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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↗
PubMed2002

Drug utilization study in dermatology in a tertiary hospital in Delhi.

The present study was undertaken to describe patterns of dermatological drug utilization in a tertiary hospital in Delhi by measuring WHO delineated drug use indicators. Six hundred and six prescriptions of dermatology out-patients were analyzed and the data collected were used to evaluate the following drug use indicators: average number of drug per prescription, average consultation time, percentage of drugs prescribed by generic name, percentage of encounters with an antibiotic prescribed, percentage of encounters with an injection prescribed and percentage of drug prescribed from the essential drugs list or formulary. The average number of drugs per prescription +/- SD was found to be 2.6 +/- 1.2, average consultation time +/- SD was 4.4 +/- 2.6 minutes, percentage of drug prescribed by generic name was 6.98, percentage of encounters with an antibiotic and injection prescribed were 46.86 and 6.76 respectively and 23% of the total drugs prescribed were from Delhi State Essential Drugs Formulary.

Anti-Bacterial Agents↗
PubMed1996

Antiepileptic drug utilization in out-patients--a prescribing pattern study.

Antiepileptic drug utilization for the treatment of different epileptic seizures had been investigated for 10 years in Bulgaria (1985-1994). The data were collected from ambulatory cards of 10,132 epileptic out-patients as well as from pharmacists' sales records. The results were expressed in DDD/1,000 inhabitants/year. During the period 1985-1989 the drug mostly prescribed had been phenobarbital both in mono- and polytherapy, but during the second period (1990-1994) it had been replaced to a high extent by carbamazepine and valproates. Polytherapy had given up its place to monotherapy in all forms of epileptic seizures during the 10-year period of investigation.

Adolescent↗
PubMed1997

Quality-monitoring of psychotropic drug therapy in post-marketing surveillance. Results of a drug utilization observation (DUO) study on moclobemide.

Thanks to their non-intervening nature, post-marketing drug utilization observation (DUO) studies reflect both the properties of the substance under investigation and doctors' treatment decisions, thus-in contrast with clinical trials-allowing the interactions of these two factors to be investigated. A DUO study involving the administration of moclobemide to 9419 patients investigated the prescribing behavior of about two-thirds of all general practitioners and internists in Germany prescribing moclobemide during the study period. The results obtained suggest that, on the whole, moclobemide is being prescribed knowledgeably and correctly for the treatment of the full spectrum of depressive disorders. The management of these patients tended to adhere strictly to existing treatment recommendations while at the same time revealing a certain degree of latitude for treatment optimization. This applies particularly to the utilization of the recommended dosage range, especially in severely depressed states, and the consistent, syndrome-based combination treatment with hypnotics/sedatives or neuroleptics in the respective patient groups indicated. Potential interactions-though comparatively few are known for moclobemide-were taken into account in most cases. The safety profile closely matches the experience gained from clinical trials. Despite the large sample size involved there was no evidence of any hitherto unknown serious events. The experience gained during this survey suggests that the DUO study is a suitable instrument for monitoring the use of an antidepressant in the early post-registration period, enabling action to be taken at an early stage to correct any systematic deviations from the conditions of registration.

Adolescent↗
PubMed2006

Effect of drug utilization reviews on the quality of in-hospital prescribing: a quasi-experimental study.

BACKGROUND: Drug utilization review (DUR) programs are being conducted in Canadian hospitals with the aim of improving the appropriateness of prescriptions. However, there is little evidence of their effectiveness. The objective of this study was to assess the impact of both a retrospective and a concurrent DUR programs on the quality of in-hospital prescribing. METHODS: We conducted an interrupted time series quasi-experimental study. Using explicit criteria for quality of prescribing, the natural history of cisapride prescription was established retrospectively in three university-affiliated hospitals. A retrospective DUR was implemented in one of the hospitals, a concurrent DUR in another, whereas the third hospital served as a control. An archivist abstracted records of all patients who were prescribed cisapride during the observation period. The effect of DURs relative to the control hospital was determined by comparing estimated regression coefficients from the time series models and by testing the statistical significance using a 2-tailed Student's t test. RESULTS: The concurrent DUR program significantly improved the appropriateness of prescriptions for the indication for use whereas the retrospective DUR brought about no significant effect on the quality of prescribing. CONCLUSION: Results suggest a retrospective DUR approach may not be sufficient to improve the quality of prescribing. However, a concurrent DUR strategy, with direct feedback to prescribers seems effective and should be tested in other settings with other drugs.

