useful for obtaining information about drug usage patterns and for identifying high cost drugs, which are of economic interest. Furthermore, the indications for the application of these substances can be identified. Our results suggest, that blood and blood-products should always be included in DURs. In our opinion, especially the usage of blood-products represents a field where considerable cost savings may be expected. As certain complications during the postoperative course (e.g. sepsis) may increase costs, they should be considered in the reimbursement negotiations between hospitals and health insurance.

Adult↗
PubMed1998

Improving prescribing patterns for the elderly through an online drug utilization review intervention: a system linking the physician, pharmacist, and computer.

CONTEXT: Pharmacotherapy is among the most powerful interventions to improve health outcomes in the elderly. However, since some medications are less appropriate for older patients, systems approaches to improving pharmacy care may be an effective way to reduce inappropriate medication use. OBJECTIVE: To determine whether a computerized drug utilization review (DUR) database linked to a telepharmacy intervention can improve suboptimal medication use in the elderly. DESIGN: Population-based cohort design, April 1, 1996, through March 31, 1997. SETTING: Ambulatory care. PATIENTS: A total of 23269 patients aged 65 years and older throughout the United States receiving prescription drug benefits from a large pharmaceutical benefits manager during a 12-month period. INTERVENTION: Evaluation of provider prescribing through a computerized online DUR database using explicit criteria to identify potentially inappropriate drug use in the elderly. Computer alerts triggered telephone calls to physicians by pharmacists with training in geriatrics, whereby principles of geriatric pharmacology were discussed along with therapeutic substitution options. MAIN OUTCOME MEASURES: Contact rate with physicians and change rate to suggested drug regimen. RESULTS: A total of 43007 alerts were triggered. From a total of 43007 telepharmacy calls generated by the alerts, we were able to reach 19368 physicians regarding 24 266 alerts (56%). Rate of change to a more appropriate therapeutic agent was 24% (5860), but ranged from 40% for long half-life benzodiazepines to 2% to 7% for drugs that theoretically were contraindicated by patients' self-reported history. Except for rate of change of beta-blockers in patients with chronic obstructive pulmonary disease, all rates of change were significantly greater than the expected baseline 2% rate of change. CONCLUSIONS: Using a system integrating computers, pharmacists, and physicians, our large-scale intervention improved prescribing patterns and quality of care and thus provides a population-based approach to advance geriatric clinical pharmacology. Future research should focus on the demonstration of improved health outcomes resulting from improved prescribing choices for the elderly.

Aged↗
PubMed1993

Michigan drug utilization review and OBRA 90.

The DUR Board's role in the Medicaid DUR process is significant. With the requirements for membership on the DUR Board and the responsibilities directed by OBRA 90, the standards will ensure that they reflect the accepted medical practice and are clinically relevant to the geographical area represented. The DUR Board has the potential to improve drug utilization review and ultimately improve the quality of care. The approval of criteria for both patient retrospective and prospective DUR and the addition of education intervention will help us to improve the quality of care. DSS encourages your input and participation on the DUR regional committees. There are currently three committees that meet monthly and are located in: Detroit, Ann Arbor, Lansing.

Drug Utilization Review↗
PubMedDate not supplied

Construction of the Korea Elderly Pharmacoepidemiologic Cohort: drug utilization review of cephalosporins in geriatric inpatients.

We performed a cohort-based pharmacoepidemiologic study in order to evaluate the pattern of cephalosporin prescriptions in elderly inpatients in Korea. The Korea Elderly Pharmacoepidemiologic Cohort was composed of a geriatric population of beneficiaries of the Korea Medical Insurance Corporation residing in Busan in 1993. The cohort consisted of 23,649 members, comprising 15,221 women (64.4%) and 8428 men (35.6%). The study population for drug utilization review consisted of those cohort members who were admitted into hospitals during the period January 1993 through December 1994. The number of hospitalized patients was 4262, comprising 2631 women (61.7%) and 1681 men (38.3%). The trend of cephalosporin prescriptions over the 2-year period showed that the use of second and third generation cephalosporins increased relative to the use of first generation. The use of cephalosporins combined with other antibiotics was found to occur in 22.8% aminoglycosides (76.7%) and quinolones (17.1%) being the most common antibiotics combined with cephalosporins. Our result demonstrates an increase in the prescription of second and third generation cephalosporins in Korea, which has implications not only for the elderly population but also for the total population because of the impact on health care costs and the potential for the emergence of antimicrobial resistance.

Age Factors↗