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Drug utilization review.

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Drug Utilization Review↗
PubMed1990

[Drug utilization in Hvalsö. An attempt to change the attitude of the population and physicians to drug use].

All of the prescriptions, a total of 1,876, issued by the five practitioners in Hvalsø in four chosen weeks in 1987/88 were copied. The prescribed drugs, a total of 3,177, were calculated for the individual groups of drugs and corrected for the age distribution among the population as a whole and in the individual doctor's practice. The main results from the following groups of drugs are presented here: hypnotics, drugs for neurosis, antibiotics, drugs for cardiac and circulatory disease, drugs for asthma, contraceptive pills and female sex hormones. By and large, considerably more medicine was prescribed for women than for men. For example, twice as much medicine for insomnia was prescribed for women. This is enough for every fourth woman over the age for 70 years to receive a daily dose of hypnotics. Women appear to commence using hypnotics at the age of 40 years and men at 60 years. Marked differences were found in the patterns of prescription between the individual practitioners and thei is apparently greatest as regards prescriptions for men while the more liberal prescription of hypnotics to women was observed for all of the practitioners. Two groups of drugs were, however, prescribed mostly for men, viz, asthma medicine for all age groups and cardiac and circulatory medicine for persons greater than 60 years. Where all of the groups of drugs were concerned, comparisons were undertaken between the prescription habits of the individual practitioners. The results of this investigation are employed in local health work among the population, in study circle work among the practitioners and as basic ideas for the county drug committee activities.

Attitude of Health Personnel↗
PubMed1997

[Drug utilization by elderly patients in Bremen old age and nursing homes with special reference to psychotropic drugs].

In five homes for the aged in the city of Bremen that were also nursing homes, we studied the drug supply and drug intake of 301 inmates with particular reference to psychotropics, basing on the available records. The average regular drug intake covered 3.99 drugs. Furthermore, prescriptions for an average of 1.16 additionally required drugs were issued. More than one-quarter of the inmates (27.2%) took between 6 to 11 different drugs permanently. More than one half of the inmates (50.8%) were given prescriptions for psychotropics; 45.2% took at least one psychotropic permanently. Prescription of benzodiazepines of medium or long half-time was strikingly frequent; these are in fact drugs that are usually unsuitable for administration to elderly persons. As far as antidepressants/tranquilisers are concerned, we noticed that tricyclic antidepressants were prescribed almost exclusively.

Aged↗
PubMed2000

Effect of heart failure program on cardiovascular drug utilization and dosage in patients with chronic heart failure.

BACKGROUND: Utilization and dosage of angiotensin-converting enzyme (ACE) inhibitors in patients with chronic heart failure (CHF) remain low. Recent data suggest that care of patients with CHF in specialized heart failure programs is associated with improved clinical outcomes. HYPOTHESIS: Specialized heart failure care is associated with better utilization and higher dose of cardiovascular drugs. METHODS: Data from 133 patients with CHF referred to a heart failure program were analyzed. Mean functional class 3.1 +/- 0.5, left ventricular ejection fraction 19 +/- 8. Utilization and doses of cardiovascular drugs were examined at initial evaluation and at last visit, after an average period of 17 +/- 14 months. Hospitalization and survival data were determined. RESULTS: Utilization of ACE inhibitors and angiotensin-receptor blockers increased from 87 to 100% (p < 0.001). Average daily dose increased by 60%, from the equivalent of captopril 105 +/- 78 mg to 167 +/- 86 mg (p < 0.001). Utilization of the following drugs increased significantly: beta blockers (16-37%, p < 0.001), metolazone (10-23%, p = 0.007), spironolactone (1-36%, p < 0.001), amiodarone (7-15%, p = 0.05), hydralazine (1-9%, p = 0.004), and nitrates (20-33%, p = 0.03). One-year survival was 90%. The 3- and 6-month hospitalization rates for heart failure were 4 and 7%, and for all cardiovascular causes they were 6 and 11%, respectively. CONCLUSIONS: Care of patients with CHF in a specialized heart failure program was associated with significant increase in the utilization and doses of all beneficial cardiovascular drugs, especially ACE inhibitors. It was also associated with excellent clinical outcomes.

Adult↗
PubMed1999

[Evaluation of drug utilization from positive lists].

