ASSIGNMENT ON

Drug Utilization Review (DUR)

Course name: Clinical and Hospital Pharmacy

Course code: PHRM 311

SUBMITTED TO:

Meena Afroze Shanta

Lecturer

Department of Pharmacy

East West University

SUBMITTED BY:

Zenifar Karim (ID: 2010-1-70-042)

Rumman Akter (ID: 2010-3-70-004)

Sharmin Sheikh (ID: 2010-3-70-007)

Debasree Paul (ID: 2010-3-70-036)

Samiya Khondaker Rinta (ID: 2010-3-70-048)

Priyanka Lyla Habib (ID: 2010-3-70-052)

Submission date: 23rd February, 2014

CONTENT

ABOUT DRUG UTILIZATION REVIEW (DUR) -----------------------------------------------------1

PURPOSE OF DUR------------------------------------------------------------------------------------------1

CLASSIFICATION OF DUR AND ISSUES ADDRESSED BY EACH CLASS------------------1

DRUG UTILIZATION REVIEW BOARD---------------------------------------------------------------3

RESPONSIBILITIES OF DUR BOARD (DURB) -----------------------------------------------------3

IMPORTANCE OF DUR FOR PHARMACISTS-------------------------------------------------------3

BENEFITS OF DUR-----------------------------------------------------------------------------------------4

CONCLUSION-----------------------------------------------------------------------------------------------5

REFERENCE-------------------------------------------------------------------------------------------------6

ABOUT DRUG UTILIZATION REVIEW (DUR)

Drug Utilization Reviews (DUR), also referred to as Drug Utilization Evaluations (DUE) or

Medication Utilization Evaluations (MUE), are defined as an authorized, structured, ongoing

review of healthcare provider prescribing, pharmacist dispensing, and patient use of medication.

In short DUR is a system used by pharmacists and pharmacies to check or monitor the

frequency, type, appropriateness and use of prescription medications (Navarro, 2008).

DUR programs help to ensure that prescriptions for outpatient drugs are appropriate, medically

necessary, and not likely to result in adverse medical consequences. DUR programs use

professional medical protocols and computer technology and data processing to assist in the

management of data regarding the prescribing of medicines and the dispensing of prescriptions

over periods of time (Navarro, 2008).

PURPOSE OF DUR

To ensure drugs are used appropriately, safely and effectively to improve patient health

status.

To ensures and enables continual improvement in the appropriate, safe and effective use

of drugs.

To prevent adverse drug reactions.

To avoid therapeutic duplications.

To determine whether a more cost-effective alternative is available (Navarro, 2008).

CLASSIFICATION OF DUR AND ISSUES ADDRESSED BY EACH CLASS

DURs are classified into three categories:

1. Prospective DUR: It is the process performed to evaluate a patient's therapy and medical

history before medication is dispensed. Issues commonly addressed by prospective DUR are:

o Clinical abuse/misuse.

o Drug-disease contraindications (when a prescribed drug should not be used with certain

diseases).

o Drug dosage modification.

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o Drug-drug interactions (when two or more different drugs interact and alter their intended

effects, often causing adverse events).

o Drug-patient precautions (due to age, allergies, gender, pregnancy, etc.).

o Formulary substitutions (e.g., therapeutic interchange, generic substitution).

o Drug allergy interaction.

o Inappropriate duration of drug treatment (Navarro, 2008).

2. Concurrent DUR: It is the ongoing monitoring of drug therapy during the course of

treatment. This type of review allows therapy for a patient to be altered if necessary. Issues

commonly addressed by concurrent DUR are:

o Drug-disease interactions.

o Drug-drug interactions.

o Drug dosage modifications.

o Drug-patient precautions (age, gender, pregnancy, etc.).

o Over and underutilization.

o Therapeutic interchange.

o Duplicate therapy (Navarro, 2008).

3. Retrospective DUR: It is the reviewing of therapy after the patient has received the

medication gains the patient’s profile and evidence-based guidelines to alert the prescribing

physician by mail to important, drug-specific, patient-specific health, safety and utilization

issues. Issues commonly addressed by retrospective DUR are:

o Appropriate generic use.

o Clinical abuse/misuse.

o Drug-disease contraindications.

o Drug-drug interactions.

o Inappropriate duration of treatment.

o Incorrect drug dosage.

o Use of formulary medications whenever appropriate.

o Over and underutilization.

o Therapeutic appropriateness and/or duplication (Navarro, 2008).

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DRUG UTILIZATION REVIEW BOARD

The Board reviews drug therapy, drug studies and utilization information, thus enabling the

Department to identify the most cost-effective policies for its members. The board, appointed by

the DCH Commissioner, is composed of:

Physicians

Pharmacists

Members of the academic community

A consumer advocate

Meetings are held quarterly or as needed (Georgia Department of Community Health, 2013).

RESPONSIBILITIES OF DUR BOARD (DURB)

Responsibilities of the DURB include:

1. The establishment and implementation of medical standards and criteria for the

retrospective and prospective DUR program (New York Social Services Law, 2013).

2. The development, selection, application, and assessment of educational interventions for

physicians, pharmacists and recipients that improve care.

3. The collaboration with managed care organizations to address drug utilization concerns and

to implement consistent management strategies across the fee-for-service and managed

care pharmacy benefits.

