Drug Utilization Review System Research Articles

Pharmacists' Perceptions on Safety Alerts of the Drug Utilization Review (DUR) in Electronic Health Records in a Tertiary Healthcare Hospital.

Electronic Drug Alarms and Drug Utilization Reviews (DURs) are crucial in improving patient safety by reducing the dispensing of contraindicated medications and minimizing adverse drug events. The DUR system often generates low-level alerts, making it challenging for pharmacists and doctors to discern more critical alerts. This can result in alert fatigue, causing burnout and jeopardizing patient safety. A cross-sectional study was conducted in a tertiary hospital to explore pharmacists' perspectives and experience with the DUR system. This study aimed to identify their responses to alerts indicating a need to change the original prescription and the difficulties encountered. Out of all the participants, 85% had prior experience with DUR alerts. However, 40% of them expressed dissatisfaction with the alerts. Moreover, 88% of the participants received highly frequent DUR alerts, but only 40% believed that DUR alerts could identify rare adverse drug reactions. Additionally, only 27% of the participants altered their prescriptions based on alerts for the MAOI/serotonin modulator. The survey showed that 66% of participants believe improvements are necessary for the DUR system. Specifically, 77% of participants felt that more information is needed on overlapping prescriptions, 82% on patients with chronic diseases, and 82% on potential reactions caused by co-administration. At the same time, 75% raised concern about the need for backup for any server breakdown. Positive perceptions about DUR lead to changing the prescription in response to an alert. Therefore, improving the DUR system is crucial to prevent pharmacists from missing important alerts and to increase their awareness of clinically significant alarm signals. By doing so, we can optimize patient safety and contribute to providing high-quality healthcare services.

Exploring the Perception on Drug Utilization Review System and DUR Modernization Pilot Project: A Qualitative Study Using Focus Group Interviews

Exploring the Perception on Drug Utilization Review System and DUR Modernization Pilot Project: A Qualitative Study Using Focus Group Interviews

Suggestion of a simpler and faster influenza-like illness surveillance system using 2014\u20132018 claims data in Korea

Influenza is an important public health concern. We propose a new real-time influenza-like illness (ILI) surveillance system that utilizes a nationwide prospective drug utilization monitoring in Korea. We defined ILI-related claims as outpatient claims that contain both antipyretic and antitussive agents and calculated the weekly rate of ILI-related claims, which was compared to weekly ILI rates from clinical sentinel surveillance data during 2014–2018. We performed a cross-correlation analysis using Pearson’s correlation, time-series analysis to explore actual correlations after removing any dubious correlations due to underlying non-stationarity in both data sets. We used the moving epidemic method (MEM) to estimate an absolute threshold to designate potential influenza epidemics for the weeks with incidence rates above the threshold. We observed a strong correlation between the two surveillance systems each season. The absolute thresholds for the 4-years were 84.64 and 86.19 cases per 1000claims for claims data and 12.27 and 16.82 per 1000 patients for sentinel data. The epidemic patterns were more similar in the 2016–2017 and 2017–2018 seasons than the 2014–2015 and 2015–2016 seasons. ILI claims data can be loaded to a drug utilization review system in Korea to make an influenza surveillance system.

Effect of a Nationwide Real-Time Drug Utilization Review System on Duplicated Nonsteroidal Antiinflammatory Drug Prescriptions in Korea.