Cisapride↗
PubMed2000

Systemwide effects of Medicaid retrospective drug utilization review programs.

Aggregate pooled cross-sectional and time-series annual state data for 1985 to 1992 were used to estimate the systemwide effects of retrospective drug utilization review programs (Retro-DUR) on Medicaid drug and nondrug outcomes. The results provide evidence that these programs produce significant cost savings in the drug budget without spillover effects (positive or negative) in other nondrug budgets within the Medicaid system. We also examine the influence of restricted formularies in this post-Retro-DUR era on drug and nondrug budgets in the Medicaid system; we find significant cost savings in the former but positive spillover effects in the latter.

California↗
PubMed2006

Drug-drug interactions of anti-infective drugs: utility of fluorescence cyp inhibition assays in drug discovery.

Drug interactions are often a result of induction or inhibition of cytochrome P450 (CYP) enzymes by co-administered drugs. A high throughput fluorescence assay using cDNA-expressed human CYP isozymes and fluorogenic substrates has been reported for the study of CYP inhibition. We used this assay to evaluate CYP inhibition profiles of 21 marketed anti-infective drugs. We found that six of the eight potent inhibitors identified in this screen (IC50 <10 microM against at least one CYP isozyme) correlated with significant drug-drug interactions in the clinic. In contrast, the intermediate and weak inhibitors (IC50 >10 microM) did not indicate clinically significant drug interactions. Furthermore, we observed that results obtained in the fluorescence assay correlated with conventional, well-established, low throughput methods that utilize human liver microsomes. These data suggest that in the early stages of drug discovery, the fluorescence assay for CYP inhibition could be used in conjunction with a human liver microsomal assay to identify new chemical entities with a potential for drug-drug interactions.

Anti-Infective Agents↗
PubMedDate not supplied

Drug utilization patterns and outcomes associated with in-hospital treatment with risperidone or olanzapine.

This study compared the drug-utilization costs and indicators of clinical outcomes associated with the use of risperidone and olanzapine in a hospital setting. We conducted a nonrandomized, retrospective chart review of consecutive patients identified as presenting with psychotic symptoms on inpatient wards at Riverview Hospital in British Columbia and given either risperidone or olanzapine as their first new drug after reassessment (n = 30 per treatment group). Data were collected for up to 120 days. No significant differences were observed between groups in terms of sex, age, duration of illness, or diagnosis. The mean dosage of risperidone for responders was 4.89 +/- 2.56 mg/d, whereas that for olanzapine was 17.19 +/- 3.88 mg/d. The associated daily drug-acquisition costs were significantly different, at CA$4.69 for risperidone and CA$11.52 for olanzapine. Notes in patient charts indicated that a significantly greater proportion of risperidone-treated patients (60.0%) than olanzapine-treated patients (26.7%) responded to therapy, as indicated by improvement in at least one target symptom (P < 0.01). Forty percent of patients initially treated with risperidone were discharged on their original therapy, compared with 13.3% of patients treated with olanzapine (P < 0.05). These results were not substantially affected by correction for markers of illness severity or treatment resistance. Overall, no significant differences in side effects were recorded in the patient records of the two groups. Within this cohort of patients, risperidone treatment was associated with lower drug-acquisition cost and better treatment outcomes than olanzapine.

Adolescent↗
PubMedDate not supplied

Retrospective drug utilization review and the behavior of Medicaid prescribers: an empirical marginal analysis.

