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Yang J, Zheng L, Guan YY, Li PB, Lv YT. Evaluating the effectiveness of drug and therapeutics committees (DTCs) in controlling irrational drug use: A retrospective analysis. J Clin Pharm Ther 2022; 47:995-1001. [PMID: 35233796 DOI: 10.1111/jcpt.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE This study aimed to explore methods to optimize the function of Drug and Therapeutics Committees (DTCs) in controlling irrational drug use. Clinical pharmacologists contribute their specific knowledge and skills to DTCs and help guide rational therapeutics. The DTC is the highest organization of hospital pharmacy management. METHODS From January 2016 to August 2021, the DTC promoted the optimization of clinical drug treatment schemes and reduced unreasonable drug use by improving the organizational framework, clarifying the division of functions, regularly monitoring drug use, organizing expert comments, scientific decision-making and functional intervention. During this time, we statistically analysed typical management cases, irrational drug use and drug cost to evaluate the effectiveness of the DTC's management. RESULTS AND DISCUSSION The DTC's intervention led to a significant reduction in prescribing errors (65.98%, p < 0.05); the intervention acceptance rate increased by 16.37%; and the rate of problem resolution increased by 45.84% (p < 0.05). The level of drug treatment was improved, and the proportion of patients' drug expenses was reduced. WHAT IS NEW AND CONCLUSION The DTC carried out a series of continuous improvement work that played a significant normative role in clinical drug use. Giving more power to the DTCs can significantly improve the level of drug treatment and reduce unreasonable drug use, which reduces unnecessary drug expenses.
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Affiliation(s)
- Jing Yang
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, China.,Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lei Zheng
- Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yu-Yao Guan
- Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Pi-Bao Li
- Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yong-Tao Lv
- Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Alefan Q, Alshareef S, Al-Shatnawi S. Drug and therapeutics committees in Jordanian hospitals: a nation-wide survey of organization, activities, and drug selection procedures. Pharm Pract (Granada) 2019; 17:1590. [PMID: 31897253 PMCID: PMC6935542 DOI: 10.18549/pharmpract.2019.4.1590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/06/2019] [Indexed: 11/14/2022] Open
Abstract
Background Drug and Therapeutics Committees (DTCs) were founded about a century ago as a guide for dealing with drugs in hospitals. Since then, it has shown a vital role in rational drug use in terms of regulatory and educational activities. Objective To describe structures, functions, and activities of hospital DTCs. Methods A questionnaire was developed based on previous studies. Questions consisted of information on respondents' demographics; structures, functions, and activities of DTCs; drug selection process and resources used, and factors and criteria used in drug selection. Results The overall response rate was 95%. DTCs were mainly present in most large hospitals (45%). All DTCs had hospital pharmacists in their structure and most of them (66%) met monthly. The main responsibilities of DTCs were related to general prescribing policies. The number, frequency, and severity of adverse drug reactions were the most reported criteria for the drug selection process. Legal implications for practical, economic, and organizational factors were the most important factors that were reported for drug selection. Conclusions DTCs are mainly present in most large hospitals. The main responsibilities of the DTC in Jordanian hospitals are general prescribing policies, drug selection, hospital formulary editing, and reporting of ADR to external authorities.
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Affiliation(s)
- Qais Alefan
- PhD. Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. Irbid (Jordan).
| | - Somayya Alshareef
- MSc. Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. Irbid (Jordan).
| | - Samah Al-Shatnawi
- PhD. Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology. Irbid (Jordan).