Since January 2013, a nationwide drug utilization review (DUR) system for therapeutic duplication (TD) of nonsteroidal antiinflammatory drugs (NSAIDs) has been implemented in Korea. Our objective was to perform an interrupted time series study to assess changes in the pattern of NSAIDs use in knee osteoarthritis patients after implementation of the regulations. We compared the prescribing patterns in 2012 and 2013 by means of an interrupted time series study, using the Health Insurance Review and Assessment Service database. TD was defined as use of concurrent NSAIDs either on the same or on different prescriptions for >3 days in a patient. Level change and trend change (with 95% confidence intervals [95% CIs]), and absolute and relative changes in the proportion of TDs, were estimated using segmented regression models. Multivariable logistic regression models were used to explore patient and provider characteristics associated with the TDs. Approximately 2.5 million patients were prescribed NSAIDs in both 2012 and 2013. The proportion of TDs before and after introduction of the DUR system was 7.4% and 5.6%, respectively. Overall, an absolute reduction of 89% and a relative reduction of 30% in TDs were observed. In the postregulation period, older patients, medical aid subscribers (odds ratio [OR] 1.87 [95% CI 1.84, 1.90]), and veterans (OR 3.28 [95% CI 3.10, 3.46]) were most likely to receive NSAID TDs. The prescription of NSAID TDs decreased with the introduction of the nationwide DUR system. Continuous adherence to the DUR regulations and safety monitoring are needed, especially with the elderly, medical aid subscribers, and veterans.

The Effects after Implementing a Drug Utilization Review System on Contraindicated Drug use: A Systematic Review

The Effects after Implementing a Drug Utilization Review System on Contraindicated Drug use: A Systematic Review

A Current Analysis on Alert Override Reasons of Pregnancy Contraindication in the Drug Utilization Review system and the Policy Implication

A Current Analysis on Alert Override Reasons of Pregnancy Contraindication in the Drug Utilization Review system and the Policy Implication

PHP20 - Prescription Drug Use Monitoring to Check for Appropriate Use of Medicines in Korea vs. Japan and Taiwan

Prescription drug use monitoring to check for appropriate use of medicines is to ensure patients to receive appropriate medications for their clinical needs and to be safe from over/under-utilization of medications. This study aimed to compare the drug use monitoring policy between three Asian countries of Korea, Japan and Taiwan. Focusing on real-time drug use monitoring system and incentive/disincentive program for appropriate use of medicines, this study compared three Asian countries (Korea, Japan and Taiwan) based on a review of the literature (Database: Pubmed, Google Scholar, Respective institutional reports written in Korean, Japanese and English). Some sort of a real-time monitoring system is in place in all three countries. Japan collects patients’ drug records and allows physicians to review them for appropriate use. Taiwan has introduced Pharma Cloud in 2014 in order to let physicians access patients’ prescription records for prevention of overuse of medicines including duplicate prescriptions. Korea has implemented a real time drug utilization review (DUR) system to monitor for duplicate prescriptions and contraindicated combination drug therapy. Japan in 2016 has provided clinicians some incentives in place to monitor for polypharmacy. Taiwanese National Health Insurance Administration (NHIA) monitors for excessive prescribing/polypharmacy in drug therapy management of chronic diseases. NHIA adjusts medical reimbursement when physicians do not improve medication overuse. Korea in 2012 has implemented an incentive program for clinicians as well as for patients on drug therapy management of chronic diseases. Each country has a real-time drug use monitoring system and incentive/disincentive program in place to check for appropriate use of medicines. The real-time DUR system of Korea needs to include patients’ health records so that physicians’ prescribing practices improve in quality. Incentive program in Korea needs to relate effectively with quality evaluation.

Toward safer prescribing: evaluation of a prospective drug utilization review system on inappropriate prescriptions, prescribing patterns, and adverse drug events and related health expenditure in South Korea.

