University Case Study: Quality Use of Medicines in Diabetes (QUM)

This case study examines the quality use of medicines (QUM) in a 58-year-old male, Mr. X, with type 2 diabetes mellitus. The case explores issues such as the appropriateness, safety, and cost-effectiveness of gliclazide compared to metformin, given Mr. X's medical history including obesity and alcohol consumption. It highlights the importance of patient education, self-management practices, and therapeutic substitution programs to improve QUM. The role of nursing, particularly in patient education and intervention strategies is discussed. Resources for implementation, including learning aids and updated medication lists, are identified, along with potential barriers such as lack of practitioner knowledge and lengthy approval processes for drug substitutions. The study emphasizes the need for healthcare professionals, consumers, and educators to prioritize QUM to enhance patient outcomes.

Running head: QUALITY USE OF MEDICINES
Quality use of medicines (QUM) in diabetes
Name of the Student:
Name of the University:
Author Note:

1QUALITY USE OF MEDICINES
Introduction
Chronic diseases constitute a significant reason for mortality and morbidity in most countries.
To reduce the burden of the most widespread chronic diseases such as diabetes, asthma,
cardiovascular diseases, and some mental health disorders, the availability of quality
medicines, superior in terms of appropriateness, safety and effectiveness are vital (Watts,
2017). Diabetes is one such significant long-term clinical condition affecting about 7.4% of
the total Australian population (Hasan et al., 2015). This paper focuses on a case study based
on diabetes and discusses the issues in the quality use of its medicines and the role of nursing
in overcoming these issues, including the required resources for the implementation,
associated benefits, and barriers.
Case scenario
X is a 58 years old male with type 2 diabetes mellitus. He was diagnosed with diabetes about
two years back. His medical history reveals obesity and excessive consumption of alcohol.
However, he quit drinking alcohol after his diagnosis of diabetes. Initially, his blood glucose
values of 6.5-7.0 mmol/L indicated borderline diabetes. He was also recommended to lose
weight of about 10 kg, but no significant action was taken. His family physician referred him
to a specialty diabetes clinic. He also demonstrates a family history of diabetes as both his
parents had diabetes. Nevertheless, he exhibits limited knowledge on the management of
diabetes.
The height of Mr. X is measured as 176 cm with a weight of about 110 kg. His observed
blood pressure is 168/100 mm Hg and a pulse rate of 86 beats/min. No evidence of peripheral
vascular disease or congestive heart failure was observed in the patient. No clinical record of
thyromegaly or retinopathy was observed. Laboratory urine tests showed a trace amount of
protein, with 1.2 mg/dl of serum creatinine and 14 mg/dl of blood urea nitrogen. The levels of
electrolytes and thyroid-stimulating hormones were normal. The patient also underwent a 24-
hour urine collection, which reveals 250mg/day of urine albumin excretion rate.
His medication dose includes Gliclazide. Gliclazide was preferred over Metformin for the
patient X as his medical history displays obesity with heavy alcohol consumption. As a result,
Metformin would put him into cardiovascular risks. Thus, Metformin was not prescribed as a
first-line drug, and instead, the doctor prescribed Gliclazide which is known for its quick
glycemic response and cardiovascular neutrality. (Chang et al., 2015).
Issues in the quality use of medicine (QUM)
With the growing incidence of diabetes mellitus worldwide, the quality of medicine and
services involved in its treatment and monitoring is not guaranteed. As in the case described
above, patient X does not comply with his proposed diabetes management program properly
which results in the progression of the disease. Non-compliance with his prescribed dose of
gliclazide can result in fluctuations in his glycemic levels and lead to events of
hypoglycemia. It is thus, essential to analyze the quality of antidiabetic medicines and the
available supplies of self-monitoring of blood glucose (SMBG) and describe their potential
impacts on the patients and the community to innovate suitable strategies for overcoming
these issues (Saraswati et al., 2019). The various issues involved in the quality use of
medicine for the patient X described above include equity of access, specifically in terms of
affordability, safety, appropriateness and efficacy of the drug and judiciousness in its use.

