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At least 235 records · Page 13Linked to original sources
PubMed2006

Use of gastroprotective agents in recommended doses in hospitalized patients receiving NSAIDs: a drug utilization study.

OBJECTIVE: In recent years, studies investigated to what extend recommendations for co-prescribing gastroprotective agents in prevention of NSAID-induced gastrointestinal complications are followed in clinical practice. However, only a few studies have also taken into consideration the recommended dose of gastroprotectives prescribed in NSAID-induced ulcer prophylaxis. The aim of our study was to evaluate the prevalence of concomitant use of gastroprotectives with NSAIDs in hospitalized patients, with emphasis on the recommended dose of gastroprotectives for ulcer prophylaxis. METHOD: This observational, cross-sectional, drug utilization study included all adult patients receiving NSAIDs hospitalized in the Clinical Hospital Center Zagreb on the day of the study. Data on age, sex, comorbidities, indications for NSAID use, type/dose of NSAIDs and gastroprotectives, history of gastrointestinal events, active gastrointestinal symptoms and risk factors were evaluated. MAIN OUTCOME MEASURE: Study outcomes were: (1) prevalence of prescription of gastroprotectives among NSAID-users at risk; (2) prevalence of prescription of gastroprotective in recommended dose; (3) association between risk factors and prescription of GPAs. RESULTS: The rates of gastroprotectives prescription were significantly higher in NSAID-users with concomitant risk factors as compared to patients without risk factors [47/70 (67.1%) and 8/22 (36.4%), respectively; p=0.01072]. However, gastroprotection in recommended ulcer-preventive dose was low in both groups [8/70 (11.4%) and 9/92 (9.8%), respectively]. The number of concomitant risk factors did not increase the odds of receiving anti-ulcer therapy (odds ratio 0.7279). Thirty-three percent of patients with concomitant risk factors were not prescribed gastroprotectives. Ibuprofen, NSAID with the lowest risk of inducing gastrointestinal complications, was prescribed in only two patients. CONCLUSION: The results indicate high awareness among hospital physicians about possible NSAID-induced gastrointestinal complications, but insufficient knowledge about risk factors related to NSAID-induced gastrointestinal toxicity, recommended dose of gastroprotectives in NSAID-induced ulcer prophylaxis and gastrointestinal toxicity of different types of NSAIDs.

Aged↗
PubMed2006

Measuring change in prescription drug utilization in Australia.

PURPOSE: The National Prescribing Service Ltd (NPS) aims to improve prescribing and use of medicines consistent with evidence-based best practice. This report compares two statistical methods used to determine whether multiple educational interventions influenced antibiotic prescription in Australia. METHODS: Monthly data (July 1996 to June 2003) were obtained from a national claims database. The outcome measures were the median number of antibiotic prescriptions per 1000 consultations for each general practitioner (GP) each month, and the mean proportion (across GPs) of each subgroup of antibiotics (e.g. roxithromycin) out of nine antibiotics having primary use for upper respiratory tract infection. Two approaches were used to investigate shifts in prescribing: augmented regression, which included seasonality, autocorrelation and one intervention; and seasonally adjusted piecewise linear dynamic regression, which removed seasonality prior to modelling, included several interventions, GP participation and autocorrelated errors. Both methods are variations of piecewise linear regression modelling. RESULTS: Both approaches described a similar decrease in rates, with a non-significant change after the first intervention. The inclusion of more interventions and GP participation made no difference. Using roxithromycin as an example of the analyses of proportions, both approaches implied that after the first intervention the proportion decreased significantly. The statistical significance of this intervention disappears when other interventions are included. CONCLUSIONS: The two analyses provide results which agree regarding the possible impact of the NPS interventions, but raise questions about what is the best way to model drug utilization, particularly regarding whether to include all intervention terms when they belong to an extended roll-out of related interventions.

Australia↗
PubMed1997

Multicenter study on self-medication and self-prescription in six Latin American countries. Drug Utilization Research Group, Latin America.