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Schiff GD, Tripathi JB, Galanter W, Paek JL, Pontikes P, Fanikos J, Matta L, Lambert BL. Drug formulary decision-making: Ethnographic study of 3 pharmacy and therapeutics committees. Am J Health Syst Pharm 2019; 76:537-542. [DOI: 10.1093/ajhp/zxz022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Gordon D Schiff
- Center for Patient Safety Research and Practice, Brigham and Women’s Hospital, Boston, MA
| | - Jaya B Tripathi
- Center for Patient Safety Research and Practice, Brigham and Women’s Hospital, Boston, MA
| | - William Galanter
- Department of Pharmacy Practice and Pharmacy Systems, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Jamie L Paek
- College of Pharmacy, University of Illinois at Chicago College of Medicine
| | - Pam Pontikes
- Center for Education and Research on Therapeutics, John H. Stroger Hospital of Cook County, Chicago, IL
| | - John Fanikos
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA
| | - Lina Matta
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA
| | - Bruce L Lambert
- Center for Communication and Health, Northwestern University, Chicago, IL
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Fadare JO, Ogunleye O, Obiako R, Orubu S, Enwere O, Ajemigbitse AA, Meyer JC, Enato E, Massele A, Godman B, Gustafsson LL. Drug and therapeutics committees in Nigeria: evaluation of scope and functionality. Expert Rev Clin Pharmacol 2018; 11:1255-1262. [PMID: 30451035 DOI: 10.1080/17512433.2018.1549488] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Inappropriate use of medicines remains a problem, with consequences including increasing adverse drug reactions (ADRs) and prolonged hospitalizations. The Essential Medicines List and Drug and Therapeutics Committees (DTCs) are accepted initiatives to promote the rational use of medicines. However, little is known about DTC activities in Nigeria, the most populous African country. Areas covered: A cross-sectional questionnaire-based study was conducted among senior pharmacists, consultant physicians, and clinical pharmacologists in 12 leading tertiary health-care facilities across Nigeria. Expert commentary: Six (50%, 6/12) health-care facilities had existing DTCs with three (50%) having a subcommittee on antimicrobials. Seventy-five percent had infection control committees, with presence even in centers without DTCs. Chairpersons and secretaries of the DTCs were predominantly physicians (83.3%) and pharmacists (100%), respectively. Hospital formularies were available in five facilities with DTCs, while one facility without a DTC had an Essential Medicines Committee responsible for developing and updating the hospital formulary. The evaluation of ADRs was undertaken by pharmacovigilance units in nine facilities. Overall, DTCs were present in only half of the surveyed facilities and most were performing their statutory functions sub-optimally. The functioning of DTCs can be improved through government directives and mechanisms for continuous evaluation of activities.
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Affiliation(s)
- Joseph O Fadare
- a Department of Pharmacology and Therapeutics, College of Medicine , Ekiti State University , Ado-Ekiti , Nigeria
| | - Olayinka Ogunleye
- b Department of Pharmacology and Medicine , Lagos State University College of Medicine and the Teaching Hospital , Ikeja , Nigeria
| | - Reginald Obiako
- c Department of Medicine, Clinical Pharmacology Unit , Ahmadu Bello University , Zaria , Nigeria
| | - Samuel Orubu
- d Faculty of Pharmacy , Niger Delta University , Wilberforce Island , Bayelsa State , Nigeria
| | - Okezie Enwere
- e Department of Medicine , Imo State University , Orlu , Nigeria
| | | | - Johanna C Meyer
- g Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa
| | - Ehijie Enato
- h Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy , University of Benin , Benin City , Nigeria
| | - Amos Massele
- i Department of Clinical Pharmacology, School of Medicine , University of Botswana , Gaborone , Botswana
| | - Brian Godman
- g Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa.,j Division of Clinical Pharmacology, Department of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden.,k Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - Lars L Gustafsson
- j Division of Clinical Pharmacology, Department of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden
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Lachhab Z, Serragui S, Hassar M, Cherrah Y, Errougani A, Ahid S. Analysis of the drug formulary and the purchasing process at a Moroccan university medical center. Expert Rev Pharmacoecon Outcomes Res 2018; 18:415-421. [PMID: 29781758 DOI: 10.1080/14737167.2018.1478291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM To give an overview of the pharmaceutical policy in the largest medical center in Morocco, a developing country in socio-economic transition. METHODS This is an analytical descriptive study of the drug formulary and the purchasing process carried out at the Ibn Sina University Medical Center. RESULTS Our formulary included 830 drugs belonging to 14 classes according to the Anatomical, Therapeutic and Chemical (ATC) Classification System. There was a respective predominance of class N (21.8%), class B (13.5%), and class J (12.6%). Injectable route was dominant (46%). Drugs had a significant actual benefit in 70% (according to the French Data), reimbursable in 42.8%, essential in 29.2% according to World Health Organization (WHO) list, and in 36.9% according to the Moroccan list. The calls for tenders included 542 drugs representing 65% of the formulary, and the attribution rate was 71%. The main reason for non-attribution was the lack of offers. Generics accounted for 45% by volume and 26.5% by value. CONCLUSION With this first study, we were able to identify key indicators on drugs used in the largest medical center in Morocco. The current challenge is to introduce pharmacoeconomics in decision making concerning the updates of the drug formulary.