This study aimed to evaluate the effect of the prospective drug utilization review (DUR) system introduced in Korea in December 2010 as a real-time method to improve patient safety, in terms of changes in prescribing practices, adverse drug events (ADEs), and ADE-related healthcare expenditure, using non-steroidal anti-inflammatory drugs (NSAIDs) and their common ADEs as a guide. We used an interrupted time-series study design using generalized estimating equations to evaluate changes in prescription rate and ADE-related healthcare expenditure. Cox regression analysis was used to evaluate the probability of NSAID-associated ADEs. A total of 154,585 outpatients with musculoskeletal or connective tissue disorders, without pre-existing gastric bleeding or ulcers were included in this study. The primary outcome was the level and trend change in prescription rate, drug-drug interactions, coprescribed gastro-protective drugs, and defined daily dose (DDD) of NSAIDs. The secondary outcome was the probability of ADEs and changes in ADE-related healthcare expenditure. There was a significant trend change after introducing the DUR system in terms of drug-drug interactions (-3.6%) and coprescribed gastro-protective drugs (+0.6%). The mean DDD of NSAIDs increased by 0.2. The probability of ADEs decreased overall (-1.7%) and in the high-risk group (age ≥65 years; -9.6%); however, only the latter was significant. There was no significant trend or level change in ADE-related health expenditure. The introduction of the DUR system was associated with more efficient prescribing, including a reduction in drug-drug interactions and an increase in the use of gastro-protective drugs. The system had a positive effect on patient outcome but was not associated with reduced ADE-related costs. Further studies are needed to evaluate the long-term effects of the DUR system in Korea.

Information exchange and cooperation with other sectors: Beyond the healthcare

Introduction: Many countries around the world are cooperating with various national and international agencies for Infectious Disease Surveillance. In 2015, there was an outbreak of Middle East Respiratory Syndrome Corona Virus (MERS-CoV) in Korea. An effective way is required to identify and trace those who are suspected to be infected. Short description of practice change implemented: The Drug Utilization Review (DUR) is an online clinical decision support system and provides a real-time drug related alert messaging services for medication orders. Any medication order must be checked with DUR to prevent drug-related medical errors. Aim and theory of change: In order to identify and to trace the individuals who were infected with MERS-CoV and had close-contacts with quickly. Targeted population and stakeholders: Korean population, Healthcare Providers (above of 80,000) and Government ministries such as Korea Immigration Office (KMO), Center for Disease Prevention and Control of Korea (KCDC) and Health Insurance Review and Assessment Service (HIRA). Timeline: June 10, 2015 ~ present. Highlights: The DUR system was effectively used: - To identify and trace infected individuals and those who had close-contacts with them; - To provide rapid infection risk information to medical personnel; - To prevent healthcare associated infections (HAIs); - To improve safety of inpatients and medical personnel; and - To reduce time for epidemiological investigations. Comments on sustainability: The DUR system has been successfully adopted by almost all hospitals and clinics that use computerized physician order entry (CPOE) systems and it will still be useful for surveillance purposes, contributing to the development of integrated medical care. It can be further developed into a national disease monitoring system like as Health Alert Network (HAN). Comments on transferability: Reliable network environment and introduction of electronic medical records are necessary. Conclusions (comprising key findings): The DUR system has been developed to reduce the risk of drug related errors, but it has evolved into a health alert system in the process of overcoming MERS-CoV. This is a good example of the meaningful use of information and information exchange across the healthcare and other sectors.

How to integrate drug Information: Korea Drug Utilization Review System

Introduction: Korea adopts a National Health Insurance System (NHIS). Under the NHIS, one of the biggest challenges is to find a way to provide affordable, yet high-quality healthcare services to citizens. This report introduces the process of establishing Korea's drug utilization review service and discusses lessons learned from the achievements. Short description of practice change implemented: The NHIS of Korea where there is no concept of family doctor separates doctor's prescription and pharmacist's dispensing. In the clinical setting, the doctor should confirm patient's medication history during consultation of the patient. But, it is difficult to confirm the characteristics and precautions of medicines with statements of patients (non-experts) only. Aim and theory of change: By integrating the medication history of the patient, physicians receive warnings in real time, upon entry of drug orders, if a risk factor to the patient is detected. It is a form of online clinical decision support. Target population and stakeholders: The whole population and approximately 80,000 healthcare providers. Timeline: - 2008: Safety checks on medicines in a single prescription - 2009: Safety checks on medicines in two or more prescriptions issued by a single provider - 2010: Safety checks of medicines in two or more prescriptions issued by multiple providers. - 2015: Enforcement through an amendment of related law Highlights: Saved over 17.96 million USD dollars per year and prevented 5.4 million cases of unsafe use of drugs in prescription. Comments on sustainability: Patient safety improvements and NHIS budget savings Comments on transferability: Reliable broadband network communication and stakeholders’ cooperation are needed. Conclusions: If information technology is used appropriately to realize integrated medical care, clinical decision support services can achieve better outcomes in more cost effective manner. Discussion: More applicable fields should be identified.

