2. DOES DRUG USE EVALUATION (DUE) REQUIRED BY NATIONAL POLICY IMPROVE USE OF MEDICINES?

3. Background  DUE was first introduced to Thailand’s MoPH hospitals in 1991  Annual survey of pharmacy activities in 92 MoPH hospitals, DUE exist 30-50%, however 7.5% has a continuous monitoring  DUE was strengthened by the policy statement in the 1999 National Essential Drug List and 1998 MoPH post-economic crisis drug management reforms under ‘Good Health at Low Cost’

4. Objectives  To assess the DUE situation in Thailand regarding policy implementation and outcomes on rational drug use  To assess health professionals’ perspectives towards and experience on DUE and its constraints since the program was strengthened in 2000

5. Methodology 1. Selection of tracers: Ceftazidime injection, imipenem plus cilastatin injection, ciprofloxacin injection and tablet, statins tablet and pentoxiphylline tablet 2. DUE package: Drug use criteria, guideline on DUE procedure, drug order forms, data collection form and report forms 3. Policy dissemination: A national meeting of chairpersons and secretariats of hospital’ drug and therapeutic committee(DTC) was organized in March 2000.

6. Methodology (cont.) 4. Analysis of voluntary report of qualitative DUE from June 2000 to December 2001 5. Self administered questionnaire survey in 2002:  on hospital pharmacists’ perspectives, experience and constraints  on physicians’ perspectives in 2 regional hospitals with 10-year experiences in DUE

7. Result 1. Percentage of regional and provincial hospitals responded to DUE policy

8. 2. Percentage of indication appropriateness

9. 2. Percentage of indication appropriateness (cont.) statin-1 = statin primary prevention, statin-2 = statin secondary prevention

10. 3. Appropriateness in dosage regimen ]Dose appropriateness: > 70% in patients without renal problem 27-78% in patients with renal insufficiency ]Dosage interval appropriateness: > 90% 4. Incidence of adverse drug reaction unable to estimate due to data limitations

11. 5. Hospital pharmacists’ self evaluation (n = 450, 64% response rate) ]32% had insufficient knowledge to set up drug use criteria ]48% was able to modify the MoPH standard criteria ]47% was able to analyse data ]constraints in conducting DUE: difficulty in patient profile evaluation, inadequate skill in clinical pharmacy, lack of coordination among physicians and pharmacists

12. 6. Physicians’ perspectives (n = 110)

13. Discussion & Conclusion Research findings: 1. An average 30% reporting rate, with a decreasing trend over 3 six-monthly periods. 2. The high percentage of appropriateness in most tracers does not represent a national picture. There is room for increase DUE coverage to more hospitals. 3. According to NLED 1999 recommended indication, pentoxiphylline tablet had the lowest appropriateness. It needs further verification and specific intervention.

14. Discussion & Conclusion (cont.) Lesson learnt: 1. Therapeutic outcomes of drug use should be assessed. 2. Existing problem: current lack of proper understandings on DUE concept, insufficient knowledge and skill, coordination among pharmacists and physicians 3. In this study, we cannot estimate cost savings from appropriate use of drugs. However, appropriateness may not represent a lower cost.

15. Discussion & Conclusion (cont.) Implication: 1. The national policy could encourage DUE in hospitals, however, continual enforcement and concomitant monitoring and support are required. 2. A mandatory DUE for drugs in sublist D in NLED should be more practical, specific and selective to suit various levels of hospital. 3. DTC should be empowered to select drugs for DUE according to their problems. 4. Qualitative and quantitative drug use data are solid ground for a complete drug surveillance.

16. Discussion & Conclusion (cont.) Utility of DUE: 1. At hospital level, DUE is a useful tool for evaluating and improving rational drug use. 2. At national level, comparative quantitative utilization of specific group of drugs and treatment outcomes would benefit to the selection of drugs into the NLED 3. DUE has a limitation, it cannot assess the magnitude and profile of “under-use” of drugs among specific population.