Data Sources for Drug Utilization Research in Brazil—DUR-BRA Study

Background: In Brazil, studies that map electronic healthcare databases in order to assess their suitability for use in pharmacoepidemiologic research are lacking. We aimed to identify, catalogue, and characterize Brazilian data sources for Drug Utilization Research (DUR).Methods: The present study is part of the project entitled, “Publicly Available Data Sources for Drug Utilization Research in Latin American (LatAm) Countries.” A network of Brazilian health experts was assembled to map secondary administrative data from healthcare organizations that might provide information related to medication use. A multi-phase approach including internet search of institutional government websites, traditional bibliographic databases, and experts’ input was used for mapping the data sources. The reviewers searched, screened and selected the data sources independently; disagreements were resolved by consensus. Data sources were grouped into the following categories: 1) automated databases; 2) Electronic Medical Records (EMR); 3) national surveys or datasets; 4) adverse event reporting systems; and 5) others. Each data source was characterized by accessibility, geographic granularity, setting, type of data (aggregate or individual-level), and years of coverage. We also searched for publications related to each data source.Results: A total of 62 data sources were identified and screened; 38 met the eligibility criteria for inclusion and were fully characterized. We grouped 23 (60%) as automated databases, four (11%) as adverse event reporting systems, four (11%) as EMRs, three (8%) as national surveys or datasets, and four (11%) as other types. Eighteen (47%) were classified as publicly and conveniently accessible online; providing information at national level. Most of them offered more than 5 years of comprehensive data coverage, and presented data at both the individual and aggregated levels. No information about population coverage was found. Drug coding is not uniform; each data source has its own coding system, depending on the purpose of the data. At least one scientific publication was found for each publicly available data source.Conclusions: There are several types of data sources for DUR in Brazil, but a uniform system for drug classification and data quality evaluation does not exist. The extent of population covered by year is unknown. Our comprehensive and structured inventory reveals a need for full characterization of these data sources.

Outpatient cardiovascular diseases and diabetes medicines dispensing in the population with government health insurance in Syria between 2018 and 2019: a retrospective analysis

Background Low- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Despite the high prevalence of cardiovascular diseases (CVDs) and diabetes in Syria, little is known about medicines utilization or prescriptions for these diseases. The aims of this study are to present the patterns and rates of dispensing medicines used for CVDs and diabetes among patients with government health insurance in Syria and examine age, sex, and regional variation in the dispensing of these medicines. Methods Outpatient data from June 2018 to May 2019 on dispensed medicines for 81,314 adults with government health insurance were obtained. The dispensing rate was expressed as the number of defined daily doses (DDDs) per 1000 beneficiaries per day (DID). The DID is a measurement that is used in drug utilization research to control for differences or changes in population size between or within countries. The number of DIDs was adjusted according to beneficiaries’ sex, age, and governorate. Results Beneficiaries received 302.09 DIDs of CVDs medicines and 35.66 DIDs of diabetes medicines, including 0.96 DID of insulin (2.99% of the total of diabetes medicines). CVDs and diabetes medicine dispensing rates were low during the study period and included very low rates of insulin dispensing compared to the dispensing rates of these medicines in other countries in East Mediterranean Region or in Europe. We found lower dispensing rates of CVDs medicines among female beneficiaries (249.59 DIDs) than male beneficiaries (388.80 DIDs). Similarly, the dispensing rates of diabetes medicines among female beneficiaries (29.42 DIDs) were lower than those among male beneficiaries (45.98 DIDs). In addition, there were lower rates of CVDs and diabetes medicines and very low to no dispensing of insulin in some governorates that were partly controlled by the Syrian government compared to other governorates that were completely or mostly controlled by the Syrian government. Conclusions Additional efforts are needed to raise awareness about the prevention and management of CVDs and diabetes especially among females in Syria and consider cultural issues that might influence access to healthcare services. There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to CVDs and diabetes medicines in some regions in Syria.