Physicians' and pharmacists' perceptions on real-time drug utilization review system: a nationwide survey.

To identify healthcare providers' experience and satisfaction for the drug utilization review (DUR) system, their impact on prescription changes following alerts, and difficulties experienced in the system by surveying primary healthcare centers and pharmacies. A cross-sectional nationwide survey. Approximately 2000 institutions were selected for the survey by a simple random sampling of nationwide primary healthcare centers and community pharmacy approximately practices, and 358 replied. The questionnaire included questions on experience and recognition of DUR alerts, personal attitude and respondents' biographical information. Space was included for respondents to suggest improvements of the DUR system. The DUR system scored 71.5 out of 100 points for satisfaction by physicians and pharmacists, who reported that the alerts prevent medication-related errors; most respondents (96.6%) received the alerts. Several respondents (10.9%) replied that they prescribe or dispense prescriptions as they are without following the alerts. Physicians (adjusted odds ratio, 8.334; 95% confidence interval, 3.449-20.139) are more likely to change the prescription than pharmacists and persons with alert experience (4.605; 1.080-19.638). However, current practice in metropolitan areas (0.478; 0.228-1.000) and frequent alerts regarding co-administration incompatibilities within prescriptions (0.135; 0.031-0.589) negatively influence adherence to DUR alerts. Although most surveyed physicians and pharmacists receive the alerts, some do not or reported that they would not follow the alerts. To increase adherence, the DUR system should be improved to ensure a preferential and intensive approach to detecting potentially high-risk drug combinations.

Constructing a Real-Time Prescription Drug Monitoring System.

ObjectivesThe objective of this investigation was to demonstrate the possibility of the construction of a real-time prescription drug monitoring system (PDMOS) using data from the nationwide Drug Utilization Review (DUR) system in Korea.MethodsThe DUR system collects information on drug prescriptions issued by healthcare practitioners and on drugs dispensed by pharmacies. PDMOS was constructed using this data. The screen of PDMOS is designed to exhibit the number of drug prescriptions, the number of prescriptions dispensed by pharmacies, and the dispensed prescription drug costs on a daily and weekly basis. Data was sourced from the DUR system between June 1, 2016 and July 18, 2016. The TOGA solution developed by the EYEQMC Co. Ltd. of Seoul, Korea was used to produce the screen shots.ResultsPrescription numbers by medical facilities were more numerous than the number of prescriptions dispensed by pharmacies, as expected. The number of prescriptions per day was between 2 to 3 million. The prescriptions issued by primary care clinics were most numerous, at 75% of the total number of prescriptions. Daily prescription drug costs were found to be approximately US $50 million. The prescription drug costs were highest on Mondays and were reduced towards the end of the week. Prescriptions and dispensed prescriptions numbered approximately 1,200 and 1,000 million, respectively.ConclusionsThe construction of a real-time PDMOS has been successful to provide daily and weekly information. There was a lag time of only one day at the national level in terms of information extraction, and scarcely any time was required to load the data. Therefore, this study highlights the potential of constructing a PDMOS to monitor the estimate the number of prescriptions and the resulting expenditures from prescriptions.

New Alert Override Codes for the Drug Utilization Review System Derived from Outpatient Prescription Data from a Tertiary Teaching Hospital in Korea.

