Drug utilization evaluation

Definition, Aims, DUE Cycle, Steps of Drug Utilization evaluation

1. DRUGUTILISATION
EVALUATION
Dr. RameshBhandari
Asst. Professor,
Department of Pharmacy Practice,
KLE College of Pharmacy, Belagavi

2. Dr.
Ramesh
Bhandari
INTRODUCTION
It is an ongoing authorised and systematic quality
improvement process which is designed to:
Review drug use/ review prescribing patterns
Provide feedback of results to clinicians and
provide other relevant groups
Develop criteria and standards which describe
optimal drug use
Promote appropriate drug use through education
and other interventions

3. Dr.
Ramesh
Bhandari
AIMSOFDUE
Reducing drug and health related treatment costs
Improving health related quality of life
Improving quality of medical treatments
Improving coordinated healthcare
Decreasing the number of medication related
problems and medication error
Decreasing the number of hospital admission
Improving prescriber awareness and practice
towards appropriate prescribing

4. Dr.
Ramesh
Bhandari
TYPESOFDUE
Drug focused: Single drug or class of drugs
examined.
Indication focused: drug use or drugs for a specific
indication examined.
Quantitative DUE studies
Collection, organisation and display of estimates
or measurements of drug use
Qualitative DUE studies
Collect, organise, analyse and report information
on actual drug use.
Make use of criteria

5. Dr.
Ramesh
Bhandari
DUE COMMITTEE
Composed of physicians, pharmacists and other
health care professionals
Functions:
Draft and approve the policies and procedures
that govern its work
Establish and maintain adequate means of
communication with the hospital administration
and other hospital committees
Prepare a schedule, yearly planning meeting
Selection and approval of criteria
Evaluating data and designing interventions

6. Dr.
Ramesh
Bhandari
DUE CYCLE
Planning
Data
Collection
Evaluation
Feedback of
Results
Intervention
Re-evaluation
of Results
Feedback of
Results

7. Dr.
Ramesh
Bhandari
Phase I: Planning
Step 1 Identify drugs or areasof practice for possible study
Step 2 Designthe study
Step 3 Define Criteria and Standards
Step 4 Design theData Collection Form
Phase II: Data Collection
Step 5 Collect Data
Phase III: Evaluation
Step 6 Collate data andEvaluate Results
Phase IV: Feedback of Results
Step 7 FeedResults Back to Clinicians and Other Hospital Staff
Phase V: Intervention
Step 8 Develop and ImplementIntervention
Phase VI: Re-Evaluation
Step 9 Re-evaluate to Determine ifDrug Use Has Improved
Step 10 Re-assess andrevise DUE Programme as Needed
PhaseVII: Feedback of Results
Step 11 Feed ResultsBack to Clinicians and Other Hospital Staff

8. Dr.
Ramesh
Bhandari
STEP1: IDENTIFYDRUGSORTHERAPEUTIC AREAS
OFPRACTICEFORPOSSIBLESTUDY
Not possible and unnecessary to evaluate every drug
Identify priority drugs or areas of practice by DUE
committee
Sources: Medication error reports, ADRs reports, feedback
from prescribers or clinical pharmacist, literatures,
microbiological data
Tools to identify high Priority drugs:
ABC Analysis
VED/VEN Analysis

9. Dr.
Ramesh
Bhandari
STEP1: IDENTIFYDRUGSORTHERAPEUTIC AREAS
OFPRACTICEFORPOSSIBLESTUDY
Common Targets for DUE Includes:
Commonly Prescribed drugs (PPI, Antibiotics)
Drugs associated with potentially significant interactions
(warfarin, digoxin, phenytoin etc.)
Expensive drugs (LMWH)
New Drugs
Narrow therapeutic index drugs (digoxin, theophylline)
Drugs frequently causing ADRs (anticonvulsants)
Drugs used in high risk patients (elderly patients,
intensive care patients, paediatrics)
Drugs used in common conditions

10. Dr.
Ramesh
Bhandari
STEP2: DESIGNOFSTUDY
Observational research methods –commonly used in DUE
Cross-sectional studies –used for problem identification
Pre-Post design –drug use examined before and after
intervention
Based on timing of the data collection, DUE studies can be
classified as
1.Prospective review –evaluating planned drug therapy
before medication is administered.
2.Concurrent review –evaluating during the course of
treatment (ongoing monitoring of the therapy)
3.Retrospective review –evaluating drug therapy after the
patient has completed the therapy

11. Dr.
Ramesh
Bhandari
STEP3: DEFINECRITERIAANDSTANDARDS
Criteria are predetermined statements describing optimal
drug use, against which the quality of actual drug use is
compared.
Standards are professionally developed expressions of the
range of acceptable variation from a criterion.
Criteria should be valid, unambiguous, realistic, easily
measured, outcome oriented, scientifically sound and should
be supported by literature.
Select, decide and review criteria by DUE Committee for
inclusion.

