Slide 1

Drug Used Evaluation TUNGGUL ADI P. CLINICAL PHARMACY LABORATORY, DEPARTMENT OF PHARMACY Faculty of Medicine and Health Sciences Jenderal Soedirman University Purwokerto Slide 2 Slide 3 Objectives introduce quality cycle DUE and evidence based medicine DUE cycle steps of DUE Slide 4 Quality CYCLE ACT PLAN DO CHECK Slide 5 DUE CYCLE ACTION COLLECT DATA EVALUATE DATA FEEDBACK EVALUATED DATA FEEDBACK Slide 6 Definisi DUE dan MUE (WHO) Drug use evaluation (DUE) is a system of ongoing, systematic, criteria- based evaluation of drug use that will help ensure that medicines are used appropriately (at the individual patient level). If therapy is deemed to be inappropriate, interventions with providers or patients will be necessary to optimize drug therapy. A DUE is drug- or disease-specific and can be structured so that it will assess the actual process of prescribing, dispensing or administering a drug (indications, dose, drug interactions, etc.). DUE is the same as drug utilization review (DUR) and terms are used synonymously. Medication use evaluation (MUE) is similar to DUE but emphasizes improving patient outcomes and individual quality of life; it is, therefore, highly dependent on a multidisciplinary approach involving all professionals dealing with drug therapy. An MUE will assess clinical outcomes (cured infections, decreased lipid levels, etc.). Slide 7 What is a DUE programme? really a quality assurance programme specific to medications Promote Pharmaceutical Care (via a partnership) Judicious appropriate safe effective -improve quality of life Slide 8 Judicious Appropriate Safe effective acceptable to patient daily commitment of the pharmacist so what is different Slide 9 Pharmaceutical care is patient orientated at the individual level achieving definite outcomes that improve patients quality of life Hepler, Strand 1990 DUE is Drug/Disease at the hospital (or even country) level Slide 10 Why have DUE? Clinical benefits: evaluate outcome and reduce adverse effect Evidence based medicine Educational benefits Economic benefits Slide 11 Evidence Based medicine Patient ValuesClinical Expertise Best research evidence Decision Slide 12 Evidence Based Medicine FIVE STEPS Answerable question best current evidence validity, impact, applicability integrate with clinical expertise integrate with clinical expertise evaluate performance evaluate performance Slide 13 Economic benefits potential to identify efficiencies (often duration reduced) potential to justify expenditure Slide 14 Goals of the Program Improve the quality of patient care by improving the clinical use of medications and minimizing adverse drug reactions Decrease hospital costs by eliminating the inappropriate use of drugs or by offering acceptable low cost substitutions Decrease liability associated with the inappropriate use of high risk drugs Slide 15 Who is involved in DUE? DUE pharmacist/Post Grad/Projec Clinical Pharmacists The whole pharmacy department. Prescribers/consultants Nurses Patients Drug and Therapeutics committee Slide 16 Examples Community Acquired Pneumonia in Australian Hospitals (CAPTION) Acute Post operative pain (APOP) Deep Vein Thrombosis prophylaxis in hospital Discharge Medication for Acute Coronary Syndrome (DMACS) Slide 17 UNSUR DASAR EPO Identifikasi masalah penting Menetapkan prioritas Kriteria/standar penggunaan obat Mengkaji masalah yang ada dengan kriteria yang sesuai Solusi masalah Memantau solusi dan keefektifannya Dokumentasi Slide 18 Penentuan Prioritas Berdasarkan Penyakit: Kelompok pasien yang masuk rumah sakit dengan penyakit komplikasi Kelompok pasien dengan kerusakan organ vital (jantung, ginjal, dan hati) yang signifikan Pasien lanjut usia, pediatrik, ibu hamil, dan menyusui Slide 19 Penentuan Prioritas Berdasarkan Terapi Obat: Kelompok pasien yang menerima obat dengan risiko tinggi reaksi toksisitas (antikoagulan, antibiotika, antineoplastik) Pasien yang diobati dengan polifarmasi Slide 20 Penentuan Prioritas PRINSIP: 1. Masalah harus secara klinik signifikan: - Frekuensi penggunaan obat - Frekuensi dan keparahan reaksi merugikan 2. Dapat diperbaiki Slide 21 DUE STEPS (Australian Drug usage evaluation starter kit, The Society of Hospital Pharmacists, Melbourne 1998) 1-make a start ( who will support you ) 2-identify drugs/areas of practice for review (examples; Vancomycin, Community acquired pneumonia) 3-critical literature evaluation (EBM) 4-define criteria 5-Data collection form 6-collect data Slide 22 STEPS in DUE (starter kit) 7-evaluate 8-feedback evaluated data 9-Action 10-Assess results of repeat data collection 11-Report, Publish, Present 12-Monitor and re-evaluate regularly Slide 23 Rancangan DUE berdasarkan waktu pengambilan data PROSPEKTIF KONKUREN RETROSPEKTIF Slide 24 Slide 25 DUE CYCLE ACTION COLLECT DATA EVALUATE DATA FEEDBACK EVALUATED DATA FEEDBACK Slide 26 DUE Studies NSAIDs in the community (GP and Pharmacist) Antibiotics in Community acquired pneumonia Vancomycin Antiemetics in Chemotherapy DVT Prophylaxis UTI management Secondary prevention post MI Aspirin use as secondary prevention of MI in the community Antibiotic prophylaxis in surgery Benzodiazepine use National Prescribing Service DUEs/Audits Slide 27 Limitations methodology levels of evidence, Cochrane Collaboration Systematic review- level 1 RCT- level 2 cohort level 3 or 4 Ideal outcome impractical to measure resources (time and personnel)-now breakthrough method sometimes used tip of the iceberg incomplete/ not completable Slide 28 CONTOH DUE