Retrospective review of medicine utilization for noncommunicable diseases in three public sector pharmacies in Jamaica / Revisión retrospectiva del uso de medicamentos para enfermedades no transmisibles en tres farmacias del sector público de Jamaica / Revisão retrospectiva do uso de medicamentos para doenças não transmissíveis em três farmácias da rede pública na Jamaica

ABSTRACT Objective. The rational use of medicines offers a cost-saving strategy to maximize therapeutic outcomes for developing and developed countries. The aim of this study was to evaluate the rational use of medicines for selected noncommunicable diseases (NCDs) at three pharmacies at public hospitals in Jamaica using the World Health Organization's (WHO's) prescribing indicators. Methods. In this retrospective cross-sectional study, prescriptions for adult outpatients containing at least one medicine for cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease or asthma that were filled between January and July 2019 were reviewed using WHO's prescribing indicators for the rational use of medicines. Data were analyzed and expressed as descriptive and inferential statistics. For all analyses conducted, significance was determined at P < 0.05. Results. A total of 1 500 prescriptions covering 5 979 medicines were reviewed; prescriptions were mostly written for female patients aged 42-60 years. Polypharmacy was observed in 35.6% (534) of prescriptions, and there was an average of 4 medicines per prescription, with a maximum of 17. Most of the prescriptions at each site were filled, with the main reason for not dispensing a medicine being that it was out of stock. Generic prescribing was high for all sites, accounting for more than 95% (5 722) of prescribed medicines. There was full compliance with prescribing according to the WHO Model List of Essential Medicines at two of the sites, but it was just off the target at Site 1, by 1.4%. Conclusions. The WHO guidelines for the rational use of medicines were followed with respect to the proportion of medicines prescribed from the WHO Model List and the proportion of antibiotics prescribed. The number of medicines per prescription and the proportion of medicines prescribed by generic name did not meet the WHO criteria. However, prescribing was aligned with treatment guidelines for the selected NCDs.

RESUMEN Objetivo. El uso racional de los medicamentos proporciona una estrategia de ahorro de costos para maximizar los resultados terapéuticos tanto en los países en desarrollo como en los países desarrollados. El objetivo de este estudio fue evaluar el uso racional de medicamentos para algunas enfermedades no transmisibles (ENT) seleccionadas en tres farmacias de hospitales públicos de Jamaica, usando los indicadores de prescripción de la Organización Mundial de la Salud (OMS). Métodos. En este estudio transversal retrospectivo se examinaron las prescripciones realizadas a pacientes ambulatorios adultos que incluían al menos un medicamento para enfermedades cardiovasculares, diabetes, cáncer, enfermedad pulmonar obstructiva crónica o asma, dispensadas entre enero y julio del 2019, utilizando los indicadores de prescripción para el uso racional de medicamentos de la OMS. Los datos se analizaron y expresaron mediante estadística descriptiva e inferencial. Para todos los análisis realizados se estableció un nivel de significación de p <0,05. Resultados. Se examinó un total de 1 500 prescripciones que incluían 5 979 medicamentos; la mayor parte de ellas correspondían a pacientes de sexo femenino de 42 a 60 años. Se observó que había polimedicación en el 35,6% (534) de las prescripciones, con un promedio de 4 y un máximo de 17 medicamentos por receta. En todos los centros se dispensó la mayor parte de los medicamentos prescritos, y el motivo principal para no hacerlo fue la falta de existencias del medicamento en cuestión. La prescripción de genéricos fue elevada en todos los centros y supuso más del 95% (5 722) de los medicamentos prescritos. En dos centros la prescripción se realizó en su totalidad de acuerdo con la Lista Modelo de Medicamentos Esenciales de la OMS, pero en el centro 1 no se alcanzó el objetivo por un 1,4%. Conclusiones. Se siguieron las directrices de la OMS para el uso racional de medicamentos en cuanto a la proporción de medicamentos prescritos de la Lista Modelo de la OMS y la proporción de antibióticos prescritos. El número de medicamentos por receta y la proporción de medicamentos prescritos mediante su nombre genérico no cumplieron con los criterios de la OMS. Sin embargo, las prescripciones estaban en consonancia con las directrices de tratamiento de las enfermedades no transmisibles seleccionadas.

