A Drug Utilization Evaluation of Antihyperlipidemic Agents -

• Main Authors: Tu, Shu-Ching, 杜書卿
• Other Authors: Kin-Wei Arnold Chan, Yea-Huei K. Yang
• Format: Others
• Language: zh-TW
• Published: 1996
• Online Access: http://ndltd.ncl.edu.tw/handle/99061572329758472154

碩士 === 國立成功大學 === 臨床藥學研究所 === 84 === Background ?Due to an increase in the elderly population and change of dietary habit, the incidence of coronary heart disease has increased in the past decade. Cholesterol reduction is generally accepted as an effective way to prevent coronary heart disease. The treatment for hyperlipidemia should undergo in a specific procedure, medical management and patients'' compliance both affect the therapeutic outcome. We conducted a prospective drug utilization evaluation program focusing on four antihyperlipidemic agents (Gemfibrozil, Lovastatin, Pravastatin and Acipimox) to compare prescribing patterns between two groups before and after intervention. We also explore the patients'' behavior through telephone interviewing.Method ?We developed the Antihyperlipidemic Agent Usage Guideline and announced the guideline to physician in National Cheng-Kung University Hospital by the Pharmacy Forum. We selected the new users who never took antihyperlipidemic agents and were prescribed antihyperlipidemic agents during 1994/10/1 to 1994/12/31 as pre- intervention subjects. After the intervention phase, patients who were new users during 1995/10/1 to 1995/12/31 become the post-intervention subjects. Two groups of patients were followed up for six and four months, respectively. Patients'' data obtained from medical charts and telephone interview. Results ? After medical chart review and telephone interview, there were 128 and 192 subjects in each groups (age range from 11 to 82 years). No significant response to the intervention was noted between two groups in ll aspects. There were 10.2% versus 14.1% complied with the indications of the Guideline, p=0.30. Although, the patient number without baseline lipid profile significantly decreased (p=0.031), most of the cases had only one lipid profile before prescribing. Only 2 cases (1.6%) and 4 cases (2.1%) pre- and post- intervention were completely met with the Guideline requirement for baseline measurement. Significant deterioration in checking LDL-D and HDL-C was also noted. The dosage of gemfibrozil and acipimox were found to be lower than general recommendation. Sixty-three and ninety-two patients discontinued the drug less than three months, and they spent NT 67,640 dollars and NT 134,436 dollars for the medication., about 20.5% and 25.1% of total costs. Only 40-50% of patients took medicine as ordered, and 59.4% and 66.1% kept with the nonpharmacologic therapy after taking medicine. Discontinuation rates in four months were 43.8% and 39.1% in each group. There were respectively 57.1% and 65.3% withdrew by patients; most of them discontinued due to stopping visiting, 18.8% and 18.4% because of adverse effects. Overall, there are 6 patients (4.7%) and 13 patients (6.8%) who suffered adverse drug reactions in each group.Conclusion ?An announcement of the Guideline by medium may not be effective on changing physicians'' prescribing behavior. To promote the appropriate use of antihyperlipidemic agents clinically and save medical cost, a more compulsory program may be necessary. rease in the elderly population and change of dietary