Background: Based on the 2017-2020 annual report of the Department of Health-Antimicrobial Resistance Surveillance Program, significant resistance patterns have been observed for common disease-causing pathogens. In the hospital setting, antimicrobial stewardship programs have been implemented to optimize the use of antimicrobials. Drug utilization review studies provide essential feedback to improve prescribing and use of medications. Objectives: This study aimed to review drug utilization of monitored parenteral antimicrobials among patients admitted from January to December 2019. Methods: The study employed a retrospective, cross-sectional, descriptive research design. A retrospective chart review of drugs administered to patients was conducted. : Results. A total of 821 patients charts met the inclusion criteria. The patients’ ages ranged from 18 to 98 years old and 52% were females. General Internal Medicine practitioners (28%) were the top prescribers of monitored parenteral antimicrobials primarily for the management of moderate-risk community-acquired pneumonia (39%). They were mostly indicated for empirical treatment of infections (94%) and were given for an average of 5.73 days. Only 58% of the total cases had orders for culture and sensitivity testing. Of which, principally 47% had colony cultures. Blood (29%) and sputum (27%) were the most common specimens taken for culture and sensitivity testing. The microorganisms often isolated were Escherichia coli (19%), Klebsiella pneumoniae (18%), and Staphylococcus aureus (9%). In addition, extended-spectrum beta lactamase-producing gram-negative pathogens (4%) and methicillin-resistant S. aureus (1%) were also isolated. All the microorganisms isolated showed most resistance to ampicillin (81%) and most susceptibility to colistin (100%). There were drug therapy-related problems encountered. There was one case of an adverse drug reaction (0.1%) and two cases of contraindications (0.2%). Therapeutic duplication was also observed in 5% of the cases. Moreover, 39% had instances of drug-drug interactions.Piperacillin-tazobactam had the highest consumption (79.50 defined daily doses/1,000-patient days) among the monitored parenteral antimicrobials. Some prescriptions were deemed inappropriate upon evaluation. 12% of cases were inappropriate based on the justification indicator. As for the critical indicators, duration of therapy (78%) was the main reason. Only four components of the DUE criteria indicators have met or exceeded the established threshold level.The cost analysis indicated that the total actual cost of therapy with the monitored parenteral antimicrobials amounted to ₱17,645,601.73. Considering Department of Health National Antibiotic Guidelines recommenda-tions, ideal total cost of treatment was ₱14,917,214.29. Potential cumulative cost savings of ₱2,728,387.44 could have been achieved for patients admitted last 2019. Conclusion Consumption of piperacillin-tazobactam was relatively high as compared to the other monitored parenteral antimicrobials covered in this study. Physicians at the study site seldom prescribe monitored parenteral antimicrobials as recommended by the National Antibiotic Guidelines. This is evidenced in the incidence of inappropriate therapy regimens, with inapt duration of therapy as the leading explanation.From the patient’s perspective, the main economic implication was on the direct medical costs, particularly the increased cost of the actual antimicrobial therapy prescribed to manage various infections. Adherence of physicians to the established guidelines and selection of the most cost-effective therapy could have resulted in considerable cost savings.
Drug Utilization Review ; Antimicrobial Stewardship

Background: The concentrated potassium chloride injection is a high-alert medication and replacing it with a pre-mixed formulation can reduce the risks associated with its use. The aim of this study was to determine the clinical characteristics of patients receiving different potassium chloride formulations available at a private institution. The study also assessed the effectiveness and safety of pre-mixed formulations in the correction of hypokalaemia. Methods: This was a retrospective observational study consisting of 296 cases using concentrated and pre-mixed potassium chloride injections in 2011 in a private hospital in Kuching, Sarawak, Malaysia. Results: There were 135 (45.6%) cases that received concentrated potassium chloride, and 161 (54.4%) cases that received pre-mixed formulations. The patients’ clinical characteristics that were significantly related to the utilization of the different formulations were diagnosis (P < 0.001), potassium serum blood concentration (P < 0.05), and fluid overload risk (P < 0.05). The difference observed for the cases that achieved or maintained normokalaemia was statistically insignificant (P = 0.172). Infusion-related adverse effects were seen more in pre-mixes compared to concentrated formulations (6.8% versus 2.2%, P < 0.05). Conclusion: This study provides insight into the utilization of potassium chloride injections at this specific institution. The results support current recommendations to use pre-mixed formulations whenever possible.
Potassium Chloride ; Electrolytes ; Drug Utilization Review

