Evaluation of Losartan Usage in a Regional Hospital in Hong Kong

Objective: To determine whether losartan usage follows the hospital's guidelines in terms of indications and reasons for use and to assess the accuracy of physicians in completing the losartan usage monitoring forms. Design: Drug utilization survey. Setting: A major government hospital in Hong Kong. Participants: Inpatients or outpatients prescribed losartan for the first time. Intervention: Physicians were to complete a monitoring form with both indications and reasons for losartan use. Main Outcome Measures: The appropriateness of losartan prescribing was evaluated in terms of indications (for hypertension with impaired left-ventricular function or hypertension in diabetic patients with persistent proteinuria) and reasons for preferred use (previous intolerance to adverse effects of angiotensin-converting enzyme inhibitors). The accuracy of completed monitoring forms was also assessed. Results: Forty-eight patients were prescribed losartan since its addition to the hospital formulary through the end of the study period (September 1997-May 1998). A review of medical records (regardless of the information provided by the physicians on the monitoring forms) revealed that 39 patients (81.3%) were prescribed losartan for appropriate indications and that 22 (45.8%) were given losartan rather than angiotensin-converting enzyme inhibitors for appropriate reasons according to the guidelines. Both appropriate indications and reasons were met in only 15 patients (31.3%). Of the 48 monitoring forms that were collected, three (6.3%) were not completed. The concordance rate of information provided by the doctors and information from case notes was 61.5% for indications and 34.8% for reasons of preferred use. Conclusions: Adherence to the hospital's usage guidelines and accuracy of the monitoring forms were suboptimal. Considering the high cost of losartan and its potential for long-term use, more educational activities, better dissemination of information, and more frequent evaluation of the acceptability of recommended usage guidelines are warranted.