Quality Drug Use & Drug Use Evaluation Flashcards
Definition of Quality/Rational/Responsible Drug Use (2)
- involve the use of drugs based on the needs of the patient, at an individualised dose, for adequate period of time, & at the lowest cost to them & the community
- it needs to take into account the best available clinical evidence on safety & efficacy, & comparative cost-effectiveness
Examples of irrational drug use (3)
- polypharmacy
- IV use when can PO
- patients self-medicate inappropriately or do not adhere to prescribed treatment
Why is rational medicines use important? (3)
- irrational medicines use is wasteful, expensive & dangerous to both patients & populations as a whole (reduce productivity)
- impact on society (government health expenditure)
- to optimise patient outcomes
WHO 12 Core Interventions to promote rational use of medicines
- Mandated multi-disciplinary national body to coordinate medicine use policies
eg Agency for Cost Effectiveness (ACE) - Evidence-based clinical guidelines
- Essential medicines list based on treatments of choice
- Medication Assistance Fund
- Standard Drug List - Drug & Therapeutics Committees in healthcare institutions
- Problem-based pharmacotherapy training in undergrad curriculum
- Continuing in-service medical education as licensure requirement
- Supervision, audit & feedback
- prescriptions - Independent information on medicines
- Public education about medicines
- Avoidance of perverse financial incentives
- Appropriate & enforced regulation
- Sufficient government expenditure to ensure availability of medicines & staff
Drug & Therapeutics Committees purposes (2)
- serves in an evaluative, educational & advisory capacity in all matters pertaining to the use of medications
- responsible for overseeing policies & procedures related to all aspects of medication use
eg compliance to SAPI
SAPI
- purpose (1)
- interaction requirements (3)
- promotion requirements (3)
Singapore Association of Pharmaceutical Industries
- guidelines on interaction & role of pharmaceutical company representatives & medical science liaisons in healthcare organisation
- interaction must be ethical, accurate & professional
- promotion must be ethical, accurate & balanced
GPP & its purpose (4)
Good Pharmacy Practice
Purpose :
- ensure welfare of patients are taken care of
- to help patients make the best use of medicines
- promotion of rational & economic drug use
- multidisciplinary collaboration
Medication use process (5)
- Medicine supply chain
- Prescription
- Dispensing
- Administer
- Monitor
Roles & Responsibilities of pharmacists in Medication Use Process (MUP) (4)
- Assure integrity of medicine supply chain
- detect counterfeits/falsified/spurious medicines
- ensure quality - Assuring proper prescribing & dispensing of medicines
- med recon & SBAR
- cost - Assisting patients & those administering medicines to understand the importance of taking medicines properly
- patient counselling - Monitor treatment for effectiveness & ADR
Quality / Rational / Responsible drug use easily accomplished? Why?
Not easily accomplished in this complex drug use environment
Hence, need tools like MUE/DUE/DUR to ensure rational use of drugs & resources
eg uncertainties in marking clinical decisions, many drugs available
MUE/DUE/DUR (3)
- is a systematic quality (performance) improvement activity
- to evaluate & improve quality of drug use & medication use process
- to achieve optimal patient outcomes
MUE > DUE (2)
- more multifaceted approach
- emphasise on improving patient outcomes
Goal of DUE (1)
- improve quality, safety & cost-effectiveness of drug use leading to optimisation of patient outcome & resource utilisation
Objectives of DUE (7)
- Facilitate multidisciplinary consensus on drug use
- Ensure updated drug therapy through regular audits
- Provide feedback of audit results to prescribers & stakeholders
- Provide information, advice & education to promote judicious, appropriate, safe & cost-effective therapy
- Minimise variations in practice
- Enhance opportunities to assess the value of or innovative medication use practices
- Ensure internal & external quality standards are met or exceeded
MUP
Medication Use Process
DUE steps (10)
- Identification of drugs/MUP for evaluation
- Assemble the multidisciplinary DUE team
- Design the study
- Get approval for the study
- ethical
- PDPA - Develop criteria & measurement instruments
- to include / exclude participants - Data collection
- Evaluation with pre-determined criteria & analysis of results
- Reporting & feedback
- Design & implementation of intervention strategies
- Re-assessment & revision of problem
Types of study design for DUE (3)
& when is the drug therapy reviewed?
- Retrospective
- after drug initiation
- simplest to perform - Concurrent
- ongoing monitoring of drug therapy - Prospective
- before or at the time of drug initiation
Why must get approval for DUE studies involving patient information? (2)
- Ethicality issues
- institutional ethics committee
- IRB (if publication outside of institution) - Privacy issues (PDPA)
IRB
Institutional Review Board
Sources of criteria to assess current MUP in DUE study (3)
- National / international guidelines
eg MOH, WHO - Institutional guidelines (hospitals)
- DUE may build inhouse criteria
Why is there a need for criteria in DUE study?
** What are the requirements of a criteria? (7)
To provide a basis of comparison whether current medication use process are valid & up to date
- *
1. Evidence-based
2. Valid, practical & relevant
3. Authoritative
4. Explicit
5. Pre-determined
6. Easily measured (objective measures)
7. Outcome oriented
- Evaluation with pre-determined criteria & analysis of results (3)
- compare MUP & pre-determined criteria to check for compliance / concordant / adherence to guidelines
- identify area of divergence & document it
- review with prescriber to determine if there is valid justification for divergence
- Reporting & feedback (2)
- non-punitive & constructive
- report both positive (encouraging) & negative findings
Intervention strategies
- multi-faceted interventions (interventions that target several areas)
Hierarchy of effectiveness of strategies (3)
- Low leverage (least effective)
- person based - Medium leverage (moderately effective)
- both person based & system based - High leverage (most effective)
- system based
Low leverage (2)
- rules & policies
- education & information
Medium leverage (2)
- simplification & standardisation of system
- reminders, checklists & double checks
High leverage (2)
- forcing functions & constraints
eg removal of from formulary - automation or computerisation
eg automated patient specific dispensing
Limitations of DUE (5)
- Lack of authority & involvement
- Poor organisation & documentation
- Lack of follow-through (only for 1 time study > cyclical)
- Lack of readily retrievable data & information management
- Evaluation methods impedes patient care
Lack of authority & involvement (1)
- req multi-disciplinary consensus
Poor organisation & documentation (2)
- need clear definition of the roles & responsibilities of individuals involved in DUE
- documentation should address recommendations made & follow up actions
Lack of follow-through (2)
- cyclical process > one time study/evaluation
- assess intervention and improve when necessary
Lack of readily retrievable data & information management (2)
- only medical records in system
- ensure data in system not outdated
Evaluation methods impedes patient care (1)
- data collection should not consume too much time that patient care activities suffer
Role of pharmacists in DUE (6)
- Exert leadership & manage DUE
- Promote the goal & objectives of DUE
- Develop operational plans for DUE
- Conduct DUE (10 steps)
- Participant actively in hospital committees concerned with quality improvement
- Presentation of DUE results