OBJECTIVE: To evaluate the patterns of self-medication in Latin-American countries. METHODS: This cross-sectional drug utilization study took place at 242 pharmacies in 11 study areas in six countries. Unselected samples of customers were interviewed with a structured questionnaire after they had purchased a medicinal product without any medical prescription and without seeking or accepting the advice of the pharmacist or pharmacy counter assistant. RESULTS: We interviewed 8597 consumers. They had purchased 10,569 pharmaceutical products. Ten percent of the products were intended for family use, 14.1% were for children, 68.2% were for adults, and 7.9% were for elderly people. Thirty-nine percent of the products were fixed-dose combinations, and 19% contained three or more active ingredients. Analgesics (16.8%) were the leading group of drugs, followed by antibiotics (7.4%), antiinflammatory and antirheumatic products (5.9%), and vitamins (5.1%). Consumers interviewed purchased relatively high numbers of cardiovascular drugs (494, 5%) and drugs that act on the central nervous system (256, 2.4%). Only 34% of dispensed drugs had an approved over-the-counter status; less restrictive criteria suggest that 24% should have been dispensed on a medical prescription. CONCLUSIONS: The high proportion of fixed-dose combinations reflects poorly regulated pharmaceutical markets. The relatively high proportion of drugs dispensed without a medical prescription that nevertheless need medical follow-up is probably attributable to difficult access to medical care. The potential effectiveness of these treatments is therefore jeopardized by lack of medical follow-up. There is a need for implementation of a comprehensive pharmaceutical and health care policy in the participating countries.

Adolescent↗
PubMed1999

Positive impact of a follow-up phone call to community pharmacies in a medicaid drug utilization program.

OBJECTIVE: To evaluate the impact of including community pharmacists in strategies to alter excessive prescribing of antiulcer medications (AUMs) in a statewide drug utilization review (DUR) program. Mailing educational materials to physicians is a common intervention strategy of retrospective DUR programs. However, pharmacists are typically left out of this process, ignoring a possibly influential healthcare provider. METHODOLOGY: Patients without gastroesophageal reflux disease who received > or = 1.0 normalized therapeutic equivalents (e.g., 1.0 NTE = ranitidine 300 mg/d or omeprazole 20 mg/d) for five of six prior months were included. The pharmacists and physicians of these patients were divided into one of three geographically distinct groups: group 1 physicians received mailed materials only (pharmacists were not contacted); group 2 physicians and pharmacists received mailed materials only; and group 3 physicians and pharmacists received mailed materials, and the pharmacists were contacted by phone. Mean NTE and AUM costs were analyzed six months before and six months following the intervention. RESULTS: One hundred thirty-eight, 329, and 248 patients were included in G1, G2, and G3, respectively. There was a 12.4%, 8.0%, and 14.0% reduction in NTE for G1, G2, and G3, respectively. G1 AUM cost decreased 7.7% ($7710); G2 decreased 6.8% ($14 037); G3 decreased 20.5% ($26722). The total decrease in AUM cost for the entire cohort from before to after the intervention was $48469 (p < 0.05) in the six months following the intervention. CONCLUSIONS: A follow-up phone call to pharmacists in a statewide DUR intervention enhances the effectiveness of DUR interventions under the conditions studied. Enlisting the support of community pharmacists may improve the cost savings of these interventions.

Anti-Ulcer Agents↗
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↗
PubMed1997

[Is the profile of antihypertensive drug utilization justified?].

OBJECTIVE: To describe the use of drugs to combat hypertension and to assess prescription in function of their counterindications to diuretics and beta blockers. DESIGN: A descriptive cross-sectional study by means of an outside audit of clinical records. SETTING: 11 urban Health Districts opened before 1991. PARTICIPANTS: 326 histories of adult hyperintense patients under pharmacological treatment were chosen at random (June-December, 1994). MEASUREMENTS AND MAIN RESULTS: Data were gathered on age, sex, present and former medication, reason for change, and counter-indications to diuretic or beta blocker treatments. Average age was 64.7 (SD 11.6); 66% were women. 437 active principles (AP) were used, of which Enalapril (68 patients) and Captopril (67) were the most common. 203 patients (62.3%; Cl 95%, 57.0-67.5) took one AP; 90 (27.6%; Cl 95%, 22.8-32.5) took two APs; 30 (9.2%), three APs; and 3 (0.9%), four APs. 47.8% of monotherapy was performed with ACE inhibitors; 27.6% with calcium antagonists; 15.3% with diuretics; 7.9% with beta blockers and 1.5% with alpha inhibitors. Diuretics were the drugs most commonly used in association. CONCLUSIONS: There is little use of diuretics and beta blockers, but two-thirds of the prescription of other treatments are justified by a counter-indication to first-choice drugs.

Adolescent↗
PubMed2006

Adverse drug reactions causing hospitalization can be monitored from computerized medical records and thereby indicate the quality of drug utilization.

