DUE Flashcards
GPP is the practice of pharmacy that responds to the needs of the people who use the pharmacists’ services to provide optimal, evidence-based care.
GPP is the practice of pharmacy that responds to the needs of the people who use the pharmacists’ services to provide optimal, evidence-based care.
The mission of pharmacy practice is to contribute to health improvement and to help patients with health problems to make the best use of their medicines.
- 6 components to the mission
1) Being readily available to patients with or without and appointment.
2) Identifying and managing or triaging health-related problems
3) Health promotion
4) Assuring effectiveness of medicines
5) Preventing harm from medicines
6) Making responsible use of limited health-care resources.
Why is there a need for GPP?
Problems with medicine use.
o The potential benefit of medicines is often not realized – there is a gap between the proven efficacy of medicines demonstrated in clinical trials and their actual effectiveness in practice.
o Reasons for this gap include
Problems with medicine selection and dosages, improper administration of medicines, concerns for DDI, DFI and ADR. (DRP)
Medicines are also increasingly expensive and their COST is compromising the affordability of health care. Managing the costs of medicines is critical to making the best use of limited resources to maximize health care for as many people as possible.
Substandard, adulterated, unlicensed and spurious/falsely-labelled/falsified/counterfeit medicines are a growing problem that compromise health. There is a need for a system of assuring the integrity of the medicine supply chain to assure the value of medicines used for the prevention of diseases and the treatment of patients.
Increasing recognition that providing consumers with medicines alone is not sufficient to achieve the treatment goals. Consumers needs to own their health and ADHERE to their treatment plans.
Requirements for GPP
- Patients come first (welfare)
- Help patients make the best use of medicines (from supply to monitoring SE)
- Promote rational and economic drug use
- Multidisciplinary collaboration - Ensure patient receives appropriate treatment.
- Many drugs, many uncertainties and a wide range of influences leading to
o Variable prescribing and drug use
o Variable clinical outcome
o Different implications.
DUE is a tool to
help us evaluate how we are using drugs and make improvement (where necessary) so as to ensure we are using drugs and resources responsibly.
- These are evaluating tools are to – improve quality, safety and cost-effectiveness of medicine use and medicinal-use processes, thereby optimizing patient outcome and resource utilisation.
Objective of DUE.
- Establish interdisciplinary consensus on drug use processes.
a. Stimulate standardization in drug use processes
b. Minimize procedural variations that contribute to suboptimal outcomes of drug use. - Evaluate the effectiveness of drug therapy
- Ensure that drug therapy meets current standard of care
- Evaluate medication-related problems and improve patient safety
- Minimize cost of medication therapy
- Identify areas in which further information and education for health care professionals may be needed
- Enhance opportunities, to assess the value of (innovative) medication-use practices
- Meet or exceed internal and external quality standards
DUE cycle
- Quality improvement cycle
o Evaluate
Identify, define and measure drug usage (problem)
Drug use is evaluated against pre-determined standards.
o Improve
Problem-solving, consensus building with development and implementation of strategies and innovations to improve drug use
Steps in conducting a DUE
- Identification of drugs/MUP for evaluation
- Assemble DUE team
- Design of study
- Approval of study
- Development of criteria and measurement instruments
- Data collection
- Evaluation with pre-determined criteria and analysis of results
- Reporting and feedback
- Design and implementation of intervention strategies
- Re-assessment and revision of problem
identification of drugs/MUP for evaluation
o Drugs under consideration for formulary retention, addition, deletion
o Drugs with high-unit or high volume cost
o Drugs known to be associated with adverse event (inc interaction) or poor patient outcomes
o Drugs used in high risk patients.
o Drugs with PK handling problems
o Drugs or processes where suboptimal use is likely to have or showed signs of negative effect on patients outcomes or system cost
o Drugs or MUP is a critical component of care for a specific disease, condition, or procedure
o Conditions where many drug options are available.
- The need for DUE may be identified through certain “flags” or indicators
o Adverse medication events reporting
o Hospital statistic e.g. unexpected readmissions, increase incidence of bacterial resistance
o Pharmacist interventions reports
o Nonformulary medications used or requested
o Patient feedback – dissatisfaction or deterioration in QOL
- Development of criteria and measurement instruments
- Criteria must be
o Evidence based o Valid, practical, relevant o Authoritative o Explicit o Pre-determined o Easily measured (objective measures) o Outcome oriented
- National, independent, authoritative sources o MOH clinical practice guidelines o NIH and clinical excellence o WHO o Medical associations o National guidelines clearing house
- Data collection instrument should
o Be unambiguous and “user friendly” –> death VS 30 days mortality
o Be simple and focused
o Include only relevant demographic, clinical or drug therapy information
o Protect patient confidentiality
o Be tested and refined in pilot studies
o Take advantage of existing automated information system.
- Design and implementation of intervention strategies
- Intervention to address issues identified in the evaluation phase of DUE
- Multi-faceted interventions works best
- Possible interventions
- ——————-
o Educational activities
o Publication of guidelines
o Restrictions – formulary changes, institution policies
o Workflow modifications (checklists, double-checks)
o Additional pharmacy services
o IT integration/enhancements
- Re-assessment and revision of problem
- DUE is a cyclical process
- Lessons learned from one cycle should be incorporated into subsequent study cycles
- Re-evaluation via
o Simple monitoring of consumption data
o Exception or threshold analysis
o Periodic screening
o Reassessment of areas or target groups.
