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PubMedDate not supplied

Effects of Medicaid drug utilization review intervention letters.

The state of Texas Drug Utilization Review (DUR) Board, composed of six physicians and six pharmacists, meets quarterly to determine criteria for implementing retrospective DUR. The board agreed to send intervention letters to physicians concurrently prescribing: (1) two histamine2 (H2)-antagonists (H2As) or (2) either any H2A or omeprazole with sucralfate. To measure the effect of these intervention letters, approximately half of these physicians were randomly chosen to receive a letter while the others served as a control group and did not receive letters. This project focused on the H2A or omeprazole with sucralfate intervention letters in a two-step process. Data on concurrent therapy involving two H2As were analyzed separately and these results are not included in this report. Objective one was to examine feedback from the physicians who received the letters, and objective two was to review and compare patient profiles 6 months after the letters were sent. Analysis of Medicaid prescription claims indicated that 190 physicians had concurrently prescribed either an H2A or omeprazole with sucralfate for 222 patients. Ninety-seven physicians (from 117 identified patient profiles) were selected to receive an intervention letter with their patient's profile or profiles, a response form, and a stamped envelope addressed to the Texas Department of Human Services. A 67.5% response rate was obtained. Of these responses, 49.4% agreed with the letter and 29.1% disagreed with the letter. The remaining indicated responses such as "not my patient," they were no longer seeing the patient, or that they did not prescribe the medication in question. (ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

A system for drug utilization review in ambulatory care.

BACKGROUND: It is more difficult to conduct drug utilization reviews in ambulatory care settings than in inpatient care settings. This is true for several reasons: it is harder to identify outpatients who are receiving specific medications; often there is less evidence on which to base clinical standards for drug use; and it is more difficult to ensure patient compliance with drug therapy. METHODS: This article describes a drug utilization review system designed to operate in ambulatory care clinics. The system consists of (1) a computerized database for efficient identification of patients who receive prescriptions for a specific medication, (2) clinic-wide consensus guidelines, (3) reminders in the medical record, (4) regular chart audits, and (5) feedback to physicians. RESULTS: Experience in monitoring the use of serum theophylline assays illustrates how this system can be used in an ambulatory care clinic. According to guidelines adopted in our clinic, overuse of assays is not a problem. The system of physician reminders and chart audits can help prevent underuse. CONCLUSIONS: Despite the difficulties in conducting drug utilization reviews in the ambulatory setting, a system based on clinic-wide guidelines is feasible and should be an integral part of quality assurance programs.

Adolescent↗
PubMed1984

A strategy to reduce drug expenditures with a drug utilization review program.

This paper describes a potential strategy for implementing a Drug Utilization Review (DUR) program aimed at reducing hospital drug expenditures. The importance of this type of program is underscored by the spiraling rise in health care expenditures and the influence of a new drug technology on this rise. The program described here consists of a utilization review program for high cost drugs for which a lower cost alternative exists. An initial retrospective usage and cost analysis must be undertaken to identify those drugs which should be reviewed initially. As the DUR program progresses, additional drugs can be added to the review program. Once the drugs to be reviewed are identified, the first step is to develop usage criteria. This can be accomplished through a review of the literature and consultation with medical and other specialists. Appropriate medical administrative staff approval and endorsement of the criteria should be obtained utilizing various committee structures and other input. The pharmacy staff must also be inserviced on the approved drug usage criteria. After the criteria are finalized, staff pharmacists will contact a DUR pharmacist daily upon receipt of any physician orders for the review drugs. This pharmacist will then compare the prescribed drug use to the approved criteria and contact the prescriber when the usage appears questionable. A lower cost therapy will then be recommended when appropriate. In order to assess the impact of this intervention strategy on drug expenditures, the cost of the initially prescribed therapies must be compared to the recommended therapies. Data should also be obtained on overall drug usage and expenditures to detect shifts in therapy and drug costs. The success or failure of this concurrent DUR program will be highly dependent upon a team approach and cooperation. A program of this type could have a significant impact on hospital drug expenditures in those hospitals where it can be successfully implemented.

Cost Control↗
PubMed1981

Internal standards: rationale for use in a drug utilization review program.

The comparison of drug usage data gathered from different institutions would be easier if standardized criteria were employed. There are, however, major difficulties encountered in gaining approval of such criteria from different physician groups. To facilitate the criteria approval process, "internal standards" were developed. These internal standards reflected the acceptable deviations from the standardized criteria, hence, permitting flexibility for innovation in drug therapy. A retrospective drug utilization review was conducted in two hospitals. The internal standards assigned were very similar to the 0 percent-100 percent standards recommended by InterQual except for the criteria on monitoring parameters and duration of therapy. It would appear from these preliminary results that the assignment of internal standards enhances the use of standardized criteria which, in turn, will allow comparisons of data.

Cefazolin↗
PubMed1995

Drug utilization review in the managed care environment.

Traditional drug use evaluation (DUE) and Medicaid drug utilization review (DUR) prototypes do not meet the needs of managed care organizations. yet, creating entirely new systems for measuring quality drug use in managed care, such as HEDIS, needlessly discards the good clinical foundations already built in the other health care settings. A better solution would be for managed care to apply its hallmark traits, namely state-of-the-art electronic data management systems, integrated health care system interchange, and strong customer communication, to make the DUR process better. A strong union between clinical criteria and sophisticated health care management can revolutionize the DUR/DUE process.

Consumer Behavior↗
PubMedDate not supplied

Drug utilization review using a Medicaid claims database.

