Optimization of Health Transformation Plan by Drug Utilization Review Strategy in a Pediatric Teaching Hospital

Health transformation planwas implemented in 2014 in Iran with the aim of reducing healthcare expenditures. Transformation plans always have a financial impact on healthcare expenditures because of potential to increase the utilization. Drug utilization review is one of the effective solutions to explore consumption and improve rational use. This study aimed to evaluate the medicine utilization after health transformation with implementation of an evidence-based protocol in a tertiary hospital.  

This is a before-after study which was conducted in a tertiary children’s hospital with 400 beds in Iran. At first, costly medications were identified by ABC analysis in drug and therapeutic committee meetings of the hospital. Increased use of these medications was measured after the implementation of the health transformation plan. Then, the pattern of prescription, its appropriateness and impact of protocol implementation on the health expenditures reduction and rational use was evaluated.  

Initial estimation of the usage showed that before protocol implementation, in six-month, albumin, pantoprazole, and Apotel® increased by 31.9%, 22.6%, and 21.9%, respectively following the health transformation plan. Medical records of 6,554 patients were evaluated for target medications. The frequency of inappropriate prescription reduced significantly from the first to the second phase for albumin (65.5%-35.8%, P=0.001), pantoprazole (58.9%-22%, p <0.001), and Apotel® (66%-17%, p <0.001), respectively. Health expenditures also reduced significantly for albumin (P=0.003), pantoprazole (P=0.001) and acetaminophen (p <0.001), respectively. 

 Conclusion:

  Timely implementation of medication prescription protocols can provide health benefits to patients and cost savings to the health service provider that could lead the health transformation plan to reach the aim of reduction in health expenditures with rational use.