RESUMO Objetivo. O uso racional de medicamentos é uma estratégia de contenção de custos para maximizar os resultados terapêuticos em países desenvolvidos e em desenvolvimento. O objetivo deste estudo foi avaliar o uso racional de medicamentos para algumas doenças não transmissíveis selecionadas em três farmácias de hospitais públicos na Jamaica a partir dos indicadores de prescrição preconizados pela Organização Mundial da Saúde (OMS). Métodos. Estudo transversal retrospectivo que avaliou receitas médicas de pacientes ambulatoriais adultos contendo pelo menos um medicamento prescrito para doença cardiovascular, diabetes, câncer, doença pulmonar obstrutiva crônica ou asma e dispensadas entre janeiro e julho de 2019. A avaliação foi realizada a partir dos indicadores de prescrição preconizados pela OMS para o uso racional de medicamentos. Os dados obtidos foram analisados por meio de estatísticas descritivas e inferenciais. O nível de significância de p <0,05 foi adotado em todas as análises. Resultados. Ao todo, foram analisadas 1 500 receitas médicas compreendendo 5 979 medicamentos. Em sua maioria, as receitas foram prescritas para pacientes do sexo feminino com idades entre 42 e 60 anos. A polifarmácia foi observada em 35,6% (534) das receitas; em média, foram prescritos 4 medicamentos, até um máximo de 17. As farmácias estudadas dispensaram a maior parte dos medicamentos receitados. O principal motivo para não fornecer algum medicamento foi o desabastecimento. O percentual de medicamentos genéricos foi alto em todos os locais, representando mais de 95% (5 722) do volume receitado. Houve plena observância da Lista Modelo de Medicamentos Essenciais da OMS nas receitas analisadas em dois dos locais estudos, e observância quase completa (diferença de 1,4%) no local 1. Conclusões. As diretrizes da OMS de uso racional de medicamentos foram cumpridas no que se refere ao percentual de medicamentos receitados de acordo com a Lista Modelo da OMS e o percentual de antibióticos receitados. Os critérios da OMS não foram cumpridos quanto ao número de medicamentos por receita e ao percentual receitado usando o nome genérico. Porém, os medicamentos foram receitados de acordo com as diretrizes terapêuticas para as doenças não transmissíveis selecionadas.

Transparencia de datos para construir un sistema de salud más sólido: estudio de caso de bases de datos administrativas argentinas sobre utilización de medicamentos / Data transparency for building a stronger healthcare system: A case study from Argentinean administrative drug utilization data sources

RESUMEN Para realizar un inventario de fuentes de datos nacionales sobre utilización de medicamentos en Argentina y verificar las fuentes de datos disponibles públicamente, llevamos a cabo un estudio transversal que investiga la existencia de bases de datos nacionales y provinciales sobre utilización de medicamentos. En julio de 2020, realizamos una búsqueda en sitios web de instituciones gubernamentales, una búsqueda sistemática en bases de datos bibliográficas sobre "drug utilization research" en Argentina y una encuesta de expertos. Se identificaron 31 fuentes de datos de utilización de medicamentos, solo una era de acceso público y conveniente, cinco publicaban datos agregados y proporcionaban un acceso más detallado mediante solicitud formal, solo siete fuentes (23%) informaban datos nacionales, y la mayoría de ellas (n=29) incluían solo datos del sector público de salud. Aunque se han encontrado fuentes de datos de utilización de medicamentos en Argentina, el acceso a investigadores y legisladores sigue siendo una barrera importante. Aumentar la transparencia de los datos de salud a través de fuentes disponibles públicamente para analizar la información de salud pública es crucial para construir un sistema de salud más sólido.