The objectives of this study were to evaluate the effectiveness of drug utilization review (DUR) letter intervention on reducing the cost of medications under Medicaid. The target drugs in this study were six antiulcer agents prescribed for Alabama Medicaid recipients. The study group consisted of 100 prescribers who received DUR intervention. A total of 3776 prescribers who did not receive DUR intervention served as the comparison group. Using an interrupted time series design, these 3876 prescribers were studied before and after the implementation of the DUR program. The study found that prescribers' behavior changed after the DUR letter were sent out, resulting in a reduction in the average marginal days of drug therapy and drug reimbursement per recipient. For the target drugs, there was an average savings of $112.73 per prescriber per month and a total of $136,370.82 savings per month for the Alabama Medicaid program.

Alabama↗
PubMedDate not supplied

Medicaid drug utilization review annual reports for federal fiscal year 1999: looking back to move forward.

OBJECTIVE: To review states' Medicaid drug utilization (DUR) annual reports for federal fiscal year (FFY) 1999 to assess the usefulness of the information provided in assisting states in improving their DUR programs. DATA SOURCES: Medicaid DUR annual reports from 43 states and the District of Columbia. DATA EXTRACTION: Five DUR experts conducted in-depth reviews of the annual reports to determine whether states provided the information required by the Health Care Financing Administration (HCFA; now the Centers for Medicare & Medicaid Services) annual report instructions, to assess the usefulness of information provided by states to other states seeking to improve their programs, and to consider what changes in report content are needed to increase the value of the reports. DATA SYNTHESIS: States provided the information requested by HCFA, but such information was not particularly useful in helping other states improve their programs, nor was it easily available to other states. These reports need to be reoriented. Rather than instruments useful for compliance monitoring, the reports should be remade as tools useful for educating DUR program staff. To do this, changes in report content are needed, and individual states should have access to reports from all states. Specific recommendations made based on these findings would be important first steps in improving the effectiveness of DUR programs. CONCLUSION: Much room for improvement remains in the content and distribution of Medicaid DUR annual reports. Finding ways to improve the effectiveness of DUR is especially important as the nation moves to implement a Medicare prescription drug benefit.

Annual Reports as Topic↗
PubMed2003

Impact of analgesic drug-use guidelines for the management of postoperative pain: a drug utilization study.

OBJECTIVE: Postoperative pain is inadequately treated in many surgical settings. The present study evaluates the impact of analgesic drug-use guidelines in the management of postoperative pain. PATIENTS AND METHODS: A prospective drug utilization study was carried out in 3 stages in a traumatology, orthopedic and rehabilitation tertiary hospital. The first stage, aimed at describing the patterns of use of analgesic strategies in the management of postoperative pain, identified habits, practices and misconceptions regarding this therapeutic area. After this, an ad hoc representative institutional working group agreed on analgesic drug-use guidelines for the management of postoperative pain. These were then published, presented and discussed with surgeons and nurses. After the guidelines had been implemented, their impact was evaluated in terms of the analgesics used, their dosage and their administration schedule. RESULTS: 101 patients were studied before the implementation of the guidelines and 108 patients after. Patients receiving opiate analgesics during the immediate postoperative period increased from 70-94% (p < 0.05). First-choice analgesics used according to the guidelines increased from 40-89% of choices after the implementation of the guidelines (p < 0.05). Administration of analgesics at regular predetermined intervals increased from 45-58% of medical orders, but this increase was not statistically significant (p = 0.07). Prescription of analgesics at adequate doses increased from 67-87% (p < 0.05). CONCLUSION: Education on the treatment of postoperative pain is made up of several messages including the drug of choice and dose regimen. Prescribers seemed more receptive to a change in drug rather than issues related to the correct dose regimen. More research is needed to assess how educational activities can improve the management of postoperative pain.

Adult↗
PubMed1996

Retrospective drug utilization review software systems: perspectives of state Medicaid DUR directors.

