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PubMed1991

Drug utilization studies and people. A Swedish perspective.

Innovative ways of collaboration between actors involved are needed to increase the quality of drug therapy. Sweden is fortunate to have access to reliable and detailed statistics on drug sales and prescribing patterns. The various data bases are being described. A common classification system (ATC) and a unit of measurement (DDD) enable comparisons at various levels. Major differences between countries, counties, and health centres are presented. Little is known about the reasons for these differences. In order to leave its infancy, drug utilization studies need that clinical pharmacology establishes linkages with primary health care where a majority of the prescribing takes place. Systems should also be developed activating the prescribers involving them in a revolving cycle of self audit. To study drug use in its context a multidisciplinary approach is needed. The descriptive phase should be complemented by targeted intervention and methods should be developed for drug information. Future drug utilization studies need more of a patient-prescriber perspective (PPP).

Databases, Factual↗
PubMed1985

A survey of psychotropic drug utilization by patients with advanced neoplastic disease.

The utilization of psychotropic drugs in patients with advanced neoplastic disease was studied over a 14-month period. Eight hundred twenty-four (82.4%) of one thousand consecutively admitted patients were prescribed at least one psychotropic agent. Antipsychotic agents were prescribed for 61.3% and hypnotics for 55.8% of the total patient sample. Only one out of ten patients received an antidepressant medication. Significantly more psychotropic drugs were prescribed for the relatively younger patients (less than 50 years). Diphenhydramine, prochlorperazine, and haloperidol were the most frequently prescribed psychopharmacologic agents. The most common reasons for prescribing psychotropic medications were for psychologic distress, sleep disorders, and nausea and vomiting. Clinical consequences are discussed.

Adjustment Disorders↗
PubMedDate not supplied

Drug utilization review using a Medicaid claims database.

A methodology for conducting drug utilization review (DUR) using Medicaid claims data is presented. The DUR allows for calculation of rates and costs of health care utilization among patients with established diagnoses and specific drug regimens; for comparison of results between competing drug therapies; for quantification of the percent market share of pharmaceutical products; and for projection of the duration of a given drug therapy. The strengths and limitations of using Medicaid data for DUR are discussed.

Databases, Factual↗
PubMed1987

Albumin/hetastarch drug utilization review in an operating room pharmacy.

A prospective drug utilization review (DUR) was performed on the colloids albumin 5% and hetastarch 6% at the University of Illinois Hospital Operating Room Pharmacy. This DUR's purpose was to evaluate the usage patterns of the two colloids. With the addition of hetastarch 6% to the formulary, an alternative colloid was available that could be therapeutically substituted for albumin 5% at a cost savings. Its usage, however, was not what would have been expected. Usage information was obtained by placing utilization forms inside the individual boxes of albumin 5% and hetastarch 6%. These forms were completed by the anesthesiologists and returned to the pharmacy, where the remainder of each form was completed. It was concluded that 93 percent of the patients administered albumin 5% could have received hetastarch 6%. Hence, potential yearly savings of approximately $12,346.00 could be realized by the Department of Pharmacy.

Albumins↗
PubMed2004

Dosage finding and outcome in the treatment of schizophrenic inpatients with amisulpride. Results of a drug utilization observation study.

