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Drug utilization review

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Main article: Drug
Further information: DUR


Drug utilization review (DUR) refers to a review of prescribing, dispensing, administering and ingesting of medication[1]. This authorized, structured and ongoing review is related to pharmacy benefit managers (PBMs)[2]. Also, drug use/ utilization evaluation (DUE) and Medication utilization evaluations (MUE) are the same as drug utilization review (DUR)[3]. In the drug utilization review, medicine and health history including all phases of dispensing for a patient is exactly listed[1]. Also, this review is designed to attempt to attain proper decision making therapeutically and gain a positive outcome for the patient[1]. Then, especially in the community medicine setting, Drug utilization review plays a key role for pharmacist[4]. In addition, The World Health Organization (WHO) regards drug utilization as 4 phases of drugs in society. These four phases are marketing, distribution, prescription and usage[3].

History of Drug Utilization Review

The doctor prescribes medication for patients

Drug utilization review originated from the North America. However, in the recent years, other countries do more research and studies about drug utilization review[5].

Some developments are regarded as important promoters for the appearance of Drug Utilization Review. One factor is the increasing coverage of insurance for medication dispensing in the 1970s and 1980s. This insurance decreased the cost of medication dispensing for the economic interest and create computer-based data of patient therapy information[5]. Another factor is that technical feasibility was improved in 1960s[5].

The first document published related to drug utilization review was in 1969. Drug utilization review acted as a background paper written by the DHEW's Task Force. This Task Force considered that drug utilization review was potential but this review should be evaluated and need valid evidence to put into effect[5].

In 1970, Drug utilization review program was carried out by a private pharmaceutical management company. It focused on the cost of another program[5].

By the mid-1970, many medical programs cooperate with private companies that providing drug utilization review[5].

From 1985, hospitals in America are requested to use drug utilization review when using antibiotics[5]. Then Drug utilization review was common in society.

Three types of Drug Utilization Review

Prospective

Prospective drug utilization review refers to assessing appropriate drug and decision making therapeutically before patients' medication are dispensed[6]. This prospective review is based on the history recording of the drug and medication. Then, practitioners could assess therapy for patients on the basis history recording[7].

There are some issues addressed by this review: drug abuse clinically, alteration of drug dosage, drug - drug interaction, and drug-disease interaction[1].

Measure and record the blood pressure for next therapy.

This review seems the best review over all three reviews because it is the closest option of the ideal[7].

Concurrent

Concurrent drug utilization review refers to conducting the review concurrently with the process of dispensing medication for patients[7]. It means that the dispensing process will stop if a potential problem occurs and it is found by the review[7].

There are some issues addressed by this review: alteration of drug dosage, drug - drug interaction, drug-disease interaction, patient prevention with the drug, and overutilization and under utilization[1].

However, there are still some problems in concurrent drug utilization review. The pharmacy of hospital and practitioners may not totally know the exact medications that patients normally use at home. Also, hospital and practitioners are not certain the document provided by patients is complete, and then this leads to some repeating test and medication. Thus, this review seems expensive and time consuming[7].

Retrospective

Retrospective drug utilization review refers to drug therapy review that after patients has got the medication[6]. The retrospective drug utilization review has a typical process[8]. This is a computer based review. Computer will show data which are in violation of the standard. The standard are the rules or expectations for the actual outcome comparing with [8].

There are some issues addressed by this review: alteration of drug dosage, drug - drug interaction, drug-disease interaction, patient prevention with drug, overutilization and underutilization, drug abuse clinically, proper generic use, and false in drug dosage[1].

However, there are still some problems in retrospective drug utilization review. If a problem occurs, practitioners are possible to prevent much worse results by ceasing the therapy during the next phase review. But if the problem is serious or toxic, then the harm is irretrievable and the worst result is death[7].

Steps in conducting Drug Utilization Review

These are the steps[5]:

A doctor using computer-based data to review.

a. Set the elementary structure.

b. Quest approval.

c. Structure of the standard or criteria. (Standard and criteria must be valid.)

d. Apply standard or criteria.

e. Assess and analyze yield

f. Set up prescribing patterns.

g. Set up intervention strategies.

h. Re-apply standard or criteria to databases.

i. Revise standard or criteria as needed.

Even though the model may be applied variously in various settings, major characteristics are the same during settings[5].