OBJECTIVE: To determine the desirability or perceived need of retrospective drug utilization review (DUR) software system characteristics. DESIGN: A 32-item questionnaire. SETTING: Ambulatory DUR directors covering more than 33 million patients. PARTICIPANTS: Medicaid DUR directors from 49 states and the District of Columbia. MAIN OUTCOME MEASURES: Five-point Likert scale measures of importance of system and vendor characteristics. RESULTS: A 100% response rate was achieved. Respondents rated the ability to change or modify criteria as very important and thought it was important to receive criteria sets from software vendors. Respondents believed cost-savings methodologies should be clearly defined and false positive DUR criteria should be minimized. CONCLUSIONS: Through the implementation of the Omnibus Budget Reconciliation Act of 1990, considerable experience in ambulatory DUR programs has been achieved. Respondents believed the ability to change DUR criteria was very important and they thought it was important to have a set of criteria supplied from software vendors. Critical issues of criteria development, cost-savings methodologies, minimizing false positive criteria, and outcomes assessment from DUR programs were important issues to DUR directors.

Drug Therapy↗
PubMed1997

An investigation of the representativity of neuropsychiatrists and their patients in a drug utilization observation study on fluoxetine.

This study presents a methodological approach to an expost facto investigation of sample bias in drug utilization observation (DUO) studies using the example of a DUO with the nontricyclic antidepressant fluoxetine. A total of 479 psychiatrists and neurologists and 2,401 patients were investigated. The purpose of the study was to judge the representativeness of our DUO sample for two populations: first, for all psychiatrics and neurologists prescribing fluoxetine or all patients being treated with fluoxetine in Germany and, second, for all psychiatrists and neurologists prescribing antidepressants or all patients being treated with antidepressants in Germany. Criteria for the representativeness test were physician variables (gender, size of community where practicing, federal state, age, volume of prescriptions) and patient variables (gender, age, prescription-related diagnosis, concurrent illnesses, concomitant medications). The study shows that the DUO sample can rightfully claim representativeness in the majority of parameters for the psychiatrists and neurologists prescribing fluoxetine and for the patients being treated with fluoxetine. There are more noticeable discrepancies with regard to the psychiatrists and neurologists in general and to the patients being treated with antidepressants in general. The methodological problems of pharmacoepidemiological investigation of representativeness are discussed.

Adult↗
PubMed1992

Drug utilization at primary health care level in southern India.

Primary health centres provide health care to the majority of the population in developing countries. A drug utilization study was conducted for 1 y at two primary health centres in Pondicherry, India. Information on complaints, diagnosis and drugs prescribed was collected. From the 2953 prescriptions studied, it was found that on an average each patient received 2.71 drugs. Vitamins, antibiotics, analgesics and antihistamines were the most commonly used, accounting for more than 80% of the drugs prescribed. The antimicrobials which constituted one fourth of the drug consumption, comprised sulphonamides, tetracycline and cotrimoxazole. About half of the patients received injections, particularly of the vitamin B Complex and antibiotics. The results will be used to plan intervention strategies for the promotion of rational drug use.

Adult↗
PubMed1996

[Individual-based statistics on drug utilization].

The Danish retail pharmacies' drug subsidy system is completely computerised. The data are person-identifiable, making it possible to chart the population's drug use from the perspective of the individual users. We undertook an analysis to explore the potential of this data source and to analyse the heavy drug users specifically. The analysis encompassed all 890,352 prescriptions presented by Odense citizens 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% percent 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. Heavy drug users were remarkably well characterised 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 generally can 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 one-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.

Adult↗
PubMed1986

Correlation of drug utilization data for trimethoprim in a defined population with patterns of resistance among bacteria causing urinary tract infections.

Data from the continuous monitoring of outpatient prescriptions performed since 1970 among the inhabitants in the county of Jämtland were used to correlate the individual utilization of the antibacterial drug trimethoprim to the occurrence of resistance to this drug among pathogenic bacteria isolated in samples from the same population. There was a good correlation between the use of trimethoprim among female and male patients of different age groups and the occurrence of drug resistant bacteria in samples from the corresponding groups of patients. From total distribution data it was estimated that approximately 3% of the population received trimethoprim in 1984. In the oldest age groups one third of the county population was exposed to trimethoprim during a 6-year period. That this intensive use of the drug exerted a pronounced selection pressure for resistant strains in the population at large is indicated by the finding that one third of the patients harbouring resistant bacterial strains had never been treated with trimethoprim. This is interpreted as a reflection of trimethoprim resistance selected to such a ubiquity that it is spread independently of individual drug therapy.

Bacterial Infections↗