ABSTRACT In order to compile an inventory of national data sources for drug utilization research (DUR) in Argentina and to verify publicly available data sources, we performed a cross-sectional study that sought to identify national and provincial databases of drug use. In July 2020, we searched the websites of government institutions, carried out a systematic query of bibliographic databases for "drug utilization research" conducted in Argentina, and conducted a survey with local experts. Data collected included: the institution responsible for the database, population covered, accessibility, source of the data, healthcare setting, geographic information, and whether data were individual or aggregated. Descriptive analyses were then performed. We identified 31 data sources for DUR; only one was publicly and conveniently accessible. Five published aggregated data and provide more detailed access by formal request. Only seven sources (23%) reported national data, and most (n=29) included only data from the public healthcare sector. Although data sources for DUR have been found in Argentina, limited access by researchers and policymakers is still an significant obstacle. Increasing health data transparency by making data sources publicly available for the purpose of analyzing public health information is crucial for building a stronger health system.

A prospective study of drug utilization in patients attending ophthalmology outpatient department at KBN teaching and general hospital of Gulbarga, India

Background: Drug utilization studies are an important part of rational use of drugs. Assessment of drug use pattern especially in developing countries is becoming increasingly necessary to promote the rational use of drugs. This study was planned to prospectively assess the drug utilization pattern in Ophthalmology outpatient department at KBN teaching and General hospital.Methods: After approval from Ethics Committee, the prescriptions of 1000 outpatients were analyzed using a predesigned form to record information from the OPD prescriptions. Mentioned WHO drug use indicators and additional indices were analyzed: Average number of drugs per prescription, number of encounters with antibiotics, percentage of encounters with injections, percentage of drugs prescribed by their generic names, percentage of drugs prescribed from the National Essential Drug List (NEDL), etc.Results: Prescription analysis showed that the average number of drugs per prescription was 2.6. The drugs were prescribed in the several forms, predominant dosage form been topical eye drops (69.58%) followed by tablets (11.98%), ointments (10.17%) and capsules (6.6%). The 慸osage form� was indicated for all of the drugs prescribed, the 慺requency� of drug administration was present in 96.5% of the drugs, and the duration of treatment for 82% of the drugs prescribed. Topical Antimicrobial agents were the most commonly prescribed drugs. followed by anti-inflammatory and anti-allergic, lubricants, anti-glaucoma drugs, etc. Percentage of drugs prescribed by generic name and from NEDL was 7.98% and 55 % respectively.Conclusions: The prescription writing errors were less, however, there was very low generic prescribing and inadequate information about the duration of therapy in many prescriptions. Generic prescribing can be improved. Duration of therapy should be mentioned in all prescriptions. It is essential that appropriate guidelines on the use of topical antimicrobials are required to ensure rational prescribing.

A prospective study of antimicrobial drug utilization in infective diseases in pediatrics at Navodaya Medical College Hospital of Raichur, Karnataka, India

Background: There is increased concern regarding the inappropriate use of antimicrobials resulting in emergence of resistant strains, unnecessary adverse effects and poor therapeutic outcome. This present study has been taken up with a view to analyze the use of various antimicrobial agents alone and/or in combination to combat diseases of infective origin in a proposed manner.Methods: This was a prospective study carried out for a period of 1 year from January 2011 to December 2011. The prescriptions of all eligible patients were reviewed on daily basis and all the relevant data were retrieved to assess the utilization pattern of antimicrobials and also their safety and potential interactions.Results: A total of 500 patients were selected randomly who satisfied the inclusion criteria. Of the total selected patients with infectious diseases, 493 patients (98.6%) received one or more antimicrobials. Use of antimicrobials was high in the age group of �months to 3 years�, 憆ural patients� constituted 62% and were mostly from 慙ower Socio-economic status� (46%). Respiratory diseases constituted 38% of the patients. Fever was the notable symptom in 68.4%. Cephalosporins (48.6%) were the most frequently prescribed class of antimicrobials. Combination of 慞arenteral therapy followed by oral therapy� was the preferred route in 92%, and a combination of two antimicrobials was seen in 34.4%. Majority of the patients (81%) were discharged on advice and most of the patients (37.6%) had duration of stay of 7-9 days. 25.8% reported 慉dverse Drug Reactions� including predictable and unpredictable reactions.Conclusions: Antimicrobial prescribing is common in pediatric infectious diseases. As inappropriate usage of systemic antimicrobials was observed, it is essential that appropriate guidelines on the use of systemic antimicrobials are implanted to ensure rational prescribing of antimicrobials.

