Useful information on DUE.

1. 1
DRUG UTILIZATION REVIEW
Bhupal Nobles College of Pharmacy
Udaipur
KISHAN LABANA
PharmD 5th year

2.  Drug utilization review (DUR) programs have been defined as
“structured, ongoing initiatives that interpret patterns of drug use
in relation to predetermined criteria, and attempt to prevent or
minimize inappropriate prescribing.”
 DUR has many synonyms, including drug use review, drug use
evaluation, and medication use evaluation.
 Drug utilization review programs are ongoing structured
systems designed to improve drug use by intervening when
inappropriate drug use is detected.
2

3.  Drug utilization review studies are ad hoc investigations that
assess the appropriateness of drug use. They are designed to
detect and quantify any drug use problems.
 DUR programs differ from drug utilization studies, which are
time-limited investigations that measure drug use, but do not
necessarily assess appropriateness or attempt to change practice.
3

4. 4
1) TO PROMOTE OPTIMAL MEDICATION
THERAPY.
2) TO ENSURE THAT DRUG THERAPY MEET
CURRENT STANDARD OF CARE.

5. 5
TYPES OF DUR STUDIES

6.  Prospective drug utilization review is designed to detect drug–
therapy problems before an individual patient receives the drug.
 Retrospective drug utilization review compares past drug use
against predetermined criteria to identify aberrant prescribing
patterns or patient-specific deviations from explicit criteria
 Quantitative DUE: The quantitative study of drug utilization
figures from which patterns of drug acquisition, prescribing,
dispensing, distribution and consumption may be determined
6

7.  Qualitative DUE: The qualitative evaluation of drug therapy and
drug therapy outcomes by comparison of practice with
predetermined criteria and standards
 A DUE program incorporates quantitative review of utilization and
qualitative evaluation of the indication, appropriateness, efficacy,
safety and outcomes of drug use.
 Concurrent DUR involves reviewing drug orders during the
course of therapy. This type of evaluation is ideal where
adjustments to drug therapy may be necessary based on ongoing
diagnostic and laboratory tests
7

8.  In the United States, drug utilization review programs are required,
by law, of each of the 50 state Medicaid programs, and have been
implemented as well in many managed care organizations.
 Recently, the use of clinical decision support within computerized
prescriber order entry (CPOE) programs has risen dramatically. The
use of such programs to improve prescribing can be considered a
form of prospective DUR in which prescribers are the targets of
interventions
8

9. AIMSAND OBJECTIVES
The aim of DUE is to achieve quality drug use and
patient care by ensuring appropriate, safe and cost-
effective drug therapy.
Objectives are to improve drug use outcomes by:
 A. Ensuring that drug therapy meets current standards
of care
 b. Controlling drug cost
 c. Preventing medication related problems
 d. Evaluating the effectiveness of drug therapy
 e. Identification of areas of practice that require further
education of practitioners
9

10. Steps in establishing a basic hospital DUR
program
The steps included in establishing a basic hospital DUR
program are listed below. The process is divided into four
phases:
 Phase 1- planning,
 Phase 2 - data collection and evaluation
 Phase 3 - intervention, and
 Phase 4 - program evaluation.
10

11. Phase 1 - Planning
Step 1. Form the DUR Committee.
Step 2. Write policies and procedures.
Step 3. Define all areas or departments of the hospital where
drugs are used
Step 4. Identify drugs for possible inclusion in the program.
 Commonly prescribed drugs, eg. Antibiotics, PPIs.
 Drugs with potentially significant DIs, eg. Warfarin,
theophylline, Phenytoin.
 Expensive drugs. Eg.. LMWt Heparins, broad spectrum
Cephalosporins
 New drugs
 Drugs with narrow therapeutic index. Eg. Digoxin,
theophylline.
11

12. Step 5. Assess resources available for criteria
development, data collection, and
evaluation, and choose drugs to be
included in program.
Step 6. For each drug, select aspects
(indications, dosing, dosage form chosen,
etc.) of drug use to monitor and evaluate.
.
12

13. Step 7. Select criteria and standards
• Perform an exhaustive literature search for the chosen
drug or therapeutic area using more than one search
mechanisms
• Critically evaluate the studies directly to the chosen drug
• Briefly summarize the literature review, identifying the
“key” papers in the chosen area and the drug criteria that
can be derived from the evidence based literature.
13

14. Step 8. Establish methodology for data collection and
evaluation and create a schedule.
 Data collectors should be familiar with how information is
arranged in the patient’s case notes.
 Knowledge of drug names, strengths and the way orders are
written are also important.
 Data collection should be done during a period.
14

15. Step 9. Educate hospital staff about DUR
program and current criteria
15

16. Phase 2 – Data Collection and Evaluation
Step 10. Collect data.
The data obtained should be collected using
available resources such as spreadsheets, databases
and word processing.
Step 11. Evaluate data and determine if drug use
problems exist.
16
Summarize the major categories of results and to
identify where exactly the data shows deviation from the
guidelines and usage criteria that are previously identified.

17. Phase 3 – Intervention
Step 12. Disseminate results to hospital staff.
Step 13. If a drug use problem was found, design and implement
interventions.
Educational interventions consist of educational meetings,
circulation of protocols, academic detailing, feedback of study
results, letters to individual prescribers, newsletters and other
informational materials such as posters and guidelines.
Operational interventions include the development/modification of
drug order forms, manual or computerized reminders, formulary
additions/ deletions, automatic stop orders or reallocation of
staff. 17

18. Step 14. Collect new data on problem drug to
determine if drug use has improved as
a result of the intervention.
Step 15. Disseminate results of re-evaluation.
18

19. Phase 4 – Program evaluation
Step 16. Evaluate all DUR program activities at
end of the evaluation year, and plan
program activities for the next year.
19

20. Role of pharmacist
 Preparation of submission for programme justification
 Programme development, supervision and co-ordination
 Education of hospital staff about DUE
 Recommendation and promotion of goals and objectives
 Development /review of audit criteria, guidelines, study
protocols and other educational material
 Development of data collection form and analysis and
report writing
20

21. Referance:
 A Textbook Of Clinical Pharmacy Practise By
G Parthasarathi
 Textbook Of Pharmaceutical Sciences By
Remington.
21