Class of 2012 Abstract / Specific Aims: To evaluate the effect on the incidence and nature of pharmacists’ drug utilization review (DUR) interventions of including patient diagnosis on electronic prescription (e-prescription) orders. Methods: This prospective pre-post evaluation was conducted in the outpatient pharmacy of a federally funded community health center over two consecutive four-week periods. During the pre-phase, a clinical pharmacist in the clinic’s onsite pharmacy prospectively reviewed the e-prescriptions received from the clinic’s primary care providers using a standard prospective DUR process and recorded all therapy-related interventions. In the post-phase, providers added a diagnosis on each e-prescription. Interventions were documented using a standard intervention form that has been used in previous research. Chi square and t-tests were used to assess the nominal and interval data, respectively (α=0.05). The Institutional Review Boards of the two collaborating universities approved the study. Main Results: Pharmacist intervention rates on problematic e-prescription orders significantly decreased (4% pre vs. 1% post, p<0.001). Drug-drug interactions (17.5% pre vs. 20% post) and missing information (15% pre vs. 20% post) were the most frequently cited problems that prompted the need for the pharmacist’s intervention. The medication classes most frequently involved in interventions were antibiotics (53% pre vs. 50% post) and central nervous system agents (17% pre vs. 10% post). After receiving clarification, the pharmacist most often dispensed the prescription (33.3% pre vs. 38.4% post) and educated the patient regarding their treatments (18.8% pre vs. 7.7% post). Conclusions: In this small pilot project, including the patient’s diagnosis on e-prescription orders significantly reduced the incidence of pharmacists’ DUR-related interventions. If duplicated in larger studies, our results suggest that providing pharmacists with additional targeted clinical information could reduce confusion and uncertainty thereby decreasing the number of unnecessary pharmacist contacts with prescribers and improving workflow and efficiency for both.

Malaria is more prevalent today and the death toll is on the increase annually. It is one of the leading causes of morbidity and mortality worldwide and most of these deaths are in the poorest regions of the world. About 500 million cases are reported annually with more than 2 million deaths, and most are children. It is the major killer in the tropics and a major public health problem in developing countries and Papua New Guinea (PNG) is no exception. Resistant strains have been reported. This may be enhanced by inappropriate human behaviour in the use of anti-malarial drugs. Human factors include inappropriate prescribing and patient behaviour in using anti-malarial drugs. Despite the establishment of the standard treatment guidelines for malaria in PNG, three out of every four patients have chloroquine-resistant falciparum malaria and malaria remains a major health problem. The aim of this study was to evaluate the influence of an education program on patients carers' understanding and effective use of anti-malarial drugs for the treatment of uncomplicated malaria in children in general health clinics in PNG. The trial design involved a pre-post intervention study with a control group. The study was undertaken in the National Capital District. Papua New Guinea using one Clinic as the intervention site and another as the control site. The two clinics were similar in characteristics as confirmed in the study by demographic data where there were no significant differences observed. The data collection took placed over the period February to April 2002. It included observation of drug provision at study sites and interviews of patient carers on the first day at the clinic and a follow up seven days later. Three questionnaires were developed to evaluate the process and outcomes of malaria drug treatment in the above health facilities. / Prescribing data were collected from prescriptions and patient carers' interviewed prior to the intervention program. Following the provision of drug information to patient carers. similar drug information and compliance questioning was undertaken. Differences in the pre-post elements of the study and in the control group over the study period were evaluated using Chi-Squared, Kruskal-Wallis, Fisher's Exact or Student's t-tests as appropriate. In excess of 100 patients in the pre- and in the post intervention phases were evaluated for their understanding and effective use of the anti-malarial drugs. In addition, 100 clients were in the control group at another clinic. Patients had attended the clinic up to 8 times in the previous year with a median of 2 visits. Amodiaquine, Fansidar, albendazole and paracetamol made up a total of 60% of the drugs prescribed. The use of medicines was strongly supported with 94.4% indicating no problems with the medication. Only 3% of patients received herbal or local remedies for malaria treatment. 