A methodology for conducting drug utilization review (DUR) using Medicaid claims data is presented. The DUR allows for calculation of rates and costs of health care utilization among patients with established diagnoses and specific drug regimens; for comparison of results between competing drug therapies; for quantification of the percent market share of pharmaceutical products; and for projection of the duration of a given drug therapy. The strengths and limitations of using Medicaid data for DUR are discussed.

Databases, Factual↗
PubMed2006

Effect of drug utilization reviews on the quality of in-hospital prescribing: a quasi-experimental study.

BACKGROUND: Drug utilization review (DUR) programs are being conducted in Canadian hospitals with the aim of improving the appropriateness of prescriptions. However, there is little evidence of their effectiveness. The objective of this study was to assess the impact of both a retrospective and a concurrent DUR programs on the quality of in-hospital prescribing. METHODS: We conducted an interrupted time series quasi-experimental study. Using explicit criteria for quality of prescribing, the natural history of cisapride prescription was established retrospectively in three university-affiliated hospitals. A retrospective DUR was implemented in one of the hospitals, a concurrent DUR in another, whereas the third hospital served as a control. An archivist abstracted records of all patients who were prescribed cisapride during the observation period. The effect of DURs relative to the control hospital was determined by comparing estimated regression coefficients from the time series models and by testing the statistical significance using a 2-tailed Student's t test. RESULTS: The concurrent DUR program significantly improved the appropriateness of prescriptions for the indication for use whereas the retrospective DUR brought about no significant effect on the quality of prescribing. CONCLUSION: Results suggest a retrospective DUR approach may not be sufficient to improve the quality of prescribing. However, a concurrent DUR strategy, with direct feedback to prescribers seems effective and should be tested in other settings with other drugs.

Cisapride↗
PubMed1987

Albumin/hetastarch drug utilization review in an operating room pharmacy.

A prospective drug utilization review (DUR) was performed on the colloids albumin 5% and hetastarch 6% at the University of Illinois Hospital Operating Room Pharmacy. This DUR's purpose was to evaluate the usage patterns of the two colloids. With the addition of hetastarch 6% to the formulary, an alternative colloid was available that could be therapeutically substituted for albumin 5% at a cost savings. Its usage, however, was not what would have been expected. Usage information was obtained by placing utilization forms inside the individual boxes of albumin 5% and hetastarch 6%. These forms were completed by the anesthesiologists and returned to the pharmacy, where the remainder of each form was completed. It was concluded that 93 percent of the patients administered albumin 5% could have received hetastarch 6%. Hence, potential yearly savings of approximately $12,346.00 could be realized by the Department of Pharmacy.

Albumins↗
PubMed2003

The ineffectiveness of retrospective drug utilization review.

As policymakers debate adding a prescription drug benefit to Medicare, they must also seek ways to promote cost-effective use of drugs and minimize inappropriate prescribing. For more than a decade, all state Medicaid agencies and most private insurers have used computerized drug utilization review (DUR) programs to prevent or rectify potential prescribing errors. DUR can be retrospective, in which claims data are reviewed to identify patterns of drug use, or prospective, in which prescriptions are reviewed before a drug is dispensed. This Issue Brief summarizes a landmark study that suggests that retrospective DUR has had no measurable effects on outpatient drug use or clinical outcomes in the Medicaid program.

Drug Utilization Review↗
PubMed1981

Drug utilization review: a practical approach.

Described is a method to perform drug utilization review retrospectively by using mutually exclusive categories. Drug use criteria were developed and structured in such a manner so that a patient's drug use experience could be readily and appropriately classified by medical records technicians during the routine medical record abstraction. Utilizing a contract abstracting service format, a summary by category of drug use experiences for the patients audited is provided monthly and used as the preliminary audit summary. The system represents an efficient and cost-conscious means of effectively monitoring selected portions of the drug utilization process.

Drug Utilization↗
PubMed1977

Watching the monitors: "PAID" prescriptions, fiscal intermediaries and drug-utilization review.

Prescription monitoring evolved from the need of drug firms to obtain marketing information. Today, extensive monitoring is also done by fiscal intermediaries who administer prepaid drug benefit plans, both private and governmental, particularly Medicaid. The most important such agent is PAID Prescriptions. Under various contracts, PAID monitors physician, pharmacy, and patient behavior related to prescriptions and uses review processes that evaluate certain kinds of behavior for appropriateness. The criteria of appropriateness are essentially those that save money. PAID negotiates a program fee with the insurer (public or private) and applies constraints so that prescription and administrative costs do not overrun that fee. PAID and other monitors have contemplated expansion into the realm of defining and encouraging appropriate prescribing under the concept of "drugutilization review." The actual practices of PAID, particularly the background of fiscal enforcement, may impede the development of an actual drug-utilization review process.

Blue Cross Blue Shield Insurance Plans↗
PubMed1994

Prescription drug utilization review in the private sector.

With increased coverage of prescription drugs by health insurance plans, utilization data are now becoming available and there is renewed interest in drug utilization review (DUR) programs. This article describes the DUR programs now being conducted by private sector firms for health insurance plans. The programs were found to be highly automated and very efficient. Most firms estimate at least two to three dollar direct savings for each dollar invested in DUR. Much of this results from controlling overutilization and gaining compliance with drug formulary guidelines. In addition, the firms report finding drug therapy problems in about two to three percent of the enrollees receiving prescriptions.

Chemistry, Pharmaceutical↗