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Affiliation(s)
- Z Lachhab
- a Pharmacoeconomics and pharmacoepidemiology Research team. Faculty of Medicine and Pharmacy , Mohammed V University , Rabat , Morocco
| | - S Serragui
- a Pharmacoeconomics and pharmacoepidemiology Research team. Faculty of Medicine and Pharmacy , Mohammed V University , Rabat , Morocco
| | - M Hassar
- a Pharmacoeconomics and pharmacoepidemiology Research team. Faculty of Medicine and Pharmacy , Mohammed V University , Rabat , Morocco
| | - Y Cherrah
- a Pharmacoeconomics and pharmacoepidemiology Research team. Faculty of Medicine and Pharmacy , Mohammed V University , Rabat , Morocco
| | - A Errougani
- b Direction of Ibn Sina , University Medical Center , Rabat , Morocco
| | - S Ahid
- a Pharmacoeconomics and pharmacoepidemiology Research team. Faculty of Medicine and Pharmacy , Mohammed V University , Rabat , Morocco
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Lima-Dellamora EDC, Caetano R, Gustafsson LL, Godman BB, Patterson K, Osorio-de-Castro CGS. An analytical framework for assessing drug and therapeutics committee structure and work processes in tertiary Brazilian hospitals. Basic Clin Pharmacol Toxicol 2014; 115:268-76. [PMID: 24528496 DOI: 10.1111/bcpt.12215] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/03/2014] [Indexed: 12/25/2022]
Abstract
University teaching hospitals usually provide tertiary care and are subject to early adoption of new technologies, which may compromise healthcare systems when uncritically adopted. Knowledge on the decision-making process - drug selection by drug selection committees or DTCs - is crucial to improve the quality of care. There are no models for studying the selection of drugs in Brazilian healthcare services. This study aims to discuss DTC structure and the processes regarding adoption of medicines in tertiary university hospitals in Brazil and to propose an analytical structure for providing direction for the future. State of the art content regarding drug selection processes and DTC procedures was reviewed in three databases. Information on the medicine selection process in a Brazilian gold standard teaching hospital was collected through observations and a review of existing procedures. A structured discussion on medicine selection and DTC procedures in tertiary hospitals ensued. This discussion resulted in findings that were organized in three dimensions, composing an analytical framework for the application in tertiary Brazilian hospitals (i) motivations for the adoption of drugs; (ii) necessary structural and organizational aspects for decision-making; and (iii) criteria and methods employed by the decision-making process. We believe that the suggested framework is compatible with tertiary Brazilian hospitals, because a gold standard in the country was able to conduct all its procedures in the light of WHO and international recommendations. We hope to contribute in producing knowledge which may hopefully be adopted in tertiary hospitals across Brazil.