1n patients 10 years or less or their carers, it was found, there was a significant improvement in the carers understanding of the medications. There was a statistically significant improvement in patient outcomes from 57.9% to 92.3% reported as cured following the intervention program. The study has also identified low levels of appropriate administration of antibiotic suspensions in children by patient carers. / For example, incorrect responses recorded for amoxycillin suspension were 80.8% (143). Septrim tablets 92% (23), Septrim suspension 86% (123), erythromycin suspension 100% (26), and chloramphenicol suspension 84.4% (38). In this study the face to face (one-to-one) education program was used to influence patient carers understanding and effective use of drugs. The intervention program involved advising, informing, encouraging, and counselling the patient carers verbally on the appropriate and effective use of medicines. The verbal message was reinforced by a suitable label typed in English and Pidgin-English where instructions were clear, simple and unambiguous. The label was then attached to the envelopes or containers containing the drugs. On feedback, the information on the understanding and effective use of drugs was re-emphasized to the carers to reinforce their understanding for future references. Results showed that the intervention program made an impact in improved patient carers understanding and effective use of drugs and children's health outcomes. In conclusion, it is evident that a patient intervention program designed to improve the dosages and frequency of administration of anti-malarial drugs in PNG had no statistically significant outcome. This may be because the current level of understanding was quite high (>70%) and the study experienced a ceiling effect. However, as shown in the results, the patient carers understanding on the appropriate and effective use of drugs was lower during the pre-intervention and control group. / When compared clinic-pre with clinic-post, there was a significant difference (P < 0.05) in the cured group and the improved cure rate increases from 57.9% to 92.3%. When compared control pre with control post groups, there was no significant difference (P > 0.05) in the cured group. Therefore, the study identified an improvement in patient outcomes with respect to malaria. Hence. the simple intervention program in influencing patient carers understanding of the appropriate and effective use of medications led to a marked improvement in patient outcomes.

Thesis (Ph.D.)--University of Wisconsin--Madison, 2006. / Includes bibliographical references (p. 155-163). Also available on the Internet.

Thesis (M.Sc.)--Memorial University of Newfoundland, Faculty of Medicine, 1998. / Bibliography: leaves 99-107.

Thesis (Ph.D.)--University of Wisconsin--Madison, 2006. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (p. 155-163).

Background Drug utilization review (DUR) is a central role of the pharmacist, especially within the community pharmacy setting. Previous literature has shown risk of “alert fatigue”, supporting the necessity of pharmacists to utilize a step-wise approach in evaluation of drug therapy during the verification process. Many students are intimidated by this process, and may lack verification practice or experience until their first day as a licensed pharmacist. Educational Activity and Setting An innovative skills-based laboratory exercise was developed for third-year pharmacy students to develop DUR skills. Through simulation of patient prescriptions, profiles, and drug information resources, students were tasked with completing a DUR for each patient case. Students were expected evaluate the clinical significance of various drug-related problems, determine if they would or would not dispense the prescription, and were required to provide rationale for their decision. Findings This learning activity was well-received by the student population; however, students struggled with the volume of cases along with identifying a solution to the clinical scenario. On average, students required nine minutes per case, which is likely longer than community pharmacists can devote to a single DUR in practice. Discussion In response, to student challenges with the activity, the number of cases was condensed to highlight key concepts and cases that facilitated strong discussion. To improve students’ approach to the DUR process, faculty developed a vodcast to watch prior to the activity explaining a systematic approach to the DUR process as well as considerations a pharmacist should have. Summary Development and integration of an active-learning, simulated dispensing activity allowed students to gain valuable experience completing the DUR process, a foundational community pharmacy practice skill; however, repeated experience should be provided to ensure competency.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

