To compare the appropriateness of omeprazole prescriptions in a concurrent drug
utilization review (DUR) with the assessed appropriateness of a retrospective
DUR.
Methods:
A retrospective DUR of omeprazole was conducted on prescriptions written from
August 23, 1993, to October 8, 1993, in a 340-bed university hospital. This DUR
served as a baseline for a concurrent DUR that began on January 27, 1995, and
ended on March 16, 1995. The concurrent DUR integrated three steps aimed at
improving the quality of omeprazole use: Approval of the criteria by the
pharmacology and therapeutics committee of the hospital, distribution of a drug
bulletin to all physicians, and a pharmacist's verbal recommendations to
physicians whose prescriptions did not meet explicit criteria.
Results:
Twenty-nine and 64 prescriptions were reviewed in the retrospective and concurrent
DURs, respectively. During the concurrent DUR, the pharmacist made 34 verbal
recommendations. Of these, 25 (74%) were agreed to by the prescribers. In
comparison with the retrospective DUR, the percentage of prescriptions meeting the
criteria of indication, combination therapy, and dosage went from 38% to 75% (p
< 0.05), from 76% to 95% (p < 0.05), and from 83% to 100% (p > 0.05),
respectively, during the concurrent DUR.
Conclusions:
The concurrent DUR appeared to successfully improve the quality of omeprazole
utilization in the hospital.
Get full access to this article
View all access options for this article.
References
1.
EinarsonTRSegalHJMannJL. Drug utilization in Canada. J
Soc Adm Pharm1989; 6:
69–82.
2.
SoumeraiSBAvornJ. Efficacy and cost-containment in hospital
pharmacotherapy: State of the art and future directions.
Milbank Q1984; 62:
447–75.
3.
JohnsonJABootmanJL. Drug-related morbidity and mortality: A
cost-of-illness model. Arch Intern Med1995; 155:
1949–56.
4.
BlackburnJL. Impact of drug usage review on drug
utilization. Pharmacoeconomics1993; 3:
14–21.
5.
Réseau de Revue d'Utilisation des Médicaments.
L'ABC de la revue d'utilisation des médicaments.
Montréal: Réseau de Revue
d'Utilisation des Médicaments,
1992.
6.
BourbeauKGervaisM. Le programme “revue d'utilisation des
médicaments.”Can J Hosp Pharm1986; 39:
53–6.
7.
StrongDKDomaratzkiJL. Pharmacist intervention in prescribing of cefuroxime
for pediatric patients. Am J Hosp Pharm1990; 47:
1350–3.
8.
Réseau de Revue d'Utilisation des Médicaments.
Revue d'utilisation de l'oméprazole, rapport individuel-Hôpital
Laval. Montréal: Réseau de
Revue d'Utilisation des Médicaments,
1994.
9.
Oméprazole. La Lettre Médicale1990; 13:
107–9.
10.
MalonPN. Omeprazole. N Engl J
Med1991; 324:
965–75.
11.
McTawishDBuckleyMMTHeelRC. Omeprazole: An update of its pharmacology and
therapeutic use in acid related disorders. Drugs1991; 42:
138–70.
12.
McQuaidKRIsengergJI. Medical therapy of peptic ulcer
disease. Surg Clin North Am1992; 12:
285–316.
13.
RubinW. Medical treatment of peptic ulcer
disease. Med Clin North Am1991; 75:
981–98.
14.
BardhanKD. Omeprazole in the management of refractory duodenal
ulcer. Scand J Gastroenterol1989; 24 (suppl
166):63–73.
15.
BardhanKDNaesdalJPorroG BianchiPetrilloMLazzaroniMHinchliffeRF, Treatment of refractory peptic ulcer with omeprazole
or continued H2-receptor antagonists: A controlled clinical
trial. Gut1991; 32:
435–8.
16.
PenJHMichielsenPPPelckmansPAVan MaerckeYM. Omeprazole in the treatment of
H2-resistant gastroduodenal ulcers (abstract).
Gastroenterology1988; 94 (Part 2):
A348.
MeuwissenSGKlinkenberg-KnolEC. Management of gastro-oesophageal reflux disease: Are
there alternatives to omeprazole?Digestion1989; 44 (suppl
1):54–62.
SandmarkSCarlssonRFausaOLundellL. Omeprazole or ranitidine in the treatment of reflux
oesophagitis: Results of a double-blind, randomized, Scandinavian multicenter
study. Scand J Gastroenterol1988; 23:
625–32.
21.
BateCMKeelingPWO'MorainCWilkinsonSPFosterDNMountfordRA, Comparison of omeprazole and Cimetidine in reflux
oesophagitis: Symptomatic, endoscopic and histological
evaluations. Gut1990; 31:
968–72.
22.
AdamsMHOstroskyJDKirkwoodCF. Therapeutic evaluation of omeprazole.
Clin Pharm1988; 7:
725–45.
23.
HowardJM. Omeprazole in the treatment of gastroesophageal
reflux disease. Can J Gastroenterol1989; 3 (suppl
A):62A–6A.
24.
SantagSJ. The medical management of reflux oesophagitis: Role
of antacid and acid inhibition. Gastroenterol Clin North
Am1990; 19:
683–712.
25.
