Drug Utilization Review

Drug Utilization Review

Drug utilization review (DUR) is defined as an authorized, structured, ongoing review of prescribing, dispensing, and use of medication. DUR encompasses a drug review against predetermined criteria that results in changes to drug therapy when these criteria are not met. It involves a comprehensive review of patients' prescription and medication data before, during, and after dispensing to ensure appropriate medication decision-making and positive patient outcomes. As a quality assurance measure, DUR programs provide corrective action, prescribe feedback, and further evaluations. 

Why DUR is important? 

DUR programs play a key role in helping managed healthcare systems understand, interpret, evaluate, and improve the prescribing, administration, and use of medications.  Employers and health plans find DUR programs valuable since the results are used to foster more efficient use of scarce health care resources. Pharmacists play a key role in this process because of their expertise in the area of medication therapy management. DUR allows the managed care pharmacist to identify trends in prescribing within groups of patients whether by disease state such as those with asthma, diabetes, or high blood pressure, or by drug-specific criteria. Pharmacists can then, in collaboration with prescribers and other members of the health care team, initiate action to improve drug therapy for patients. 

DUR is classified into three categories: 

Prospective: Evaluation of a patient's drug therapy before medication is dispensed. 

Concurrent: Ongoing monitoring of drug therapy during treatment. 

Retrospective: Review of drug therapy after the patient has received the medication.

Prospective Drug Utilization Review   

A prospective review involves evaluating a patient's planned drug therapy before a medication is dispensed. This process allows the pharmacist to identify and resolve problems before the patient has received the medication. Pharmacists routinely perform prospective reviews in their daily practice by assessing a prescription medications dosage and directions while reviewing patient information for possible drug interactions or duplicate therapy. When part of an online claims adjudication process, prospective DUR often relies on computerized algorithms to perform key checks including drug interactions, duplications, or contraindications with the patient’s disease state or condition. 

Issues Commonly Addressed by Prospective DUR: 

• Clinical abuse/misuse. 

• Drug-disease contraindications (when a prescribed drug should not be used with certain diseases). 

• Drug dosage modification. 

• Drug-drug interactions (when two or more different drugs interact and alter their intended effects, often causing adverse events). 

• Drug-patient precautions (due to age, allergies, gender, pregnancy, etc.). 

• Approved by AMCP Board of Directors November 2009. 

• Formulary substitutions (e.g., therapeutic interchange, generic substitution). 

• Inappropriate duration of drug treatment.

Concurrent Drug Utilization Review   

Concurrent review is performed during treatment and involves the ongoing monitoring of drug therapy to foster positive patient outcomes. It presents pharmacists with the opportunity to alert prescribers to potential problems and intervene in areas such as drug-drug interactions, duplicate therapy, over or underutilization, and excessive or insufficient dosing. This type of review allows therapy for a patient to be altered if necessary. 

As electronic prescribing becomes more widely adopted, the concurrent DUR process may be performed by the prescriber at the time of prescription transmission to the pharmacy, allowing interventions before the drug is dispensed. An important component of DUR will require complete and current drug and allergy records for the patient, as well as knowledge of appropriate therapeutic interchanges for individuals. As a safety net, pharmacists will perform a similar role as prescribers on the dispensing side of these transactions. 

Issues Commonly Addressed by Concurrent DUR: 

• Drug-disease interactions. 

• Drug-drug interactions. 

• Drug dosage modifications.

• Drug-patient precautions (age, gender, pregnancy, etc.). 

• Over and underutilization. 

• Therapeutic Interchange.

Retrospective Drug Utilization Review 

A retrospective DUR reviews drug therapy after the patient has received the medication.  A retrospective review aims to detect patterns in prescribing, dispensing, or administering drugs. Based on current patterns of medication use, prospective standards and target interventions can be developed to prevent the recurrence of inappropriate medication use or abuse. The outcomes of this review may aid prescribers in improving the care of their patients, either individually or within a certain target population (e.g., patients with diabetes, asthma,  or high blood pressure). 

Issues Commonly Addressed by Retrospective DUR: 

• Appropriate generic use. 

• Clinical abuse/misuse. 

• Drug-disease contraindications. 

• Drug-drug interactions. 

• Inappropriate duration of treatment. 

• Incorrect drug dosage. 

• Use of formulary medications whenever appropriate. 

• Over and underutilization. 

• Therapeutic appropriateness and/or duplication.

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