Impact of the Health Insurance Coverage Policy on Oral Anticoagulant Prescription among Patients with Atrial Fibrillation in Korea from 2014 to 2016

BACKGROUND: To evaluate oral anticoagulant (OAC) utilization in patients with atrial fibrillation after the changes in the health insurance coverage policy in July 2015. METHODS: We used the Health Insurance Review and Assessment Service-National Patient Samples (HIRA-NPS) between 2014 and 2016. The HIRA-NPS, including approximately 1.4 million individuals, is a stratified random sample of 3% of the entire Korean population using 16 age groups and 2 sex groups. The HIRA-NPS comprises personal and medical information such as surgical or medical treatment provided, diagnoses, age, sex, region of medical institution, and clinician characteristics. The studied drugs included non-vitamin K antagonist OACs (NOACs) such as apixaban, dabigatran, edoxaban, and rivaroxaban, and were compared with warfarin. We analyzed drug utilization pattern under three aspects: person, time, and place. RESULTS: The number of patients with atrial fibrillation who were prescribed OACs was 3,114, 3,954, and 4,828; and the proportions of prescribed NOACs to total OACs were 5.1%, 36.2%, and 60.8% in 2014, 2015, and 2016, respectively. The growth rate of OACs prescription increased from 61.4 patients/quarter before June 2015 to 147.7 patients/quarter thereafter. These changes were predominantly in elderly individuals aged more than 70 years. The proportion of NOACs to OACs showed significant regional difference. CONCLUSION: The change of health insurance coverage policy substantially influenced OACs prescription pattern in whole Korean region. But the impact has been significantly different among regions and age groups, which provides the evidence for developing standard clinical practice guideline on OACs use.

Research and Demonstration of DUE Mode in the Clinical Utilization Evaluation of Insulin / 中国药师

Objective:To establish the drug utilization evaluation(DUE)criteria for isophane protamine biosyntheti(30R)to provide reference for the rational drug use. Methods:Referred to the domestic and foreign literatures and the authorized guidelines for diabetes treatment,and combined with the Delphi expert consultation method,the drug utilization evaluation criteria was established,and after the evaluation,intervention and revaluation,the final criteria were determined. Results:The drug utilization evaluation criteria for isophane protamine biosyntheti(30R)contained three parts,including medication indications,medication process and medication results,which showed the clinical feasibility. Conclusion:The established DUE criteria for isophane protamine biosyntheti(30R)can not only be applied in the drug utilization evaluation,but also provide reference for the DUE in medical institutions.

Antibiotic utilization evaluation of inpatient and outpatient prescriptions in a rural general hospital in Iran.