OBJECTIVES: Amisulpride is an unique neuroleptic drug insofar as it has a dual pharmacodynamic effect. At low doses it blocks selectively presynaptic autoreceptors, and at high doses it blocks postsynaptic D(2)/D(3) receptors. This allows the dosage to be adjusted and the treatment tailored to various clinical situations. It is unknown whether this pharmacological property has any bearing for routine treatment. The questions are: which dosages of amisulpride are chosen by physicians in the treatment of schizophrenic inpatients and does this dosage handling deviate from prescription guidelines?; which factors can explain dosage selection, and what is the treatment outcome with different dosages? The study pertains to drug management and dosage finding as principal factors in explaining positive and negative medication results. METHODS: In a drug utilization observation study the prescribing of amisulpride for 811 schizophrenic inpatients from 240 psychiatric hospitals was monitored for 8 weeks. Standardized assessment included dosage, the positive and negative symptom scale (PANSS), the clinical global impression rating (CGI), the patients' subjective reaction to amisulpride, psychosocial functioning, EPS and other adverse events. The mean observation period was 49 days. RESULTS: The mean initial daily dose of amisulpride was 361 mg/day. The mean daily dose at day 56 was on average 550 (SD 266) mg/d, ranging from 100 mg to 1600 mg. 17.9% of patients received a maximum dose up to 399 mg/d, 48.1% between 400 and 799 mg/d, and 25.5% 800 mg/d and higher. Higher doses were preferably prescribed for males, patients with involuntary admission, patients with paranoid schizophrenia with acute exacerbation, high CGI and high PANSS-positive scores. Patients with higher doses of amisulpride at the same time received higher rates of additional other neuroleptic drugs. Higher doses yield better results in very severe cases. CONCLUSIONS: Prescribed dosages were in the lower range of what is recommended for acute cases. Dosage was significantly influenced by the severity of the illness. Polypharmacy was the rule rather than the exception. Efficacy rates under conditions of routine care were similar to the results from controlled clinical trials, which speaks for their generalizability. Very severe cases profit from higher doses.

Adult↗
PubMed2004

Changing trends in the hospital management of unstable angina: a drug utilization analysis.

OBJECTIVE: The current study was designed to investigate drug utilization in the management of unstable angina in India and to examine the changing trends in the management of unstable angina over the past 4 years. METHODS: We conducted a prescription survey to examine the use of antianginal drugs in patients with unstable angina in a tertiary care Indian hospital. The use of concurrent medications such as antidiabetic, antihypertensive and lipid-lowering agents was also examined. This study results were compared with a similar study done in this institute 4 years earlier. RESULTS: A total of 159 consecutive prescriptions were evaluated. Aspirin (86%), nitroglycerin infusion (77%) and low-molecular weight heparins (93%) were the most frequently prescribed drugs. Enoxaparin accounted for 76% of the total LMWH use. One of the heparins was used by 92% of all patients, angiotensin-converting enzyme inhibitors (ACEIs) and beta-blockers by 70% and 67%, respectively. Lipid-lowering agents (57%), antidiabetic agents (16%) and antianxiety agents (33%), in addition to antianginals, were also frequently co-administered. Time trend analysis showed that the use of unfractionated heparin fell from 35% to 10% and the use of ACEIs and enoxaparin increased from 17% to 70% and from 51% to 71%, respectively. CONCLUSIONS: The study showed that unfractionated heparin is less frequently used in the treatment of unstable angina than in the past and that ACEIs are preferred to calcium channel blockers. Enoxaparin remains the most commonly used low-molecular weight heparin for this indication. A variety of low-molecular weight heparins are available for therapy but comparative clinical trials of efficacy and pharmacoeconomic studies comparing the various LMWHs still need to be carried out.

Angina, Unstable↗
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↗
PubMed1984

A strategy to reduce drug expenditures with a drug utilization review program.

This paper describes a potential strategy for implementing a Drug Utilization Review (DUR) program aimed at reducing hospital drug expenditures. The importance of this type of program is underscored by the spiraling rise in health care expenditures and the influence of a new drug technology on this rise. The program described here consists of a utilization review program for high cost drugs for which a lower cost alternative exists. An initial retrospective usage and cost analysis must be undertaken to identify those drugs which should be reviewed initially. As the DUR program progresses, additional drugs can be added to the review program. Once the drugs to be reviewed are identified, the first step is to develop usage criteria. This can be accomplished through a review of the literature and consultation with medical and other specialists. Appropriate medical administrative staff approval and endorsement of the criteria should be obtained utilizing various committee structures and other input. The pharmacy staff must also be inserviced on the approved drug usage criteria. After the criteria are finalized, staff pharmacists will contact a DUR pharmacist daily upon receipt of any physician orders for the review drugs. This pharmacist will then compare the prescribed drug use to the approved criteria and contact the prescriber when the usage appears questionable. A lower cost therapy will then be recommended when appropriate. In order to assess the impact of this intervention strategy on drug expenditures, the cost of the initially prescribed therapies must be compared to the recommended therapies. Data should also be obtained on overall drug usage and expenditures to detect shifts in therapy and drug costs. The success or failure of this concurrent DUR program will be highly dependent upon a team approach and cooperation. A program of this type could have a significant impact on hospital drug expenditures in those hospitals where it can be successfully implemented.

