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# OUTCOME MEASURES & DRUG USE MEASURE.pptx

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# OUTCOME MEASURES & DRUG USE MEASURE.pptx

Outcome measures and drug use measures.

Outcome measures and drug use measures.

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### OUTCOME MEASURES & DRUG USE MEASURE.pptx

1. 1. OUTCOME MEASURES & DRUG USE MEASURE BY: ASIYA NAAZ PHARM.D 5TH YEAR
2. 2. INTRODUCTION  Epidemiology is about identifying association between exposure and outcomes.  To identify any associations, exposure and outcomes must first be measured in quantitative manner.  In treatments & healthcare programs, outcomes are the results of treatment or care, which includes both positive and negative results.  Outcome measurement: It is defined as the systematic quantitative analysis of the outcome indicator at a point of time.  Outcome indicator: measures performance of function process and outcomes over a period of time.
3. 3. 2 APPROACHES  These measures are used to find out whether the goal of the patient, are identified and achieved. Measurement of outcome can be done by two approaches: 1. STATISTICAL METHOD PREVALENCE INCIDENCE CUMULATIVE INCIDENCE INCIDENCE RATE/ INCIDENCE DENSITY
4. 4. PREVALANCE  It is the proportion of people affected with a disease or exposure to a particular drug in a population at a “specific point or period of time”.  Usually determined by surveying the population of interest.  Prevalence varies between 0-1; can be expressed as percentage.  It is a census type of measure, indicating how frequently a disease is at a period of time.  Estimate the magnitude of health.  To identify the potential high risk population community.  Mathematically, Prevalence=A/B  A= no. of population with disease at given time.  B=Total no. of population at a given time.  Ex. If there are 1000 pts with epilepsy in a district of 10,00,000 population.Then prevalence of epilepsy= 1000/10,00,000=0.001%
5. 5. INCIDENCE  Definition: It is a measure of risk of developing some “new condition” within a specific period of time.  In the case of descriptive studies 2 measurements of incidents are commonly use:  1. Cumulative incidence  It is a no. of new cases within a specific period of time, divided by the size of population initially at risk.  It is used for the measure of the risk of disease or probably probability of developing the disease during specified period.  Normally it is measured with an inception cohort i.e. a large group of population is observed over a period of time, and the no.of cases or outcomes is measured.
6. 6. INCIDENCE RATE  C.I = No.of new cases of disease or injury during specified period size of population at start of period Ex: If a population initially contains 1000 non disease persons & 28 develop a condition over two years of observation, the incidence proportion is 28 cases per 1000 persons. Incidence rate: It is a no.of new cases per population at risk in a given period of time.  Describes the probability of a new case occurring during a given time interval or how quickly disease occurs in a population.  Measurement combining the no.of persons and their time contribution (years, months or weekly) in a study.  IR= no.of new cases of disease or injury during specified period  total time each person was observed (totaled for all persons)
7. 7. 2. DRUGUSE MEASURES RELATIONSHIP BETWEEN PREVALENCE & INCIDENCE  P = I X D; D = duration  It shows, longer the duration of the disease, greater the prevalence. DRUG USE MEASURES 1. MONETARY UNITS 2. NUMBER OF PRESCRIPTIONS 3. UNITS OF DRUGS DISPENSED 4. DEFINED DAILY DOSES (DDD) 5. PRESCRIBE DAILY DOSE (PDD) 6. MEDICAL ADHERENCE MEASUREMENT
8. 8. 1. MONETARY UNITS 2. NO.OF PRESCRIPTION 1. Drug use has been measured in monetary units to quantify the amounts being consumed by population.  It can indicate the burden on society from drug use.  Monetary units are convenient and can be converted to a common unit, which then allows for comparison.  The disadvantage is quantifies of drug actually consumed, are not known and prices may vary widely. 2. It has been used in research, due to the availability and ease.  Prescription number analysis is used to get rough estimates like percentage of analgesic drugs, oral contraceptives or antibiotics used by population.
9. 9. 3. UNITSOF DRUG DISPENSED  Units of drugs represent measures like no. of capsules or tablets or doses of vaccines.  It is easy to obtain and can be used to compare usage trends within population.  Helps to analyze drug use trend in various countries.  Helps to compare hypothesis generated related to drug use, like overuse or under use.  It has limilations like units of drugs dispensed need not always reflect the actual number of drugs used by the population.  Hence, difficult to determine the actual no. of pts exposed to the drug.
10. 10. 4. DEFINED DAILY DOSES (DDD)  According toWHO, the DDD is assumed avg maintenance dose per day for a drug for its main indications in adults.  Normally expressed as DDD/1000 pts/day or DDD/100 bed/day.  Drug usage = item used amount of drug per item DDD Ex:A pt has taken paracetamol as painkiller. It is having DDD= 3g i.e. avg pt who uses paracetamol uses 3g in a day or within period of 24hrs. This is equivalent tp 6 standard tablets of 500mg each. If pt consumes 24 such tablets. DDD = 24 X 500 / 3 DDD = 4
11. 11. 5. PRESCRIBE DAILY DOSE (PDD) 6. MEDICAL ADHERENCE MEASUREMENTS 5. It is the avg daily dose of a drug that has actually been prescribed.  Calculated from representative samples of prescription.  PDD is useful for validating that DDD. 6. Consist of :  Biological assays  Pill counts  Weight of topical medications  Electronic monitoring  Patient interviews
12. 12. 1. Biological assays 2. Pill counts  1. biological assays measure the conc.Of a drug, its metabolites, or tracer compounds in blood or urine of a patient.  Drug or food interaction, physiological differences, dosing schedules and the half life of the drugs may influence the results.  All these methods have high costs for assays that limit the feasibility of these techniques.  2. counting the no. of pills remaining in a pts supply and calculating the no. of pills that the pt has taken since filling the prescription is easiest method for calculating patient medication adherence.  Patterns of non-adherence are often difficult to discern with a simple count of pills on certain date weeks to months afer prescription was filled.
13. 13. 3.Weight of topical medications 4. Electronic monitoring  3. the weight of a topical medication remaining in a tube is used as a measure of adherence.  When compared with patient log books of daily medication use, weight estimates of adherence were considerably lower than patient log estimates.  4. the medication event monitoring system MEMS manufactured by Aardex Corporation allows the assessment of the number of pills missed during a period as well as adherence to dosing schedule.  The system electronically monitors when the pill bottle is opened, and the researcher can download the information to a computer.  The availability and cost of this system could limit the feasibility of its use.
14. 14. 5. Patient interviews 5. Interviewing the patients to assess their knowledge of the medication they have been prescribed and the dosing schedule provide information as to whether the patient is adherent with the actual dosing schedule.
15. 15. THANK YOU