The high use and often inappropriate antimicrobial is the main factor related to increased incidence of multiresistant microorganisms . This fact highlights the need to promote rational use through actions , such as monitoring the use of these drugs . The present study aimed to characterize the pattern and trends of antimicrobial use , comparing pediatric intensive care units ( ICU -PED ) and adult ( AD - ICU ) between July 2006 and June 2011 , in a public hospital high complexity of the state of Sergipe . This is a study of time series using data collected prospectively by the Office of Infection Control ( HICS ) hospital study on the use of antimicrobials . To measure the use of these drugs , we calculated the percentage and density and incidence rates per 1,000 patient-days , by means of measurement units : days of treatment ( DOT ) and treatment period (LOT ) . As a result it was observed that the percentage of use of these drugs was greater than 80 % in both units , with greater frequency among pediatric patients . During the study were recorded incidence density of 1,530.8 DOT/1.000 patient-days of all antimicrobials in the ICU and ICU -PED -AD DOT/1.000 1,344.4 patient-days . The most frequently used were cephalosporins , carbapenems and glycopeptides . By analyzing the temporal trend of the use of these drugs was observed that cefepime and ceftriaxone showed a downward trend , with increased use of carbapenems in the two ICUs . The drugs were more likely to increase over time were : polymyxin B ICU -AD and antifungal ICU -PED . The median antibiotic use differed between the two ICUs ( p < 0.005 ) , except for : ceftriaxone , carbapenems , ciprofloxacin , however the median LOT were equivalent . The use of antimicrobials by DOT and LOT demonstrated trend towards increasing in both units and different usage pattern , showing the relevance of this monitoring as part of the programs for the rational use of antimicrobials and control multiresistant microorganisms . / O uso elevado e muitas vezes inadequado de antimicrobianos é o principal fator relacionado ao aumento da incidência de microrganismos multiresistentes. Tal fato evidencia a necessidade de se promover uso racional por meio de ações, como o monitoramento da utilização destes fármacos. O presente estudo teve o objetivo de caracterizar o padrão e tendências do uso de antimicrobianos, comparando unidades de terapia intensiva pediátrica (UTI-PED) e adulta (UTI-AD), entre julho de 2006 e junho de 2011, em um hospital público de alta complexidade do Estado de Sergipe. Trata-se de um estudo de série temporal com utilização de dados coletados de forma prospectiva pelo Serviço de Controle de Infecção Hospitalar (SCIH) do hospital em estudo, acerca da utilização de antimicrobianos. Para mensurar o uso destes fármacos, foi calculado o percentual e taxas de densidade e incidência por 1.000 pacientes-dia, por meio das unidades de medida: dias de tratamento (DOT) e período de tratamento (LOT). Como resultado foi observado que o percentual de uso desses fármacos foi superior a 80% em ambas as unidades, com maior frequência entre os pacientes pediátricos . Durante o estudo foram registrados a densidade de incidência de 1.530,8 DOT/1.000 pacientes-dia de todos os antimicrobianos na UTI-PED e na UTI-AD 1.344,4 DOT/1.000 pacientes-dia. As classes mais utilizadas foram as cefalosporinas, os carbapenêmicos e os glicopeptídeos. Ao analisar a tendência temporal do uso destes fármacos observou-se que o cefepime e a ceftriaxone apresentaram tendência de queda, com aumento do uso dos carbapenêmicos nas duas UTI. Os fármacos que apresentaram maior tendência de aumento ao longo do tempo foram: a polimixina B na UTI-AD e os antifúngicos na UTI-PED. As medianas de uso de antimicrobianos diferiram entre as duas unidades intensivas (p< 0,005), exceto para: ceftriaxone, carbapenêmicos, ciprofloxacina, entretanto as medianas de LOT foram equivalentes. A utilização de antimicrobianos por DOT e LOT demostrou tendência de aumento crescente nas duas unidades e padrão de uso diferenciado, mostrando a relevância deste monitoramento como parte dos programas de uso racional de antimicrobianos e controle de microrganismos multirresistentes.