Role and Benefits of Drug Utilization Review

Drug utilization review applies more and more in many aspects and areas. It is important for medication and mechanism to find the reasons and types of the variations and decrease the unfavorable and unsupportable variation[9]. Also, drug utilization review technology show the possibility to the elevated pharmacy therapy over the history recording of medication[9].Drug utilization review helps pharmacists to evaluating the medication for patients[3]. Drug utilization review plays a key role in therapy and medication dispensing. It also helps improving the medication and drug dosage and provides feedback to hospital and practitioners for their therapy and their performance[3]. In addition, this Drug utilization review information may also encourage practitioners to modify and alter their normal habits in prescribing and then improve care[3].

Medication use evaluation (same as DUR) is beneficial to medical students and provides practice places[10]. It not only improves prescribing practices and ensures safety outcomes but also help students improve their medication therapy[10].

Future of Drug Utilization Review

Drug store of future

According to reasonable research, prospective drug utilization review and retrospective drug utilization review program are not providing an improvement in the outcome of clinic within a basis of population[5]. In addition, there exist some major drug utilization review program problems including questions and validity in standards and highly unacceptable alert rates[5]. Furthermore, the knowledge base should be strengthened and improved.

The cost of non-optimal drug utilization is enormous and this was one of the reason that drug utilization review appears [5]. The development and research of the drug utilization review program are expected and need more creative methods[5].



References

  1. ^ a b c d e f Academy of Managed Care Pharmacy (2009). "Drug Utilization Review". amcp.org. Retrieved 2019-05-12. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
  2. ^ Radloff, Tom; Jones, Steven (2007). "Patient Safety Through Drug Utilization Review". Benefits & Compensation Digest. 44 (7): 32–35.
  3. ^ a b c d e Shimpi, R. D.; Salunkhe, P. S.; Bacaskar, S. R.; Laddha, G. P.; Kalam, A. A.; Patel, K.; Jain, S. S. (2012). "Drug utilization evaluation and prescription monitoring in asthmatic patients" (PDF). International Journal of Pharmacy and Biological Sciences. 2 (1): 117–122.
  4. ^ Mospan, Cortney M.; Alexander, Katelyn M. (2017). "Teaching drug utilization review skills via a simulated clinical decision making exercise". Currents in Pharmacy Teaching and Learning. 9 (2): 282–287. doi:10.1016/j.cptl.2016.11.021.
  5. ^ a b c d e f g h i j k l m Hennessy, Sean; Soumerai, Stephen B.; Lipton, Helene Levens; Strom, Brian L. (2006-03-07), Strom, Brian L. (ed.), "Drug Utilization Review", Pharmacoepidemiology, John Wiley & Sons, Ltd, pp. 439–453, doi:10.1002/9780470059876.ch29, ISBN 9780470059876, retrieved 2019-05-12
  6. ^ a b Donohoe, Krista; Vaughn, L. Michelle; Patel, Jaykumar; Clare, Danielle M. (2014). "Medication use evaluation (MUE): A review of current literature and how-to guide for preceptors and pharmacy students". Currents in Pharmacy Teaching and Learning. 6 (5): 699–705. doi:10.1016/j.cptl.2014.05.005. Retrieved 2019-05-12.
  7. ^ a b c d e f Wertheimer, A. I. (1988). "Quality control and drug utilization review". Pharmaceutisch Weekblad Scientific Edition. 10 (4): 154–157. doi:10.1007/BF01959424. ISSN 0167-6555.
  8. ^ a b Hennessy, Sean (2003-09-17). "Retrospective Drug Utilization Review, Prescribing Errors, and Clinical Outcomes". JAMA. 290 (11): 1494. doi:10.1001/jama.290.11.1494. ISSN 0098-7484.
  9. ^ a b Lyles, Aln (2004). "The medicare drug benefit, prescribing variations, and drug utilization review". Clinical Therapeutics. 26 (1): 100–101. doi:10.1016/S0149-2918(04)90010-0. Retrieved 2019-05-12.
  10. ^ a b Lefkowitz-Ziegler, Pat (1989). "Drug Utilization Evaluation:". Journal For Healthcare Quality. 11 (3): 16–17. doi:10.1111/j.1945-1474.1989.tb00413.x. ISSN 1062-2551. Retrieved 2019-05-12.



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