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a PR3145 > Quality Drug Use & Drug Use Evaluation > Flashcards

Quality Drug Use & Drug Use Evaluation Flashcards

1
Q

Definition of Quality/Rational/Responsible Drug Use (2)

A
  • 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
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2
Q

Examples of irrational drug use (3)

A
  • polypharmacy
  • IV use when can PO
  • patients self-medicate inappropriately or do not adhere to prescribed treatment
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3
Q

Why is rational medicines use important? (3)

A
  • 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
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4
Q

WHO 12 Core Interventions to promote rational use of medicines

A
  1. Mandated multi-disciplinary national body to coordinate medicine use policies
    eg Agency for Cost Effectiveness (ACE)
  2. Evidence-based clinical guidelines
  3. Essential medicines list based on treatments of choice
    - Medication Assistance Fund
    - Standard Drug List
  4. Drug & Therapeutics Committees in healthcare institutions
  5. Problem-based pharmacotherapy training in undergrad curriculum
  6. Continuing in-service medical education as licensure requirement
  7. Supervision, audit & feedback
    - prescriptions
  8. Independent information on medicines
  9. Public education about medicines
  10. Avoidance of perverse financial incentives
  11. Appropriate & enforced regulation
  12. Sufficient government expenditure to ensure availability of medicines & staff
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5
Q

Drug & Therapeutics Committees purposes (2)

A
  • 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
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6
Q

SAPI

  • purpose (1)
  • interaction requirements (3)
  • promotion requirements (3)
A

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
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7
Q

GPP & its purpose (4)

A

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
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8
Q

Medication use process (5)

A
  1. Medicine supply chain
  2. Prescription
  3. Dispensing
  4. Administer
  5. Monitor
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9
Q

Roles & Responsibilities of pharmacists in Medication Use Process (MUP) (4)

A
  1. Assure integrity of medicine supply chain
    - detect counterfeits/falsified/spurious medicines
    - ensure quality
  2. Assuring proper prescribing & dispensing of medicines
    - med recon & SBAR
    - cost
  3. Assisting patients & those administering medicines to understand the importance of taking medicines properly
    - patient counselling
  4. Monitor treatment for effectiveness & ADR
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10
Q

Quality / Rational / Responsible drug use easily accomplished? Why?

A

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

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11
Q

MUE/DUE/DUR (3)

A
  • is a systematic quality (performance) improvement activity
  • to evaluate & improve quality of drug use & medication use process
  • to achieve optimal patient outcomes
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12
Q

MUE > DUE (2)

A
  • more multifaceted approach

- emphasise on improving patient outcomes

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13
Q

Goal of DUE (1)

A
  • improve quality, safety & cost-effectiveness of drug use leading to optimisation of patient outcome & resource utilisation
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14
Q

Objectives of DUE (7)

A
  1. Facilitate multidisciplinary consensus on drug use
  2. Ensure updated drug therapy through regular audits
  3. Provide feedback of audit results to prescribers & stakeholders
  4. Provide information, advice & education to promote judicious, appropriate, safe & cost-effective therapy
  5. Minimise variations in practice
  6. Enhance opportunities to assess the value of or innovative medication use practices
  7. Ensure internal & external quality standards are met or exceeded
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15
Q

MUP

A

Medication Use Process

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16
Q

DUE steps (10)

A
  1. Identification of drugs/MUP for evaluation
  2. Assemble the multidisciplinary DUE team
  3. Design the study
  4. Get approval for the study
    - ethical
    - PDPA
  5. Develop criteria & measurement instruments
    - to include / exclude participants
  6. Data collection
  7. Evaluation with pre-determined criteria & analysis of results
  8. Reporting & feedback
  9. Design & implementation of intervention strategies
  10. Re-assessment & revision of problem
17
Q

Types of study design for DUE (3)

& when is the drug therapy reviewed?

A
  1. Retrospective
    - after drug initiation
    - simplest to perform
  2. Concurrent
    - ongoing monitoring of drug therapy
  3. Prospective
    - before or at the time of drug initiation
18
Q

Why must get approval for DUE studies involving patient information? (2)

A
  1. Ethicality issues
    - institutional ethics committee
    - IRB (if publication outside of institution)
  2. Privacy issues (PDPA)
19
Q

IRB

A

Institutional Review Board

20
Q

Sources of criteria to assess current MUP in DUE study (3)

A
  1. National / international guidelines
    eg MOH, WHO
  2. Institutional guidelines (hospitals)
  3. DUE may build inhouse criteria
21
Q

Why is there a need for criteria in DUE study?

** What are the requirements of a criteria? (7)

A

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
22
Q
  1. Evaluation with pre-determined criteria & analysis of results (3)
A
  • 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
23
Q
  1. Reporting & feedback (2)
A
  • non-punitive & constructive

- report both positive (encouraging) & negative findings

24
Q

Intervention strategies

A
  • multi-faceted interventions (interventions that target several areas)
25
Q

Hierarchy of effectiveness of strategies (3)

A
  1. Low leverage (least effective)
    - person based
  2. Medium leverage (moderately effective)
    - both person based & system based
  3. High leverage (most effective)
    - system based
26
Q

Low leverage (2)

A
  • rules & policies

- education & information

27
Q

Medium leverage (2)

A
  • simplification & standardisation of system

- reminders, checklists & double checks

28
Q

High leverage (2)

A
  • forcing functions & constraints
    eg removal of from formulary
  • automation or computerisation
    eg automated patient specific dispensing
29
Q

Limitations of DUE (5)

A
  1. Lack of authority & involvement
  2. Poor organisation & documentation
  3. Lack of follow-through (only for 1 time study > cyclical)
  4. Lack of readily retrievable data & information management
  5. Evaluation methods impedes patient care
30
Q

Lack of authority & involvement (1)

A
  • req multi-disciplinary consensus
31
Q

Poor organisation & documentation (2)

A
  • need clear definition of the roles & responsibilities of individuals involved in DUE
  • documentation should address recommendations made & follow up actions
32
Q

Lack of follow-through (2)

A
  • cyclical process > one time study/evaluation

- assess intervention and improve when necessary

33
Q

Lack of readily retrievable data & information management (2)

A
  • only medical records in system

- ensure data in system not outdated

34
Q

Evaluation methods impedes patient care (1)

A
  • data collection should not consume too much time that patient care activities suffer
35
Q

Role of pharmacists in DUE (6)

A
  1. Exert leadership & manage DUE
  2. Promote the goal & objectives of DUE
  3. Develop operational plans for DUE
  4. Conduct DUE (10 steps)
  5. Participant actively in hospital committees concerned with quality improvement
  6. Presentation of DUE results

a PR3145 (14 decks)

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