BACKGROUND: The introduction of positive drug lists (positive lists) is part of the regulating mechanisms which try to reduce the increasing expenditure on drugs. An essential part of these provisions is at present an analysis of the trend of drug consumption. The objective of the work was to introduce and evaluate the method DU 90% which in analyses of drug consumption uses a 90% ratio of preparations of their total consumption. METHODS AND RESULTS: The analysis was focused on prescriptions in medical clinics of the General Faculty Hospital Classification of drugs according to anatomical, therapeutic and chemical groups and the use of defined daily doses made it possible to calculate DU 90% and to prepare a consecutive list of drugs according to costs in different departments. The number of drugs with a defined daily dose was within the range of 280-316. In the interval DU 90% were 116-142 drugs. In all departments there was a practically identical ratio of drugs which were part of the positive list. The greatest expenditure were anti-infectious drugs for systemic use and drugs with an effect an blood and haematopoietic organs. CONCLUSIONS: The advantages of the method DU 90% is its easy application, low cost and possibility to identify controversial lields. This facilitates further qualitative and quantitative evaluation of the standard of pharmacotherapy.

Czech Republic↗
PubMed2003

Drug utilization study in patients with Crohn's disease in Spain.

OBJECTIVE: To discover the therapeutic strategies for Crohn's disease used in Spain and to analyse the factors associated with the use of each treatment. DESIGN: Observational, cross-sectional study of patients with Crohn's disease who attended hospitals in Spain. METHODS: Two structured questionnaires were used, one completed by gastroenterologists about demographic clinical data and disease activity, and the other a telephone interview with the patients to obtain epidemiological and drug utilization data. RESULTS: A total of 635 patients from 39 hospitals were included. Aminosalicylates (77%) and corticosteroids (41%) were the most commonly used drugs. Monotherapy was used in 52% of the patients and was associated with less severe disease and relapse. Aminosalicylate use was associated with relapse and associated inversely with use of immunosuppressors. Corticosteroid use was associated with relapse, disease activity, and emergency visit frequency, and associated inversely with perianal disease. Use of immunosuppressors was associated with perianal disease, chronic active disease, and routine visit frequency, and associated inversely with aminosalicylate use. Antibiotic use was associated with relapse, perianal disease, chronic active disease and hospitalization. CONCLUSION: Aminosalicylates, corticosteroids and a combination of both drugs are the drugs used most frequently against Crohn's disease in Spain. Gender, age, clinical pattern and location were not associated with the type of drug used either in monotherapy or in combined therapy.

Adrenal Cortex Hormones↗
PubMed2004

Attenuation of mechanical allodynia by clinically utilized drugs in a rat chemotherapy-induced neuropathic pain model.

Chemotherapy-induced peripheral neuropathy is a common, dose-limiting side effect of cancer chemotherapeutic agents, including the vinca alkaloids such as vincristine. The resulting symptoms, which frequently include moderate to severe pain, can often be disabling. The current study utilized a vincristine-induced neuropathic pain animal model [Pain 93 (2001) 69], in which rats were surgically implanted with mini-osmotic pumps set to deliver vincristine sulfate (30 microg kg(-1)day(-1), i.v.), to examine the time course of progression of various pain modalities and to compare the dose-response effects of clinically utilized drugs on mechanical allodynia to further validate the relevance of this model to clinical pathology. Vincristine infusion resulted in significant cold allodynia after 1 week post-infusion, however mechanical and thermal nociception showed little to no effect. In contrast, marked mechanical allodynia occurred by 1 week of vincristine infusion and returned nearly to pre-infusion levels by the 4th week after infusion pump implantation. ED(50) values (micromol/kg, p.o.) were determined in the mechanical allodynia assay for lamotrigine (82), dextromethorphan (94), gabapentin (400), acetaminophen (1100) and carbamazepine (3600); however, aspirin and ibuprofen had no effects up to 300 and 1000 micromol/kg, respectively. Additionally, ED(50) values (micromol/kg, i.p.) were determined in the mechanical allodynia assay for clonidine (0.35) and morphine (0.62), but desipramine and celecoxib had no effects up to 66 and 260 micromol/kg, respectively. Findings from the current, preclinical study further validate this model as clinically relevant for chemotherapy-induced pain. The surprisingly good effects observed with acetaminophen warrant further investigation of its mechanism(s) of action in neuropathic pain.

Analgesics↗