Quality drug use & Drug use evaluation

Question 1

Define rational use of drugs.

Answer 1

• Patients receive medications appropriate to their clinical needs,
• in doses that meet their own indiv requirements
• for an adequate duration of time
• at the lowest cost to them and their community

Question 2

What are the 12 core interventions recommended by WHO to promote rational use of medications?

Answer 2

1. A mandated multi disciplinary national body to coordinate medicine use policies (Agency for care effectiveness in sg)
2. Evidence-based clinical guidelines
3. Essential medicines list based on treatments of choice (aka standard drug lists)
4. Pharmacy and Therapeutics (P&T) committee in healthcare institution
5. Problem-based pharmacotherapy training in undergraduate curriculumn
6. Continuing in service medical education as a licensure requirement
7. Supervision, audit and feedback
8. Independent information on medicines (unbiased)
9. Public education about medicines
10. Avoidance of perverse financial incentives
11. Appropriate and enforced regulation
12. Sufficient government expenditure to ensure availability of medicines and staff

Question 3

What is the role of a pharmacist in ensuring quality use of medicines?

Answer 3

1) assuring integrity of medicine supply chain:
- detect falsified or counterfeit medicines
- proper storage
- quality preparation when needed

2) assuring proper prescribing and dispensing:
- all meds indicated
- dosing regimens, dosage form appropriate
- instructions for use is clear
- interactions prevented
- allergies and contraindications noted
- unnecessary tx minimized and cost is considered

3) assisting pts to understand importance of taking medicines properly:
- right drug, right route, right time, right dose, right patient
- foods to avoid
- what to expect

4) monitor treatment for effectiveness and adverse events

Question 4

What is drug use evaluation (DUE)?

Answer 4

A systematic quality improvement activity that focuses on evaluating and improving quality of drug use and medication-use processes with the aim to achieve optimal patient outcomes

Question 5

Why is DUE important?

Answer 5

Quality improvement process -> better use of drugs -> better patient outcomes.

Question 6

Briefly describe the 10 steps involved in conducting a DUE.

Answer 6

1. Identification of drugs for DUE
   - drugs under consideration for formulary retention, addition or deletion
   - drug associated w adverse events or poor outcomes
   - drugs used in high risk pts
   - high-unit or high-volume cost
2. Assemble the DUE team
   - multidisciplinary
   - include all stakeholders in the medication use process
   - obtain authorization
3. Design of DUE
   - retrospective: review of drug therapy aft pt has received the medication
   - concurrent: ongoing monitoring of drug therapy during course of treatment
   - prospective: evaluation of a patient’s drug therapy before or at the time medication is initiated
   - document study design prior to starting DUE
   - include background, aims, pt selection, data collection methods, proposed method of analysis
   - sampling
4. Approval of DUE
   - ethical and patient privacy considerations
   - de identification of pt data
5. Development of criteria and measurement instruments
   - criteria must be evidence based, relevant, explicit, authoritative
   - use MOH guidelines, WHO guidelines etc.
6. Data collection
   - data collection instrument should be unambiguous and user friendly
7. Evaluation with pre-determined criteria and analysis of results
   - compare with pre-determined criteria
   - mark as compliant
   - identify and document areas of divergence
   - may need to review with prescriber to determine valid justification for divergence
8. Reporting and feedback
   - to prescribers and other stakeholders
   - non-punitive and constructive
   - make recommendations on ways to improve
9. Design and implementation of intervention strategies
   - intervention to address issues identified
   - multi-faceted intervention works best
   - eg. guidelines, education, formulary changes, institution policies, workflow modifications, etc.
10. Re-evaluate and revision of problem
    - DUE is a cyclical process
    - lessons learnt from one cycle incorporated into subsequent study cycles
    - simple monitoring of consumption data

Question 7

How should the medication-use criteria be developed?

Answer 7

Interdisciplinary consensus process

Question 8

What is a pharmacist’s role in DUE?

Answer 8

• exert leadership, manage the process
• educate and promote the goals and objectives of DUE
• work collaboratively with prescribers and others to develop or review criteria
• analyze data
• develop strategies for problems