4. The review of therapeutic classes subject to the Preferred Drug Program (Department of

Health, 2014).

IMPORTANCE OF DUR FOR PHARMACISTS

DUR programs play a key role in helping managed health care systems understand, interpret, and

improve the prescribing, administration, and use of medications. Pharmacists play a key role in

this process because of their expertise in the area of pharmaceutical care. DURs afford the

managed care pharmacist the opportunity to identify trends in prescribing within groups of

patients such as those with asthma, diabetes, or high blood pressure. Pharmacists can then, in

collaboration with other members of the health care team, initiate action to improve drug therapy

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for both individual patients and covered populations (Navarro, 2008). DURs serve as a means of

improving the quality of patient care, enhancing therapeutic outcomes, and reducing

inappropriate pharmaceutical expenditures, thus reducing overall health care costs.

1. In Prospective DUR: 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. For

example, a patient being treated with warfarin to prevent blood clots may be prescribed a

new drug by another specialist to treat arthritis. If taken together, the patient could

experience internal bleeding. Since a common outcome of a prospective DUR is

identification of drug-drug interactions, so upon reviewing the patient's prescriptions, the

pharmacist would note the potential drug interaction and contact the prescriber to alert

him/her to the problem (Navarro, 2008).

2. In Concurrent DUR: 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 under utilization and excessive or insufficient dosing. For example, DUR often

occurs in institutional settings, where patients often receive multiple medications. Periodic

review of patient records can detect actual or potential drug-drug interactions or duplicate

therapy. It can alert the pharmacist to the need for changes in medications, such as

antibiotics, or the need for dosage adjustments based on laboratory test results. The key

prescriber(s) must then be alerted to the situation so corrective action can be taken.

3. In Retrospective DUR: An example of the importance of a retrospective DUR for

pharmacists may be the identification of a group of patients whose therapy does not meet

approved guidelines. For example, a pharmacist may identify a group of patients with

asthma, who according to their medical and pharmacy history, should be using orally

inhaled steroids. Using this information, the pharmacist can then encourage prescribers to

utilize the indicated drugs. So based on current patterns of medication use, prospective

standards and target interventions can be developed to prevent recurrence of inappropriate

medication use or abuse using retrospective DUR (Navarro, 2008).

BENEFITS OF DUR

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By following all the criteria of DUR the following benefits can be easily obtained:

1. Protects patients from possible harmful drug interactions and harmful duplicate therapies

2. Detects and reduces the number of inappropriately used medications and non-compliance

to prescribed regimens.

3. Tracks and identifies over-consumption and under-consumption.

4. Detects fraud and prescription drug abuse.

5. Checks against the plan member’s drug claim profile and therefore provide a more

comprehensive review (Holloway and Green, 2004).

6. Keeps physicians well informed.

7. Allows refined practice guidelines.

8. Improve overall healthcare and patient safety.

9. Improve therapy management for chronically ill patients.

10. Cost containment (Health Information Designs, 2014).

CONCLUSION

Drug Utilization Reviews help pharmacists fulfill their professional responsibility and ensure

that medication is dispensed safely. It also assists in monitoring compliance with the physician's

intended drug regimen. When possible harmful drug interactions are detected, alternative drug

therapies may be recommended after discussions with the prescribing physician. This may take

the form of dosage adjustments, alteration of medication administration and/or additional patient

monitoring (Navarro, 2008).

Still the process of DUR is still evolving. Using DUR information, managed care pharmacists

can identify prescribing trends in patient populations and initiate corrective action to improve

drug therapy for groups of patients as well as individuals. As the variety of health care

professionals (e.g., pharmacists, prescribers, nurses, optometrists, naturopaths, chiropractors)

involved in the medication use process expands, DUR will require a more multidisciplinary

approach to improving patient care. In addition, rapidly improving data systems will soon

provide the methodology for combining medical and pharmacy data with patient outcome data.

This will lead to the next logical step, the evolution of DUR into a more comprehensive health

care utilization evaluation (Navarro, 2008).

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REFERENCE

Department of Health (2014) Drug Utilization Review (DUR) Available from:

https://www.health.ny.gov/health_care/medicaid/program/dur/ [Accessed 22nd February

2014].

Georgia Department of Community Health (2013) Drug Utilization Review Board. Available

from: http://dch.georgia.gov/drug-utilization-review-board [Accessed 22nd February 2014].

Health Information Designs (2014) Retrospective Drug Utilization Review. Available from:

http://www.hidinc.com/solutions/drug-utilization-review-solutions/retrospective-drug-

utilization-review1.html [Accessed 22nd February 2014].

Holloway, K. and Green, T. (2004) ‘Drug and Therapeutics Committees - A Practical Guide: 6.5

Drug use evaluation (DUE) (drug utilization review)’ WHO: Department of Essential Drugs

and Medicines Policy.

Navarro, R. (2008) ‘Chapter 8: Drug Utilization Review Strategies.’ Managed Care Pharmacy

Practice, pp. 215 – 229.

New York Social Services Law (2013) Section 369-bb: Drug utilization review board. Available

from: http://www.weblaws.org/new_york/laws/n.y._social_services_law_sec._369-bb

[Accessed 22nd February 2014].

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