Quality Drug Use, Drug Use Evaluation Flashcards
1
Q
rational use of drugs requires:
A
- patient receive medications appropriate to their clinical needs
- in doses that meet their own individual requirements
- for an adequate period of time
- at the lowes cost to them and the community
2
Q
what is responsible/quality/rational drug use
A
according to WHO:
- take account of the best available
- clinical evidence of :
(1) Efficacy
(2) safety
(3) cost-effectiveness
3
Q
common examples of irrational drug use
A
- polypharmacy
- using injections where PO formulations would be more appropriate
- antimicrobial med given in inadequate doses or duration / abx prescribed for non-bacteria infections
- prescriptions do not follow clinical guidelines
- patients self-medicate inappropriately or do not adhere to prescribed tx
4
Q
12 core interventions to promote rational use of meds
A
- mandated multi-disciplinary national body to coordinate medicine use policies
- evidence-based clinical guidelines
- essential medicines list based on tx of choice
- drugs and therapeutics committees in a healthcare institutions
- problem-based pharmacotherapy training in undergrad curricula
- continuing in-service medical education as a licensure requirement
- supervision, audit, and feedback
- independent information on medicines
- public education about medicines
- avoidance of perverse financial incentives
- appropriate and enforced regulation
- sufficient government expenditure to ensure availability of medicines and staff
5
Q
what does drug and therapeutics committee (DTC) do
A
- serves in an evaluative, educational, and advisory capacity to the medical staff and organisational administration in all matters pertaining to the use of medications
- is responsible for overseeing policies and procedures related to all aspects of medication use
- addition, deletion, review to/on formulary
- drug use evaluation
- medication error prevention
- development of clinical care plans and guidelines
- guidelines on interaction and role of pharmaceutical company representatives and medical science liaisons in a healthcare organisation
6
Q
requirement for GPP (good pharm practice)
A
- first concern to be welfare of pt
- core of activity is to help patient make the best use of medicines
- promote rational and economic drug use
- the objective of each element of pharmacy service to be relevant to patient, clearly defined and effectively communicated to all those involved
7
Q
roles of pharmacist in ensuring rational use of medicines
A
optimising meds use within health system is a collaborative venture necessitating partnerships across disciplines
pharmacists must:
- take ownership and
- assume accountability for outcomes
- related to medication use across the continuum of care in a health system
8
Q
why is quality/rational/responsible drug use important
A
- impact on patients, need to optimise patient outcomes
2. impact on society (health and resources)
9
Q
factors influencing drug use
A
- education (knowledge and information)
- experience
- drug promotion
- monitoring
- habits and cultural believes
- restriction (access to information)
- consultation time
- workload
- peer influence
- demands and expectations
- med management system
- infrastructure
- supervision
10
Q
what do many drugs, uncertainties and wide range of influence lead to
A
- variable prescribing and drug use
- variable clinical outcomes
- different cost implications
11
Q
is quality/rational/responsible drug use easily accomplished
A
lol no
- complex drug use environment
- hence need tolls to help evaluate how we are using drugs to make improvements where necessary
12
Q
drug use evaluation (DUE)
A
- ongoing, structured, organisation
- authorised process designed to ensure that drugs are used appropriately, safely and effectively
- systematic quality improvement activity to improve the quality and cost-effectiveness of drug use (improve pt outcome)
13
Q
Medication use evaluation (MUE)
A
- systemic and interdisciplinary performance improvement method
- with an overarching goal of optimising patient outcomes via ongoing evaluation and improvement of medication utilisation
- encompasses goals and objective of DUe in the broader application
- emphasis on improving patient outcome
- used over DUE emphasise the need for a more multifaceted approach to improve medication use
14
Q
Drug use review (DUR)
A
- a system of continuous, systematic, criteria-based drug evaluation
- ensures appropriate use of drugs
- method of obtaining information to identify problems related to drug use
- if properly developed, can provide a means of correcting the problem and thereby contributes to rational drug therapy
15
Q
what are MUE/DUE and DUR in totality
A
- systematic quality (performace) improvement activity that
- focus on evaluating and improving quality of drug use and mediction-use process
- aim to achieve optimal patient outcomes
16
Q
goal of DUE
A
improve quality, safety, cost-effectiveness of drug use, thereby optimising patient outcome and resource utilisation
17
Q
objectives of DUE
A
- facilitate multidisciplinary consensus on drug use
- conduct regular audits to ensure that drug therapy meets current standard of care (concordance with best practice)
- provide feedback of audit results to prescribers and stakeholders
- promote judicious, appropriate, safe and cost-effective therapy through provision of information, advice and education
- minimise variations in practice which contribute to suboptimal clinical outcomes
- enhance opportunities, to access the value of inno. meds use practices
- meet or exceed internal and external quality standards
18
Q
quality improvement cycle
A
- observe and measure drug use / MUOP
- evaluate/investigate (identify problem) - - identify and share issues
- develop consensus approach