Background: High rate of antibiotic prescription is commonly encountered in hospital settings. Although the problem of the irrational use of antibiotics is particularly acute in rural health centers of developing countries, antibiotic utilization studies in such areas are scarce. In this study, we aimed to compare antibiotic prescription patterns between inpatients and outpatients in a rural general hospital. Methods: Inpatient and outpatient records were evaluated during a 1-month period. Data including patients’ demographics, length of hospital stay, final diagnosis, antibiotic regimen, dosing, rout of administration, microbiological culture/sensitivity tests and other laboratory data were retrieved from the hospital information system. Results: The number of prescriptions with at least one antibiotic was 686/1410 (48.6%) cases and 3812/6126 (62.2%) cases for inpatient and outpatient prescriptions, respectively. The mean number of antibiotic per prescription was 1.7±0.7 and 1.3±0.8 for inpatient and outpatients, respectively (p<0.05). Ceftriaxone had the highest rate of prescription among hospitalized patients with 791 (35.2%) times encounter while penicillin constituted the largest proportion of outpatient administrations with 2505 (29.8%) times. About 79% of inpatient and 62% of outpatient prescriptions containing final diagnosis data had the correct indication. Conclusion: Our study showed that implementation of strict regulations for antibiotic use is extremely needed in this rural hospital. Establishing local guidelines, providing adequate education for healthcare professionals and putting restrictions for broadspectrum antibiotic use can be beneficial.

Empirical Study on the Application of Drug Utilization Evaluation Model in Special Rectification Activities of Antibacterial Drug / 中国药师

Objective:To investigate the application of drug utilization evaluation( DUE) as a kind of clinical pharmacy work model in the antibacterial drug special rectification. Methods: Following the steps of DUE schedule,retrospective method was conducted to collect the data of the use of vancomycin in one institution and the model of clinical drug use was improved by the evaluation result. Re-sults:The rationality of vancomycin use was improved in the institution. The index of drug use reasons and key disease course indica-tors was improved significantly. The qualification rate of indications and drug indications was increased from 79. 5% to 95. 0%,and the qualification rate of antibacterial drugs classification management was increased from 63. 3% to 92. 7%. The qualification rate of dosing frequency was increased from 72. 5% to 96. 0%. Conclusion:As a program for continual improvement of new clinical pharmacy work mode and medical care quality,the mode plays an important role in the institution and improves the rational use of vancomycin.

Drug Utilization Review of Potassium Chloride Injection Formulations Available in a Private Hospital in Kuching, Sarawak, Malaysia

Background: The concentrated potassium chloride injection is a high-alert medication and replacing it with a pre-mixed formulation can reduce the risks associated with its use. The aim of this study was to determine the clinical characteristics of patients receiving different potassium chloride formulations available at a private institution. The study also assessed the effectiveness and safety of pre-mixed formulations in the correction of hypokalaemia. Methods: This was a retrospective observational study consisting of 296 cases using concentrated and pre-mixed potassium chloride injections in 2011 in a private hospital in Kuching, Sarawak, Malaysia. Results: There were 135 (45.6%) cases that received concentrated potassium chloride, and 161 (54.4%) cases that received pre-mixed formulations. The patients’ clinical characteristics that were significantly related to the utilization of the different formulations were diagnosis (P < 0.001), potassium serum blood concentration (P < 0.05), and fluid overload risk (P < 0.05). The difference observed for the cases that achieved or maintained normokalaemia was statistically insignificant (P = 0.172). Infusion-related adverse effects were seen more in pre-mixes compared to concentrated formulations (6.8% versus 2.2%, P < 0.05). Conclusion: This study provides insight into the utilization of potassium chloride injections at this specific institution. The results support current recommendations to use pre-mixed formulations whenever possible.

Evaluation of Drug Utilization in 78 Patients with Chronic Hepatitis B by DUR and DUE Methods / 中国药房

OBJECTIVE:To evaluate the status quo and the rationality of the drug utilization in patients with chronic hepatitis B in our hospital.METHODS:The methods of drug utilization review (DUR) and drug utilization evaluation (DUE) were used to comprehensively analyze the drug utilization,diagnosis,monitoring of therapeutic process as well as therapeutic outcome of 78 patients with chronic hepatitis B hospitalized in our hospital from April 2007 to April 2008.RESULTS:Of the 78 cases reviewed,2 were treated with 1 kind of drug,and 76 with at least 2 kinds of drugs in combination;pathological staging was performed for only 6 cases,all of the 78 underwent therapeutic monitoring during therapeutic process.The DUIs of 11 kinds of drugs were more than 1,DUI