2. Drug Utilization Reviews (DUR)
Drug Utilization Evaluations (DUE)
Medication Use Evaluation (MUE)
Why DURs are important:
> DUR programs play a key role in helping managed health care systems
understand, interpret, and improve the prescribing, administration, and
use of medications.
> Employers and health plans find DUR programs valuable because the results are
used to foster more efficient use of healthcare resources.
> 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 etc..
> Pharmacists can then, in collaboration with other members of the health care
team, initiate action to improve drug therapy for both individual patients and
covered populations.
> 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.
3. Objectives of MUE by
CLINICAL PHARMACIST
Promoting optimal medication therapy.
Preventing medication-related problems.
Evaluating the effectiveness of medication
therapy.
Improving patient safety.
Establishing interdisciplinary consensus on
medication-use processes.
Stimulating improvements in medication-use
processes.
Stimulating standardization in medication-use
processes.
4. Minimizing procedural variations that contribute to
suboptimal outcomes of medication use.
Identifying areas in which further information and
education for health care professionals may be
needed.
Minimizing costs of medication therapy.
Promoting pharmacoeconomics.
Meeting or exceeding internal and external quality
standards
Objectives of MUE by
CLINICAL PHARMACIST
5. Responsibilities of Clinical Pharmacist in
DUE
Recommendation and promotion of the GOALS & Strategic objectives of the DUE.
Program consortium., development., coordination and mediation
Education of the hospital staff about the THEORY AND PRACTICE OF
DUE.
Coordination of development and review of audit criteria,
guidelines , study protocols and other educational material.
Coordination and development of data collection, instruments,
field testing, analysis, development of recommendation for
intervention and report writing.
Documentation of program outcome, effectiveness and cost
benefit.
Participation as a member of PHARMACY & THERAPEUTIC
COMMITTEE with QUALITY ASSURANCE in general and DUE in
particular.
7. DUE & Topic Selection
Based on the mission and scope of care of PATIENT.
oEffect on performance and improved
patient outcomes
oSelected high-volume, high-risk, or
problem-prone processes/medication
processes
oResources and organizational priorities
oInstitutional priorities (initiation of new
clinical programs or services)
8. DUE & Topic Selection
They should reflect the over all scope of medication
use throughout the organization
Annual plan that will establish goals for new topics
to be assessed and provide for follow-up on
previous evaluations
9. DUE ---- and Sources of Topic
slection
Medication error reports {MER’s}
ADRs
Advances in patient care modalities that involve
changes in optimal pharmacotherapy..
Disease-or diagnosis-based length of stay or cost
outliers with in an organization..
Purchasing reports indicating a significant increase
in the use of an agent … LIKE COX –II INHIBITORS
Medications that are a key component of a process
or procedure., “LIKE INJ ZAFRAN against CINV”
10. Criteria for the DUE..
Are statements of the activity to be measured
Should be based on the Good Clinical practice
“GCP”
Appropriate for the target patient population
Well Supported by current literature
Multidisciplinary group develops the criteria
Should be phrased yes/no or T/F
Should avoid interpretation on the part of data
collection
Assess important aspects in the use of the
medication evaluated
Focus on aspects related to outcomes.
11. DUE and Indicators
They are not direct measures of quality they
simply work as a tool to identify potentially
problematic aspects of care that require more
detailed assessment in order to identify the
cause.
E.g. patient discharged on > x
number of prescription
medications
12. Type of indicators
Rate based event
(how often)
Sentinel events
(occur rarely but are significant impact)
Assess structure
(resources ,tools, and other established attributes of the setting in
which care is provided)
Assess Process
(activities that take place in giving and receiving care)
Assess outcome
(the effects of care on the health status of the patient or
population
13. DUE and Standards
standards: define the performance
expectations
They are set at
o 0% (should never happen(
o100%(should always happen)
Thresholds specifying an
acceptable level should be set
higher then 0% and lower than
100%
14. Data collection
Prior to initiation the multidisciplinary gp or cp
must approve
oTopic selection
oCriteria
oPatient selection process
oSample size
oSampling method and technique
oTimeframe of the process.
oData collection method
oStandards of performance.
15. Data Collection
Limiting the number of data collectors or
automating data collection is valuable in
maintaining consistency
17. Patient selection and Sample
size
Patient selection
Unbiased
Consistent
Representative of the care provided
Sample size should be based on
The size of patient population
o Frequently occurring events 5%
o Rare events minimum 30 cases
18. confidentiality
It is a key component of all quality improvement
initiatives
The patients and the practitioners names should
be kept under confidentiality.
19. Data analysis
Reports should compare actual performance with
expectations defined by the standards
Performance not meeting standards they are considered
opportunities for improvement
Standards can be too rigorous?
Specific corrective action should be recommended.
A follow up should be started based on the needs and
prevalence ,severity and frequency of the problem
20. The Report
Should contain the rationale for the topic
selection
Team members involved in the evaluation
Description of the patient population evaluated
Any selection criteria used
A copy of the criteria /indicators
Discussion of the results
Identification of likely causes for opportunities
identified
Recommendations for corrective action
Follow –up evaluation
22. Follow up
The same criteria, standards, and sample should
be used for the follow up assessment as in the
initial assessment
23. DUE……. And Pitfalls…
Lack of authority.
Lack of organization.
Poor communication.
Poor documentation.
Lack of involvement.
Lack of follow-through
Evaluation methodology that impedes patient care
Lack of readily retrievable data and information
management.
24. Medication Use Evaluation Criteria
Serotonin Receptor (5HT3) Antagonist Use in Pediatric and Adult
Populations
Drug Utilization Reviews (DUR)
Drug Utilization Evaluations (DUE)
Medication Use Evaluation (MUE)