Drug utilization review (DUR) system has been defined as "structured, ongoing initiatives that interpret patterns of drug use in relation to predetermined criteria, and attempt to prevent or minimize inappropriate prescribing." This paper introduces the concept, purpose, and effective application of DUR in Korea. DUR can be classified as retrospective DUR, prospective DUR, and concurrent DUR based on the time direction of applying DUR. DUR can also be classified as quantitative DUR defined by retrospective DUR using databases including previously prescribed medicines, and qualitative DUR defined by DUR reflecting patient's clinical condition. We described the history of developing DUR in the United States and the Europe. Finally current status of DUR in Korea is described and the strategy of future settlement of DUR system in Korea is suggested.
Drug Utilization ; Drug Utilization Review ; Europe ; Korea ; United States

OBJECTIVE: The objective of the present study was to evaluate the effects of implementing a systematic Drug Utilization Review (DUR) system on contraindicated drug use and pharmaceutical expenditures in Korea. METHODS: A literature search was conducted using search engines such as PubMed, EMBASE, NDSL, and RISS for relevant systematic studies. The database search was performed and updated in April 2018. Two independent reviewers evaluated the abstracts to find potentially eligible articles. RESULTS: In total, 1433 potentially eligible studies were selected, and 11 articles were eventually shortlisted for inclusion in the present review system. The outcome showed that contraindicated drug use decreased after implementation of the DUR system in Korea. The analysis also showed that the DUR system contributed to a reduction in pharmaceutical expenditures. CONCLUSION: Our study showed that implementing the DUR system reduced both contraindicated drug use and pharmaceutical expenditures in Korea.
Drug Utilization Review ; Drug Utilization ; Health Expenditures ; Korea ; Search Engine

S +nce errors in prescription potentially result in serious outcomes but can be prevented by multiple interventions, it is very important to update the knowledge on medicines and to improve physicians' prescription for medication safety. The aim of this article is to review useful interventions to improve prescription in developed countries. The passive dissemination of drug information or clinical practice guide-lines alone is an insufficient method for improving most pre-scribing behaviors, although necessary. While the concurrent drug utilization review (DUR) could reduce inappropriate drug prescription and help physicians' prescribing decisions, retrospective DUR and penalties should not be operated in order to hold down the cost of medication.
Developed Countries* ; Drug Prescriptions ; Drug Utilization Review ; Prescriptions* ; Retrospective Studies

Blood utilization review has recently been used to minimize inappropriate transfusion, reduce post transfusion infections and improve the quality of transfusion practices. Ajou University Hospital is a 906 bed tertiary care teaching institution. Since March, 1995, the concurrent review of blood transfusion requests using institutional blood transfusion criteria has been initiated. To evaluate the effectiveness of the transfusion review, the units of blood components transfused per patient(total number of units of blood components transfused/total number of patients discharged) and inappropriate transfusion ratio of blood components(total number of units of blood components inappropriately transfused/total number of units of blood components transfused) were compared during the concurrent review for 9 months and pre-concurrent review for 9 months, respectively. The possible savings of blood components realized by the review were also extrapolated. The results were as follows : 1. The unit transfused per patient for pre-review and during review were 0.675 (9,080/ 13,422) and 0.654(12,123/18,546) for packed RBC(PRBC); 0.417 (5,602/ 13,422) and 0.296 (5,444/18,546) for fresh frozen plasma(FFP); 0.372(5,007/13,422) and 0.424(7,868/18,546) for platelet con-centrates(PC), respectively. 2. The inappropriate transfusion ratio of blood components for pre-review and during review were 0.039 and 0.009 for PRBC; 0.321 and 0.064 for FFP; 0.143 and 0.008 for PC, respectively. These differences were statistically significant(p=0.000). 3. The PRBC and FFP anticipated to have been saved by this review was 519 units and 2,992 units annually, respectively. 4. However, 2,621 units of PC were used additionaly during this review due to increased number of oncology patients and better hemostatic therapy practiced during the same period. In conclusion, the concurrent review of transfusion requests was very effective tool to educate residents in clinical departments the transfusion medicine and improve utilization of blood and its components.
Blood Platelets ; Blood Transfusion* ; Concurrent Review* ; Humans ; Income ; Tertiary Healthcare ; Transfusion Medicine ; Utilization Review

The Korean Government has launched a pilot program of the Drug Utilization Review (DUR) system in an effort to facilitate safe and adequate use of pharmaceuticals by providing reference to physicians and pharmacists at the prescription or dispense stage, with regards to the drugs that should not be combined or should not be given to certain age groups. Implementation of the DUR system is absolutely necessary in Korea, as the number of drug taken per patient is on a continuous rise with increase of senior population and development of new pharmaceuticals. The DUR system is expected to contribute to promotion of people's health and reduction of pharmaceutical expense. However, for a successful establishment of the DUR system, the following conditions should be considered: First, inclusion of non-prescription drugs in the system, Second, review on the current classification of non-prescription and prescription drugs, Third, review on therapeutic duplication contraindication, age contraindication, and gravida contraindication by physicians as clinical experts. Moreover, reimbursement within the framework on medical fee schedule for the DUR system should be followed as well as the efforts to adjust problems through open discussion between insurers and providers.
Appointments and Schedules ; Drug Utilization ; Drug Utilization Review ; Fees, Medical ; Humans ; Insurance Carriers ; Korea ; Nonprescription Drugs ; Pharmacists ; Prescription Drugs ; Prescriptions