A Prospective Observational Study on Prescription Pattern and Its Efficacy in the Management of Osteoarthritis at Multispecialty Teaching Care Hospital

Background: osteoarthritis is a severe clinical condition in elderly patients. Almost any bone can fracture as a result of the increased bone fragility of osteoarthritis. Aim and Objective of study: The principle aim of drug utilization research is to facilitate the rational use of drugs in an individualized patient. To Study current prescription pattern and its efficacy to manage osteoarthritis. Methodology: This study was a prospective observational study and conducted over a period of six month from October 2015 to March 2016. Patients diagnosed with arthritis with or without co-morbidities were enrolled in the Study considering the inclusion and exclusion criteria. The main sources of data collection were OPD file and case sheets of patients. Results: In this study 148 patients were enrolled, 105 (70.9%) female patients and 43 (29.1%) male patients were participated. Out of 148 study participants 60 (40.54%) patients from age group 51-65 years, followed by 54 (36.48%) patients from age group 36-50 years. In the study population 94 (63.51%) patient were suffering osteoarthritis of both knee, 29 (19.59%) patients were suffering osteoarthritis of right knee and 25 (16.89%) patients were having osteoarthritis of left knee. X-ray report were representing in study population, in 44 patient reports were shows degenerative change seen in both knee, 08 patient report were shows degenerative change seen in right knee. In our study out of 148 patients, 92 (62.16%) patients prescribed NSAIDs, 25 (16.89%) patients prescribed Analgesic, 05 (03.37%) patients were prescribed Opioid analgesic, 11 (07.43%) patients were prescribed supplements and 15 (10.13%) patients received other class of drugs. Among the study population 112 (75.67%) patients were received oral route of drugs and 36 (24.32%) Patients were prescribed topical preparation. The visual analogue scale has been categorized as follows 0-3 Mild pain, 4-7 Moderate pain and 8-10 severe pain. In visual analogue scale initially 16 patients were suffering mild pain, but after treatment it was 93 patients suffering mild pain. The facial pain scale has been categorized as follow 0 = very happy, no hurt, 2 = hurts just a little bit, 4 = hurts a little more 6 = hurts even more, 8 = hurts a whole lot, 10 = hurts as much as you can imagine. Among 148 study participants 14 patients were having final Facial pain score 0, 67 patients were having a final Facial pain score 2 and 3 patients having Initial Facial Pain score 2, 42 patients were having a final Facial pain score 4 and 42 patients having Initial Facial pain score 4, 19 patients were having a final Facial pain score 6 and 63 patients having Initial Facial pain score 6, 06 patients were having final Facial pain score 8 and 33 patients having Initial Facial pain score 8, 07 patients having Initial Facial score 10. Conclusion: The principal aim of drug utilization research is to facilitate the rational use of drugs in an individualized patient. For the individual’s patients, the rational use of a drug implies the prescription of the well documented drug at optimal dose, together with the correct information, at an affordable price.

Data transparency for building a stronger healthcare system: A case study from Argentinean administrative drug utilization data sources

In order to compile an inventory of national data sources for drug utilization research (DUR) in Argentina and to verify publicly available data sources, we performed a cross-sectional study that sought to identify national and provincial databases of drug use. In July 2020, we searched the websites of government institutions, carried out a systematic query of bibliographic databases for “drug utilization research” conducted in Argentina, and conducted a survey with local experts. Data collected included: the institution responsible for the database, population covered, accessibility, source of the data, healthcare setting, geographic information, and whether data were individual or aggregated. Descriptive analyses were then performed. We identified 31 data sources for DUR; only one was publicly and conveniently accessible. Five published aggregated data and provide more detailed access by formal request. Only seven sources (23%) reported national data, and most (n=29) included only data from the public healthcare sector. Although data sources for DUR have been found in Argentina, limited access by researchers and policymakers is still an significant obstacle. Increasing health data transparency by making data sources publicly available for the purpose of analyzing public health information is crucial for building a stronger health system.

