General medications utilization and cost patterns in hospitalized children

Abstract

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.ObjectivesThe 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.MethodsThe 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.ResultsThe 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).ConclusionsA 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.

How many medications do doctors in primary care use? An observational study of the DU90% indicator in primary care in England.

“…Unique medicines were identified using the first nine digits of the British National Formulary (BNF) code, which identifies each chemical substance. In line with previous studies which excluded products without a WHO Defined Daily Dose,[3, 15, 18] certain non-oral pharmaceutical products were excluded before analysis based on their BNF codes (see eTable 1). Medicines were arranged in descending order of total number of prescriptions for each medicine within a practice and the DU90% calculated represents the number of medicines where the cumulative sum of prescriptions is >90% of all prescriptions issued by the practice.…”

A population-based study of prescribing trends in a potentially vulnerable paediatric population from 1999 to 2012

“…In an aim to advance medication safety for children, an understanding of paediatric prescribing trends is required to identify the type and prevalence of medications prescribed, particularly those that are associated with high‐risk adverse events. To date, most studies on prescribing trends in children have focused on the inpatient setting or on specific drug categories, such as antipsychotics, antidepressants and medications used to treat attention‐deficit/hyperactivity disorder (ADHD) . These studies have revealed important changes in paediatric prescribing over time; however, most reflect a narrow examination of specific drug classes, producing a gap in understanding overall prescribing trends.…”