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In recent years, the rapid development of medical information technology has made it critical to analyze large-scale diagnosis and therapeutic data and extract rules based on real medical environment. This has become an essential approach for marketing evaluation and regulatory decision-making of drugs and devices both domestically and internationally. Real world study （RWS）, as a novel methodology for clinical evaluation of drugs in the field of drug utilization research （DUR）, have presented opportunities and challenges for observational studies in assessing actual efficacy or effectiveness. However, despite being a popular methodological approach among scholars in the field, there are still limitations and deficiencies when analyzing population medication characteristics in RWS. Systematic evaluation research methods have not yet been established, leading to inadequate generation of real-world evidence （RWE）. The research design, methodological pathways, evaluation indicators, confounding factors, and bias management involved in DUR based on real-world data （RWD） were reviewed in this artical with the intention of providing guidance for further exploration into DUR.
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Resumo Introdução Antibacterianos sistêmicos são medicamentos amplamente utilizados e os gastos públicos com este grupo têm aumentado consideravelmente. Objetivo Avaliar os gastos com antibacterianos sistêmicos e seus determinantes, entre 2010 e 2015, no Estado de Minas Gerais. Método Estudo de Utilização de Medicamentos (EUM), longitudinal, com dados do banco de administração pública do Sistema Integrado de Administração de Materiais e Serviços de Minas Gerais (SIAD-MG). Foram estimados gastos e volumes totais por ano, bem como por subgrupo terapêutico. Os antibacterianos responsáveis pelo maior gasto foram identificados pelo método Drug Cost 90%. Análise de decomposição foi utilizada para avaliar os determinantes dos gastos, preço, volume ou escolha terapêutica. Resultados No período analisado houve uma redução de 22,2% nas despesas e de 25,5% no volume adquirido. As penicilinas corresponderam a 42% do total adquirido, sendo a amoxicilina, isolada ou em associação, o fármaco mais consumido. A redução das despesas, entre 2010 e 2015, foi determinada principalmente pela redução do volume (queda de 25%) e preços (queda de 5%). Conclusão A redução de volume no período pode ter impacto negativo na cobertura populacional. O investimento em agentes de amplo espectro, em fármacos de segunda linha de tratamento ou com pouca evidência clínica requerem a criação de protocolos clínicos universais que orientem a prescrição mais adequada.
Abstract Background Antibacterials for systemic use are widely used and public spending on these drugs has increased considerably. Objective To evaluate the expenditures with Antibacterials for systemic use and its drivers in the state of Minas Gerais, between 2010 and 2015. Method Longitudinal Drug Utilization Study, based on data from the public administration database SIAD-MG. Total expenditures and volumes were estimated per year and per therapeutic subgroup. Drug Cost 90% method was used to identify antibacterials responsible for the highest expenditure. Decomposition analysis was used to evaluate the determinants of expenditures (price, volume, or drug mix). Results There was a reduction in expenditure (22.2%) and in volume (25.5%) from 2010 to 2015. Penicillins corresponded to 42% of the total volume. Amoxicillin plain or in combination was responsible for consuming more than one-third of the budget. The reduction in expenditure between 2010 and 2015 was mainly determined by the reduction in volume (25%) and prices (5%). Conclusion Volume reduction in the period may harm population coverage. The investment in broad-spectrum agents, drugs considered the second line of treatment, or with little clinical evidence raises the need to create universal clinical protocols that guide the appropriate prescription.
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OBJECTIVE：To provide reference for safe and rational use of Sodium tanshinone ⅡA sulfonate（STS）injection in the clinic. METHODS ：The information of the patients who received STS injection from Jan. 2016 to Dec. 2017 were collected from a Grade 3 hospital. According to relevant suggestions in drug package inserts ，drug utilization rationality was evaluated ，and single-factor and multi-factor analysis on the risk and influential factors for ADR/ADE were performed by group design and individual matching to examine their correlation. RESULTS ：Totally 3 283 patients were included in the study. The drug use frequency were less than 1.5，and the drug utilization indexes were less than 1.0，suggesting that the hospital using STS injection was basically reasonable. Irrational use of drugs mainly included that inappropriate indications （46.48％），unreasonable solvent selection（15.84％），and excessive concentration （2.71％）. Patients with renal insufficiency received STS injection ，and then the risk of ADR/ADE increased by correlation analysis （P＜0.05）. CONCLUSIONS ：Irrational use of STS injection in clinics existed ， mainly like off-label drug use ，excessive concentration ，irrational solvent selection. Drug use evaluation and monitoring should be strengthened. For patients with renal insufficiency ，it is necessary to prevent the occurrence of ADR/ADE ．
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Data from drug utilization research is an invaluable resource for all stake holders involved in drug and health policies. Drug utilization is “marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences”. Research on drug utilization includes factors related to prescribing, dispensing, administering and intake of medication and its associated events. The ultimate purpose of drug utilization research is to estimate the optimal quality of drug therapy by identifying, documenting, analysing problems in drug utilization and monitoring the consequences. It encourages the prescribers to prescribe correct drug at appropriate dose and affordable price. It contributes to the knowledge of rational use of drugs in the society; whether the drug is being prescribed appropriately, whether the drug is taken in correct dosage, whether the drug is available at affordable price or misused. It provides valuable feedback about the rationality of the prescription to the doctors. It also assesses whether an intervention affects the drug use in the population by examining the outcomes of different types of intervention given to improve rationality in drug use. Drug utilization research can be qualitative or quantitative and can be done by various methods. This review highlights the understanding of various aspects, different designs and WHO guidelines for conducting drug utilization research.
