The effect on prescribing habits of a drug supply and cost sharing system was studied in a hill district in Nepal. In this district the inadequate yearly supply of drugs from the government was supplemented by an extr...
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The effect on prescribing habits of a drug supply and cost sharing system was studied in a hill district in Nepal. In this district the inadequate yearly supply of drugs from the government was supplemented by an extra supply from the project. Drugs were sold at a fixed prescription charge which covered all drugs for one episode of illness. The prescribing pattern in this district was compared to a control district with only the yearly government drug supply and no drug scheme. Drugs prescribed were also compared to theoretical needs based on the recorded diagnoses of the same patients and recommended treatment guidelines. Attendance figures were studied before and after the introduction of the drug scheme in the test district. A 25% sample of prescriptions was taken from all health posts in both districts, over a one year period. This was in total 11 772 prescriptions from 22 health posts. The results show that in the drug scheme district health workers prescribed essential drugs excessively. However, the doses that were prescribed were somewhat better than in the control district. Utilization of health facilities dropped by 18% in the drug scheme district and then increased in the second year. A supply of essential drugs does not necessarily improve the quality of care, or increase attendance levels. The WHO indicators designed to assess the quality of drug use at health facilities can give a misleading picture, as they do not include information on dosages. The effect on quality of care of supply and financing mechanisms needs further study.
OBJECTIVE: To address important problems and needed changes in online and retrospective drug utilization review (DUR) programs. Emphasis is placed on reliability of DUR criteria and the shift of traditional retrospect...
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OBJECTIVE: To address important problems and needed changes in online and retrospective drug utilization review (DUR) programs. Emphasis is placed on reliability of DUR criteria and the shift of traditional retrospective DUR programs toward disease management and health care outcomes. DATA SOURCES: Published literature evaluating the role of online and retrospective DUR programs. STUDY SELECTION: Particular attention was given to studies assessing DUR criteria reliability and new interventions with retrospective DUR programs. DATA SYNTHESIS: A literature review was conducted along with an expert summary from the U.S. Pharmacopeia Drug Utilization Review Advisory Panel. Studies have revealed variations in DUR criteria that could be affecting clinical practice and patient care. Appropriate formal methodologies and use of consistent procedures in developing online prospective DUR programs and systems could help resolve these problems. Traditional retrospective DUR is also shifting to incorporate disease management and methodologies from health outcomes and pharmacoeconomics studies. CONCLUSIONS: Refinements are needed to improve the reliability and validity of online DUR criteria and to minimize false positive messages. Databases created as a result of DUR efforts have been used in new and innovative ways to incorporate health outcomes data and disease management interventions. Additional outcomes data, combined with quality assurance efforts, should increase the utility of DUR/disease management efforts in evaluating health systems while improving the effectiveness and efficiency of pharmacists' health care interventions.
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