Cost Control↗
PubMed2003

A study of anesthetic drug utilization in different age groups.

STUDY OBJECTIVE: To determine anesthetic drug utilization in different age groups. DESIGN: Retrospective, automated, intraoperative database study. SETTING: Tertiary care medical center. MEASUREMENTS: 30,842 noncardiac general anesthesia case records between January 1991 and July 1997 were studied. We investigated the effect of age on anesthetic requirements for fentanyl (F), midazolam (M), thiopental sodium (T), propofol (P), isoflurane (I), and nitrous oxide (N). Because drugs are not given in isolation we looked at the most common drug combinations, IFNTM, IFNPM, INFT, and PFNM. Regression analyses on log-transformed drug dosages were used to test the significance of age on individual requirements. RESULTS: In each of the above anesthetic drug combinations, reduced doses of fentanyl, propofol, midazolam, thiopental, and isoflurane were used with increasing age. Fentanyl, propofol, thiopental, and isoflurane showed a 10%, 8%, 6%, and 4% reduction in dose per decade of age, respectively, from age of maximum dose to age 80 years. CONCLUSIONS: In clinical practice, increasing age results in decreased anesthetic drug administration. The mechanism of this observation needs to be determined.

Adult↗
PubMed1994

Drug utilization & therapeutic intervention programs: pharmacy services that pay for themselves.

This mailed survey was a follow-up to a 1989 study to assess the status of pharmacy-directed, drug-related, patient care programs in response to the Pharmaceutical Inquiry of Ontario (Lowy Inquiry). A specific focus on Therapeutic Interventions and Drug Utilization Review/Evaluation Programs was adopted because the earlier study indicated a significant "financial return" for pharmacist time spent on these initiatives. A response rate of 62.2% (89 out of 143 hospitals) was achieved compared with an 80% response rate in 1989. Therapeutic interventions were performed by 97.7% of hospitals which identified an average of 184 therapeutic interventions per month and an 84.3% acceptance rate by prescriber. Based on data from 53 hospitals, an average of 29 minutes was taken on each intervention and financial data from 10 hospitals showed cost savings/avoidance of $49.34 per intervention. Drug Utilization program data was available from 45% of hospitals and specific financial data was provided by 29.2% of institutions. Cost savings/avoidance data demonstrated a return of $29.99 for every dollar invested in pharmacist time performing these activities. Collectively, both programs were recognized for their value in optimizing pharmacotherapy, improving patient outcomes as well as demonstrating a financial return to the institution. Despite the recessionary times, these programs are easily justified since they more than pay their own way.

Cost Savings↗
PubMed1997

Drug utilization in indoor ANC patients of Govt Medical College Hospital, Nagpur.

Drug utilization in the indoor patients of ANC ward of Govt. Medical College Hospital, Nagpur was studied in 42 patients. The prescriptions of these patients were audited to find number of drugs per prescription; prescribing trends and category-wise drug consumption. In most of the prescriptions drugs were prescribed by generic names (68.53%), Dosage form was mentioned, Frequency given, but duration was not mentioned. Dose in recommended units was not mentioned in 69.93% of prescriptions. Even though prescription of drugs was found to be rational, prescription writing was far from desired. The enquiry reveals these findings.

Drug Utilization Review↗
PubMed2005

Effects of electronic prescribing on formulary compliance and generic drug utilization in the ambulatory care setting: a retrospective analysis of administrative claims data.

