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PubMedDate not supplied

Drug utilization review.

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Drug Utilization Review↗
PubMedDate not supplied

Current status of prospective drug utilization review.

BACKGROUND: The Omnibus Budget Reconciliation Act of 1990 offered the promise that prospective drug utilization review (pDUR) systems would improve the quality of drug prescribing and patient drug use. There is little evidence that this promise has been fulfilled. To the contrary, there is growing evidence that suboptimal use of drugs (in terms of preventable drug-related morbidity) is at least as costly as the prescription drugs themselves. Online computerized pDUR has been the subject of numerous critical examinations in the pharmacy and medical literature. Recent publications have sought to illustrate perceived shortcomings in the DUR systems currently in use. OBJECTIVE: We focus on the state of the art with regard to pDUR, what is known about its effectiveness, and how emerging technologies may change pDUR and consider the work that may be needed to establish its effectiveness. SUMMARY: A growing body of literature documents numerous problems and concerns with respect to the quality of DUR criteria, DUR alerts, and the response of health care professionals to these alerts. Problems with the current pDUR "system" can be grouped into those involving technical aspects (e.g., duplicate messaging from in-store and online systems, or message text limitations) and into those involving human aspects, specifically how pharmacists and other health care providers interpret and respond to potential drug therapy problem alerts generated by the electronic systems. CONCLUSION: DUR is a quality assurance system that holds promise as a tool that, if implemented effectively, could enhance appropriate drug use. We believe a more systematic approach to DUR is needed. Evaluation and management of public and private pDUR systems must link documentation of processes of care, such as pharmacists. cognitive services, patient interventions, etc. To address technical aspects, we strongly recommend (a) a national effort to validate DUR screen criteria relying upon evidence-based studies and (b) adoption of a minimal set of.critical. pDUR screen criteria by pharmacy service providers and third-party intermediaries, including pharmacy benefit managers. To address the human component of pDUR systems, we advocate (a) adoption of performance standards for pharmacists and (b) explicit remuneration for time spent identifying and responding to drug therapy problems.

Drug Therapy↗
PubMed1977

Drug utilization review in an HMO. I. Introduction and examples of methodology.

An experimental drug utilization review program was developed for a health maintenance organization (HMO). The objectives of the program were to develop and implement an ongoing mechanism for reviewing drug use using criteria based on the scientific literature, and to evaluate the effect of the drug use review program on physician precribing patterns. Seven therapeutic categories of drugs, accounting for over 65 per cent of prescribing, were selected and criteria developed for their use. The drug use review prcedure is described briefly. The evaluation of the drug use review program is based on a comparison of rates of prescription use for specific therapeutic categories before and after the criteria were ceveloped and approved. As an example, data for the antihistamine therapeutic category are presented. Criteria for prescribing antihistamines suggested restricting use of combination cold preparations and refraiming from antihistamine use in viral upper respiratory tract infections. After the criteria were adopted, prescribing of antihistamines for viral URIs declined, particularly in pediatrics. In general, prescribing of combination antihistamine preparations did not change; where one combination preparation was deleted from the formulary, prescribers appeared to substitute another combination preparation.

Adolescent↗
PubMed2006

Drug utilization review across jurisdictions--a reality or still a distant dream?

OBJECTIVE: There is a perception that many drug usage evaluations do not widely influence prescribing behaviour. The aim of this study was to critically evaluate recent journal articles which fit the Medline definition for Drug Utilization Review (DUR) and which also cover multiple healthcare sites. METHODS: PubMed (National Library of Medicine, NLM) (2003, 2004) was searched using the MeSH topic 'drug utilization'. Retrieved studies were evaluated to ascertain those describing a DUR (measuring drug use against specific criteria). These were subdivided according to whether the DUR was conducted at one site or across many. The multi-centre DURs were critically reviewed, including evaluating whether all phases of a quality cycle were completed and determining aspects of design such as whether the study was prospective or retrospective, any interventions conducted and provision of feedback. RESULTS: A total of 646 unique articles were retrieved. Of these, 495 (77%) did not meet the definition for DUR, while 151 (23%) articles did. Thirty-five (5%) described English language multi-centre DURs; ethics approval was obtained in ten of these and 18 were carried out retrospectively. In all 35 studies some comparator or standard was used, but only eight conducted an intervention and only three provided feedback to the prescribers. CONCLUSION: Most DURs were not conducted across a number of centres. Of the recent published multi-centre DURs most presented only an initial audit and did not complete the quality cycle with feedback, intervention and re-audit. To widely influence prescribing behaviour, the full cycle is required with involvement of as many sites as possible to achieve improvements across many jurisdictions.