- improvement/intervention (problem solving) -
4. initiate and implement change strategies
19
Q
steps in conducting DUE
A
- identification of drugs / MUP for evaluation
- assemble the 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
20
Q
identification of drugs / MUP for DUE
A
- drugs under consideration for formulary retention, addition, or deletion
- drugs known to be associated with ADR or poor patient outcomes
- drugs with high-unit/volume cost
- drugs used in high-risk patients
- drugs or processes where suboptimal use is likely to have or showed signs of negative effect on patients outcome or system cost
- adverse med events (actual or averted)
- signs of tx failure
21
Q
Need for DUE identified through indicators like:
A
- adverse medication events reporting
- hospital statistics (unexpected readmissions, increase incidence of bacterial resistance
- pharmacist interventions reports
- nonformulary meds used or requested
- pt feedback- dissatisfaction or deterioration in quality of life
22
Q
assembly of DUE team
A
- include all stakeholders in MUP with expertise to ensure sound assessment of practice performance
- obtain authorisation: frequently by CEO or CMB, with oversight from institutional committee responsible fro regulating drug use
23
Q
types of design of DUE
A
- retrospective: review of drug therapy after the patient has received the medication
- concurrent: ongoing monitoring of drug therapy during the course of tx
- prospective: evaluation of a patient’s drug therapy before or at time medication is initiated
24
Q
retrospective DUE
A
- simplest to perform since drug therapy is reviewed after the patient has received the medication
- may detect patterns in prescribing, dispensing, or administering drugs to prevent the recurrence of inappropriate use or abuse
- serves as a means for developing prospective standards and target intervention
- medical charts or computerised records are screened to determine whether drug therapy met approved criteria and aids prescribers in improving care for their patients
25
how should the design of DUE be
- documented prior to commencement of study
- include background, aims, patient selection, data collection methods and proposed method of analysis
- sampling- may not be able to assess every patient
26
approval of DUE
- all DUE studies must be mindful of ethical and privacy considerations
- ethical issue resolved before data collection
- may require de-identification of patient-specific data
- ethics committee or IRB approval may be required
27
criteria of measurement instruments should be:
1. evidence-based
2. valid, practical, relevant
3. authoritative
4. explicit
5. pre-determined
6. easily measures (objective measures)
7. outcome-oriented
28
why does DUE team build inhouse criteria
1. ensure quality
| 2. explicitly agreed by team with input from expert clinicians or main stakeholders/users
29
drug availability criteria
hospital restrictions
30
national, independent, authoritative sources
1. MOH clinical practice guidelines
2. national institute for health and clinical excellence (UK)
3. WHO
4. medical associations
5. national guidelines clearinghouse
31
data collection instrument should be
1. unambiguous and user friendly
2. simple and focused
3. include only relevant demographic, clinical or drug therapy information
4. protect patient confidentiality
5. tested and refined in pilot studies
6. take advantage of existing automated information systems
32
criteria and analysis of results
- drugs/ MUP compared with pre-determined criteria
- mark as compliant/ concordant/ adherent
- identify and document areas of divergence
- may need to review with prescriber to determine valid justification for divergence
33
reporting and feedback
- to prescribers and other stakeholders
- feedback has to be non-punitive and constructive
- report positive and negative findings to relevant committees and departments under review
- make recommendations to identified problems
- reporting also in forms of: articles in hospital bulletin, presentations at rounds/scientific or clinical meetings, publication in journal
34
possible intervention strategies
1. educational activities
2. publication of guidelines
3. restriction - formulary changes, institution policies
4. persuasive strategies (opinion leaders, rewards)
5. workflow modifications (checklist, double checks)
6. additional pharmacy services
7. IT integration/ enhancements
35
how should re-evaluation of DUE be like
1. simple monitoring of consumption data
2. exception of threshold analysis
3. periodic screening
4. reassessment of areas or target groups
36
fitfalls of DUE
1. lack authority and involvement (criteria should be developed through interdisciplinary consensus process)
2. poor organisation and documentation (poor definition of roles and responsibility may lead to unsuccessful DUE process)
3. lack of follow-through (one time study will have limited success)
4. lack of readily retrievable data and information management (max benefit from available computerised information management)
5. evaluation methods impedes patient care (data collection should not consume too much of pt time)
37
role of Pharmacist in DUE
1. exert leadership
2. educate and promote the goals and objectives
3. develop operational plan for DUE programs and processes that are consistent with health system's overall goals and resource capabilities
4. collaborate with prescribers and others to develop/ review criteria to design effective MUP
5. collect, analyse, evaluate data
6. develop strategies to identify, resolve, prevent drug-related problems
7. interpret and report DUE findings and recommend change in MUP
8. provide information and education based on DUE findings
9. document program outcome, effectiveness, cost benefit
10. participate as member
11. present DUE results
