General medications utilization and cost patterns in hospitalized children
Drug utilization in the in-patient setting can provide mechanisms to assess drug prescribing trends, efficiency and cost-effectiveness of hospital formularies and examine sub-populations such as children for which prescribing habits are different from adults.
Objectives: The aim of this descriptive study was to analyze general medication utilization patterns and costs excluding antimicrobials prescriptions and to compare two pediatric admission units in a tertiary care university hospital.
Methods: The total number of admitted children was 1,521 and 1,467 for the A and B admission units, respectively. The electronic data from 252 and 253 hospitalized children in the A and B admission unit were prospectively screened for general medication prescriptions, children on antimicrobials were excluded from the analysis. Their electronic charts were viewed once weekly from October 15, 2007 up to April 7, 2008 using the prescription-point prevalence method. One medication was considered to be one prescription.
Results: The general medications prescription number was 790 for 94 children (8.4 prescription/patient) in A and 959 for 88 children (10.9 prescription/patient) in B (p=0.02). The general medications defined daily dose (DDD) and drug utilization 90% (DU90%) index were 2,509.63, 2,259 for A; and 6,110.35, 5,499 for B, respectively. The DU90% index placed salbutamol inhalation with 835 DDD and sodium heparin with 2,102 DDD in the first place for the A and B admission units, respectively. A net increment in medication cost was registered according to the calculated cost from the depicted DU90% when the A (20,263 NIS) and B (6,269 NIS) admission units were compared (p=0.04).
Conclusions: A significant difference in the prescription utilization of general medications was shown between the A and B admission units. The A admission unit had lower prescriptions measured by the DU90% index with higher medication cost. Potential drug-drug interactions were depicted in 18 (19%) and 17 (19%) subjects in the A and B admission unit, respectively.
2. Matuz M, Benko R, Doro P, Hajdu E, Nagy G, Nagy E, et al. Regional variations in community consumption of antibiotics in Hungary, 1996-2003. Brit J Clin Pharmacol. 2005;61:96-100.
3. Guidelines for ATC classifications and DDD assignment. WHO Collaborating Center for Drug Statistic Methodology. Oslo (www.whocc.no), date of access October 1st 2007.
4. Krivoy N, Mattalon N. Antimicrobial utilization pattern in a hematologic intensive care unit. J Pharm Technol. 2001;17:15-18.
5. Bergman U, Popa C, Tomson Y, Wettermark B, Einarson TR, Aberg H, Sjoqvist F. Drug Utilization 90% - A simple method for assessing the quality of drug prescribing. Eur J Clin Pharmacol. 1998;54:113-118.
6. Wettermark B, Pehrsson A, Jinnerot D, Bergman U. Drug utilization 90% profiles - a useful tool for quality assessment of prescribing in primary health care in Stockholm. Pharmacoepidemiol Drug Saf. 2003; 12: 499-510.
7. Krivoy N, Abed El-Ahal W, Bar- Lavie Y, Haddad S. Antibiotic prescription and cost patterns in a general intensive care unit. Pharm Pract (Internet). 2007;5:67-73.
8. Gendel I, Azzam ZS, Braun E, Levy Y, Krivoy N. Antibiotic utilization prevalence: prospective comparison between two medical departments in a tertiary care university hospital. Pharmacoepidemiol Drug Saf. 2004;13:735-739.
9. Martinbiacho J, Zuckermann J, Dos Santos L, Silva MM. Profile of drug interactions in hospitalized children. Pharm Pract (Internet). 2007;5:157-161.
10. Conroy S, Choonara I, Impicciatore P, Mohn A, Arnell H, Rane A, et al. Survey of unlicensed and off label drug use in paediatric wards in European countries. BMJ. 2000;320:79-82.
11. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients. JAMA. 1998;279:1200-1205.
12. Arulmani R, Rajadran SD, Suresh B. Adverse drug reaction monitoring in a secondary care hospital in South India. Br J Clin Pharmacol 2007;65:210-216.
13. Ortega A, Aguinagalde A, Lacasa C, Aquerreta I, Fernandez-Benitez M, Fernandez LM. Efficacy on an adverse reaction electronic reporting system integrated into a hospital information system. Ann Pharmacother. 2008;42:1491-1496.
14. Knight M. Adverse drug reactions in neonates. J Clin Pharmacol. 1994;34:128-135.
15. Byl B, Clevenbe4rgh P, Jacobs F, Struelens MJ, Zech F, Kentos A, Thys JP. Impact of infectious disease specialist and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis. 1999;29:60-66.
The authors hereby transfer, assign or otherwise convey to Pharmacy Practice (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print or epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Author Self-Archiving Policy
Pharmacy Practice permits and encourages authors to post and archive the final PDFs of their respective articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.