Medication Review PDF

MODULE 4 3) Dosage modification MEDICATION REVIEW 4) Drug-drug interactions 5) Drug-patient precautions (due to age, allerg...

MODULE 4 3) Dosage modification MEDICATION REVIEW 4) Drug-drug interactions 5) Drug-patient precautions (due to age, allergies, gender, pregnancy, etc.) OUTLINE 6) Therapeutic interchange & generic substitution Overview of Medication Review 7) Inappropriate duration of drug treatment Goals of Medication Review A patient being treated with warfarin to prevent blood clots may be prescribed a new Medication Review drug by another specialist to treat arthritis. If Also referred to as Drug Utilization taken together, the patient could experience Evaluations (DUE) or Medication Example: internal bleeding. Medication Utilization Evaluations (MUE) Upon reviewing the patient's prescriptions, Review It is an authorized, structured, ongoing review the pharmacist would note the potential drug of prescribing, dispensing, and use of interaction and contact the prescriber to alert medication. him/her to the problem. Importance of Medication Review Concurrent Ongoing monitoring of drug therapy during 1) DUR programs help to understand, interpret, evaluate, the course of treatment and improve the prescribing, administration, and use of Some refer to this as case management. medications. 2) Permit a more efficient use of insufficient health care Concurrent It presents pharmacists with the opportunity to alert prescribers to potential problems and resources. to intervene. 3) Pharmacists play a key role in this process because of This type of review allows therapy for a their expertise in the area of medication therapy patient to be altered if necessary. management. Issues Commonly Addressed by Concurrent DUR: 4) DURs afford the pharmacist the opportunity to identify 1) Drug-drug interactions trends in prescribing within groups of patients such as 2) Over and underutilization asthma or diabetes. 3) High or low dosages 5) Pharmacists can then, in collaboration with other 4) Duplicate therapy members of the health care team, initiate action to improve 5) Drug-disease interactions drug therapy as: 6) Drug-age precautions Prevent the use of unnecessary or inappropriate drug 7) Drug-gender precautions therapy 8) Drug-pregnancy precautions Prevent adverse drug reactions Hospitalized patients often receive multiple Improve overall drug effectiveness. medications. A pharmacist’s periodic review of patient records can detect actual or potential drug-drug interactions or duplicate therapy. Also, alert the pharmacist to the need for Example: changes in medications such as antibiotics or the need for dosage adjustments based on laboratory test results. Drug Utilization Reviews (DURs) serve as a means of: The physician must then be alerted to the 1) Improving the quality of patient care situation so that corrective action can be 2) Enhancing therapeutic outcomes taken. 3) Reducing inappropriate pharmaceutical expenditures Thus, reducing overall healthcare costs Retrospective The simplest to perform Classification of Medication Review Drug therapy is reviewed after the patient Evaluation of a patient’s therapy has received medication. 1. Prospective before medication is dispensed May detect patterns in prescribing, Ongoing monitoring of drug therapy dispensing, or administering drugs to 2. Concurrent prevent recurrence of inappropriate use or during the course of treatment Review of therapy after the patient abuse and serves as a means for 3. Retrospective Retrospective has received the medication. developing prospective standards and interventions. Prospective In retrospective DUR, patient medical charts or computerized records are Evaluation of a patient's therapy before screened individually and within groups of medication is dispensed patients, such as diabetes, asthma, or Pharmacists routinely perform prospective high blood pressure. Prospective reviews in their daily practice by: Issues Commonly Addressed by Retrospective DUR: (1) Assessing the dose and directions (2) Reviewing for possible drug 1) Therapeutic appropriateness interactions or duplicate therapy 2) Over and underutilization 3) Appropriate generic use Issues Commonly Addressed by Prospective DUR: 4) Therapeutic duplication 1) Drug abuse / misuse 5) Drug-disease contraindications 2) Drug contraindications 6) Drug-drug interactions 7) Incorrect dose 8) Inappropriate duration of treatment Examples of Drugs that Require Monitoring 9) Drug abuse/misuse Upon retrospective review, the pharmacist may identify a group of patients with asthma who, according to their medical and pharmacy history, should be using Example: advanced treatment as orally inhaled steroids. Using this information, the pharmacist can then encourage physicians to prescribe the indicated drugs. Medication Review Steps in Conducting a Drug Use Evaluation 1. Determine Optimal Use Established criteria are defined to compare optimal use with actual use. o Should focus on relevant outcomes and identify the relevant drugs to be monitored for optimal use in advance. For example, if the use of a drug class prescribed to treat a patient with diabetes is being evaluated, then standards should be determined to identify all drugs within the drug class and to evaluate each drug’s effectiveness, such as a decrease in blood glucose level to within normal limits. 2. Measure Actual Use This step is where data are gathered to measure the actual use of medications. These data can be obtained from medical and prescription records or electronic claim forms. 3. Evaluate Acceptable thresholds (percent of patients meeting the indicator) should be determined prior to comparison between optimal and actual. During this process, the evaluator determines causes for any discrepancies and whether findings are expected. In this process, patterns can be identified and interpreted. 4. Intervene This is the step where corrective action is implemented. Action should be targeted to areas of concern such as prescribing patterns, quality of drug therapy, or economic consideration. 5. Evaluate the Medication Review Program Conclusion This step assesses the effectiveness of the medication Using DUR information, pharmacists can identify prescribing review program. trends in patient populations and initiate corrective action to Efforts should be made to evaluate the outcomes and improve drug therapy for groups of patients as well as document reasons for positive and negative results. individuals. Implementing appropriate changes to the medication review With an increasing number of healthcare professionals such program and continued observation should be undertaken. as pharmacists, prescribers, and nurses involved in medication use, a more multidisciplinary approach to 6. Report the DUR Findings improving patient care will be necessary for DUR. The final step is to report these findings to the appropriate team within the organization (e.g., the Pharmacy & Therapeutics Committee) and/or individual prescribers when appropriate.