Fynn Akhona, Helberg Elvera, Godman Brian, Meyer Johanna C
Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University , Ga-Rankuwa, South Africa.
KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.
Hosp Pract (1995). 2020 Mar 14;48(2):92-99. doi: 10.1080/21548331.2020.1724454. Epub 2020 Mar 11.
Drug utilization reviews (DURs) can be used to promote rational prescribing and ensure compliance with standard treatment guidelines. In recent years, the use of tramadol hydrochloride (HCl) for pain has increased significantly across countries. We sought to determine prescribing patterns and the use of tramadol in a regional hospital in South Africa to provide future guidance in view of increasing concerns with the prescribing of tramadol.
A prospective, quantitative and descriptive study was conducted over two months. Outpatient and inpatient prescriptions and ward requisitions where tramadol HCl was prescribed or ordered were identified, which included outpatients collecting antiretroviral treatment. Prescriptions were reviewed and evaluated to determine the level of compliance to the Standard Treatment Guidelines and Essential Medicines List (STGs/EML) for South Africa as a measure of rational prescribing. Quantities issued to the inpatient wards and expenditure incurred by the pharmacy departments were assessed to determine overall usage and total costs.
In total, 415 tramadol HCl prescriptions were collected over a 2-month period. Compliance was 70.1% to the STGs/EML. The outpatient pharmacy department had the highest compliance at 76.4% while the antiretroviral pharmacy compliance was 29.1%. Most prescriptions dispensed at the outpatient pharmacy were from the Surgical Outpatient Department (140; 33.7%) and the Orthopedic Outpatient Department (108; 26.0%). The outpatient pharmacy had the highest tramadol HCl consumption and expenditure at $4,874.13 (R72,054.28), while the inpatient pharmacy's expenditure was $2,526.63 (R37,351.20), and the antiretroviral pharmacy $590.13 (R8,722.75). The hospital's tramadol HCl expenditure increased when compared to previous financial years, from $10,576.04 (R156,326.00) in 2014-2015 to $39,584.00 (R585,088.80) in 2016-2017.
This study highlights the need for the implementation of monitoring and evaluation tools to enhance rational prescribing and use of tramadol HCl. These are being implemented and will be evaluated in future projects.
药物利用评估（DURs）可用于促进合理用药并确保遵循标准治疗指南。近年来，各国使用盐酸曲马多治疗疼痛的情况显著增加。鉴于对曲马多处方的担忧日益增加，我们试图确定南非一家地区医院的曲马多处方模式及使用情况，以便为未来提供指导。
进行了一项为期两个月的前瞻性、定量和描述性研究。确定了开具或订购盐酸曲马多的门诊和住院处方及病房申请单，其中包括领取抗逆转录病毒治疗药物的门诊患者。对处方进行审查和评估，以确定对南非标准治疗指南和基本药物清单（STGs/EML）的遵循程度，作为合理用药的一项衡量指标。评估了发放到住院病房的数量以及药房部门的支出，以确定总体使用情况和总成本。
在两个月的时间里，共收集到415份盐酸曲马多处方。对STGs/EML的遵循率为70.1%。门诊药房的遵循率最高，为76.4%，而抗逆转录病毒药房的遵循率为29.1%。门诊药房发放的大多数处方来自外科门诊（140份；33.7%）和骨科门诊（108份；26.0%）。门诊药房的盐酸曲马多消耗量和支出最高，为4,874.13美元（72,054.28兰特），而住院药房的支出为2,526.63美元（37,351.20兰特），抗逆转录病毒药房为590.13美元（8,722.75兰特）。与前几个财政年度相比，该医院的盐酸曲马多支出有所增加，从2014 - 2015年的10,576.04美元（156,326.00兰特）增至2016 - 2017年的39,584.00美元（585,088.80兰特）。
本研究强调需要实施监测和评估工具，以加强盐酸曲马多的合理处方和使用。目前正在实施这些工具，并将在未来项目中进行评估。
