Academic Day Seminar #7: Medication Use Evaluation

I won’t be doing my MUE rotation until much later on in my residency, so it was nice to get an introduction into MUE early on in the residency. Before the start of my MUE rotation, I will review the following notes:

  • Main Purpose: Evaluate medications for the formulary
    • for new drugs/therapies or new indications for an existing drug
  • 3 layers of PNT (Pharmacy And Therapeutics):
    • top layer = provincial layer (MUE pharmacists who review and evaluate drugs for the entire province)
        • Indications, Restrictions, Exclusions = are done by provincial
    • middle layer = regional layer (each health authority (e.g. VCH, providence, VIHA))
      • anything that is formulary has to make into policies and decisions on how to use it
      • – if we list a drug from formulary, what can we institute to make sure it is effective and safe – e.g. PPO or restrict to certain prescribers or restriction criteria by indication – e.g. dabigatran = restrict for only post-op ortho ß this restriction is determined at a provincial layer…if at VGH we are determining that only ortho docs can order ß determined at regional layer and can turn into a PPO, drug use evaluations = put out memos, quarterly newsletter, policies. Some policies are corporate policies (two things you do in hospital for everybody who is admitted = assess HIV status, DVT prophylaxis).
      • Restrictions by area, by prescriber = done by regional
    • bottom layer = local PNT (for each hospital…make sure that provincial and regional policies are all followed, and to get feedback for the upper layers).
  • If a drug is restricted = possible ways of restriction are by indication, by prescriber or by area
  • Excluded = for health authorities, does not make sense for us to carry it…but it does not mean it cannot be used…it can be brought in on a case by case basis
  • If something has increased in budget = PNT will evaluate them
  • Therapeutic Interchange: done to minimize spending since can’t carry everything
  • Most common ARB in the community: cand, val, and telmisartan
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