DRUG USE EVALUATION

KEERTHANA N
M PHARM (2ND SEM)
DEPT OF PHARMACY PRACTICE
GRACE COLLEGE OF PHARMACY
 DRUG USE EVALUATION(DUE)
Drug use evaluation is a system ongoing, systematic, criteria-
based evaluation of drug use that will help to ensure that
medicines are used appropriately.
It is usually done at individual patient level.
 It will assess the actual process of prescribing, dispensing, or
administration of a drug( indications, dose, drug interactions
etc..)
DUE is almost same as drug utilization review (DUR) and
these terms are used synonymously.
 IT IS DESIGNED TO:

Review drug use and or prescribing patterns

Provide feedback of the result to the clinicians
To develop and standards which describes
optimal drug use .
Promote appropriate drug use through education
and other interventions
 THE DUE CYCLE
• Due operates in a repeating cycle.
• The cycle is a continuous one and will be most valuable if
the cycle is completed rather than performing different steps
in isolation.
• It include the following major cycles,
 4.FEEDBACK OF RESULT

3.EVALUATION 5.INTERVENTION

2.DATA 6. RE-
COLLECTION EVALUATION OF
RESULT

1.PLANNING 7.FEEDBACK OF
RESULT
 GOALS AND OBJECTIVES
• GOALS
 The goal of a drug use evaluation or medication use evaluation
is to :-
1) PROMOTE OPTIMAL MEDICATION THERAPY
2) TO ENSURE THAT DRUG THERAPY MEET CURRENT
STANDARDS OF CARE.
• OBJECTIVES
1) Creating guidelines(criteria) for appropriate drug utilization.
2) Evaluating the effectiveness of medication therapy.
3) Enhancing responsibility or accountability in the medicine
use process.
4) Controlling medicine cost.
5) Preventing medication related problems, ex: adverse drug
reactions, treatment failures, over-use etc..
6) Identifying areas in which further information and education
may be needed by health care providers.
 TYPES OF DUE
1.QUANTITATIVE DUE

 Quantitative studies involves the collection, organization and

display or measurement of drug use.
This type of data is often used for making purchase decisions or
other financial activities.
2. QUALITATIVE DUE
•The is a multidisciplinary operation. Which collect, organize,
analyses and report information on actual drug use.
•The main difference between quantitative and qualitative studies is
that qualitative DUE includes the concept of criteria. ( quality,
medical necessity).
 DUE COMMITTEE

• The DUE committee should be composed of physicians,

pharmacists, and other relevant healthcare professionals.
• The body may be hospitals drug and therapeutic committee
(DTC)or a specific DUE committee, depending on local
resource and administrative structure.
• DUE committee is administered by the pharmacy department.
Functions of DUE
1. The committee should draft and approve the policies and
procedure, establish and maintain adequate means of
communication with hospital administration.
2. The committee should prepare a schedule, including a
yearly planning meeting, designing, intervention and
reviewing the programme.
3. To review the standards and criteria of DUE studies.
4. Reviewing the data generated from the study.
5. To ensure compliance with good clinical guidelines
research guidelines such as maintaining confidentiality of
all patient data.
STEPS IN DRUG USE
EVALUATION
 1.IDENTIFY DRUGS OR THERAPEUTIC AREAS
OF PRACTICE
• Due committee must identify priority drugs and areas of practice where
improvement in use will result in the greatest clinical impact. .
• The areas can be identified through various source of information such
as medication errors , ADR report, feedback.
• ABC or VEN analysis can be used as another tool.
 ABC (always better control)
1. Class a - highest cost (75-80%)
2. Class b (20%)
3. Class c (5-10%)
• According to VEN analysis , its is classified as vital , essential,
non essential.
• Another common target for DUE includes
1. Commonly prescribed drugs, such as antibiotics and proton
pump inhibitors
2. Drug with potential drug interaction , such as warfarin,
theophylline, digoxin, phenytoin
3. Expensive drugs such as heparin, cephalosporins, anti-HIV
drugs
4. New drug
5. Drug with narrow therapeutic index ( digoxin, phenytoin,
theophylline)
• Drugs with serious ADRS such as antibiotics,
anticonvulsant, anti- coagulants, NSAIDS
• Drug with high risk such as elderly , transplant patient,
cancer chemotherapy and neonates and children.
• Drugs used in common condition such as chronic pain,
urinary infection or UTI
• Complex areas of prescribing such as anti thrombotic and
post transplantation therapy.
 2.DESIGN OF STUDY
• It can done by observational studies , experimental studies,
randomized studies .
• Study design is mainly categorized into ;
1. Prospective reviews– evaluating a patients planned
therapy before medication is administered.
E.g.: drug-drug interaction studies (administration of
warfarin and NSAIDS should be designed in a way that
allows the pharmacist to advice the doctor in its risk)
2. Concurrent review-it is done during the course of treatment
and involves ongoing monitoring of drug therapy. This may
involves the consideration of lab values and monitoring other
data. For e.g.: prescribing high doses of amino glycoside for
patient with reduced renal function.
3.Retrospective reviews- it is reviewed after the patient has
completed a course of therapy.
Eg: reviewing patient medication chart, daily progress notes,
nursing observations, therapeutic monitoring results etc.
 3.DEFINE CRITERIA AND
STANDARD
 After the DUE is targeted, it is important to conduct a
comprehensive literature review. The steps involved in literature
review are:
 Perform a literature search for the chosen drug or a therapeutic
area using multiple search mechanism-medline, drugdex.
 Assemble full copies of all relevant original research papers.
 Critically evaluate the studies ( identifying strength, weakness)
and deciding appropriate conclusion have been made from data
presenter
 Briefly summarize literature review and can be used as a key
paper in the chosen area.
 4: DESIGN THE DATA COLLECTION
FORM
• The success of any audit depends on data collected.
Hence, the more specific the information the more
useful it will be.
• This form should have a user friendly format to
encourage completion by data collector.
COMMON ASPECTS OF DRUG USE
STUDIED IN DUES
Patient demographics
Prescriber details
Disease severity
Co-morbidities
Indications for drug use
Drug-disease contraindications
Side/adverse effects
Dosing information
Duration of drug treatment
Drug or drug class duplication
Therapeutic duplication
Preparation and administration
Drug-drug and drug-food interactions
Monitoring of drug therapy
Patient education/instructions
Cost of therapy
Over/under utilization of drugs
EXAMPLE: DATA COLLECTION FORM FOR A
DUE ASSESSING THE APPROPRIATENESS OF
CIPROFLOXACIN
 PATIENT CHARACTERISTICS
 CRITERIA 1:
• Details of ciprofloxacin treatment
 CRITERIA 2:
• No (%) of patients receiving an appropriate dose based on renal
function
 CRITERIA 3:
• Mean days of treatment.
 CRITERIA 4:
• No. Of patients (%) receiving different concomitant antibiotics.
• No. Of patients receiving other antibiotics in concordance with criteria.
 CRITERIA 5:

• Assessment of renal function during treatment

• CRITERIA 6:

• Details on culture and sensitivity

• Name and signature of data evaluator
 5.DATA COLLECTION
• Data collectors should be chosen carefully, and
should be familiar with how information is arranged
in the patient’s case notes.
• Depending on their availability, physcians,
pharmacists and nurses make ideal data collectors.
 6.EVALUATE RESULTS

• The data obtained should be collated using available

resources such as spread sheeting, data basing and word
processing.
• Summarize the main categories of results and to identify
where exactly the data shows deviation from the guidelines
and usage criteria.
• The reasons for the deviation should be evaluated. If there is
a true reason for deviation, it may necessary to redefine the
criteria.
• REASONS FOR DEVIATION :-
Drug being used for new indication
Outdated procedures
Inadequate resources
Gaps in knowledge or misinformation/misunderstanding.
 7.PROVIDE FEEDBACK OF RESULTS

• It is important to prepare a scientific interpretation

of the results rather than a value judgment.
• The results can also be circulated to hospital staff
through newsletters, DUE meetings or the hospital's
academic meetings.
 8.DEVELOP AND IMPLEMENT
INTERVENTIONS
Interventions to improve drug use can be
• Educational interventions
• Operational interventions
And can target groups or only those prescribers who did not
meet drugs use criteria.
Educational interventions consist of
• Educational meetings, Academic detailing circulation of
protocols, Feedback of study results, letters to individual
physcians, newsletters and other informational materials
such as posters and guidelines.
Operational interventions include :
• The development/ modification of drug order forms, manual
or computerized reminders, prescribing restrictions,
formulary additions/deletions, automatic stop orders or
reallocation of staff.
9. RE-EVALUATE TO DETERMINE
IF DRUG USE HAS IMPROVED
• Drug use and prescribing patterns need to be monitored to
determine the success of interventions.
• Typically the re-evaluation is done 3-12 months after the
introduction of the intervention and should involve collecting
the same data as in the original due evaluation
 10. RE-ASSESS AND REVISE THE
DUE PROGRAMME
• At the conclusion of a DUE evaluation cycle, an evaluation of the due
programme is necessary.
• The questions addressed should include the following:-
 Did the programme address important aspects of care ?
 Were the criteria developed appropriate?
 Were drug use problems identified?
 Were the interventions appropriate ?
 Did the interventions have any unexpected or adverse effects?
 Were drug use problems solved?
 11. FEEDBACK RESULTS
• It is important to circulate the results of the due to clinicians
and other involved hospital staff or the interventions and
how these can be improved.
THE PHARMACIST ROLE IN ‘DUE’
• Program development , supervision and coordination
• Education of hospital staff
• Promotion of goals and objectives
• Development / review of audit criteria
• Development of data collection instrument