There has been an increase of anti-ulcer drug consumption in Spain. A high proportion of this consumption may be due to the use of those drugs as gastroprotective agents when co-prescribed with nonsteroidal anti-inflammatory drugs (NSAIDs). The aim of this study was to learn how these treatments are being used: the prevalence of use, the type of drug and the main features of patients. A sample of patients going to pharmacies with a NSAID prescription, with or without a gastroprotective agent, was obtained. A survey questionnaire was distributed to learn clinical and demographic data of the patients. Of the 942 patients interviewed, 41.6% were co-treated with a gastroprotective agent in addition to the NSAID. Most of these patients received proton-pump inhibitors and, to a lesser extent, histamine-2-receptor antagonists, antacids and prostaglandin analogues. The use of gastroprotective agents increased with age, treatment duration and illness chronicity; specialists prescribed a higher proportion of those co-treatments than did general practitioners. There was a high prescription rate of gastroprotective agents; in general, these were used according to recommendations. However, the type of gastroprotective agents being used does not seem to be justified by the current guidelines: histamine-2-receptor antagonists and antacid drugs have not proved their efficacy in this indication. The fact that one in four treatments with gastroprotective drugs was issued to patients without associated risk factors identifies a possible problem where an intervention could be appropriate.
Background
Our 450-bed general hospital had a unit dose dispensing system in 100% of inpatient wards until July 2010, when an automated dispensing system (ADS) incorporating most of the medicines was introduced in the Large Burns Unit (LBU).
Purpose
To quantify the variation in drug expenses allocated per patient after introduction of an ADS in the LBU and to identify the products mainly affected by this change. Materials and Methods To quantify the variation in the expenses allocated, The authors compared two equal periods of four months, before the introduction of the ADS (September-December 2009) and four months after (September-December 2010). The authors used the average book price to calculate the cost of the Unit, by adding the cost of stock replenishment and unit dose medicines dispensed in the case of the first period and extracted from the ADS in the case of the second period.
Results
In the period prior to ADS implementation, Unit expenses were 53,037 euros of which 45.43% were allocated to the patient. After ADS implementation, the Unit cost 50,732 euros to run, of which 73.33% were allocated per patient. Of the 68 products that went from dispensing stock to ADS, the ones that mainly affected the change in the medicines expense allocation per patient were: sulfadiazine (47.5%), midazolam (8.5%) atracurium (5.8%), propofol (5.5%) and ketamine (4.3%).
Conclusions
The medicines that mainly affected the change in the allocation of medicines belong to the D06, N05, M03 and N01 ATC classification groups in financial terms:, these were traditionally dispensed by replenishing stock. This has represented a significant reduction in the Unit stock. The ADS improve the allocation per patient of medicines expenses, including special units with prior unit dose dispensing, which enables the pharmacist to increase the level of knowledge about drug use in the Unit.
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