<p>Zbog visoke stope morbiditeta i mortaliteta od kardiovaskularnih bolesti, udeo lekova za terapiju kardiovaskularnih bolesti značajno učestvuje u ukupno utro&scaron;enoj količini lekova u svetu. Evidentan je porast potro&scaron;nje lekova za kardiovaskularne bolesti. Radi postizanja &scaron;to je moguće vi&scaron;eg stepena racionalizacije terapije u većini zemalja stručna tela donose farmakoterapijske smernice kako bi se mogućnost pogre&scaron;nog lečenja svela na najmanju moguću meru. Na ovaj način lekaru-praktičaru pružena je sigurnost pravilnog izbora i najadekvatnijeg postupka u datim okolnostima. Ciljevi ovog istraživanja bili su: 1) izračunavanje ukupne vanbolničke potro&scaron;nje lekova za lečenje kardiovaskularnih bolesti na teritoriji Novog Sada i njeno poređenje sa propisivanjem u Republici Srbiji i u zemljama sa razvijenom farmakoterapijskom praksom; 2) analiza strukture propisanih lekova za lečenje kardiovaskularnih bolesti (grupa C prema ATC klasifikaciji) po grupama i njeno poređenje sa propisivanjem u Republici Srbiji i u zemljama sa razvijenom farmakoterapijskom praksom; 3) analiza strukture propisanih lekova po dijagnozama i provera usklađenosti sa farmakoterapijskim smernicama; 4) komparacija propisanih lekova sa morbiditetnom statistikom kardiovaskularnih bolesti; 5) analiza farmakoekonomskih aspekata propisivanja lekova za kardiovaskularne bolesti. Sprovedeno istraživanje spada u IV fazu kliničkih ispitivanja-farmakoepidemiolo&scaron;ko, retrospektivno, opservaciono. Podaci su prikupljeni na osnovu izve&scaron;taja iz elektronske baze podataka za period od 6 meseci (01. 01. 2012 &minus; 01. 07. 2012), na teritoriji grada Novog Sada. Na osnovu ovih podataka na teritoriji grada Novog Sada analizirana je upotreba lekova za kardiovaskularne bolesti na 100% uzorku stanovnika. Ispitivanje se sastojalo iz dva dela. Prvi deo obuhvata prikupljanje, obradu i analizu podataka o ukupno propisanoj količni lekova za kardiovaskularne bolesti na teritoriji grada Novog Sada. U drugom delu istraživanja kori&scaron;ćenjem podataka dobijenih iz državne &bdquo;Apoteke Novi Sad&ldquo; detaljnije je analizirana upotreba lekova za lečenje kardiovaskularnih bolesti izdatih na recept. Upotreba lekova analizirana je: prema uzrastu i polu pacijenata, prema dijagnozama za koje su lekovi propisani i prema ceni. Sruktura upotrebe lekova po indikacijama za dijagnoze kod kojih je ukupna upotreba propisanih lekova bila veća od 1 DDD/1000stanovnika/dan upoređena je sa postojećim nacionalnim vodičima i sa upotrebom u zemljama sa razvijenom farmakoterapijskom praksom, odnosno sa međunarodnim vodičima. Ovi podaci upoređeni su sa morbiditetnom statistikom na teritoriji grada Novog Sada. Ukupno propisana količina lekova za kardiovaskularne bolesti u posmatranom periodu iznosila je 399,79 DDD/1000st/dan. Od te količine, preko polovine (201,11DDD/1000st/dan) propisivanih lekova za kardiovaskularne bolesti su lekovi koji deluju na sistem renin-angiotenzin, slede blokatori kalcijumskih kanala, zatim blokatori beta-adrenergičkih receptora, a na četvrtom mestu po ukupno propisanoj količini su lekovi za terapiju bolesti srca. Od najče&scaron;ćih dijagnoza za koje su propisivani lekovi za kardiovaskularne bolesti, najzastupljenije su bile arterijska hipertenzija, a potom ishemijska bolest srca. Upotreba lekova za kardiovaskularne bolesti u vanbolničkoj sredini na teritoriji grada Novog Sada (399,79 DDD/1000st/dan) vi&scaron;a je u odnosu na zemlje u okruženju (Hrvatsku, Crnu Goru), a niža u odnosu na zemlje sa razvijenom farmakoterapijskom praksom. U odnosu na zemlje sa razvijenom farmakoterapijskom praksom postoje odstupanja u pogledu strukture propisivanja. Struktura propisivanja lekova za kardiovaskularne bolesti odstupa od važećih nacionalnih vodiča o racionalnoj upotrebi lekova za kardiovaskularne bolesti u Republici Srbiji. Istovremeno struktura propisanih lekova nije u skladu sa morbiditetnom statistikom kardiovaskularnih bolesti prema zvaničnim podacima. Među 10 najče&scaron;će propisanih lekova nalaze se i skupi lekovi, koji imaju adekvatne, a mnogo jeftinije paralele. Nedovoljno i neracionalno lečenje kardiovaskularnih bolesti verovatno su jedan od značajnih razloga za visoku smrtnost od kardiovaskularnih bolesti u Srbiji.</p> / <p>Due to high rates of morbidity and mortality from cardiovascular diseases, the share drugs for the treatment of cardiovascular diseases significantly contributes to a total utilization among drugs in the world. There is an evident increase in the consumption of drugs for cardiovascular diseases. In order to achieve as much as possible a higher level of rationalization of therapy in most countries the professional bodies making pharmacotherapeutic guidelines to the possibility of the wrong treatment was reduced to a minimum. In this way, the physician-practitioner provided the security proper selection and the most appropriate procedure in the circumstances. The objectives of this study were: 1) the calculation of the total outpatient consumption of drugs for the treatment of cardiovascular diseases on the territory of Novi Sad and its comparison with the prescribing in the Republic of Serbia and the countries with developed pharmacotherapeutical