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Affiliation(s)
- Elisangela da Costa Lima-Dellamora
- School of Pharmacy, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Sergio Arouca National School of Public Health, Post-Graduate Program -Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Sharma S, Gupta M. Drug Cost Containment. JOURNAL OF HEALTH MANAGEMENT 2013. [DOI: 10.1177/0972063413516222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the absence of a well implemented Drug Policy, paucities in access, affordability, efficiency, quality and effectiveness of health services and limited resources continue to handicap the functioning of the health system. Higher accessibility and quality is taken to be synonymous with higher costs. The main objective of the study was to study the impact of a drug policy on availability of essential drugs and cost containment in a tertiary care hospital from 1996 through 2007. The interventions consisted of selection of list of essential drugs and procurement through centralized pooled system in 1996–1997, followed by setting up of Drugs & Therapeutic Committee (1997). Average drug expenditure increased slightly from 3.63 per cent to 5.16 per cent while there was 6-fold rise in hospital patient attendance. Drug expenditure reduced by 47 per cent, without any compromise on key drug availability which increased to 94.6 per cent. Despite high expenditure on key drugs (75.89 per cent) mean availability was 67.48 per cent but after intervention with the same expenditure (77.68 per cent) it increased to 95.28 per cent. Number of drugs out-of-stock decreased from 27.57 per cent to 19.57 per cent of minor duration only and no stock out of vital drugs. ABC analysis revealed 3.33 drugs only in category A consuming 74 per cent budget which increased markedly to 9.63 drugs consuming 79.53 per cent budget after intervention along with reversal of previous trend of non-essential among top 10 drugs where only vital drugs represented top 10 drugs. The present study showed cost-containment accompanied by increased availability of essential drugs is possible and optimizes the value of limited government funds and thereby empower and support government in making basic medicines available to all. Managerial interventions such as limited list of essential drugs, efficient procurement, through Drugs and Therapeutic Committee (DTCs) have a vital role in improving day-to-day care of patients and can serve as an effective strategy in curtailing inappropriate drug use, reducing drug expenditures and serve to increased availability and accessibility to essential medicines thus optimizing the value of limited government funds.
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Tan EL, Day RO, Brien JAE. Prioritising drug and therapeutics committee (DTC) decisions: a national survey. ACTA ACUST UNITED AC 2006; 29:90-6. [PMID: 17187221 DOI: 10.1007/s11096-006-9074-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Accepted: 11/01/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A national survey was conducted to explore stakeholder opinions about: (1) the domains of activity and criteria used to determine "important" decisions; (2) the "importance" of Drug and Therapeutics Committee (DTC) decisions as an appropriate approach for prioritising implementation and actions and (3) how DTC decisions could be prioritised for action. SETTING This is a study of DTCs conducted in the Australian health care setting. METHODS A semi-structured questionnaire was sent to Directors of Pharmacies or Chief Pharmacists in Australian hospitals. Questionnaires could be returned by email or by fax. Two weeks after initial mail-out, non-responders were followed-up. Responses were collated and analysed using descriptive statistics. Free-text responses were collated. QSR NVivo was used as a data management tool. RESULTS The response rate was 61%. All respondents indicated that "patient safety" was a domain of importance for a decision. Other domains of important DTC decisions include: "ensuring the practice of evidence based medicine within their institution" (94%), "cost" (93%), "ensure practice according to legislative requirements" (87%). Most respondents agreed that some DTC decisions were more important than others. Given constraints on time and resources, the majority agreed that DTC decisions should be prioritised for implementation, although most had no suggestions about how this could be done. Some suggested that the domains of importance could be the basis for priority assignment. CONCLUSION Currently DTC decisions and policies are implemented in an ad hoc manner. As a result implementation may be incomplete and ineffective, and may pose a risk of serious consequences in patient care. This study identifies the domains or criteria of DTC decisions so that DTCs may allocate scarce resources to the systematic implementation of important decisions.
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Affiliation(s)
- Ee Lyn Tan
- Therapeutics Centre, St Vincent's Hospital, Sydney, NSW, Australia.