Proceedings V International Workshop on Rational Use of Medicines; III Worknowledge of Evidence-Informed Police; III Symposium ISPE BrazIntRIG; I Symposium of ISPE Brazilian Student Chapters

Producing and sharing knowledge have been the main goals of the Graduate Program in Pharmaceutical Sciences of the University of Sorocaba. With a focus on the rational use of medicines, the importance of the event is justified by highlighting one of the main concerns worldwide, with an important impact on society, health systems, institutions, and communities. The improvement of professional practices depends on the engagement of researchers, health professionals, managers, students, and others interested in improving health policies, programs, services, and actions. Developing and applying scientific methods in producing and using the best evidence is the path we have chosen. Therefore, everyone was invited to discuss relevant topics in this field of knowledge, including Drug Utilization Research; Health Technology Assessment; Global Health Systems and Environment; and Innovation and Development of Health Technologies. Experts from several countries in deprescribing, interactive teaching approaches, implementation science and policy, environment and pharmaceutical care joined us sharing their experiences and encouraging debate. We are sure that the social distancing, essential in this period, did not represent an obstacle in making new connections, and effective and bright collaborations that are able to transform reality.

Pharmacoepidemiology for nephrologists (part 1): concept, applications and considerations for study design

Randomized controlled trials on drug safety and effectiveness are the foundation of medical evidence, but they may have limited generalizability and be unpowered to detect rare and long-term kidney outcomes. Observational studies in routine care data can complement and expand trial evidence on the use, safety and effectiveness of medications and aid with clinical decisions in areas where evidence is lacking. Access to routinely collected large healthcare data has resulted in the proliferation of studies addressing the effect of medications in patients with kidney diseases and this review provides an introduction to the science of pharmacoepidemiology to critically appraise them. In this first review we discuss the concept and applications of pharmacoepidemiology, describing methods for drug-utilization research and discussing the strengths and caveats of the most commonly used study designs to evaluate comparative drug safety and effectiveness.

A Study of Psychotropic Drugs Being Prescribed to the Patients Attending the Psychiatric Outpatient Department in a Tertiary Care Hospital

BACKGROUND & PURPOSE: Drug utilization research evaluates the appropriateness of the prescriptions which is important in clinical practice. Psychotropic polypharmacy is a major problem in psychiatric practice, which can lead to the development of adverse effects of those drugs in patients. Therefore, this study was carried out to evaluate the utilization of psychotropic drugs being prescribed for various psychiatric illnesses. MATERIALS & METHODS: A prospective, cross sectional, observational study was carried out in patients visiting the Psychiatric Out-Patient Department of B J Government Medical College and Sassoon General Hospital, Pune, INDIA; from December 2016 to May 2018. A total of 500 prescriptions were analysed using WHO Drug Use indicators and some other indicators. RESULTS: Average number of drugs per prescription was 3.14 ± 1.18; while average number of Psychotropic drugs per prescription was 2.27 ± 0.90. 84.35% of the total drugs prescribed by Generic name. 43.89% and 41.67% of the total drugs were prescribed from National List of Essential Medicines 2015 and WHO Model List of Essential Medicines 2017, respectively. Antipsychotics was the most commonly prescribed group of Psychotropic drugs, while Olanzapine was the most commonly prescribed Psychotropic drug. 64.25% of the total drugs were prescribed from the hospital drugstore. CONCLUSION: In the present study, drugs were prescribed rationally and judiciously. But there was a need to increase the prescription of drugs from essential drug lists. Apart from that, there was found a need to increase the availability of the commonly prescribed Psychotropic drugs in the hospital drugstore of the study institution.

Drug utilization research in coinfected patients with tuberculosis and HIV/AIDS

Objectives: This study aims to describe and classify the drugs prescribed for coinfected patients treated at a reference hospital. Methods: A retrospective cross-sectional study with analysis of information contained in a database prepared in an earlier study The Anatomical Therapeutic Chemical (ATC) classification system was used to classify the prescribed drugs. Results: Eighty-one coinfected individuals participated in the study, with a mean age of 40 years old and numerous comorbidities. A total of 147 drugs were found and, when the frequency of prescription was evaluated, the most used therapeutic groups were anti-infectious, considering the large number of opportunistic infections (OIs) presented by coinfected patients, followed by feeding tract drugs used to treat adverse drug reactions. We could observe that 73% of the evaluated population had a CD4+ T lymphocyte count <200 cells/mm3 and a high viral load, indicating advanced immunodeficiency. Conclusion: It is necessary to develop strategies aimed at coinfected patients, such as specialized care, early diagnosis and appropriate treatment of coinfection. It is also important to carry out more studies on the use of drugs among coinfected patients to create actions directed to this population that may contribute to the rational use of drugs.