practice; 2) analysis of the structure of prescribed drugs for the treatment of cardiovascular diseases (group C according to the ATC classification) by the groups and its comparison with the prescribing in the Republic of Serbia and the countries with developed pharmacotherapeutical practice 3) analysis of the structure of prescribed drugs per diagnosis and verification of compliance with pharmacotherapeutic guidelines; 4) comparison of prescribed drugs with morbidity statistics cardiovascular diseases; 5) analysis of pharmacoeconomic aspects of prescribing drugs for cardiovascular diseases. A research conducted among the phase IV clinical trials-pharmacoepidemiological, retrospective observational. Data were collected on the basis of a report from the electronic database for the period of 6 months (01. 01. 2012 - 01. 07. 2012), on the territory of the city of Novi Sad. Based on these data on the territory of the city of Novi Sad analyzed the use of drugs for cardiovascular diseases at 100% sample of the population. The research consisted of two parts. The first part comprises the collection, processing and analysis of data on the total quantity of the prescribed cardiovascular drugs on the territory of the city of Novi Sad. In the second part of this research using data from the public &quot;Pharmacy Novi Sad&quot; is a more detailed analysis of the utilization of drugs for the treatment of cardiovascular diseases of prescription. The utilization of drugs is analyzed: according to the age and sex of patients, in diagnosis for which the drugs prescribed and to the cost. Structure of the use of drugs by indications for diagnosis in which the total utilization of prescribed drugs was greater than 1 DDD/1000inhabitants/day was compared with the existing national guidelines and use in countries with developed pharmacotherapeutical practice, and with international guidelines. These data were compared with morbidity statistics on the territory of the city of Novi Sad. Total amount of prescribed drugs for cardiovascular diseases in the examined period was 399.79 DDD/1000inh/day. Of this amount, more than half (201.11 DDD/1000inh/day) were drugs acting on the renin-angiotensin system, followed by calcium channel blockers, beta adrenergic receptor blockers, and fourth in total prescribed quantity drugs for treatment of heart diseases. Of the most common diagnosis for which drugs for cardiovascular diseases were prescribed, the most common were arterial hypertension, and then ischemic heart disease. The use of drugs for cardiovascular diseases in outpatient environment on the territory of the city of Novi Sad (399.79 DDD/1000inh/day) is higher compared to neighboring countries (Croatia, Montenegro), and lower than in countries with developed pharmacotherapeutical practice. Compared to countries with developed pharmacotherapeutical practice there are variations in terms of the structure of prescribing. Structure of prescribing of drugs for cardiovascular diseases deviates from the existing national guidelines on rational use of drugs for cardiovascular diseases in the Republic of Serbia. At the same time the structure of prescribed drugs is not in compliance with morbidity statistics cardiovascular diseases according to official data. Among the 10 most commonly prescribed drugs are costly drugs, that have adequate, and much cheaper parallels. Insufficient and irrational treatment of cardiovascular diseases are probably one of the major reasons for the high mortality from cardiovascular diseases in Serbia.</p>

Nesta pesquisa foram avaliados 186 idosos hospitalizados quanto ao aparecimento de reações adversas a medicamentos (RAM). Encontrou-se 199 RAM (1,07 por paciente). Para 11,3% dos idosos a RAM constituiu a causa da internação, para 17,2% estava presente à internação mas não como causa e 46,2% apresentaram RAM durante a hospitalização. As RAM sérias mais comuns foram a insuficiência renal aguda, a hipercalemia e a hipotensão postural. Concluiu-se que houve uma prevalência importante de RAM nesses pacientes, encontrando-se como fatores de risco significativos o número de diagnósticos, o número de medicamentos e o uso de medicamento inapropriado para idosos / The present study evaluated the prevalence of adverse drug reactions (ADR) among 186 hospitalized elderly. A total of 199 ADR were founded (1.07 per patient). For 11.3% of the patients the ADR was the cause of hospitalization, for 17.2% the ADR was present at hospitalization but not as the cause and for 46.2% it was presented during hospitalization. The most common serious ADR were acute renal insufficiency, hyperkalemia and postural hypotension. We concluded that a significant prevalence of ADR was found among that patients, with the number of diagnosis, the number of drugs and the use of a drug considered to be inappropriate as risk factors