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Imipenem is an expensive broad-spectrum antimicrobial, reserved for infections caused by multi-resistant nosocomial pathogens. Since 2001 our university hospital applies a restriction policy that allows rejecting or authorizing its use after a supervising evaluation with pre-specified criteria for appropriate or inappropriate use. An audit was performed for all the supervisions made during the periods of March-April and September-October, 2004, totalling 136 treatments. In global terms, 58.1% of treatments were considered appropriate and 11.8% inappropriate; other 20.6% had been discontinued by physicians in charge prior to evaluation. Susceptibility to other antimicrobials compounds was the main reason for inappropriate use. The remaining fraction involved deceased or discharged patients. Discontinuation of treatments by supervising physicians allowed to save 75 days and 362 vials of imipenem equivalent to US $ 6,777 during this period after discounting administrative and human resources costs.

Objective: To validate the GRDOSIS software program as a tool to calculate Spanish drug weights within diagnosis-related groups (DRGs), and to analyse information used in this calculation., Material and Methods: Information corresponding to a 7-hospital sample is analysed after exchanging data between the minimum basic data set processed by the DRG-grouping program Estación Clínica -3M and unit-dose drug consumption. Data are purged by eliminating cases with an unusual (either long or short) length of stay in each DRG, and both weights and pondered weights are calculated. Data from the 5 most prevalent DRGs are analysed by using the different options provided by the software program, with the aim of detecting intervention points in order to improve results., Results: Extreme case elimination noticeably reduces mean cost per DRG. A reduced group of DRGs represents a high percentage of total cost. Similarly, a reduced number of drugs may represent a high percentage of cost within a given DRG. The use of specific therapeutic groups for specific DRGs is demonstrated, as is the correct use of first-choice drugs versus other therapeutic options within therapeutic groups. An unwarranted variability regarding drug administration dosing and frequency is, however, observed., Conclusions: The GRDOSIS software program proves itself a powerful tool for both the qualitative (drug usage profiles, dosage) and quantitative (costs) analysis of information originating in a Pharmacy Department

Aim: In our setting systemic antibiotics comprise one of the most extensively used treatment groups in Primary Care. Among these, the use of macrolides has increased considerably in recent years and has shown variations in consumption according to geographic areas. This work was performed to quantify these variations., Methods: Information on macrolide consumption in six geographic areas of the providence of Valladolid over 5 years (1996-2000) was compiled through data provided by International Marketing Services. The indicator used was the defined daily dose per 1,000 inhabitants and day., Results: Macrolide consumption varied considerably among the areas studied. Greatest use of the major macrolides (clarithromycin, erythromycin and spiramycin) was observed in the area of Medina del Campo. Use of the remaining active principles in this subgroup of antibiotics showed the following distribution: midecamycin in the city of Valladolid, azithromycin in Area Norte and roxithromycin in Area Sur., Conclusions: Macrolide consumption showed significant differences according to areas, with some areas showing double the consumption of others. This diversity indicates specific patterns of use of the antimicrobials in this subgroup.

Introduction: Knowledge of adherence to highly active antiretroviral treatment (HAART) and the variables associated with poor compliance is useful for the follow-up of HIV infected patients., Patients, Material and Methods: Patients were consecutively recruited from the HIV outpatient clinics of the Hospitals of Leon and El Bierzo from January to June 2000. Patients were considered non-adherent to treatment if they failed to take 10% or more of their prescribed total dose of at least one drug during the 4 days before the interview, or if they had accumulated a delay of more than 9 days over the previous 3 months in picking up their prescribed drugs from the hospital pharmacy. Logistic regression analysis was performed with variables found to be associated with adherence in the univariate analysis., Results: The methods used to determine adherence had a Kappa index of 12.6%. Among the 206 patients interviewed, 108 were considered non-adherent (52.4%; CI 95% 5 45.6-59.2). Multivariate analysis showed that the following factors were associated with poor treatment adherence: cocaine consumption in the previous six months (adjusted OR 5 5.1); patients unsure about the proper way to take prescribed treatment; (adjusted OR 5 2.5); and patients not prescribed the zidovudine-lamivudine combination (adjusted OR 5 1.9). Over one-third of patients with no variable associated with treatment adherence were considered non-compliant., Conclusion: Measurement of medication adherence and its predictive factors involved methodological difficulties. With the criteria used in the present study more than half the patients were considered non-compliant. The variables found to be related to poor adherence can be modified by social, psychological or health care interventions.

Objectives: To determine the usefulness of patients' reports in constructing indicators of the rational use of medicines and to analyse these reports' benefits and limitations in comparison with the medical records., Design: Cross-sectional multi-centred study., Setting: Eight primary care health centres., Patients: For each centre a randomised sample, stratified by medical list, was selected of 125 subjects over 18 who had attended on some occasion the medical clinic in the previous 12 months (1000 subjects in all)., Measurements and Main Results: A <> questionnaire was designed and distributed (with questions referring to objective concrete experiences), in which information was gathered on various aspects of the use of medicines. In addition, these data were checked against the medical records of the subjects who answered the questionnaire. The reply rate was 43.7% for the questionnaire as a whole. It fluctuated between 92.0% and 46.0% in different specific items. The age of the patient, the number of consultations and suffering a chronic illness all affected the level of response to the questionnaire. Nevertheless, the users provided between 2 and 5 times more information than the medical record, with moderate-to-high reliability. Concordance between what was reported and what was recorded varied between 72.0% and 82.0%., Conclusions: The user's report can be useful, as a substitute for and as a complement to other sources of information, to construct indicators of the rational use of medication from an integrated perspective.