Drug Utilization Review by Immanuel.pptx

Drug Utilization Review

1. M. Immanuel Jebastine, M. Pharm., HonD. , Assistant Professor, Department of Pharmacy Practice

2. Dru g u se evaluation is an ongoing, authori z e d an d s y s tem a ti c q u ality improvement process, which is designed to: Review drug use and or prescribing patterns Pr o v i d e fe e d b ac k o f res u lt s t o clin i ci a ns a n d other relevant groups Develop criteria and standards Promote appropriate drug use

3. 1. Quantitative DUE studies 2. Qualitative DUE studies

4. planning Data c o l l e ct i o n Evaluation Feed back of results Intervention Re- evalu a t i o n Feedback of results

5. STEP 1:Identify drugs or therapeutic areas of practice for possible inclusion in the program STEP 2:Design of study STEP 3:Define criteria and standards STEP 4: Design the data collection form STEP 6:Evaluate results STEP 5:Data collection

6. STEP 6:Evaluate results STEP 7:Provide feedback of results STEP 8:Develop and implement interventions STEP 9:Reevaluate to determine if drug use has improved STEP 10:Reassess and revise the DUE program STEP 11 :Feedback results

7. Common targets for DUE includes: Commonly prescribed drugs Drugs associated with potentially significant drug interactions Expensive drugs New drugs Drugs with narrow therapeutic index Drugs that frequently cause serious ADR Drugs used in high risk patient

8. DUE studies may also be described as prospective, concurrent or retrospective ADVANTAGE: The prescribers and others are unaware of data collection DISADVANTAGE : patient do not gain immediate benefit.

9. After the DUE target has been selected ,it is important to conduct a comprehensive literature review. Criteria Standards

10. COMMON ASPECTS OF DRUG USE STUDIED IN DUEs Patient demographics Prescriber details Disease severity Indication for drug use Contraindications Side/adverse effects Dosing information Drug-drug and drug-food interactions Monitoring of drug therapy Cost of therapy

11. SOURCES OF DATA FOR DUEs IN HOSPITALS Clinical data Patient treatment charts Patient admission records Departmental audits Pathology records Microbiological data Demographic data Administrative data

12. H O S P IT A L N A M E Drug Use Evaluation of renal function monitoring during aminoglycoside therepy Patient Data Collection Form A ge: ……………………………. male/Female InpatientNo:……………………….. Weigt(Kg):……………………… Nam e: ………………… Date of Admission: ……/……/2014 Previous history of renal impai r me nt ? Date of Discharge: …./……/2014 Indication(circle): C o nsultant ………………………… … … Y ES / No Details of aminoglycoside therapy Reason for ceasing(circle): Infection resolved Toxicity Other(please specify) Date …/…../14 UTI/Pneumonia/Septicemia/Endocarditis Other(please specify) Drug(circle) Dose(mg) Route IV IM Frequency(circle) qd bd tds O t h e r Date started …./…./14 ceased G enta m yc in T o b r a m yc in Amikacin Date S e rum …/…/14 …. / …. /14 …. / …. /14 …. / …. /14 Creatinine Comments:…………………………………………………………………………………………………………………………………. Data collector’s signature:………………………………………………………………………………………………………….

13. Data collectors should be chosen carefully, and should be familiar with how information is arranged in the patient’s case notes. The data obtained should be collected using available resources such as spreadsheets ,databases and word processing.

14. Th e repor t s should b e a w el l – pre s ente d and well –reasoned document ,with no grammatical or typographical errors Educational Operational

15. The reevaluation is done three to twelve months after the introduction of the intervention. The questions addressed should include: Did the program address important aspects of care? Were the criteria developed appropriate? Were drug use problems identified?

16. Program development, supervision and coordination Education of hospital staff Promotion of the goals and objectives Development /review of audit criteria, Development of data collection instrument

17. STEP 1:Identify target drug or therapeutic area of practice STEP 2 :Design of study- A concurrent observational study STEP 3:Defining criteria and standards STEP 4:Design data collection form STEP 5:Data collection STEP 6:Evaluation Criteria 1:38 patients (60.3%) Criteria 2: 12 of 38 patients(31.5%) Criteria 3:4 of 6 patients (66.6%)

18. STEP 7:Feedback results STEP 8:Development and implement interventions STEP 9:Reevaluate after intervention Criteria 1:47 of 60 patients(78.3%) Criteria 2:18 of 47 patients(38.2%) Criteria 3: 8 of 12 patients (66.5%) STEP 10:Reassess and revise DUE program STEP 11:Feedback results