OBJECTIVE: Electronic prescribing (e-prescribing) provides formulary information at the point of care. The objective of this study was to assess the effects of e-prescribing on formulary compliance and generic utilization. METHODS: This was a retrospective analysis of pharmacy claims data from a large national managed care organization. A sample of 95 providers using predominantly e-prescribing was randomly selected (e-prescriber group). A matched sample of 95 traditional prescribers was selected (traditional prescriber group), matched to the e-prescriber group by zip code and medical specialty. A total of 110,975 paid pharmacy claims, for the 12 months from August 1, 2001, through July 31, 2002, were analyzed to assess the effect of e-prescribing on formulary compliance and generic utilization. All paid pharmacy claims were examined for each group; for the e-prescriber group, this included all claims, not just those prescribed using an e-prescribing device. A written qualitative survey was distributed to physicians and office managers to assess e-prescribing usage, sources of formulary information, and effects of e-prescribing on office resources. RESULTS: Both predominantly e-prescribers and traditional prescribers demonstrated high levels of formulary compliance, 83.2% versus 82.8%, respectively (P=0.32). Formulary compliance for these groups did not differ from the overall prescriber population (82.0%). There was not a difference in generic drug utilization rates between e-prescribers and traditional prescribers (absolute rates 37.3% versus 36.9%, P=0.18). Qualitative survey responses supported previously reported research indicating reductions in calls both to and from pharmacies for prescription orders. CONCLUSIONS: An examination of paid pharmacy claims from a large, national managed care organization demonstrated no differences between predominantly e-prescribers and traditional prescribers in measures of formulary compliance or generic drug utilization. Future studies should examine keystroke data at the point of care to observe more detail about drug selection methods.

Ambulatory Care Information Systems↗
PubMed1984

Measurement of drug utilization in Sweden: methodological and clinical implications.

The available sources of information on drug utilization in the Swedish population at large are reviewed. They comprise whole-sale statistics, drug deliveries to hospitals and prescription data. Drug consumption is preferably expressed in defined daily doses (DDD) per capita, where DDD is the average recommended dose on the major indication of the drug. Under ideal circumstances--drugs used continuously on one indication--the number of DDDs per population ought to agree with morbidity data. This turned out to be the case with antidiabetic drugs. The pitfalls with this unit of measurement include major discrepancies between recommended and prescribed doses, and the use of the drug on vastly different indications (such as neurosis and psychosis in the case of neuroleptics). Nevertheless, the DDD methodology may serve as a therapeutic audit in attempts to follow and influence therapeutic habits of health personnel in hospitals and primary health care. Wholesale data combined with individual-based prescription data are particularly useful in this regard.

Data Collection↗
PubMed2005

Pattern of drug utilization among hypertensives in a Nigerian teaching hospital.

PURPOSE: To describe the drug utilization pattern among hypertensive patients in a tertiary care setting, assess the short-term outcome of anti-hypertensive drugs usage and identify points for future intervention to improve outcomes. METHODS: A cross sectional retrospective drug use review was conducted between 1st June and 31st August 2002 on randomly selected 200 case notes of hypertensive patients at a tertiary care facility in South-Western Nigeria. RESULTS: Diuretics were the most frequently prescribed anti-hypertensive class (39.4%), followed by centrally acting agents (23.3%), calcium channel blockers (21%), angiotensine converting enzyme (ACE) inhibitors (8.6%) and beta blockers (1.9%). Aspirin was the most frequently prescribed adjoining non-anti-hypertensive drugs (39.7%), followed by anxiolytics (23.6%), other non-steroidal anti-inflammatory drugs (NSAIDs) (14.8%), metformin (6.7%), glibenclamide (5.9%), paracetamol (5.9%) and Mist. Magnesium Trisilicate (3.3%). All patients made out-of-pocket payments for their prescribed anti-hypertensive drugs at the study site. Blood pressure control was adequate in only 33.9% of patients. There was no significant difference in blood pressure control between male and female hypertensives ( p > 0.05). Anti-hypertensive drugs were changed at least once in 44% of patients and blood pressure control was significantly better in patients with at least one change ( p < 0.05). Adherence with drug therapy was documented as adequate in 82.5% of patient. Diabetes mellitus (NIDDM) (39.6%) and osteoarthritis (22.9%) were the most frequent co-morbidities. Potential harmful drug interactions were identified in 3.8% (49) of patients. CONCLUSIONS: Diuretics and centrally acting agents were the most frequently prescribed anti-hypertensive drugs in a tertiary care setting in Nigeria. Physicians' prescribing decisions appear significantly influenced by cost consideration.