12. Dr.
Ramesh
Bhandari
STEP4: DESIGNTHEDATACOLLECTION FORM
Impossible to evaluate all aspects of the drug use
Common aspects of drug use includes:
Indications for drug use
Side/adverse effects
Dosing information
Treatment duration
Drug duplication
Drug-drug or drug-food interactions
Cost of the therapy
Monitoring of the therapy.

13. Dr.
Ramesh
Bhandari
STEP4: DESIGNTHEDATACOLLECTION FORM
Sources of data for DUE:
Patient treatment charts
Old records of patients
Microbiological data
Medication charts
Observation charts
Patient interview
Progress notes etc.
Based on aspects to be evaluated and sources used, data
collection form should be designed accordingly.

14. Dr.
Ramesh
Bhandari
STEP5: DATACOLLECTION
Data Collectors
Chosen carefully
Should be familiar with how information is arranged in
patient’s case notes
Should have knowledge of drug names and strength
Physicians, pharmacists and nurses are the ideal data
collectors
Timing of Data Collection

15. Dr.
Ramesh
Bhandari
STEP6: EVALUATERESULTS
Data should be collated using appropriate resources
Resources include spreadsheet, database and word etc
Summarize the main categories and to identify where
exactly the data shows deviation from the guidelines or
criteria
Reasons for the deviations should be evaluated
Drugs used for new indication
Outdated procedures
Inadequate resources
Gaps in knowledge
True deviation –redefine the criteria

16. Dr.
Ramesh
Bhandari
STEP7: PROVIDEFEEDBACK OFRESULTS
Success of DUE studies depends on feedback to the
prescribers and other health care professionals
Report can be prepared before presenting to other health
care staffs
Report should be well presented and should not have
grammatical and typographical errors
Also can be circulated to other hospital staffs

17. Dr.
Ramesh
Bhandari
STEP8: DEVELOPANDIMPLEMENT INTERVENTION
Problem identified –consider how it can be addressed
Interventions –Educational
Operational
Educational Intervention:
Educational meetings
Feedback of results
Letters/posters to physicians
Operational Intervention:
Development/modification of drug orders forms
Manual or computerized reminders
Prescribing restriction

18. Dr.
Ramesh
Bhandari
STEP8: DEVELOPANDIMPLEMENT INTERVENTION
Formulary additions/deletion
Automatic stop orders
oIntervention can be both educational and operational
oPlanning of intervention can be done carefully
oMore than one interventions are often needed
oIntervention can be chosen based on:
Ease of application
Cost
Resources required
Sustainability
Their success rate

19. Dr.
Ramesh
Bhandari
STEP9: RE-EVALUATE TODETERMINE IFDRUGUSE
HASIMPROVED
Drug use/prescribing patterns -Need to be monitored to
determine success of intervention
Re-evaluation –usually done after 3-6 months of
implementing intervention
Focus may be narrowed down if problems not solved

20. Dr.
Ramesh
Bhandari
STEP10: RE-ASSESSANDREVISETHEDUE
PROGRAM
Following questions should be addressed:
Did the program addressed important issue?
Were the criteria developed appropriate?
Were drug use problem identified?
Were the intervention made appropriate?
Were the drug use problem solved?
Did DUE program has an impact (either incidence of
ADR or financial impact)?

21. Dr.
Ramesh
Bhandari
STEP11: FEEDBACK RESULTS
Disseminate the results of DUE to clinicians and other
health care professionals
Collect opinions about success of the DUE/Intervention
Collect feedback also to improve DUE/Intervention

23. Dr.
Ramesh
Bhandari
RESOURCES ANDTOOLSREQUIRED
Human resources
Resources for development of criteria:
Primary literatures and up-to-date reference texts
Guidelines: Locally developed or national and
international treatments guidelines
Published protocols and criteria
Resources for documentation:
Computer databases

25. Dr.
Ramesh
Bhandari
ROLEOFPHARMACIST INDUE
Planning, organising and implementing a DUE program
Program development, supervision and coordination
Education of hospital staff about DUE in conceptual and
practical terms
Promotion of the goals and objectives of DUE
Development/review of audit criteria, guidelines, study
protocols and educational material

26. Dr.
Ramesh
Bhandari
ROLEOFPHARMACIST INDUE
Development of data collection instruments
Pilot testing, data collection, analysis and report writing
Documentation of program outcome, effectiveness and cost
benefits.
Presentation of DUE results at meetings and conferences
Publication of results in peer reviewed journals

27. Dr.
Ramesh
Bhandari
REFERENCE
G. Parthasarathi, Karin NyfortHansen, MilapC Nahata. A textbook
of clinical pharmacy practice Essential concepts and skills.
Universities Press. 2
nd
edition.