2QUALITY USE OF MEDICINES
A primary concern regarding the quality use of antidiabetic medication for Mr. X is ensuring
the appropriateness of the medicine in maintaining the blood glucose levels. Selecting
clinically appropriate medicines and doses and self-monitoring the levels of blood glucose
and HbA1C are essential for optimum care in diabetes (Chaudhury et al., 2017). Also, the
drug Gliclazide which is prescribed to patient X also poses the issue of cost-effectiveness
compared to metformin. Gliclazide is comparatively costlier than metformin posing it a
challenge in its continued use. Another noteworthy consideration for patient X in the quality
use of diabetic medicine includes judiciousness in its use. It is crucial to consider the position
of the medication such as gliclazide instead of metformin considering obesity in Mr. X and
his history of drinking, in the treatment of the disease and eliminating cardiovascular risks. It
also includes realizing that non-pharmacological therapies also provide effective management
of the disease and judicious choice of the treatment procedure. It is also crucial on the part of
healthcare providers such as physicians and nurses to provide the treatment plan judiciously.
Another issue related to the quality use of medication for patient X’s diabetes is safety and
efficacy concern. Nurse practitioners play an essential part in ensuring the most optimum
outcome of the treatment, carefully regulating the dose of the medication and take suitable
measures to resolve problems related to the medication (Australian Commission on Safety
and Quality in Health Care, 2014).
Role of nursing in overcoming QUM issues
The national indicators of QUM are formulated primarily to be used by the healthcare
providers, particularly physicians and nurses. Nurses play a crucial role as they are directly
responsible for providing patient care and are involved in the monitoring of the indicators,
interpreting the results and decisions, and taking suitable action (Davis, 2014). The various
stakeholders including governments, physicians, nurses, pharmaceutical companies, clinical
settings and health insurance firms, play essential roles in ensuring QUM measures.
An effective strategy to overcome the issue of appropriateness and ensuring optimum quality
in the quality use of antidiabetic medicines include patient education. It is a crucial
component and influences the prescription of medicines. Nurse practitioners play a crucial
role and can educate the less-aware patients, like Mr. X, in the case presented above, about
the disease so that they can seek appropriate therapy and thereby improving health outcomes
(Coppola et al., 2016). The resources involved in implementing this strategy are adequate
learning aids and appropriate settings for the session to ensure a better understanding of the
concept. Also, visual and hearing tools in the session are essential resources for enhanced
education. A notable benefit of this process is that an educated patient population results in a
better perception of their disease and its pharmacological implication (Stenberg et al., 2016).
As a result, the compliance of the patients to their medical regime is increased. Also, another
benefit is that educated patients realize the side-effects associated with their medication to
deal with it more precisely and demand less for inappropriate medication such as antibiotics
to curb the adverse effects. Along with educating the patient, Mr. X about his diabetes and
associated clinical implications, another critical nursing intervention includes teaching him
various self-management practices. This intervention is vital to overcome the issue of the
efficacy of his medication and ensuring an overall improvement in the quality use of his
medicine. Self-management practices that the practitioner needs to teach Mr. X can begin
with organizing his dietary plan and physical exercise for maintaining healthy levels of blood
glucose. Another essential practice is the proper administration of insulin and recognizing the
adversities of hypoglycemia and related coping mechanisms (Chrvala, Sherr & Lipman,
2016). However, a major barrier to the implementation of these plans is that often the

3QUALITY USE OF MEDICINES
practitioners are not well-updated and contain basic level knowledge of the disease.
Frequently, they lack relevant expertise of the different conditions that might affect the
patient along with diabetes, such as the relationship between obesity and diabetes in this case
(Modic et al., 2014). This barrier can be overcome by holding individual training sessions for
these professionals to develop their existing knowledge of diabetes and its clinical
implications and effects.
A useful nursing strategy to improve the safety and maintain the quality of the medicine
prescribed is the therapeutic substitution programs which allow substituting or interchanging
medical products with those who have close similarity and improved safety output. The
critical resources required in this scheme are the updated lists of medicines approved under
this scheme and timely access to the list. The benefit of such a program is to substitute the
dose of inappropriate medicine with another medicine more suitable for the patient (Who.int,
2020). This is critically important for the case of patient X described in the above case to
replace the prescription of the usual dose of Metformin for diabetic patients with Glicazide
considering other factors such as obesity and related cardiovascular risk. The barrier to the
implementation of this strategy is that the process of approval might take a prolonged time
and are not readily accessible in many cases.
The cost effective barrier of using Gliclazide can be reduced by consuming a newer
formulation of Gliclazide called Gliclazide modified release (MR) which requires a lower
dose of the drug compared to its previous counterpart. This reduces the quantity of medicines
required thereby reducing the costs incurred to some extent. Also, it is safe in terms of
polypharmacy issues as Gliclazide does not cause weight gain and is in line with the obesity
issue of Mr. X. the benefit of using gliclazide MR is that it has shown better compliance of
the patient with this medication. Advanced nurses or practioners play an essential role in
identifying the issues of non-compliance of Mr. X with his regular medication and
considering his medical history of obesity and suggesting suitable alternative formulations. A
major barrier in this intervention is that gliclazide MR often affects the cognitive or
functional decline in older patients.
Conclusion
In conclusion, appropriate implementation of the strategies described by the National
Strategy for quality use of medicines concerning improved QUM with a higher commitment
to these standards by healthcare practitioners, consumers, health providers and educators can
improve the health status of the patient X in the case presented. The medicines prescribed to
Mr. X are required to be of high quality, safe, effective, appropriate and cost-effective for the
quality use of the medicine. Also, it is vital to prescribe the medication with considerations of
his past medical history and compliance issues.

4QUALITY USE OF MEDICINES
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