ObjectivesThis paper proposes new alert override reason codes that are improvements on existing Drug Utilization Review (DUR) codes based on an analysis of DUR alert override cases in a tertiary medical institution.MethodsData were obtained from a tertiary teaching hospital covering the period from April 1, 2012 to January 15, 2013. We analyzed cases in which doctors had used the 11 overlapping prescription codes provided by the Health Insurance Review and Assessment Service (HIRA) or had provided free-text reasons.ResultsWe identified 27,955 alert override cases. Among these, 7,772 (27.8%) utilized the HIRA codes, and 20,183 (72.2%) utilized free-text reasons. According to the free-text content analysis, 8,646 cases (42.8%) could be classified using the 11 HIRA codes, and 11,537 (57.2%) could not. In the unclassifiable cases, we identified the need for codes for "prescription relating to operation" and "emergency situations." Two overlapping prescription codes required removal because they were not used. Codes A, C, F, H, I, and J (for drug non-administration cases) explained surrounding situations in too much detail, making differentiation between them difficult. These 6 codes were merged into code J4: "patient was not taking/will not take the medications involved in the DDI." Of the 11 HIRA codes, 6 were merged into a single code, 2 were removed, and 2 were added, yielding 6 alert override codes. We could codify 23,550 (84.2%) alert override cases using these codes.ConclusionsThese new codes will facilitate the use of the drug–drug interactions alert override in the current DUR system. For further study, an appropriate evaluation should be conducted with prescribing clinicians.

Therapeutic duplicate prescribing in Korean ambulatory care settings using the National Health Insurance claim data.

Duplicate prescribing is known to occur across health systems and is one of the most frequent drug related problems. Therapeutic duplication (TD) increases the risk of adverse drug reactions without additional therapeutic benefits. This study aimed to develop TD criteria concerning four drug categories which are acid-related disorder drugs, antimicrobials, antihypertensives, and lipid modifying drugs and to estimate the prevalence of therapeutic duplicate prescribing at the ambulatory care settings in Korea. TD criteria were developed using the WHO anatomical therapeutic chemical classification and modified with an expert consensus panel using the Delphi method. The prevalence of TD including ingredient duplication (ID) of four drug categories was examined using National Health Insurance claim database including 15 million patients during one month in 2009 (December). TD was defined as prescribing medications within the same category in the developed TD criteria list. The numbers of patients who received acid-related disorder drugs, antimicrobials, antihypertensives, and lipid-modifying drugs in the study period were 10,049,292, 7,584,131, 4,349,945, and 1,425,292 respectively. In the field of acid-related disorder drugs prescribed, there were 0.3 % IDs and 2.5 % TDs within a prescription issued by one prescriber. There were 8.4 % IDs and 14.5 % TDs between prescriptions issued at different ambulatory visits. In the field of antimicrobial medicines, there were 0.1 % IDs and 2.6 % TDs within a prescription, while there were 5.0 % IDs and 7.6 % TDs between different prescriptions. Amongst the antihypertensives prescribed, there were 0.4 % IDs and 1.9 % TDs within a prescription, while there were 9.9 % IDs and 11.5 % TDs between prescriptions. Lastly, looking at lipid-modifying drugs prescribed, there were 0.3 % IDs and 0.5 % TDs within one prescription, while there were 8.9 % IDs and 9.4 % TDs between prescriptions. The prevalence of duplicate prescribing was substantial in the ambulatory care setting which is to be improved using the TD criteria developed from this study in the national drug utilization review system in Korea.

