Improve Drug Utilization Research Articles

Potential drug interactions during a three-decade study period: a cross-sectional study of a prescription register

The thesis aimed to study the developments, in the area of pharmacoinformatics, of the electronic prescribing and dispensing processes of drugs - in medical praxis, follow-up, and research. For hundreds of years, the written prescription has been the method of choice for physicians to communicate decisions on drug therapy and for pharmacists to dispense medication. Successively the prescription has also become a source of information for the patient about how to use the medication to maximize its benefit. Currently, the medical prescription is at a transitional stage between paper and web, and to adapt a traditional process to the new electronic era offers both opportunities and challenges The studies in the thesis have shown that the exposure of prescribed drugs in the general population has increased considerably over three decades. The risk of receiving potentially interacting drugs was also strongly correlated to the concomitant use of multiple drugs, polypharmacy. The pronounced increase in polypharmacy over time constitutes a growing reason for prescribers and pharmacists to be aware of drug interactions. Still, there were relatively few severe potential drug interactions. Recently established national prescription registers should be evaluated for drug interaction vigilance, both clinically and epidemiologically. The Swedish National Pharmacy Register provides prescription dispensing information for the majority of the population. The medication history in the register may be accessed online to improve drug utilization, by registered individuals, prescribers, and pharmacists in a safe and secure way. Lack of widespread secure digital signatures in healthcare may delay general availability. With a relatively high prevalence of dispensed drugs in the population, the National Pharmacy Register seems justified in evaluating individual medication history. With a majority of prescriptions transferred as ePrescriptions, the detected increased risk for prescription errors warrants quality improvement, if the full potential of ePrescriptions is to be fulfilled. The main conclusion of the studies was that ePrescribing with communication of prescribed drug information, storing and retrieving dispensed drug information, offers new opportunities for clinical and scientific

Inter-rater Reliability of a Classification System for Hospital Adverse Drug Event Reports

Hospital pharmacovigilance systems frequently classify adverse drug event (ADE) reports on various axes such as severity and type of outcome in an attempt to better detect changes in the frequency of certain types of ADEs. The aim of this study was to measure the inter-observer reliability of an ADE classification system. Two pharmacists and two internal medicine physicians reviewed 150 pharmacist-generated ADE reports and used a structured form to classify reports on four domains: the presence or absence of process measures leading to ADE; the individual who initiated the process that potentially leads to ADE; the severity of ADE; and whether the ADE was related to dose. There was wide variation in inter-observer reliability of different elements in a classification system for ADEs. Agreement on specific processes associated with ADEs ranged from poor to moderate, which limits the ability to target accurately processes to improve drug utilization.

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.

Treatment of Type 2 Diabetes in Primary Health Care: A Drug Utilization Study

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. 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. 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. 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. 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.

Can an Educational Program for Residents of Assisted Living Facilities Improve Drug Utilization for Osteoporosis?

To examine the utilization of medications for prevention or treatment of osteoporosis in assisted living facilities and to determine the effect of an educational program for residents on changes in the use of osteoporosis medications. Assisted living facilities. All residents living in 21 assisted living facilities. Assisted living facilities were randomized into an intervention or control group. The intervention group received an education program on osteoporosis. The control group received usual care. Drug utilization for prevention or treatment of osteoporosis was determined before the intervention and at two and six months post-intervention. Drug use before and after the educational program. Of 1,284 residents, only 17% were receiving prescription medication for prevention or treatment of osteoporosis, and only 4.6% of residents were receiving calcium supplementation. The educational intervention did not alter osteoporosis drug use over a six-month period. A single educational program for residents of assisted living facilities did not improve drug therapy use.

Drug utilization in Panama

The availability and use of therapeutic agents in Panama is critically reviewed. Of the 3800 drug products on the market, 50% are vitamins, tonics and fixed ratio combination products. Many drugs are of unproven efficacy and safety, not marketed in more developed countries. Hospital and outpatient studies have documented inappropriate prescribing habits. To improve drug utilization, regulatory and educational strategies have been implemented in the Panama Social Security Institute. Drugs of doubtful or no value and unnecessary duplications have been withdrawn from its therapeutic formulatory. Outreach services provided by the Panama Social Security Institute include the distribution of a drug bulletin, workshops, seminars and person to person drug information (counterdetailing) to health personnel. Drug information to patients is also included in the overall strategy to promote the rational use of drugs. Nevertheless, much work is still needed to formulate and implement an essential drugs and health policy in Panama.