Aspirin↗
PubMed1981

Record-linked audit of drug utilization data in a hospital: antimicrobial use on a urology ward.

Antimicrobial drug utilization patterns were studied on a urology ward with a view to establishing base-line data and subsequently determining drug usage data during the implementation of antimicrobial prescribing guidelines. Methods of data collection, storage and interpretation are described. The results of therapeutic audit of the use of antimicrobial agents over a period of time during which discussion, constitution and acceptance of guidelines took place, are described. The effectiveness of a multidisciplinary approach in rationalizing drug prescribing and the effects of intensive monitoring on prescribing patterns are illustrated.

Amoxicillin↗
PubMedDate not supplied

[Drug utilization at the end of pregnancy].

To evaluate drug utilization during the last 15 days of pregnancy, one hundred six women were interviewed post-delivery in the CHU Bretonneau in Tours. Eighty-three percent received at least one drug during the 15 days preceding delivery and 27% more than 3 different drugs. Treatments for venous disorders (31% of patients), iron (31%), analgesics (25%), antacids (11%), magnesium (11%) and laxatives (11%) were most frequently used. In 92% of cases the drug was prescribed. Five women received a drug with potential risk for the neonate. However only one infant developed and adverse effect, possibly due to benzodiazepine (hypotonia).

Adult↗
PubMed1985

The effects of drug counseling and other educational strategies on drug utilization of the elderly.

The medication behavior of 183 elderly apartment residents was assessed for problems in medication regimen compliance, regimen comprehension, drug interactions, and drug storage. Following an initial assessment, the residents were given instructions in drug utilization and access to drug counseling was provided intermittently for almost 2 years. Approximately 1 year after the educational intervention a final assessment of a sample of 39 residents, who initially were found to have the greatest numbers of problems, revealed a significant 11% decrease in the number of prescriptions taken and a significant 39% decrease in the number of medication behavior problems. The initial average was 3.7 prescriptions currently used and 2.7 problems per person that subsequently decreased to 3.3 prescriptions and 1.6 problems for the same residents at the end of the study. Results suggest that pharmacist consultation provides an effective health prevention strategy in elderly resident settings. Educational strategies used in this study appear to be well adapted for use with elderly home-based populations.

Aged↗
PubMed1997

Medical status, functional status and drug utilization patterns of a population of older dental patients in Winnipeg, Manitoba.

Despite the wealth of epidemiological studies that have evaluated the oral health status of older Canadian dental patients, comprehensive epidemiologic data on their medical status, functional status and drug utilization patterns are deficient. To address this deficiency, the authors evaluated 170 older dental patients (> or = 65 years, mean = 82 years, sex distribution = 77.1 per cent female, 22.9 per cent male) in Winnipeg, Manitoba. Study participants averaged five medical conditions per person (males = females). The most prevalent conditions were vision deficits, cardiovascular disorders and orthopedic problems. Functional assessment of the Activities of Daily Living revealed that study participants were essentially independent. Within the study population, 90 per cent were taking at least one medication (mean = 2.8 drugs per person), most of which were analgesics, diuretics and gastrointestinal agents. Drug utilization rates were consistent with other studies that have evaluated prescribing patterns in community-dwelling older Canadian adults.

Activities of Daily Living↗