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OBJECTIVE:To investigate the utilization and trend of bisphosphonates drugs in patients with bone metastasis of breast cancer from Zhejiang province,so as to provide reference for the further promotion of their rational use. METHODS:The utilization of this type of drugs in 11 hospitals of Zhejiang province during 2010-2015 was analyzed statistically,counted and ranked by using the method of cost ranking analysis and DDDs analysis in the respect of amount,DDDs,DDC,etc. RESULTS:The amount of bisphosphonates drugs was increased steadily in 6 years(increasing greatly in 2011),increased by 96.26% in 2015,compared to 2010. Top 3 drugs in the list of amount were Zoledronic acid for injection(imported),Zoledronic acid for injection(domestic)and Pamidronate disodium for injection. Among them,Zoledronic acid for injection(imported)basically showed an upward trend,while Pamidronate disodium for injection showed decline trend. Top 3 drugs in the list of DDDs were Zoledronic acid for injection(domestic),Zoledronic acid for injection(imported)and Pamidronate disodium for injection;DDDs of Zoledronic acid for injection(domestic)and Zoledronic acid for injection(imported)were generally on the rise,while that of Pamidronate disodium for injection showed an overall downward trend. B/A value of bisphosphonates ranged 0.33-2.00,among which B/A value of Zoledronic acid for injection(domestic)was 2.00 and that of Zoledronic acid for injection(imported)was 0.50 during 2012-2015. The first and second drugs in the list of DDC were Clodronate disodium for injection and Zoledronic acid for injection(imported). CONCLUSIONS:The total amount of bisphosphonates drugs in patients with bone metastasis of breast cancer from 11 hospitals of Zhejiang province during 2010-2015 was increased steadily. Some varieties of second and third generation bisphosphonates with definite curative effect,good safety and reasonable price are dominant in clinical use. The selection and use of bisphosphonates is basically reasonable,but price is still the primary factor restricting the further wide application of some varieties.
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Background: Skin diseases of microbial etiology are caused by bacteria, fungi, viruses and ectoparasites of which bacterial infections are most common than others. Although many bacteria reside on skin, they are unable to establish infection because of the natural defense mechanisms. Most of the bacterial infections are caused by Staphylococcus and Streptococcus. Antibiotic resistance among the micro-organisms is developing due to indiscriminate use of antibiotics and irrational prescription of drugs. Periodic study on drug utilization research and analysis of prescription pattern of antibiotics followed in recent past will guide physicians to prescribe the antibiotics judicially and with a rational approach. Methods: A prospective analysis of 291 in-patients admitted in the Department of Dermatology, Karaikal, over a period of 1-year (January 2013-December 2013) was carried out to analyze the usage of antibiotics through various routes to treat infections associated with dermatological disorders. Results: Among the study population, 60.48% were male and 39.51% were female. We found that out of 29 diseases observed, most common skin disease diagnosed was psoriasis (24.82%), followed by eczema (24.82%). The average number of drugs per prescription was 6.37±2.06. Oral antibiotics were mostly prescribed than parenteral and topical formulations among the study population. Among the oral antibiotics, amoxicillin with clavulanic acid (29.6%) was widely prescribed. In the context of parenteral formulations, cefotaxime (38.92%) was majorly prescribed. Among the topical antibiotics, mupirocin (60.71%) was mostly used. Conclusion: Our study provided an idea about the prevalence of dermatological disorders in a coastal area of Karaikal, Puducherry, the drug utilization strategy of antibiotics, the rationality behind usage and has given useful suggestions to achieve treatment success through judicious use of antibiotics.
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Objective To analyze the current situation and developing trend of utilizaion of medical insurance drugs.Methods Data were collected from Suqian Hospital.Drug Utilization Analysis System and DDD were taken as the basic unit of measurement.Results The consumption of cost,DDDs and variety of type A medical insurance drugs were rising year by year,but the proportion in total was in declining trend.When analyzed according to DDDc,the type A,non medical insurance drugs and the type B ranked the first,the second and the third place during the 2009-2010,the DDDc of type A was lower than the non medical insurancedrugs and the type B.For example,the DDDc of type A was 3.32 yuan/day,the DDDc of the non medical insurance drugs and the type B was 15.04 and 15.97 yuan/day respectively.Conclusion Analyzed in respect to DDDs,the protortion of type A was in high level and the type B was in low.But analyzed in respect to the comsumption cost,the protortion of type B was in high level and the type A was in low.
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OBJECTIVE:To promote the implementation of essential medicine system by combining drug utilization research with national essential medicine system. METHODS:The importance of information monitoring in the implementation of essential medicine system was analyzed and the application of drug utilization research in the implementation of essential medicine system was also discussed. RESULTS & CONCLUSIONS:It is suggested that the indicators for example DDDs are used in the monitoring of clinical drug utilization,and conditions also should be created to carry out further research of drug utilization so as to promote the implementation of essential medicine system in China.
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OBJECTIVE: To analyze utilization of antibiotics for special use in medical institution in order to provide reference of reducing incidence of ADR and avoiding rapid occurrence of bacterium. METHODS: The utilization of antibiotics for special use in our province from Jan. 2005 to Jun. 2008 was analyzed with DDD and DDDs as index. RESULTS&CONCLUSION: The changes of DDDs, cost order and proportion of antibiotics for special use were different from each other. The ratio of order of cost to order of DDDs of antibiotics for special use was between 0.33～5.00 and 72.22% of antibiotics for special use were widely used in different grades of medical institutions. Therefore, it is necessary to strictly control the introduction and utilization which meet requirement. Drug resistance rate of some antimicrobials for special use is up to 100%. So the relevant measure should be taken such as withdrawal of antibotics, monitor of drug resistance and establishment of warning system. Considering a certain degree of abuse, strict measure should be adopted in the primary medical institutions.