Bibliometrics↗
PubMed1979

Using the PAS system for hospital drug utilization review.

The PAS system, subscribed to by many hospitals, is readily adaptable to drug usage review. Useful for this purpose are PAS data on drug usage according to (1) drug type, (2) diagnosis, and (3) information supplied at patient admission. The PAS system also permits "special coding," or "targeting," of other data for review. Whatever the drug utilization system used, pharmacist input into the process is highly important.

Commission on Professional and Hospital Activities↗
PubMedDate not supplied

Medicaid drug utilization review annual reports for federal fiscal year 1999: looking back to move forward.

OBJECTIVE: To review states' Medicaid drug utilization (DUR) annual reports for federal fiscal year (FFY) 1999 to assess the usefulness of the information provided in assisting states in improving their DUR programs. DATA SOURCES: Medicaid DUR annual reports from 43 states and the District of Columbia. DATA EXTRACTION: Five DUR experts conducted in-depth reviews of the annual reports to determine whether states provided the information required by the Health Care Financing Administration (HCFA; now the Centers for Medicare & Medicaid Services) annual report instructions, to assess the usefulness of information provided by states to other states seeking to improve their programs, and to consider what changes in report content are needed to increase the value of the reports. DATA SYNTHESIS: States provided the information requested by HCFA, but such information was not particularly useful in helping other states improve their programs, nor was it easily available to other states. These reports need to be reoriented. Rather than instruments useful for compliance monitoring, the reports should be remade as tools useful for educating DUR program staff. To do this, changes in report content are needed, and individual states should have access to reports from all states. Specific recommendations made based on these findings would be important first steps in improving the effectiveness of DUR programs. CONCLUSION: Much room for improvement remains in the content and distribution of Medicaid DUR annual reports. Finding ways to improve the effectiveness of DUR is especially important as the nation moves to implement a Medicare prescription drug benefit.

Annual Reports as Topic↗
PubMed1990

Drug utilization review in a teaching hospital: experience with vancomycin.

A prospective, two-phase, drug utilization review (DUR) was performed at the Royal Adelaide Hospital (RAH) to determine the extent and pattern of vancomycin use. For all patients commencing oral or parenteral vancomycin, treatment indication, route of administration, duration of therapy, results of culture and sensitivity tests, adverse drug reactions and results of therapeutic drug level monitoring were recorded. Vancomycin courses were classified as being for therapy or prophylaxis and compared with predetermined audit criteria to assess appropriateness of use. During the 8 week initial phase, data on 62 treatment courses in 59 patients were recorded, 50% for therapy and 50% for prophylaxis. Sixty four percent were classified as inappropriate, occurring in 32% of therapeutic courses and 97% of those for prophylaxis. During the 10 week re-evaluation, conducted 10 months later, data for 43 treatment courses in 43 patients were reviewed, 42% for therapy and 58% for prophylaxis. Sixty five percent were inappropriate occurring in 17% of therapeutic courses and 100% of the prophylactic courses. When compared with the initial phase, the re-evaluation demonstrated a decrease in the empirical use of vancomycin in the combination treatment of neutropaenic fever and also in the duration of vancomycin use for surgical prophylaxis. During both study phases, criteria contraventions were mostly due to inappropriate indication or duration of therapy. The cost of inappropriate vancomycin use was reduced by over 50% between survey phases, from $Aus11,500 or 55% of total vancomycin cost during the initial phase to $Aus3,600 or 25.7% during the re-evaluation. The most effective of the remedial strategies implemented after the initial phase was direct consultation with prescriber groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Retrospective drug utilization review software systems: perspectives of state Medicaid DUR directors.