BACKGROUND: To evaluate oral anticoagulant (OAC) utilization in patients with atrial fibrillation after the changes in the health insurance coverage policy in July 2015. METHODS: We used the Health Insurance Review and Assessment Service-National Patient Samples (HIRA-NPS) between 2014 and 2016. The HIRA-NPS, including approximately 1.4 million individuals, is a stratified random sample of 3% of the entire Korean population using 16 age groups and 2 sex groups. The HIRA-NPS comprises personal and medical information such as surgical or medical treatment provided, diagnoses, age, sex, region of medical institution, and clinician characteristics. The studied drugs included non-vitamin K antagonist OACs (NOACs) such as apixaban, dabigatran, edoxaban, and rivaroxaban, and were compared with warfarin. We analyzed drug utilization pattern under three aspects: person, time, and place. RESULTS: The number of patients with atrial fibrillation who were prescribed OACs was 3,114, 3,954, and 4,828; and the proportions of prescribed NOACs to total OACs were 5.1%, 36.2%, and 60.8% in 2014, 2015, and 2016, respectively. The growth rate of OACs prescription increased from 61.4 patients/quarter before June 2015 to 147.7 patients/quarter thereafter. These changes were predominantly in elderly individuals aged more than 70 years. The proportion of NOACs to OACs showed significant regional difference. CONCLUSION: The change of health insurance coverage policy substantially influenced OACs prescription pattern in whole Korean region. But the impact has been significantly different among regions and age groups, which provides the evidence for developing standard clinical practice guideline on OACs use.
Aged ; Anticoagulants ; Atrial Fibrillation* ; Dabigatran ; Drug Utilization ; Drug Utilization Review ; Humans ; Insurance, Health* ; Korea* ; Prescriptions* ; Rivaroxaban ; Warfarin

Between 1st January 1999 and 31st December 2000, 452 foreign nationals were treated at the Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru. Eighty-five percent were male. The peak age range was from 21 to 30 years old. The patients were predominantly Indonesians (61%). A history of trauma was present in 63% of patients. Eight percent of eyes had severe visual impairment. Six patients (1.3%) were blind by WHO standards. Traumatic eye conditions, inflammatory/allergic eye conditions and degenerative eye conditions comprised 66%, 13% and 10% respectively of ocular pathology seen. The commonest ocular findings were corneal foreign body, corneal abrasion and subconjunctival haemorrhage.
Chi-Square Distribution ; Eye Injuries/epidemiology ; Eye Injuries/*therapy ; Hospital Departments/*utilization ; Malaysia ; *Ophthalmology ; Retrospective Studies ; Transients and Migrants ; Utilization Review

OBJECTIVES: This study aimed to develop a list of potentially inappropriate drugs for the elderly in Korea using the Delphi technique. METHODS: A Delphi evaluation with a two-round survey was used to reach a consensus on the criteria for inappropriate medications for the elderly in an outpatient setting. The expert panel consisted of 7 family medicine specialists, 3 psychiatrists, 1 neurologist and 3 clinical pharmacists. The level of inappropriateness was determined by considering clinical importance of the risk and availability of alternative therapy, and was rated on a scale of 1 (very low) to 4 (very high). The drugs were categorized into three groups. The first group (Group 1) was drugs that should be avoided. The second (Group 2) was for drugs that need to be monitored. And the third (Group 3) was for drugs with a low level of risk. RESULTS: We took a list of 60 ingredients for drugs and created a list of 57 potentially inappropriate ingredients for the elderly, independent of diagnosis. Forty-two drugs were classified as Group 1. 13 drugs were classified as Group 2. And 2 drugs were classified as Group 3. Ninety-three drugs were potentially inappropriate for the elderly with 29 diagnoses. Groups 1, 2, and 3 included 63, 28, and 3 drugs, respectively. CONCLUSIONS: This study is an important development of a list of drugs potentially inappropriate for the elderly in Korea. The application of this list may be useful for identifying potentially inappropriate medication uses and decreasing drug-related problems.
Aged ; Consensus ; Drug Utilization Review ; Humans ; Korea ; Outpatients ; Pharmacists ; Prescriptions ; Psychiatry ; Specialization