SY01-3 * THE PROBLEMS OF PRESCRIPTION DRUG ABUSE IN KOREA AND TAKING ACTIONS TO OVERCOME

Objectives. According to the criminal data related to illegal drug abuse in Korea, the most popular drugs were psychotropics. However, the majority of the illegal drug was psychostimulant including methamphetamine, MDMA not the prescription medication. Nevertheless, we cannot overlook the problem of prescription drug abuse owing to the serious hidden problems. Methods. The result of survey with the non-psychiatric doctors in Korea about the prescription patterns of benzodiazepine will be presented. Recently, the National Evidence-based Healthcare Collaboration Agency reported the potential risks of over-prescriptions of Benzodiazepine in Korea. Some news reported that the problem of Propofol abuse of several celebrities. Those data was summarized. Results. The benzodiazepines were prescribed quite diverse area not only for anxiety relieve or sleep induction but also for just relax of nearly most of impaired physical conditions. The percentage of people who filled BZD prescription of at least once was 8.4–18.6% during one year in all population without restriction of age. Most frequent prescribing active ingredient was diazepam, and gastro-duodenal disease was the most frequent indication for BZD prescription. (29.8% among out-patient claims and 14.7% among in-patient claims). BZD prescription of at least once during five years occurred for a total of 22,361,449 patients (≥ 18 years old) using 5% sampling data. The average national prescription prevalence per 100 people per one year was 23.7%, 7.9%, 4.7%, and 3.2% for BZD annual prescription of ≥1 day, ≥30 days, ≥90 days, and ≥ 180 days, respectively using total number of population (≥18 years old) during study periods. The risk for fracture was higher in patients with BZD prescription than people without BZD prescription. Most of the doctor had a mind to reduce benzodiazepine prescription but only the 17.6% of non-psychiatric doctors tried to discontinue the benzodiazepine prescription. Conclusion. The online DUR (Drug Utilization Review) system was disseminated from general hospital to small private clinics nationwide. Through DUR system the authority keeps their eyes on the prescription pattern. For each drug that might have abuse liability limitation of dosage and duration of prescription is strictly monitored. Other ongoing counteract processed will be discussed.

Impact of doctors' resistance on success of drug utilization review system.

ObjectivesThe drug utilization review (DUR) system, which checks any conflict event of medications, contributes to improve patient safety. One of the important barriers in its adoption is doctors' resistance. This study aimed to analyze the impacts of doctors' resistance on the success of the DUR system.MethodsThis study adopted an augmented the DeLone and McLean Information System (D&M IS) Success Model (2003), which used doctors' resistance as a socio-technological measure. This study framework is the same as that of the D&M IS Success Model in that it is based on qualities, such as system, information, and services. The major difference is that this study excluded the variable 'use' because it was not statistically significant for mandatory systems. A survey of doctors who used computers to enter prescriptions was conducted at a Korean tertiary hospital in February 2012.ResultsThis study is very meaningful in that it is the first study to explore the success factors of the DUR system associated with doctors' resistance. Doctors' resistance to the DUR system was not statistically associated with user usefulness, whereas it affected user satisfaction.ConclusionsThe results indicate that doctors still complain of discomfort in using the DUR system in the outpatient clinical setting, even though they admit that it contributes to patient safety. To mitigate doctors' resistance and raise user satisfaction, more opinions from doctors regarding the DUR system have to be considered and have to be reflected in the system.

Evaluation of the pilot program on the real-time drug utilization review system in South Korea

PurposeA pilot drug utilization review (DUR) program was initiated by the Korean government, which provided safety information in real-time at the stage of prescribing and dispensing. This study aimed to compare the “physician/pharmacist Co-DUR” system and the traditional “pharmacist-only DUR” system. MethodsData collected during a DUR pilot program from July 1 to October 31 of 2009 were obtained from the Health Insurance Review & Assessment Service. Descriptive analyses were conducted to investigate DUR-pop up alert rates, categories of alerts, the reasons for dispensing without prescription change after an alert, and changes in drug expenditures associated with the DUR. ResultsDUR pop-up alert rates were 8.55% at clinics and 1.90% at pharmacies in the physician/pharmacist Co-DUR, whereas the rate was 2.22% in the pharmacist-only DUR. Rates of pop-up alerts were high for between-prescription ingredient duplication at pharmacies, whereas for clinics, the rate for drug-pregnancy contraindications was high. A greater reduction in drug expenditure was estimated in the physician/pharmacist Co-DUR compared to the pharmacist-only DUR. ConclusionsThe physician/pharmacist Co-DUR has better sensitivity at detecting potential adverse drug events than the pharmacist-only DUR. Pharmacists also have opportunities to double-check prescribed drugs when doctors do not voluntarily modify pop-up alerts. Further comprehensive study will be needed to confirm the results of pilot program that favored the physician/pharmacist Co-DUR.

