DOES DRUG USE EVALUATION (DUE) REQUIRED BY NATIONAL POLICY IMPROVE USE OF MEDICINES?

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DOES DRUG USE EVALUATION (DUE) REQUIRED BY
NATIONAL POLICY IMPROVE USE OF MEDICINES?
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Background

• DUE was first introduced to Thailands MoPH
  hospitals in 1991
• Annual survey of pharmacy activities in 92 MoPH
  hospitals, DUE exist 30-50, however 7.5 has a
  continuous monitoring
• DUE was strengthened by the policy statement in
  the 1999 National Essential Drug List and 1998
  MoPH post-economic crisis drug management reforms
  under Good Health at Low Cost

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Objectives

• To assess the DUE situation in Thailand
  regarding policy implementation and outcomes on
  rational drug use
• To assess health professionals perspectives
  towards and experience on DUE and its constraints
  since the program was strengthened in 2000

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Methodology

• 1. Selection of tracers Ceftazidime injection,
  imipenem plus cilastatin injection, ciprofloxacin
  injection and tablet, statins tablet and
  pentoxiphylline tablet
• 2. DUE package Drug use criteria, guideline
  on DUE procedure, drug order forms, data
  collection form and report forms
• 3. Policy dissemination A national meeting of
  chairpersons and secretariats of hospital drug
  and therapeutic committee(DTC) was organized in
  March 2000.

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Methodology (cont.)

• 4. Analysis of voluntary report of qualitative
  DUE from June 2000 to December 2001
• 5. Self administered questionnaire survey in
  2002
• on hospital pharmacists perspectives,
  experience and constraints
• on physicians perspectives in 2 regional
  hospitals with 10-year experiences in DUE

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Result
1. Percentage of regional and provincial
hospitals responded to DUE policy
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2. Percentage of indication appropriateness
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2. Percentage of indication appropriateness
(cont.)
statin-1 statin primary prevention, statin-2
statin secondary prevention
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3. Appropriateness in dosage regimen

• Dose appropriateness
• gt 70 in patients without renal problem
• 27-78 in patients with renal insufficiency
• Dosage interval appropriateness gt 90
• 4. Incidence of adverse drug reaction
• unable to estimate due to data limitations

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5. Hospital pharmacists self evaluation

• (n 450, 64 response rate)
• 32 had insufficient knowledge to set up drug use
  criteria
• 48 was able to modify the MoPH standard criteria
• 47 was able to analyse data
• constraints in conducting DUE difficulty in
  patient profile evaluation, inadequate skill in
  clinical pharmacy, lack of coordination among
  physicians and pharmacists

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6. Physicians perspectives (n 110)
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Discussion Conclusion

• Research findings
• 1. An average 30 reporting rate, with a
  decreasing trend over 3 six-monthly periods.
• 2. The high percentage of appropriateness
  in most tracers does not represent a national
  picture. There is room for increase DUE coverage
  to more hospitals.
• 3. According to NLED 1999 recommended
  indication, pentoxiphylline tablet had the lowest
  appropriateness. It needs further verification
  and specific intervention.

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Discussion Conclusion (cont.)

• Lesson learnt
• 1. Therapeutic outcomes of drug use should be
  assessed.
• 2. Existing problem current lack of proper
  understandings on DUE concept, insufficient
  knowledge and skill, coordination among
  pharmacists and physicians
• 3. In this study, we cannot estimate cost
  savings from appropriate use of drugs. However,
  appropriateness may not represent a lower cost.

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Discussion Conclusion (cont.)

• Implication
• 1. The national policy could encourage DUE in
  hospitals, however, continual enforcement and
  concomitant monitoring and support are required.
• 2. A mandatory DUE for drugs in sublist D in
  NLED should be more practical, specific and
  selective to suit various levels of hospital.
• 3. DTC should be empowered to select drugs for
  DUE according to their problems.
• 4. Qualitative and quantitative drug use data
  are solid ground for a complete drug surveillance.

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Discussion Conclusion (cont.)

• Utility of DUE
• 1. At hospital level, DUE is a useful tool for
  evaluating and improving rational drug use.
• 2. At national level, comparative quantitative
  utilization of specific group of drugs and
  treatment outcomes would benefit to the selection
  of drugs into the NLED
• 3. DUE has a limitation, it cannot assess the
  magnitude and profile of under-use of drugs
  among specific population.