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.