Appropriate Use Of Pharmaceuticals Research Articles

Using health technology assessment for better healthcare decisions.

Canadian health leaders can benefit from greater involvement in the design and production of Health Technology Assessment (HTA) through enhanced working relationships with HTA producers. The HTA producers and health leaders have a shared interest in the appropriate use of pharmaceuticals, healthcare devices, and procedures which benefit patients and support sustainable health systems. This article highlights the shared responsibility of HTA producers and decision makers in the appropriate use of these healthcare interventions through an examination of a HTA-informed policy and practice change in the management diabetes in elderly residents in long-term care settings. Consideration is given to the role of the co-responsibility model and LEADS in a Caring Environment framework (LEADS) in helping to facilitate partnerships between decision-makers and HTA producers in the realization of HTA-informed policy and practice.

Pharmacists and Regulatory Science.

For providing appropriate pharmacotherapy, "Doing the right things, and doing things right" are necessary. Additionally, vigilance is required for the appropriate use of pharmaceuticals. Evidence-based medicine has been a common approach to healthcare, and many guidelines have been published. In addition, risk management plans (RMPs) are developed upon the approval of new drugs. Therefore an environment to provide the best healthcare based on scientific evidence has been developed. When putting RMPs into practice, it is necessary to understand and utilize regulatory science (RS). If pharmaceuticals are not used, no adverse drug reactions will occur; at the same time, diseases will not be cured or symptoms controlled. We should exploit RS to use drugs appropriately. RS is not meant to limit the use of drugs in pharmacotherapy but to indicate the rules for their appropriate use. Pharmacists should ensure that patients receive maximum benefit from prescribed drugs in every case and should determine the best ways to minimize risk.

Cross-Sectional Survey on Prescribing Patterns for Food Animal Medications in Bangladesh

The aim of this study was to examine current prescribing patterns for food animal medications among veterinary hospitals in Bangladesh. We analyzed veterinary practice records and extracted data regarding medications prescribed for 626 cattle and 374 goats. Anthelmintics were the medications most often prescribed (465 patients [46.50%]), followed by antibiotics (425 patients [42.50%]) and nutritional supplements (140 patients [14.00%]). Sulfa drugs were the most commonly prescribed antibiotics (143 patients [33.65%]). Our results indicate that medication choice is not generally based on sensitivity testing. Following published guidelines for medication use will lead to more appropriate use of pharmaceuticals in the animal health care sector.

MONITORING REGISTRIES AT ITALIAN MEDICINES AGENCY: FOSTERING ACCESS, GUARANTEEING SUSTAINABILITY.

The AIFA (Agenzia Italiana del Farmaco--Italian Medicines Agency) Monitoring Registries track the eligibility of patients and the complete flow of treatments, guaranteeing appropriateness in use of pharmaceutical products, according to approved indications. This study describes the Italian pharmaceutical context and the aims and functioning of AIFA Monitoring Registries, focusing on the applications to the Managed Entry Agreements (MEAs) and HTA approaches. The AIFA Monitoring Registries System has been operational in Italy since 2005. In 2012, the system became part of the NHS Information Technology system, aiming at enhancing appropriate use of pharmaceuticals and efficiency of the administrative activity. Currently, seventy-six medicines are monitored through the system, corresponding to fifty-eight therapeutic indications; individual treatments recorded are more than 515,000, for a population of approximately 505,000 patients. For each monitored product, patients eligible for treatment are registered in the specific therapeutic indication dynamic monitoring database to collect epidemiologic and clinical data, including data on the safety profile, and ex-post information missing at first evaluation stage. AIFA Monitoring Registries allow the evaluation of the pharmaceuticals' performance in clinical practice and may promote innovation and quicker access to medicines at affordable prices, for the benefit of patients.

