Tiêu đề 4. DRUG UTILIZATION REVIEW.pdf ✅

PHARMD GURU Page 1 DEFINITION: According to WHO, Drug Utilization evaluation is defined as the marketing, distribution, prescription and use of drugs in society, with special emphasis on the resulting medical, social and economic consequences. Drug Utilization Evaluation (DUE) is an ongoing authorized and systematic quality improvement process, designed to:  To optimize drug use by developing criteria and standards.  To educate clinicians and other Health Care Professionals (HCP), to increase appropriate drug use.  To provide feedback of results obtained during study to clinicians and other HCP.  To review drug use.  To analyze prescription pattern. DUE COMMITTEE:  DUE Committee should be composed of physicians, pharmacists and other relevant health-care professionals.  The committee must include professionals with on interest in improving drug therapy in the hospital and have ready access to experts in the medicine, surgery and major hospital specialists.  Pharmacists generally play a major role in the delivery of DUE and it is usual for the committee to include pharmacy department representation. ROLE OF PHARMACIST IN DUE:  Planning, organizing and implementing a DUE program.  Program, development, supervision and coordination.  Education of hospital staff about DUE in conceptual an practical terms.  Promotion of the goals and objectives of DUE.  Development or review of audit criteria, guidelines, study protocols and educational materials.  Development of data collection, analysis and report writing  Documentation of program outcome, effectiveness and cost benefits. DRUG UTILIZATION REVIEW
PHARMD GURU Page 2  Participation in hospital committees concerned with quality assurance in general and drug usage.  Presentation of DUE results at meeting and conferences.  Publication of results in peer-viewed journals. FUNCTIONS OF DUE COMMITTEE:  The committee should draft and approve the policies and procedures.  Establish and maintain adequate means of communication with hospital administration and other relevant hospital committee.  Medical and other hospital staff should understand that the DUE program is a continuous quality improvement activity designed to ensure safe and effective drug use.  The committee should prepare a schedule including a yearly meeting and selecting and approving criteria, evaluating data, designing interventions and reviewing the program.  The committee should develop or review standards and criteria of DUE studies based on their knowledge, experience and literature findings.  Reviewing the data generated from study.  Initially, monthly meetings may be necessary to discuss start up problem and make corrections in the program.  Later quarterly meetings may be sufficient.  The committee should ensure compliance with good clinical research guidelines such as maintaining the confidentiality of all patients’ data.
PHARMD GURU Page 3 DUE CYCLE:  It is important to keep in mind that DUE operates in a repeating cycle.  The DUE cycle should include the following seven major activities or phases: 1) Planning (step 1-4) 2) Data collection (step 5) 3) Evaluation (step 6) 4) Feedback if results (step 7) 5) Interventions (step 8) 6) Re-evaluation (step 9-10) 7) Feedback of results (step 11) METRICS USED IN DRUG UTILIZATION EVALUATION: 1) Defined daily dose (DDD): The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. It can be done to only products which is approved and marketed at least in one country. PLANNING DATA COLLECTION EVALUATION FEEDBACK OF RESULTS INTERVENTION RE-EVALUATION FEED BACK OF RESULTS DUE CYCLE
PHARMD GURU Page 4 2) DDDs/1000 inhabitants/day: It provides a rough estimate of the quantity of drug that is used in a proportion of specific population. This kind of DDD is mostly used for estimating drugs that are used chronically. DDDs/1000 people/d = (amount drug (mg) × 1000) (DDD × 365 d × sample size) 3) Prescribed daily dose/consumed daily dose: It is defined as an average dose prescribed according to a representative sample of prescriptions. This gives the information about average amount of a drug that is actually prescribed on daily basis. 4) BMI: It is defined as the weight in kilograms divided by square of height in meters. It is a ratio of weight to height usually used to classify individuals with overweight, underweight and obesity. 5) Creatinine clearance: Creatinine clearance is the amount of plasma or blood that is cleared of creatinine this used as a tool to measure the kidney functioning. This can be calculated using Cockcroft-Gault equation. If female, C. cr = ((140 − age) × weight) (72 × S. cr)) × 0. 85 If male, C. cr = ((140 − age) × weight) (72 × S. cr)) × 1 STEPS INVOLVED IN CONDUCTING A DUE CYCLE: STEP 1: IDENTIFY DRUGS OR THERAPEUTIC AREAS OF PRACTICE FOR POSSIBLE INCLUSION IN THE PROGRAM 1) The DUE committee must identify priority drugs or areas of practice where improvement in use will result in the greatest clinical impact. 2) These areas can be identified through various sources of information such as medication error reports, ADR reports, feedback from prescribers or clinical pharmacists, local microbiological data and medical and pharmaceutical literatures 3) ABC or VEN analysis is another important tool used to identify high priority or target drugs. 4) ABC analysis divides the drugs into three classes based on their annual usage: