Identification of Inappropriate Drug Prescribing by Computerized, Retrospective DUR Screening in Korea

2005 ◽  
Vol 39 (11) ◽  
pp. 1918-1923 ◽  
Author(s):  
Jong Hum Yeom ◽  
Ji Sun Park ◽  
Ock-Hee Oh ◽  
Hyun Taek Shin ◽  
Jung Mi Oh
Keyword(s):  
Health Insurance ◽  
Drug Use ◽  
Inappropriate Prescribing ◽  
Drug Dosage ◽  
Inappropriate Drug ◽  
Prescription Data ◽  
Drug Prescribing ◽  
Inappropriate Use ◽  
Use Patterns ◽  
Outpatient Settings

BACKGROUND In Korea, the drug use process has changed significantly since the new pharmacy law was implemented in 2000, separating the prescribing and dispensing functions between physicians and pharmacists and mandating prospective drug use review (DUR) practice by pharmacists immediately before dispensing medications. However, a high prevalence of inappropriate prescribing has been suspected by the public, pharmacists, and health insurance managers, possibly due to suboptimal DUR practice by pharmacists. OBJECTIVE To assess overall patterns of drug usage and potential problems of inappropriate use in outpatient settings by analyzing prescription data that were electronically submitted to the national health insurance manager with a computerized DUR system and develop a computerized adjudication system model for drug claims. METHODS The national prescription drug claims data that were submitted electronically by pharmacies located in the northern part of Korea during 15 days in 2002 were retrospectively screened against the predetermined DUR standards of the selected criteria on drug dosage, duration of therapy, and drug interaction using the DUR screening system. The results of all the DUR conflicts were further validated manually by an expert panel and statistically analyzed to determine drug use patterns. RESULTS Of 31 994 260 drugs prescribed, 3 325 760 (10.4%) items showed a conflict with at least one of the DUR standards. The average number of drugs prescribed on each prescription was 4.07, and even more troubling was the high incidence of under-dosing, over-dosing, and contraindicated drug prescribing. CONCLUSIONS It is evident that inappropriate drug prescribing is very common in Korea; thus, a great deal of attention is urgently needed in the country with respect to proper prescribing and supportive interventions.

scholarly journals Decreased Outpatient Fluoroquinolone Prescribing Using a Multimodal Antimicrobial Stewardship Initiative

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Kevin Lin ◽  
Yorgo Zahlanie ◽  
Jessica K Ortwine ◽  
Norman S Mang ◽  
Wenjing Wei ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
Multidrug Resistant ◽  
Outpatient Setting ◽  
Urgent Care ◽  
Hospital System ◽  
Inappropriate Use ◽  
History Of ◽  
Outpatient Settings ◽  
The Impact

Abstract Background Fluoroquinolones are antibiotics prescribed in the outpatient setting, though they have serious side effects. This study evaluates the impact of stewardship interventions on total and inappropriate prescribing of fluoroquinolones in outpatient settings in a large county hospital and health system. Methods In an effort to decrease inappropriate outpatient fluoroquinolone usage, a multimodal antimicrobial stewardship initiative was implemented in November 2016. Education regarding the risks, benefits, and appropriate uses of fluoroquinolones was provided to providers in different outpatient settings, Food and Drug Administration warnings were added to all oral fluoroquinolone orders, an outpatient order set for cystitis treatment was created, and fluoroquinolone susceptibilities were suppressed when appropriate. Charts from October 2016, 2017, and 2018 were retrospectively reviewed if the patient encounter occurred in primary care clinics, emergency departments, or urgent care centers within Parkland Health & Hospital System and a fluoroquinolone was prescribed. Inappropriate use was defined as a fluoroquinolone prescription for cystitis, bronchitis, or sinusitis in a patient without a history of Pseudomonas aeruginosa or multidrug-resistant organisms and without drug allergies that precluded use of other oral antibiotics. Results Total fluoroquinolone prescriptions per 1000 patient visits decreased significantly by 39% (P < .01), and inappropriate fluoroquinolone use decreased from 53% to 34% (P < .01). More than 90% of inappropriate fluoroquinolone prescriptions were given for cystitis, while bronchitis and sinusitis accounted for only 4.4% and 1.6% of inappropriate indications, respectively. Conclusion A multimodal stewardship initiative appears to effectively reduce both total and inappropriate outpatient fluoroquinolone prescriptions.

scholarly journals Analysis of Potentially Inappropriate Drug Prescribing in Hospitalized Elderly Patients

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Ksenija Kojicic
Keyword(s):  
Health Care ◽  
Screening Tool ◽  
Inappropriate Prescribing ◽  
Inappropriate Drug ◽  
Drug Prescribing ◽  
Control Groups ◽  
First Line ◽  
Hospitalized Elderly ◽  
Start Criteria ◽  
Hospitalized Elderly Patients

Abstract The inappropriate prescribing of drugs to patients older than 65 is one of the major problems across the world due to its association with increased morbidity, mortality and health care costs. Fortunately, it is possible to detect high percentage of potentially inappropriate prescribing in this population. The aim of this study is to evaluate the prevalence of prescribing potentially inadequate drugs according to STOPP and START criteria from 2014, in hospitalized elderly patients (≥65 years) and to detect associated factors. The research was designed as an observational, non-therapeutic, prospective cross-sectional study, with a nested case-control study. The study was conducted at the Clinical Centre of Kragujevac, the Clinic for Internal Medicine, during the period March-May 2016. The study population consisted of patients older than 65 that were treated at different departments of the Clinic for Internal Medicine. Data were collected from hospital medical records of patients and anonymous semi-structured questionnaires. STOPP (screening tool of older people's prescriptions)/START (screening tool to alert to right treatment) criteria from 2014 were used to monitor the outcome of interest. Based on the outcome – PIM (potentially inappropriate drugs)/PPO (potential prescribing omissions), respondents were divided into groups of cases - patients to whom at least one potentially inappropriate drug determined by STOPP criteria was prescribed and those with at least one potential prescribing omission determined by START criteria. Control groups were patients without these outcomes. All investigated and control groups were age-matched. The study included a total of 109 patients. PIM was recorded in 54.13% and PPO was detected in 15.60% of patients. Potential prescribing errors in terms of a single PIM/PPO was observed in the majority of patients encompassing both observed outcomes, while the simultaneous presence of two or more of these errors was noticed in smaller number of cases. Most commonly, PIM was detected in the treatment of cardiovascular system diseases (27.12%), followed by the use of drugs that predispose falls in elderly (20.34%). Drug prescribing without a clear indication and the use of antihistamine of I generation as the first line of therapy were detected in 13.56%. Duplication of therapy, inappropriate antithrombotic/anticoagulant or endocrinology therapy was detected in 11.86%, 10.17% and 3.39%, respectively. These drugs were centrally acting antihypertensives, amiodarone as first-line therapy of arrhythmia, prescription of NSAIDs as a dual therapy or therapy without concomitant use of PPIs as a protective therapy and the use of first-generation antihistamines instead of safer and less toxic antihistamines for the older population. The most important risk factors for the occurrence of PIM were female gender (OR=3.27; 95% CI 1.01-10.64), polypharmacy (5-8 drugs used simultaneously) (OR=3.10; 95% CI 1.11-12.04) and with whom the patient lives (OR=11.26; 95% CI 1.46-86.68). Potential prescription omission was detected in the treatment of cardiovascular system diseases in 52.94%, followed by musculoskeletal (29.41%) and urogenital tract disease therapy (17.65%). Errors in drug application for central nervous system and eye therapy were detected in 5.88%. Statins and antiplatelet drugs were the most omitted drugs in patients with a history of cerebrovascular, cardiovascular or peripheral vascular disease. The main predisposing factors for PPO were: previous hospitalizations (OR=19.21; 95% CI 1.13-326.2), comorbidities (OR=4.073; 95% CI 1.71-9.7) and monthly visits of representatives of pharmaceutical companies (OR=25.05; 95% CI 1.65-381.26). The use of STOPP/START criteria is proved to be efficient in the detection of PIM/PPO at the secondary level of health care. Full attention should always be paid to patients who are at the highest risk for inappropriate drug prescription. Doctors should make their decisions conscientiously and in line with clinical evidence, not blindly believing the pharmaceutical representatives. Unnecessary polypharmacy should be avoided. In addition, the functioning of the health care system should be improved, so that doctors are provided by optimal working conditions. In order to achieve this, it is necessary to work on education of both patients and doctors.

scholarly journals 773. First National Survey of Antibiotic Use Prescribed by All Dentists in Japan from 2015 to 2017 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S343-S344
Author(s):  
Masahiro Ishikane ◽  
Chika Tanaka ◽  
Sachiko Ono ◽  
Yoshiki Kusama ◽  
Shinya Tsuzuki ◽  
...  
Keyword(s):  
Health Insurance ◽  
Inappropriate Prescribing ◽  
World Health ◽  
National Database ◽  
Antibiotic Prescribing ◽  
Defined Daily Dose ◽  
Insurance Claims ◽  
Health Insurance Claims ◽  
Outpatient Settings ◽  
Specific Health

Abstract Background The surveillance of antimicrobial use (AMU) among medical doctors and dentists is a key component of the Japanese national plan on antimicrobial resistance (AMR). However, there are no epidemiological studies of AMU among dentists in Japan. We aimed to evaluate the epidemiology of AMU among dentists in Japan and investigate the factors affecting inappropriate prescribing. Methods Total AMU among dentists in Japan between 2015 and 2017 was analyzed by using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), from the Ministry of Health, Labor and Welfare of Japan, which accounted for 98% of total claim data in Japan. Antimicrobials were classified by the World Health Organization (WHO) Anatomical Therapeutic Chemical Classification. The WHO measures antimicrobial usage by using the Defined Daily Dose per 1,000 inhabitant-days (DID) parameter. The patterns of oral AMU in 2017 in outpatient settings were compared between in-house and outside prescriptions. Results DID values of total AMU in 2015, 2016, and 2017 were 1.23, 1.22, and 1.21, respectively (Figure 1). In 2017, the DID value of oral AMU in outpatient settings was 1.19 (98.4%), comprising cephalosporins (0.76, 63.6%), macrolides (0.23, 18.9%), penicillins (0.12, 10.2%), and quinolones (0.07, 5.5%). DID values of oral AMU in outpatient settings were compared for in-house (0.89, 74.4%) and outside (0.31, 25.6%) prescriptions; in-house resulted in a higher proportion of oral cephalosporins (0.60, 66.9% vs. 0.17, 54.1%), but a lower proportion of oral penicillins (0.08, 9.0% vs. 0.04, 13.8%) (Table 1). Conclusion Oral AMU in outpatient settings comprised the highest proportion of antibiotic prescribing by dentists in Japan (98.4%). Oral cephalosporins, the predominant drug type and thought to result from inappropriate prescribing in general, were more frequently prescribed in-house than outside. To tackle AMR, further studies are needed to determine the patient and dentist characteristics encouraging cephalosporin prescription. Disclosures All authors: No reported disclosures.

scholarly journals Analysis of the potential inappropriate use of medications in pediatric outpatients in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jing Cui ◽  
Lei Zhao ◽  
Xianghong Liu ◽  
Mengyujie Liu ◽  
Lihong Zhong
Keyword(s):  
Drug Use ◽  
Cross Sectional Study ◽  
Inappropriate Drug ◽  
Cross Sectional ◽  
Study Objective ◽  
Off Label ◽  
Inappropriate Use ◽  
Academic Center ◽  
Pediatric Outpatients ◽  
Inappropriate Prescriptions

Abstract Background The appropriate use of medications is essential in children. Yet, detailed information on how drugs are being prescribed and dispensed to pediatric populations is not documented in China. Aim The study objective was to analyze the details of medicine use and categorize the types of inappropriate use of medications on children. Methods A retrospective cross-sectional study was conducted on the prescriptions of pediatric outpatients aged < 18 years from 2019 to 2020 at a major Chinese tertiary academic center. Each age group’s demographic and clinical characteristics were collected, and the ratios of inappropriate prescriptions were analyzed. Results The total number of pediatric outpatients was 652,152, and 49.37% (322000) were prescribed medications, in which the most widely used medicines were respiratory, anti-infectives, and Traditional Chinese Medicines (TCMs). The prevalence rate of inappropriate prescriptions reached 20.49%, and in 2019 it was higher (21.71%) than that in 2020 (18.36%). The top three common inappropriate categories were indication-related off-label drug use, improper administration frequency, and overdosing, accounting for 67.93, 17.80 and 11.06% of all inappropriate prescriptions, respectively. The inappropriate prescriptions were more likely seen in patients aged 2–5 years and respiratory medicines. Conclusions The study findings indicate that inappropriate drug use in pediatric outpatients is still common, and great attention needs to be paid. More prospective trials are required to identify the effectiveness, safety, and necessity of off-label drug use of medicines in children.

scholarly journals Review of Drug Utilization Studies in Neonatal Units: A Global Perspective

2020 ◽  
Vol 17 (16) ◽  
pp. 5669 ◽  
Author(s):  
Asma Al-Turkait ◽  
Lisa Szatkowski ◽  
Imti Choonara ◽  
Shalini Ojha
Keyword(s):  
Drug Use ◽  
Drug Utilization ◽  
Antibiotic Use ◽  
Global Perspective ◽  
Use Patterns ◽  
Rational Prescribing ◽  
Drug Use Patterns ◽  
General Drug ◽  
The Usa ◽  
Drug Utilization Studies

Rational prescribing is challenging in neonatology. Drug utilization studies help identify and define the problem. We performed a review of the literature on drug use in neonatal units and describe global variations. We searched databases (EMBASE, CINAHL and Medline) from inception to July 2020, screened studies and extracted relevant data (two reviewers). The search revealed 573 studies of which 84 were included. India (n = 14) and the USA (n = 13) reported the most. Data collection was prospective (n = 56) and retrospective (n = 26), mostly (n = 52) from one center only. Sixty studies described general drug use in 34 to 450,386 infants (median (IQR) 190 (91–767)) over a median (IQR) of 6 (3–18) months. Of the participants, 20–87% were preterm. The mean number of drugs per infant (range 11.1 to 1.7, pooled mean (SD) 4 (2.4)) was high with some reporting very high burden (≥30 drugs per infant in 8 studies). This was not associated with the proportion of preterm infants included. Antibiotics were the most frequently used drug. Drug use patterns were generally uniform with some variation in antibiotic use and more use of phenobarbitone in Asia. This study provides a global perspective on drug utilization in neonates and highlights the need for better quality information to assess rational prescribing.

scholarly journals Characteristics of Osteoporosis & Osteoporotic Fractures in Korea Based on Health Insurance Review and Assessment (HIRA) Database: 2009–2017

Healthcare ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 324
Author(s):  
Ho-Seok Oh ◽  
Sung-Kyu Kim ◽  
Hyoung-Yeon Seo
Keyword(s):  
Health Insurance ◽  
Age Groups ◽  
Osteoporotic Fractures ◽  
Prescription Data ◽  
Diagnostic Codes ◽  
Number Of Patients ◽  
Upper And Lower Extremities ◽  
Fractures Of The Spine ◽  
And Gender ◽  
Age Range

To investigate the incidence and characteristics of osteoporosis and osteoporotic fractures in Korea, we used the Health Insurance Review and Assessment Service (HIRA) database. Patients over 50 years old, who were diagnosed or treated for osteoporosis and osteoporotic fractures in all hospitals and clinics, were analyzed between 1 January 2009 and 31 December 2017 by using the HIRA database that contains prescription data and diagnostic codes. These data were retrospectively analyzed by decade and age-specific and gender-specific incidents in each year. We also evaluated other characteristics of patients including medication state of osteoporosis, primary used medical institution, regional-specific incidence of osteoporosis, and incidence of site-specific osteoporotic fractures. The number of osteoporosis patients over 50 years old, as diagnosed by a doctor, steadily increased from 2009 to 2017. The number of osteoporosis patients was notably greatest in the 60′s and 70′s age groups in every study period. Patients undergoing treatment for osteoporosis increased significantly (96%) from 2009 to 2017. Among the patients diagnosed with osteoporosis, the proportion who experienced osteoporotic fracture increased gradually (60%) from 2009 to 2017. The number of patients with osteoporotic fractures of the spine and hip was highest in the 70 to 90 age range, and the number of patients with osteoporotic fractures in the upper and lower extremities was highest in the 50 to 70 age range. Understanding the trends of osteoporosis in Korea will contribute to manage the increased number of patients with osteoporosis and osteoporotic fractures.

Personality, Motivation, and Adolescent Drug Use Patterns

1976 ◽  
Vol 5 (2) ◽  
pp. 17-23
Author(s):  
Samuel E. Krug ◽  
Thomas J. Henry
Keyword(s):  
Drug Use ◽  
Adolescent Drug Use ◽  
Use Patterns ◽  
Drug Use Patterns
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