Drug Utilisation Evaluation (DUE) Flashcards
What is Drug Utilisation Evaluation?
Detailed analysis of drug usage including appropriate indications (drug selection), dosage, frequency, duration, and patient outcomes.
What is Drug Utilisation Review?
DUE + review of system delivery, laboratory testing, patterns of usage and issues such as patient counselling
What is one thing that is shared between DUE and DUR?
Evidence-based quality improvement methods to enhance quality, safety and cost-effectiveness of drug use.
Why is there a need to do DUE? Provide FIVE reasons.
- Monitor trends and patterns of drug use to detect problems with prescribing practices
- Ensure quality of drug use with respect to consensus-based standards
- To provide comparative data on prescribing practices
- To achieve optimal pharmacoeconomic outcomes
- To evaluate drug usage in a particular setting or patient group
- To develop a quality improvement tool for the use of medicines
- To improve patient outcomes by implementing strategies to reduce inappropriate prescribing –> longer term goal of DUE
Provide FIVE desirable endpoints of DUE
- Improve clinicians’ understanding of illness and/or drugs
- Improve concordance with guidelines
- Reduction in need for drug administration
- Reduction in drug expenditure and use of expensive dosage forms
- Appropriate use of laboratory tests
- Reduction in length of hospital stay and re-admissions
- Reduced adverse drug reactions
What are the 9 steps to do for the process of DUE/DUR?
- Identify the QUM or DUE problem
- Conduct a literature review
- Identify best-practice criteria
- Design the research protocol
- Obtain permission and ethics or institutional approval
- Collect data (with respect to guidelines or standards to quantify the problem)
- Analyse and interpret the data
- Feedback the results
- Design and conduct and intervention
Describe what 1. Identify the QUM or DUE problem consists of.
- Frequency of use or escalating use of meds
- Cost and cost effectiveness
- Risk of adverse events
- Appropriate use of meds (e.g. antibiotics)
- Pharmacokinetic monitoring
- Laboratory monitoring
- Specific patient groups
- Effects of prescribing criteria
What is the purpose of 2.Conduct a literature review?
- Explain the significance of the issue
- Explore methods used by others (what can be adapted to the current study)
- Identify what’s known/established (findings of previous studies)
- Identify the ‘gap’ (whats not known)
Required for ethics application and final report (reduced to an introduction)
How is 3.identify best-practice criteria achieved?
- Therapeutic Guidelines
- Local or national hospital guidelines
- National prescribing service guidelines?
- An international ‘gold standard’
- A previous DUE (compare findings prospectively)
What are the several methods for 4.designing the research protocol? What is the type of studies used?
- RCT (not usual in DUE)
- Cross-sectional investigations (snapshot)
- Pre-post design (before and after an intervention)
- Controlled cross-over design
- Cohort studies
- Retrospective vs prospective
- Data collection instrument, method, sampling
For 5. obtain permission and ethics or institutional approval;
A) Provide a example of it used in a hospital
B) What is reciprocal Curtin approval?
A)
DUE usually qualifies as a Quality Activity in hospitals:
> GEKO (governance, ethics, knowledge, outcomes) platform –> private hospital doesn’t have GEKO
> Approved by a hospital committee
> May include publication approval
B)
Reciprocal Curtin approval also required
> QA approval is endorsed by Curtin’s Human Reasearch Ethics Committee
How is 6.collect data done? What are the different types?
Hard-copy patient records/file/notes
- Prospective: on the wards/in clinics
- Retrospective: in Medical Records/archives
Electronic patient records/files/notes
- Hospital will arrange access (login)
Other Types of Data
- Patient records/notes (prospective or retrospective)
- Drug acquisition (purchasing) data
- Drug supply data
- Microbiological and other pathology data
- Pharmacokinetic and assay data
- Drug issues documented in wards/units
Regardless of method –> ensure confidentiality of data and restrict variables to those required to answer the research questions
How is 7.analysing and interpreting the data achieved?
- Data cleaning
- Upload Excel data to SPSS for analysis
- Describe samples –> frequencies and proportions
- If a gold standard has been identified –> choose appropriate tests to compare to the standard/guidelines (or pre-post analysis)
- Tease apart the issues e.g. any associations more evident in a particular ward or group
How is 8.Feed back the results done?
- Written report (here, as a manuscript for submission to a journal)
- Oral presentation (adapt for a conference)
- Bulletins, newsletters, posters
as a courtesy –> continue to be available to work on dissemination post-completion
Is 9.design and conduct and intervention applicable to a project? What does it consist of?
Not applicable to project –> for hospital
- beyond scope of DUE
- report should reflect on future directions –> what type of actions are needed now?
- DUE should be part of or lead to a program of continuous quality improvement.