Abstract B95: Disparities in cancer drug use in the geriatric patient

Abstract Background: Many older patients with cancer have multiple co-morbidities requiring multiple medications in addition to their anticancer therapies. Ensuring appropriate medication use in this population, including adequate treatment dosage and adhering to treatment guidelines, is therefore a public health priority. We reviewed the epidemiological literature regarding anticancer treatment administration to older cancer patients. Methods: We conducted a systematic literature review of population-based, epidemiological studies published between 1983 and 2006 on medication use involving chemotherapy and hormonal therapy among cancer patients aged 65 and older. Articles were classified into content areas based on processes of care and adverse drug reactions. Searches were conducted using PubMed, CancerLit, and Ageline. Medical subheadings were used to supplement searches. Only population-based, epidemiological studies published in English between 1983 and 2006 that examined medication use involving anticancer therapies (chemotherapies and hormonal therapies) and included cancer patients 65 years and older were included. Articles were systematically reviewed and classified based on Chassin's paradigm of quality problems in health services use: underuse, overuse, and misuse. For this study, underuse reflected the use of substandard, low-intensity anticancer drug therapies or the omission of standard drug treatments. Overuse included greater than appropriate use of pharmaceuticals, such as polypharmacy or over-dosage. Misuse included avoidable improper use of anticancer therapies, such as inappropriate drug choices, and adverse interactions among drugs or between pharmacotherapies and co-morbidities. Results: A total of 78 articles were identified. Sixty five articles about overuse, underuse, and misuse of medications involving anticancer therapies among older cancer patients were identified: 64 (98%) evaluated underuse, 1 (2%) overuse, and none evaluated misuse. An additional 13 retrieved articles focused on ADRs associated with chemotherapy or hormonal therapy administration to older patients with cancer. One article reported overuse of hormonal treatments in elderly cancer patients with localized prostate cancer. The 64 articles on underuse were further subcategorized into under-treatment (n=47), deviation from treatment criteria (n=16), and patient non-adherence (n=1). Forty-seven studies described under-treatment, operationally defined as: no therapy, less frequent administration, and other non-standard anticancer treatment regimens. Seven studies analyzed medical records and primarily included data from one geographical location or healthcare system. Breast cancer was the most frequently studied cancer diagnosis, being the focus of 22 studies on under-treatment (47%). Thirty-nine of these studies reported that advanced age, regardless of physiologic condition, was a significant risk factor for under-treatment in anticancer therapy. Conclusions: 98% of the epidemiological studies on processes of care associated with use of anticancer therapies among older patients with cancer evaluated underuse. Since cancer cases are expected to rise as the population ages and a tandem increase in the complexity of drug regimens is expected, additional research needs to focus how decisions are made relative to the utilization of cancer therapies older patients. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B95.

The development and operation of a package inserts service system for electronic medical records

To promote the appropriate use of pharmaceuticals and to prevent side effects, physicians need package inserts on medicinal drugs as soon as possible. A medicinal drug information service system was established for electronic medical records to speed up and increase the efficiency of package insert communications within a medical institution. Development of this system facilitates access to package inserts by, for example, physicians. The time required to maintain files of package inserts was shortened, and the efficiency of the drug information service increased. As a source of package inserts for this system, package inserts using a standard generalized markup language (SGML) form were used, which are accessible to the public on the homepage of the Organization for Pharmaceutical Safety and Research (OPSR). This study found that a delay occurred in communicating revised package inserts from pharmaceutical companies to the OPSR. Therefore a pharmaceutical department page was set up as part of the homepage of the medical institution for electronic medical records to shorten the delay in the revision of package inserts posted on the medicinal drug information service homepage of the OPSR. The usefulness of this package insert service system for electronic medical records is clear. For more effective use of this system based on the OPSR homepage pharmaceutical companies have been requested to provide quicker updating of package inserts.

Economic Impact of a Diabetes Disease Management Program in a Self-Insured Health Plan: Early Results

Disease management has grown to a $350 million industry with over 100 providers. Delivery models vary among providers, but short-term economic outcomes are the standard by which a program's success is generally measured. This report focuses on a large self-insured organization that offered the CarePatterns® Disease Management Program for diabetes. Individuals with diabetes were identified by pharmacy claims and invited to participate. Enrollment was voluntary (n = 2745). Medical claims history of eligible individuals who chose not to participate (control group) was used to understand the progress of these chronic diseases in the absence of intervention (n = 8978). Standard forecasting methods using medical claims data from 1997 and 1998 were used for spending projections. The study period ran from 1/1/1997 through 12/31/1999. Evaluation of 24 months of medical claims data showed that participants in the program had higher direct healthcare costs than nonparticipants. Actual medical expenditures for participants decreased by $747 (9.4%) from the baseline period (1998). When participants' 1999 actual spending is compared to 1999 projected medical spending, savings are $1474 (17%) per participant. Conversely, nonparticipant control medical spending increased by $230 (3.3%) per individual. Pharmacy spending for participants increased 23.5% from Baseline to 1999. For nonparticipant controls, pharmacy spending increased by 19.7%. Although further analysis is required to determine which component of interventions significantly contributed, an effective patient-focused disease management program is an important factor in promoting the appropriate use of pharmaceuticals and medical resource utilization.

