Vol 4 No 1/2 (2018)
Original Article(s)
-
Background: As an essential human protein and an expensive biological drug, albumin is, in several cases, prescribed without an appropriate indication. This study determined the compatibility of albumin administration with the current standard protocols in a university-affiliated hospital in Iran.Methods: A total of 151 patients admitted to a university-affiliated hospital in Iran from June 22, 2016, to 2017 participated in the present cross-sectional study. The demographic information of the patients (age, gender, and ward), the reason for albumin prescription, and details of its use were recorded (the total amount prescribed, the duration of albumin therapy, dosage, or frequency). The compliance of the albumin administration with the current guidelines (appropriate vs. inappropriate) was checked and confirmed by a senior clinical pharmacist.Results: Sixty-six (43.7%) patients were female and 85 (56.3%) were male. The Mean±SD age of the patients was 53.98±25.34 years. Among the patients receiving albumin, patients with infectious diseases, burn injuries, and operations were the most frequent cases. Generally, 171 vials were administered inappropriately during the study. Also, the inappropriate administration of albumin was most common among infectious disease specialists, followed by internists and general surgeons, resulting in $35878.5 wastage (each vial is around $33.5 in Iran).Conclusion: The logical administration of albumin should be based on the appropriate guidelines and clinical needs of the patients. In a majority of the cases, albumin was prescribed inappropriately and at an alarming rate. These results indicate the need for educational programs and appropriate policies for physicians prescribing albumin.
-
Background: Since at the time of this study fusidic acid was not available in the pharmaceutical market of Iran, this study was designed to investigate the economic aspects of the availability of fusidic acid for the treatment of topical infection in Iran.Methods: A decision tree model was used to compare circumstances, in which only mupirocin and fusidic acid were available. Medical and hospitalization costs were considered as direct medical costs. Budget impact analysis and sensitivity analysis were performed to examine the robustness of the base-case analysis.Results: It was assumed that a 50/50 ratio exists between burn patients to other patients. The treatment cost of 1000 cohort hypothetical patients was estimated at $54766 when mupirocin was the only available treatment choice and $15951 when fusidic acid was available as well. In other words, overall, $39 per patient was saved when physicians could consider fusidic acid as another choice of treatment.Conclusion: The availability of fusidic acid appears to be reasonable because it reduces the costs of skin infection treatment. It also improves antibiotic consumption appropriateness.
-
Background: Vancomycin is a glycopeptide antibiotic that is widely used for the treatment of gram-positive microorganisms, including methicillin-resistant Staphylococcus aureus. It is a valuable antibiotic in practice; unfortunately, its excessive use and mistakes in prescription have increased bacterial resistance. Hence, this study seeks to investigate the common errors related to the pharmacokinetics of vancomycin prescription in teaching hospitals in Iran.Methods: This study is an observational study that research orders with errors related to pharmacokinetics parameters of vancomycin. A total of 150 patients were enrolled in the study from May 2016 to September 2018 in teaching hospitals. Errors in drug prescription were identified based on literature resources.Results: About 22.7% of patients did not receive the loading dose. Also, 85.3% of patients were prescribed a fixed dose, instead of weight-based dosing. About 46% of patients had kidney problems (chronic kidney disease or acute kidney injury) and all of them had received a much lower dose than they needed according to guidelines. Another 46% of patients did not undergo therapeutic dose monitoring correctly. Finally, 69.3% of patients had not received consequent doses after encountering a nontherapeutic trough level correctly. Also, none of 22 obese patients with a body mass index of greater than 40 kg/m2, had received the proper dose.Conclusion: Since the incorrect use of vancomycin significantly increases the prevalence of resistant organisms and, consequently, the mortality rate of patients, it is necessary to define guidelines for its use in the hospital.
-
Background: The overuse and misuse of antibiotics contribute to the development of antibiotic resistance, increase the incidence of adverse drug reactions, and impose high costs on the healthcare system. In Iran, the Food and Drug Administration is responsible for the surveillance of drug consumption. The aim of the present study is to assess the distribution pattern of 10 most commonly used antibiotics from drug distribution companies to private and national health pharmacies supervised by the Food and Drug Deputy of Ahvaz Jundishapur University of Medical Sciences in 2016. The administration rate of these antibiotics was also assessed by a survey of prescriptions documented by the Social Security Organization and Health Insurance.Methods: The distribution pattern of 10 antibiotics was obtained from pharmaceutical distribution companies. The per capita consumption of antibiotics with and without prescription was determined by the Social Security Organization and Health Insurance.Results: More than half of the total distributions of all antibiotics in the cities of Khuzestan Province were related to private pharmacies. Many surveyed cities had a high percent of antibiotic consumption without prescription.Conclusion: The accurate recording of the distribution of antibiotics by pharmaceutical companies and the submission of monthly and annual reports to food and drug deputies are necessary. It is also necessary to increase the surveillance of pharmacies and the process of antibiotic provision.
-
Background: Access to medicines needs to be fully integrated with health financing, human resource planning, service delivery, information and governance systems. We aimed to explore key themes for the identification of priority policy research questions in the area of access to and use of medicines.Methods: We interviewed a purposeful sample of twenty participants in Iran. The interviewees were selected from diverse stakeholders and the listing comprised of the Ministry of Heath, Departments of Health, Industry, Researchers, Development Partners, Advocates, Clinicians, Pharmacists and Private Providers. Qualitative data was analyzed using the framework approach. We then conducted a nominal group technique meeting to reach consensus on research priorities.Results: Seven themes explain important access to medicine policy and practice issues: health sector organization, health sector pharmaceutical policies, health system financing/ insurance system, drug distribution system in the country, individual, household and community level, health care providers, and policies beyond the health sector. As a result of the consensus development process, 17 research priorities related to access to and use of medicines were identified.Conclusion: The key informant interviews clearly demonstrate that the majority of policy concerns were not addressed. There was a mismatch between the concerns and research, and hence the outcomes of this study can contribute to developing a research agenda for improving access to and appropriate use of medicines.
