Post on 03-Feb-2015
description
Opportunities to enhance prescribing efficiency for patients
with diabetes in Abu Dhabi without compromising care
Dr Mohammed AbuelkhairHead, Pharma/Medicine & Medical Product
Regulation
The goal of the Pharmacovigilance and Rational Medicine Use program of at HAAD is to identify and promote optimal drug prescribing and use.
Strategies, tools, and services are provided to encourage the use of evidence-based clinical and cost-effectiveness information in decision making among health care providers, consumers and policy makers.
The aim of the audit was to analyze current treatment approaches among patients with Type 2 diabetes (T2DM) and compare with international standards. Secondly, assess the extent of different management approaches/prescribing pattern among different facilities.
GOALS AND OBJECTIVES
Audit of 561 random patients across 3 facilities treating T2DM patients over 1 year.
1 specialist diabetes center, 1 government (SKMC) diabetes center 1 independent private sector hospita
Data included extent of patient monitoring (BP, lipids, HbA1c, weight, renal function, etc.), oral glycemic drugs prescribed, whether these prescribed at maximal doses (NICE guidance) before insulins, whether insulin treatment delayed and insulin type.
METHODS
Prescribing High use of patent protected drugs including:
Expensive modified release medicines (e.g. metformin MR / gliclazide MR) versus generic standard release preparations
Gliptins including sitagliptin 50mg TWICE DAILY doseExpensive insulins such as insulin glargine
High use of glimepiride
Quality of care HbA1crecorded in(83% to100%) of all patients with diabetes Less than 50% of patients had a recorded HbA1c of < 7.5%
MAJOR FINDINGS
MAJOR FINDINGS
No of patients at each participating facility
Types of medical intervention used to control diabetes
MAJOR FINDINGS
HbA1c
Types of medical intervention used to control diabetes
MAJOR FINDINGS
Prescribing of agents to control hyperglycemia
Independent hospital (Private)
Government Hospital
Specialist Center
Metformin
39 %
85.5 %
87.6 %
Sulphonylurea
47 %
57.4 %
50.5 %
Glitazone
13 %
20.3 %
12.4 %
Prandial regulators
0 %
3.1 %
5.7 %
Gliptins
33%
64.5 %
61 %
Newer Agents (eg: Exanetide)
0 %
7.4 %
3.8 %
Older anti -hyperglycemic agents (eg:Acarbose)
2%
0.8 %
1.0 %
Trends in prescribing of oral anti-hyperglycemics.
MAJOR FINDINGS
Trends in prescribing of generics Trends in prescribing sitagliptin
MAJOR FINDINGS
Trends in prescribing Insulins
MAJOR FINDINGS
Trends in prescribing sulphonylureas
Gliclazide modified release preparations may be useful in patients who suffer with hypoglycaemia with standard release preparations. However the cost of the modified release tablets is significantly higher than standard tablets. In addition Glimepiride is significantly more expensive than Gliclazide
There is no strong evidence to suggest increased efficacy or lower incidence of side effects from Glimepiride use.
MAJOR FINDINGS AND CONCLUSIONS
We estimate costs could be reduced by approximately 30% through following international guidelines and reducing utilisation of expensive modified release preparations
Care could also improved by regular monitoring of HbA1c levels
Introduction of Pharmacy Benefit Management Systems should also help improve appropriate step wise care and reduce costs. In addition, increase INN prescribing, help monitor compliance, as well as monitor doses of drugs prescribed, e.g. statins