동시적 의약품 사용평가(cDUR) 시스템 구축 및 적용 사례 연구 : 국내 한 대학병원을 중심으로

Medical errors such as adverse drug event, improper transfusion, wrong-site surgery, mistaken patient identity and so on commonly occur at health care practice. Information technology, like Drug Utilization Review(DUR) system which reviews, analyzes, and interprets medication data when prescribing, can play a key role in reducing such medical errors and improving patient safety. Korean Government has guided all hospitals to implement concurrent DUR(cDUR) system, which is the first case worldwide in that all healthcare providers have to use cDUR system when prescribing. This paper introduced a case study that a tertiary hospital has integrated the cDUR system into its comprehensive Hospital Information System(HIS) and analyzed the whole prescription data during a week right after adoption of cDUR system. Considering technical strength and weakness, the cDUR system was integrated into the HIS, using Broker Servers for minimizing doctors' anxiety. As the quantitative analysis of the whole prescription data, DUR conflict events, which mainly included duplicate medications and contra-indicated drug interactions for outpatients, were 2.77%. Although only 0.7% is for the contra-indicated drug interactions, it will be greatly devoted to achieve the purpose of DUR such as improving patient safety.

의원 외래환자의 약품비 변화 관련요인: 처방총액 절감 인센티브제도와 DUR 제도 시행 전후를 중심으로

This study was performed in order to compare a change in pharmaceutical expenditures per outpatient of clinic and to analyze factors relevant to a systems as part of evaluating policies for the incentive scheme to reduce total prescribed drug expenditure and for the drug utilization review system("DUR system" hereafter). For this, it had finally analytical subjects as 21,320 clinics nationwide without a change in location, clinics symbol and signed subject during both terms of the first half of 2010 and the first half of 2011. As a result, the odds ratio with reduction in pharmaceutical expenditures of clinic was statistically higher significantly in the shorter year number of opening clinic, in the larger number of doctors, when the classification of establishment is other, not individual, and when the signed subject is surgical division. Also, the odds ratio was significantly higher in the less patient number of clinic and in the lower ratio of patients aged over 65. Finally, the odds ratio was significantly high when a clinic had been located in DUR system demonstrative project area. Through this, a case of policy for improvement in doctor's autonomous prescription behavior like DUR system can be known to be effective for reduction in pharmaceutical expenditures. A future research on evaluation of policy for pharmaceutical expenditure management system will need to be performed in-depth analysis in consideration of diverse characteristics on the participatory entities.

The contraindication of comedication drugs and drug utilization review

A drug interaction can be defined as an interaction between a drug and other drugs that prevent the drug from performing as expected. These processes may include alterations in the pharmacokinetics of the drug, such as modulations in the absorption, distribution, metabolism, and elimination (ADME) of a drug. Alternatively, drug interactions may be the result of the pharmacodynamic characteristics of the drug: the concomitant medication of a receptor antagonist and an agonist for the same receptor. The following interaction may increase or decrease the effectiveness of the drugs or the adverse drug reactions of the drugs. The possibilities of drug interactions should increase as the number of drugs being taken increases in patients. Therefore, patients taking several drugs simultaneously are at the greatest risk for interactions. Drug interactions can contribute to the increasing cost of healthcare because of the costs of medical care that are required to treat problems caused by changes in effectiveness or adverse drug reactions. The drug utilization review (DUR) system has been defined as a structured, ongoing initiative that interprets patterns of drug usage in relation to predetermined criteria and attempts to prevent or minimize inappropriate prescribing. The primary objectives of DUR are to improve the quality of health care for healthcare members and to assist in containing health care costs. In order to achieve these goals, prescription claims must be reviewed both prospectively and retrospectively. The DUR system supplies information to prohibit co-dispensing of contraindicated drugs which increases the risk of drug interactions properly to all the healthcare professionals participating in the care of the patients. In this article, we suggest the importance of DUR in relation to the contraindication of co-medication drugs.