OBJECTIVE: To determine the desirability or perceived need of retrospective drug utilization review (DUR) software system characteristics. DESIGN: A 32-item questionnaire. SETTING: Ambulatory DUR directors covering more than 33 million patients. PARTICIPANTS: Medicaid DUR directors from 49 states and the District of Columbia. MAIN OUTCOME MEASURES: Five-point Likert scale measures of importance of system and vendor characteristics. RESULTS: A 100% response rate was achieved. Respondents rated the ability to change or modify criteria as very important and thought it was important to receive criteria sets from software vendors. Respondents believed cost-savings methodologies should be clearly defined and false positive DUR criteria should be minimized. CONCLUSIONS: Through the implementation of the Omnibus Budget Reconciliation Act of 1990, considerable experience in ambulatory DUR programs has been achieved. Respondents believed the ability to change DUR criteria was very important and they thought it was important to have a set of criteria supplied from software vendors. Critical issues of criteria development, cost-savings methodologies, minimizing false positive criteria, and outcomes assessment from DUR programs were important issues to DUR directors.

Drug Therapy↗
PubMedDate not supplied

Retrospective drug utilization review and the behavior of Medicaid prescribers: an empirical marginal analysis.

The objectives of this study were to evaluate the effectiveness of drug utilization review (DUR) letter intervention on reducing the cost of medications under Medicaid. The target drugs in this study were six antiulcer agents prescribed for Alabama Medicaid recipients. The study group consisted of 100 prescribers who received DUR intervention. A total of 3776 prescribers who did not receive DUR intervention served as the comparison group. Using an interrupted time series design, these 3876 prescribers were studied before and after the implementation of the DUR program. The study found that prescribers' behavior changed after the DUR letter were sent out, resulting in a reduction in the average marginal days of drug therapy and drug reimbursement per recipient. For the target drugs, there was an average savings of $112.73 per prescriber per month and a total of $136,370.82 savings per month for the Alabama Medicaid program.

Alabama↗
PubMed2000

Systemwide effects of Medicaid retrospective drug utilization review programs.

Aggregate pooled cross-sectional and time-series annual state data for 1985 to 1992 were used to estimate the systemwide effects of retrospective drug utilization review programs (Retro-DUR) on Medicaid drug and nondrug outcomes. The results provide evidence that these programs produce significant cost savings in the drug budget without spillover effects (positive or negative) in other nondrug budgets within the Medicaid system. We also examine the influence of restricted formularies in this post-Retro-DUR era on drug and nondrug budgets in the Medicaid system; we find significant cost savings in the former but positive spillover effects in the latter.

California↗
PubMed2006

Drug utilization review on a tertiary palliative care unit.

Drugs are indispensable for the management of symptoms in palliative care patients, and account for a significant proportion of expenditures on a Tertiary Palliative Care Unit (TPCU). Drug expenditures for Edmonton's TPCU increased by 40% in 2002 compared to 2001. Fifty-five percent of the increase was attributable to injectable fentanyl, oral and injectable ondansetron, and total parenteral nutrition (TPN). As there was no increase in the unit cost of these drugs between 2001 and 2002, the increased expenditures reflected increased utilization. The hypothesis of this study was that the increased utilization of these drugs reflected appropriate prescribing. The objective was to compare the indications for prescribing these drugs in 2002 against evidence- and consensus-based criteria. Patients who received these drugs while admitted to the TPCU from January 1 to December 31, 2002 were identified through the pharmacy database. Evidence- and consensus-based criteria for drug utilization were developed. Prescribing indications were retrospectively compared against the criteria. Drug prescriptions were categorized as follows: (1) meeting criteria, (2) not meeting criteria, or (3) uncertain. The drugs under study were prescribed during 48 out of 234 admissions to the TPCU in 2002. Prescriptions for fentanyl met criteria in 26 of 29 cases. Indications were unsuccessful therapy with morphine, hydromorphone, and oxycodone (20), requirement for rapid titration from fentanyl patch (5), renal failure (2), and sublingual administration for breakthrough pain (1). Prescriptions for ondansetron met criteria in 19 of 21 cases. Indications were nausea refractory to metoclopramide and dexamethasone (13), and nausea related to radiotherapy or chemotherapy (6). Prescriptions for TPN met criteria for initiation in only one of five cases. However, in all cases, TPN had been started prior to admission. In cases where death was considered imminent, TPN was continued pending consultation with the patient and family regarding discontinuation. These data indicate that the increased prescribing of fentanyl and ondansetron on the TPCU satisfied evidence- and consensus-based criteria in most cases, apparently justifying the associated increase in drug expenditures. This type of analysis may be useful whenever increased drug utilization requires review. A cost effectiveness analysis would be the next step in evaluating the costs vs. the benefits. The issue of discontinuing TPN in palliative care patients requires further investigation.

Adult↗