Traditional systems of duck farming and duck egg incubation in South Vietnam

Few descriptions of traditional duck farming in Vietnam are available. This small study reports on these traditional techniques before they disappear as a consequence of the country's rapid economic and social development. Five production farms and two hatcheries located in South Vietnam were evaluated. The study covered basic questions relating to farm and hatchery management, nutrition, vaccination, pharmaceutical use, costs and priority needs. Questions were translated into Vietnamese for personal interviews. Out of five production farms, three did not use the local veterinary services. However, four used a French duck plague vaccine and not the Vietnamese product. There was little knowledge on the appropriate use of pharmaceuticals. Hatching methods within the two hatcheries were similar to those of South China. The traditional farming system made efficient use of a scavenging resource base that would not otherwise be used. The study highlighted the resourcefulness of Vietnamese farmers in their present situation, and identified areas for disease control and research.

Pharmaceutical services in the Department of Veterans Affairs.

The status of pharmaceutical services in the Department of Veterans Affairs (VA) is described. The VA health care system is transforming itself from a hospital-based organization into 22 health care networks that emphasize primary and ambulatory care. The impact on VA pharmacy has been substantial. Roles of VA pharmacists and technicians have been enhanced, and a clinical career ladder for pharmacists was created. VA pharmacy officials and leaders from the University of Tennessee College of Pharmacy have been partnering since 1988 in strategic planning to determine how VA pharmacy can do business and serve patients better. Areas targeted for implementation or improvement include staff development, prescribing authority for pharmacists, automation, the physical design of VA pharmacies, residency programs, and a pharmacy benefit management (PBM) product line. The VA PBM is working to enhance the appropriate use of pharmaceuticals in the veteran population, reduce overall health care expenditures, and provide a more consistent quality of care. Specific PBM programs involve the implementation of drug treatment guidelines, a national formulary, and national contracts. There are plans for pharmacoepidemiologic and pharmacoeconomic research in the geriatric veteran population. The VA health care system and its pharmacy service are changing in ways intended to bring about easier access to care, higher quality, and increased responsiveness to patients' needs.

Pharmaceutical container labels: enhancing preference perceptions with alternative designs and pictorials

The appropriate use of pharmaceuticals, as well as their hazards, are not commonly known to most people. In fact, the only information available to consumers at the time of consumption is usually the material found on the product label. Unfortunately, people often have difficulty with the labels because the print on the label is too small for them to read. Two alternative (tag and fold-out) designs were developed to increase the available surface area on a fictitious prescription drug label. The alternative label designs, with and without pictorials depicting instructions and warnings, were compared to a standard control label. In Expt. l, 84 undergraduates rated the labels on several preference dimensions, including: ease of reading the labels, likelihood of noticing the warnings, likelihood of reading the warnings, preference for each of the labels, and likelihood that they would recommend each label for use by a friend or family member. Across all dimensions, undergraduates preferred the alternative labels, especially the tag labels, and labels with pictorials. In Expt. 2, the ratings of 58 older adults (mean age = 73 years) showed a similar pattern of results. Implications of these results and recommendations for future research in this area are discussed.

Outcomes measurement. The key to the appropriate use of pharmaceuticals.

Outcomes measurement will be key to the appropriate use of pharmaceuticals as health care costs continue to rise. The generation of data showing the clinical, economic, and humanistic outcomes of pharmaceutical care will be essential to avoid decision making based solely on cost and to ensure that cost-effective, high-quality health care remains the health care system's top priority.

Enhancing the Perceived Readability of Pharmaceutical Container Labels and Warnings: The use of Alternative Designs and Pictorials

The appropriate use of pharmaceuticals, as well as their hazards, are not commonly known to most people. In fact, the only information available to consumers is usually the material found on the product label. Unfortunately, for some consumers this method of communicating instructions and risks may be ineffective, and potentially dangerous. People may have difficulty with the labels because the print on the label is too small for them to read. Two alternative (tag and fold-out) designs were developed to increase the available surface area for information printed on a fictitious prescription drug label. The alternative label designs were compared to a standard control label. The presence versus the absence of pictorials visually depicting several instructions and warnings was also examined. Participants rated the labels on ease of reading the labels, likelihood of noticing the warnings, likelihood of reading the warnings, preference for each of the labels, and likelihood that they would recommend each label for use by a friend or family member. The results showed that participants ( n = 84) preferred the alternative label designs, especially the tag labels, and those with illustrative pictorials. Implications of these results and recommendations for future research in this area are discussed.