PURPOSE: To use computerized medical records to study the frequency of adverse drug reactions (ADR) as a cause for acute admission to a university hospital. METHODS: Computerized medical records in 168 consecutively acutely admitted cases to a short-term internal medicine ward at a university hospital were retrospectively evaluated to see if an ADR could have caused the admission. RESULTS: In 18 cases (11%), an ADR was judged to be the reason for acute admission to the hospital. Augmented pharmacological effects (type A reactions) accounted for 89% of the cases. An additional eight cases (5%) were intentional intoxications with prescription drugs. ADR-associated hospital admissions were age-related (average age 72 compared to 65 in patients admitted for other reasons) and also associated with poly-pharmacy (8.3 drugs compared to 5.2). The ADR was considered to arise from a drug-drug interaction in four cases (22%). Although all ADRs fulfilled the criteria for mandatory reporting, none of them were reported to the Swedish Adverse Drug Reactions Advisory Committee (SADRAC). CONCLUSIONS: The observed frequency of ADR-related acute hospital admissions in this pilot study is similar to earlier reported data from Sweden and abroad. Almost all of these reactions were known pharmacological (type A) reactions and many therefore theoretically preventable. In contrast to many prospective and costly studies, this retrospective analysis of computerized medical records offered a simple method that can be used in routine health care and also serve as an indicator of the quality of drug use.

Adverse Drug Reaction Reporting Systems↗
PubMed2002

Effects of managerial intervention on drug utilization pattern at King Chulalongkorn Memorial Hospital.

The economic crisis in Thailand since 1997 has a major impact on all sections of the country including health care. There were several suggestions for reducing the drug expenditure budget including restriction of hospital formulary, generic prescribing and generic dispensing. At King Chulalongkorn Memorial hospital, the new hospital formulary was established and implemented in March 1998. The generic dispensing policy was also in place at the same time. This study aimed to evaluate the impact of the new implementation by comparing the prescription patterns in out patient departments (OPDs) of the hospital before and after the new hospital formulary implementation. The prescriptions from several OPDs were systematically stratified samplings 5 weeks before and 5 weeks after March 1st, 1998. The information from the prescriptions including drug category, drug name, amount of dispensed drug, drug cost, etc. was collected and analyzed. The total number of prescriptions and the average number of drug items/prescription before and after the implementation were similar (2,049 vs 2,052, and 2.52 +/- 0.048 vs 2.45 +/- 0.03 respectively). The total cost of the prescription, the cost/prescription and the cost/item seemed to be different (1,690,484 baht vs 1,282,343 baht, 844 +/- 54.04 vs 633 +/- 41.11 and 332.58 +/- 29.59 vs 255.29 +/- 19.98 respectively). After the implementation, physicians in the hospital increasingly prescribed drugs by generic name (37.1% vs 44.85%). Locally made drugs were also prescribed by physicians and received by patients more than before (9.56% vs 84.27% and 28.15% vs 60.72%, respectively). Anti-infective agents were studied in depth as they contribute to significant amount of drug expenditure. The total cost of prescribed anti-infective agents and the cost/prescription were increased after the implementation (223,529 vs 274,435 Baht and 585.38 +/- 102.84 vs 772.71 +/- 147.59). The increased cost mainly came from the cost of anti-HIV drugs. Our data indicate that the new hospital formulary may have played a part on the impact of drug expenditure reduction and may have changed the prescribing attitude of physicians in King Chulalongkorn Memorial Hospital.

Costs and Cost Analysis↗
PubMed1998

Drug utilization in a hospital general medical outpatient clinic with particular reference to antihypertensive and antidiabetic drugs.

OBJECTIVES: To examine the prescribing patterns, particularly antihypertensive and antidiabetic drugs, in a hospital outpatient clinic and to evaluate the expenditure incurred. METHODS: Prescriptions from a general medical outpatient clinic in a teaching hospital were collected for 4 weeks. Drug expenditures were calculated. RESULTS: A total of 622 prescriptions containing 1903 items were collected. Antihypertensive and antidiabetic drugs accounted for 25.9 and 9.1% usage, respectively. Calcium channel blocking agents, angiotensin converting enzyme inhibitors and beta-blocking agents were the most popular antihypertensive drugs used. Sulphonylureas were the most frequently prescribed antidiabetic agents. Amlodipine, doxazosin and sotalol accounted for 4.5% of all prescription items but 27.8% of the total drug expenditure. CONCLUSION: The use of antihypertensive and antidiabetic drugs accounted for most of the drug usage in this study. Use of newer and more expensive agents has further increased drug expenditure. Monitoring drug usage and their correlations with clinical outcomes are warranted.

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