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Tordoff JM, Norris PT, Kennedy JM, Reith DM. Processes for the Assessment and Introduction of New Medicines in New Zealand Hospitals. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2004. [DOI: 10.1002/jppr2004344267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Zaidenstein R, Eyal S, Efrati S, Akivison L, Michowitz MK, Nagornov V, Golik A. Adverse drug events in hospitalized patients treated with cardiovascular drugs and anticoagulants. Pharmacoepidemiol Drug Saf 2002; 11:235-8. [PMID: 12051123 DOI: 10.1002/pds.693] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE To evaluate the incidence of serious adverse drug events (ADEs) caused by cardiovascular drugs during hospitalization in a department of internal medicine, and to identify patients at highest risk. PATIENTS AND METHODS All the patients treated with cardiovascular drugs and/or anticoagulants in the department between November 1999 and January 2000 were recruited into the study. During hospitalization the patients' charts were reviewed by a pharmacist and a clinician, and the occurrence of serious ADEs was assessed using the Naranjo algorithm. 'Possible' and 'doubtful' ADEs were not counted. RESULTS Of 496 patients who were enrolled in the study, 20 (4%) had serious ADEs. Compared to patients without ADEs, patients in the ADE group were older (72 +/- 12.6 years (mean +/- SD) vs. 65 +/- 13 years, p = 0.048), their average stay in hospital was longer (7.3 +/- 5.5 days vs. 5.2 +/- 3.7 days, p = 0.018) and their mean urea levels were higher (10.8 +/- 9.3 mmol/l vs. 7.8 +/- 5.3 mmol/l, p = 0.027). The most frequent background pathologies of the 20 patients with ADEs were hypertension (in 18 (90%)) and atrial fibrillation (in nine (45%)). In 50% of the the ADE group there was a history of drug allergies. The ADEs recorded were bleeding in four (20%), arrhythmias in six (30%), orthostatic hypotension in six (30%) and skin necrosis, paranoid reaction, acute hepatitis and acute renal failure in four (20%). The causative drugs were warfarin (which accounted for 25% of the ADEs), beta-blockers (15%), propafenone (5%), amiodarone (5%), and Ca(2+)-channel blockers, nitrates and diuretics (together accounting for 50% of ADEs). Drug combinations were implicated in 50% of ADE. CONCLUSIONS Serious ADEs were developed by 4% of hospitalized patients taking cardiovascular drugs. Those at highest risk were older, were receiving multiple drug therapy and had higher urea levels. Warfarin and beta-blockers were the drugs causing the largest number of adverse effects. ADEs are an important cause of preventable morbidity, often with serious economic implications and special attention should be given to their prevention.
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Affiliation(s)
- R Zaidenstein
- Department of Internal Medicine A, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, 70300 Zerifin, Israel.
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Portelli R, Collopy B, Desmond P. Addressing adverse events through clinical indicators. JOURNAL OF QUALITY IN CLINICAL PRACTICE 1999; 19:79-83. [PMID: 10408746 DOI: 10.1046/j.1440-1762.1999.00294.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In an attempt to improve the reporting rate of adverse drug reactions the Adverse Drug Reaction Advisory Committee approached the Australian Council on Healthcare Standards Care Evaluation Program to develop a set of indicators to improve healthcare standards by heightening awareness amongst clinical staff of the morbidity, mortality and financial implications of adverse drug reactions. Ten clinical indicators addressing: (i) reporting of adverse drug reactions; (ii) adherence to treatment protocols for anaphylaxis; (iii) monitoring of warfarin; and (iv) monitoring of streptokinase, were field tested in ten Australian health-care organizations, to determine that the data were available, that the indicators were relevant to clinical practice and that the measures were achievable. Based on the results of this field test, six adverse drug reaction clinical indicators will be introduced into the Australian Council on Healthcare Standards Evaluation and Quality Improvement Program from January 1999.
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Affiliation(s)
- R Portelli
- Australian Council on Healthcare Standards Care Evaluation Program, Aikenhead Centre, Fitzroy, Vic
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