Prospective Drug Utilization Review Research Articles

On-Line, Real-Time Drug Utilization Review: Evolution toward Decision Support

On-line real-time drug utilization review (ORDUR) in general, and prospective drug utilization review, specifically, have been embraced conceptually by the health care industry. To date, ORDUR has focused on the avoidance of harmful drug combinations or misuse of medications as a means of both reducing costs and preventing adverse health outcomes. Health care organizations that are responsible for prescription drug benefit programs are able to demonstrate some cost savings as a direct result of implementing ORDUR, which has contributed to its wide acceptance. The limiting factor for the effectiveness of clinical algorithms used in such applications is the type of information available via community pharmacy information systems. Thus, in order to improve the effectiveness of ORDUR screening, additional information is required. Specifically, diagnostic information normally found in patients' medical records is a primary requirement for enhancing the integrity and accuracy of current clinical algorithms. In ...

Documentation of Pharmaceutical Care Activities in Community Pharmacies by Doctor of Pharmacy Students

The practice of pharmacy is evolving from a product-related focus to one that is more patient-oriented and outcome-directed. This new focus can reduce the cost and/or improve the quality of care. Pharmacists often detect and resolve medication-related problems, though few reimbursement incentives exist for the amount of time and effort it takes. With statutory restrictions on the total use of pharmacy technicians and state-mandated OBRA patient counseling and prospective drug utilization review, community pharmacists are pressed for time more than their hospital colleagues to document their daily interventions for improving drug therapy for their patients. PharmD students can assist the community pharmacist in documenting these medication-related problems. Documentation of these "cognitive" or "value-added services," including their outcome on cost and care, is critically necessary for future reimbursement consideration by third-party payers. Copyright © 1995 by W.B. Saunders Company

OBRA '90: The Impact on Pharmacists and Patients: Two related studies of pharmacists and patients in Georgia show that pharmacists are counseling more frequently since implementation of the federal law in January 1993.

Two separate studies were conducted in Georgia for this investigation. The first study measured, by observation, pharmacists' compliance with the mandates of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) before (December 1992) and after (June 1993) the law took effect in January 1993. The second assessed patient awareness, experience, and degree of cooperation with pharmacists in complying with OBRA '90. Eight chain and four independent pharmacies were recruited for the first study. For the second, a representative sampling of patients answered questions by telephone. Findings from the pharmacy study indicated more streamlined information gathering, more time devoted to prospective drug utilization review, and a 29% increase in counseling frequency in the post-OBRA '90 period. Some changes may be due to increased computer sophistication. The patient survey indicated a lower frequency of counseling than was reported in the pharmacy study. Patients appeared willing to supply information to pharmacists when patients viewed it as a way to improve the care they receive.

Drug utilization review in ambulatory settings: state of the science and directions for outcomes research.

There are escalating national pressures to analyze pharmaceutical outcomes and to develop drug-related clinical guidelines. These interests coincide with passage of the Medicaid Rebate Law (OBRA, 1990), which mandates the implementation of prospective and retrospective drug utilization review (DUR) programs by Medicaid in 1993. This report investigates DUR programs that target outpatient drug therapies. The authors present a conceptual framework that identifies the factors influencing drug prescribing and the range of potential patient outcomes. Current types of DUR interventions and their applications are described, in addition to problems that hinder implementation or evaluation of DUR programs. DUR evaluation studies are reviewed, and a critique identifies the limitations of available DUR research. The authors recommend an expanded DUR policy research agenda, strongly suggesting that priority be given to studies in the following areas: DUR criteria development and validation; prevalence of prescribing problems and their association with patient outcomes; efficacy, toxicity and costs of therapeutic alternatives; and DUR program evaluation. The overall conclusion is that the state of the science pertaining to DUR is not well developed. The potential of DUR may not be realized due to the lack of resources needed to design, implement, and evaluate effective programs. Instead, DUR efforts may be limited to cost-containment issues without due consideration of quality-of-care outcomes. The authors call for rigorous evaluation efforts to inform DUR design and implementation, thereby assuring more rational prescribing and enhancing patient outcomes.

Albumin/Hetastarch Drug Utilization Review in an Operating Room Pharmacy

A prospective drug utilization review (DUR) was performed on the colloids albumin 5% and hetastarch 6% at the University of Illinois Hospital Operating Room Pharmacy. This DUR's purpose was to evaluate the usage patterns of the two colloids. With the addition of hetastarch 6% to the formulary, an alternative colloid was available that could be therapeutically substituted for albumin 5% at a cost savings. Its usage, however, was not what would have been expected. Usage information was obtained by placing utilization forms inside the individual boxes of albumin 5% and hetastarch 6%. These forms were completed by the anesthesiologists and returned to the pharmacy, where the remainder of each form was completed. It was concluded that 93 percent of the patients administered albumin 5% could have received hetastarch 6%. Hence, potential yearly savings of approximately $12,346.00 could be realized by the Department of Pharmacy.