Klinkenberg-KnolECMeuwissenSG. Treatment of reflux oesophagitis resistant to
H2-receptor antagonists. Digestion1989; 44 (suppl
1):47–53.
26.
BardhanKDMorrisPThompsonMDhandeDSHinchliffeRFJonesRB, Omeprazole in the treatment of erosive oesophagitis
refractory to high dose Cimetidine and ranitidine.
Gut1990; 31:
745–9.
27.
Klinkenberg-KnolECJansenJBJMde BruyveJW. Long-term efficacy and safety of omeprazole in
healing and prevention of patients with reflux oesophagitis
(abstract). Gastroenterology1988; 9 (part
2):A230.
28.
DentJKlinkenberg-KnolECElmGErikssonKRiknerLSölvellL. Omeprazole in the long-term management of patients
with reflux oesophagitis refractory to histamine H2-receptor
antagonists (abstract). Scand J Gastroenterol1989; 24 (suppl
166):176.
29.
Klinkenberg-KnolECJansenJBLamersCBNelisFSnelPMeuwissenSG. Use of omeprazole in the management of reflux
oesophagitis resistant to H2-receptor antagonists.
Scand J Gastroenterol1989; 24 (suppl
166):88–93.
30.
LundellLBackmanLEkströmPEnanderLKFalkmerSFausaO, Prevention of relapse of reflux oesophagitis after
endoscopic healing: The efficacy and safety of omeprazole compared with
ranitidine. Scand J Gastroenterol1991; 26:
248–56.
31.
KoopHHotzJPommerGKleinMArnoldR. Prospective evaluation of omeprazole treatment in
reflux oesophagitis refractory to H2-receptor
antagonists. Aliment Pharmacol Ther1990; 4:
593–9.
32.
LampkinTAOuelletDHakLJDukesGE. Omeprazole: A novel anti-secretory agent for the
treatment of acid-peptic disorders. DICP Ann
Pharmacother1990; 24:
393–402.
33.
Lloyd-DaviesKARutgerssonKSölvellL. Omeprazole in the treatment of Zollinger-Ellison
syndrome: A 4 year international study. Aliment Pharmacol
Ther1988; 2:
13–22.
34.
FruchtHMatonPNJensenRT. Use of omeprazole in patients with Zollinger-Ellison
syndrome. Dig Dis Sci1991; 36:
394–404.
35.
MatonPNVinayekRFruchtHMcArthurKAMillerLSSaeedZA. Long-term efficacy and safety of omeprazole in
patients with Zollinger-Ellison syndrome: A prospective study.
Gastroenterology1989; 97:
827–36.
36.
HirschowitzBIDerenJRaufmanJPLaMontBBermanRHumphriesT. A multicenter US study of omeprazole treatment of
Zollinger-Ellison syndrome (ZES) (abstract).
Gastroenterology1988; 94 (5 part
2):A188.
37.
National Institutes of Health. Helicobacter pylori in peptic ulcer disease: NIH consensus
conference. JAMA1994; 272:
65–9.
38.
PeuraDAGrahamDY. Helicobacter pylori: Consensus reached. Peptic ulcer is on the
way to becoming an historic disease. Am J
Gastroenterol1994; 89:
1137–9.
39.
van ZantenSJ VeldhuyzenShermanPM. Indications for treatment of Heliocbacter
pylori infection: A systematic overview. Can
Med Assoc J1994; 150:
189–98.
40.
HopkinsRJMorrisJG. Heliocbacter pylori: The missing link in
perspective. Am J Med1994; 97:
265–77.
41.
WildeMIMcTavishD. Omeprazole: An update of its pharmacology and
therapeutic use in acid-related disorders. Drugs1994; 48:
91–132.
42.
PorroG BianchiParenteF. Long-term treatment of duodenal ulcer: A review of
management options. Drugs1991; 4:
38–51.
43.
EarnestDL. Maintenance therapy in peptic ulcer
disease. Med Clin North Am1991; 75:
1013–38.
44.
JansenJBLamersCB. Omeprazole in the short-term treatment of reflux
oesophagitis. Digestion1989; 44 (suppl
1):40–6.
45.
HetzelDJDentJReedWDNarielvalaFMMackinnonMMcCarthyJH, Healing and relapse of severe peptic oesophagitis
after treatment with omeprazole. Gastroenterology1988; 95:
903–12.
46.
SölvellL. The clinical safety of omeprazole.
Scand J Gastroenterol1989; 24 (suppl
166):106–10.
47.
TatroDSOlinBRHebelSK. Drug interaction facts. St.
Louis: Facts and Comparisons,
Inc., 1992.
48.
SutfinTBalmerKBoströmHErikssonSHöglundPPaulsenO. Stereoselective interaction of omeprazole with
warfarine in healthy men. Ther Drug Monit1989; 11:
176–84.
49.
AndersonT. Omeprazole drug interaction studies.
Clin Pharmacokinet1991; 21:
195–212.
50.
BerbatisCGMäherMJPlumridgeRJStoelwinderJUZubrickSR. Impact of a drug bulletin on prescribing oral
analgesics in a teaching hospital. Am J Hosp
Pharm1982; 39:
98–100.
51.
MayFEStewartRBCluffLE. Drug use in the hospital: Evaluation of
determinants. Clin Pharm Ther1974; 16 (5 part
l):834–45.
