DUR

APPE Managed Care Rotation

August 8, 2014
Gene Terkoski, PharmD Candidate 2015
Definitions
Drug Utilization Review (DUR): A systematic, ongoing review of
prescribing, dispensing, and member drug fills to detect and manage
preventable drug-related issues related to cost, safety, and/or efficacy.
Synonyms: medication use management
Drug Utilization Evaluation (DUE): A qualitative evaluation of drug use,
prescribing, and member fill patterns to determine the appropriateness
of drug therapy.
Synonyms: medication use evaluation (MUE)
Background
In 1976, Brodie and Smith published a model for DUR
based on 5 utilization review principles
Authority derived from an appropriate source
Ex: Qualified pharmacists with authority to review
Knowledge of population served and delivery system
Access to member drug utilization data
Established standards for comparison
Ex: Guidelines, EBM
System of evaluation through which the impact of review can be measured

Goals of DUR
Improve quality of care
Encourage the practice of evidence-based, clinically
appropriate, cost-effective drug use
Reduce drug misuse and abuse
Reduce costs related to inappropriate drug use
Pharmacist Role
Identifies opportunities for quality improvement by evaluating processes:
Prescribing medications
Preparing medications
Dispensing medications
Administering medications
Monitoring efficacy and safety
Participates in efforts to improve:
Patient outcomes
Quality of programs
Promotes appropriate drug use to reduce overall health care costs and
improve access to care
Carries out ethical and professional responsibility
Types of DURs
Prospective
Reviews drug
therapy before it is
dispensed or
administered
Electronic DUE
programs at
pharmacy
PA programs
Physician
education
Concurrent
Reviews drug therapy
at the time of
dispensing or during
treatment
Case management
Review of records
Real-time system
edits at the point of
service
Retrospective
Reviews drug
therapy after it has
been dispensed or
treatment
Review of medical
charts, electronic
medical records
and/or claims data
Review provider
prescribing
patterns
Commonly Identified Items During
DUR
Prospective
Abuse/misuse
Drug-allergy
interactions
Drug-disease
interactions
Drug-drug interactions
Inappropriate duration
of treatment
Incorrect dosage
Therapeutic
duplication
Therapeutic
interchange
Concurrent
Drug-disease
contraindications
Drug-drug interactions
Drug-gender
precautions
Incorrect dosage
Over/underutilization
Therapeutic
interchange
Retrospective
Abuse/misuse
Appropriate generic
use
Drug-drug interactions
Drug-disease
contraindications
Inappropriate duration
of treatment
Incorrect dosage
Over/underutilization
Therapeutic
appropriateness
Therapeutic
duplication
Evidence Supporting DUR
Alavela JL., Jones MK., Ritter M. A prospective trial of a clinical pharmacy intervention in a
primary care practice in a capitated payment system. J Manag Care Pharm. 2008 Nov-
Dec;14(9):831-43.
CONCLUSION: Compared with patients of PCPs who received no input from a clinical
pharmacist, patients of PCPs who received clinical pharmacist recommendations were more
likely to have several medication-related issues addressed, including medication
nonadherence, untreated indications, suboptimal medication choices, and cost-ineffective
drug therapies.
Prospective
Gregoire JP., Moisan J., Potyin L., Chabot I., Verreault R., Milot A. Effect of drug utilization
reviews on the quality of in-hospital prescribing: a quasi-experimental study. BMC Health
Serv Res. 2006 Mar 14;6:33
CONCLUSION: Results suggest a concurrent DUR strategy, with direct feedback to
prescribers seems effective and should be tested in other settings with other drugs
Concurrent
Angalakuiti M., Gomes J. Retrospective drug utilization review: impact of pharmacist
interventions on physician prescribing. Clinicoecon Outcomes Res. 2011;3:105-8. doi:
10.2147/CEOR.S21789. Epub 2011 Jun 27.
CONCLUSION: RDUR is an effective interventional program which results in decreased
numbers of interventions per physician and provides a significant impact on future
prescribing habits.
Retrospective
Steps in Conducting DUR
Gain Organizational
Authority and Assign
Responsibility
Determine Criteria
Drugs to be
monitored
Identify Indicators
Establish Threshold
Collect data
Compare the data to
established criteria
Perform
intervention
Analyze results
Document DUR
Communicate
relevant information
to appropriate
individuals
Re-evaluate the
program (on-going)
Who Benefits From DUR
Plan member
Health care provider
Pharmacist
Health care system
Conclusion
Pharmacists have always been involved in analyzing the effect of drug
therapy
Managed Care Presents both challenges and Opportunities for DUR



DURs will grow in importance as a tool to optimize drug therapy
Pharmacists will play a key role in the future improvements of patient
care using DURs.
Opportunities Challenges
Access to data
Responsibility to identify and correct inappropriate
drug use
Large number of patients
Enormous amount of data
Inability to interact with prescibers