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At least 19 recordsLinked to original sources
PubMed1999

Drug utilization reviews of oral quinolone, cephalosporin, and macrolide use in nonacute care: a systematic review.

Drug utilization review (DUR) is a tool for monitoring the appropriateness of physicians' prescribing patterns. The present systematic overview was undertaken to determine the extent of appropriate use of oral quinolones, cephalosporins, and macrolides in nonacute-care settings in North America reported in published DUR studies. Potentially relevant DURs conducted since 1987 were retrieved from an electronic search of 6 databases (augmented by manual searches of bibliographies of appropriate articles) and from personal communications with local experts. Independent reviewers applied objective criteria to select the DURs for inclusion. Quality assessments were performed by 4 independent reviewers using the Edmonton Quality Assessment Tool for Drug Utilization Reviews, an instrument developed to assess the potential for systematic bias in a DUR. Data from the studies included were abstracted independently by 2 reviewers using a standard data-collection form. Twelve of 587 (2.0%) articles met the inclusion criteria. Eight studies targeted the appropriateness of prescriptions for ciprofloxacin (appropriateness range, 5% to 95%), 3 included cephalosporins (range, 0% to 100%), and 2 examined erythromycin (40%). There were 2 primary reasons for a rating of inappropriate: (1) the prescription was not first-line therapy, or (2) there was insufficient documentation in the patient record. The designation inappropriate did not mean that the drug did not benefit the patient. Of the 4 intervention-based DURs, 1 study showed a significant improvement in appropriate use. Because of heterogeneity in study design, delivery of interventions, and outcome assessment, a pooled estimate of effect was not derived. Four studies estimated the cost of inappropriate prescribing to the institutional study site, which ranged from $20,500 to $173,359 annually; however, these estimates cannot be generalized because of various limitations. When the 12 studies were assessed for methodologic quality, 1 study was rated as high, 7 as moderate, and 4 as low. Levels of prescribing appropriateness reported in the DUR literature should be interpreted cautiously. The DUR studies included in this review varied greatly in the methodologic rigor applied to sample selection, standardized data collection, application of standardized screening criteria, and validated data analysis.

Bacterial Infections↗
PubMed1982

An assessment of prescribing using drug utilization review criteria.

Drug utilization review screening criteria were applied to a sample of 30 000 prescriptions written by Iowa physicians. Characteristics of the physicians who had high percentages of prescriptions violating the explicit criteria were examined. It was found that the proportion of prescriptions failing the screening criteria did not differ significantly among physicians of differing board certification groups, medical school of graduation, year of graduation from medical school, age, or size of town where the physicians practiced. Regardless of the physicians' demographic characteristics, approximately 50 percent of their prescriptions violated the prescribing criteria. The three categories of screening criteria included irrational mixture, quantity prescribed, and daily dosage. An analysis of the relationship between physician ratings obtained for each of the categories revealed that no relationship existed between a physician's quantity prescribed rating and daily dosage rating, or between a physician's irrational mixture rating and daily dosage rating. A negative relationship was found between a physician's quantity prescribed rating and irrational mixture rating. This tends to indicate that the three categories measure different prescribing patterns and each warrants respective monitoring by pharmacists.

Drug Prescriptions↗
PubMedDate not supplied

Drug utilization review: mechanisms to improve its effectiveness and broaden its scope. The U.S. Pharmacopeia Drug Utilization Review Advisory Panel.

OBJECTIVE: To address important problems and needed changes in online and retrospective drug utilization review (DUR) programs. Emphasis is placed on reliability of DUR criteria and the shift of traditional retrospective DUR programs toward disease management and health care outcomes. DATA SOURCES: Published literature evaluating the role of online and retrospective DUR programs. STUDY SELECTION: Particular attention was given to studies assessing DUR criteria reliability and new interventions with retrospective DUR programs. DATA SYNTHESIS: A literature review was conducted along with an expert summary from the U.S. Pharmacopeia Drug Utilization Review Advisory Panel. Studies have revealed variations in DUR criteria that could be affecting clinical practice and patient care. Appropriate formal methodologies and use of consistent procedures in developing online prospective DUR programs and systems could help resolve these problems. Traditional retrospective DUR is also shifting to incorporate disease management and methodologies from health outcomes and pharmacoeconomics studies. CONCLUSIONS: Refinements are needed to improve the reliability and validity of online DUR criteria and to minimize false positive messages. Databases created as a result of DUR efforts have been used in new and innovative ways to incorporate health outcomes data and disease management interventions. Additional outcomes data, combined with quality assurance efforts, should increase the utility of DUR/disease management efforts in evaluating health systems while improving the effectiveness and efficiency of pharmacists' health care interventions.

Computer Systems↗
PubMedDate not supplied

Drug utilization review of sedative/hypnotic agents in Texas Medicaid patients. Texas Medicaid Vendor Drug Program Drug Utilization Review Board.

OBJECTIVE: To assess use of sedative/hypnotic agents in Texas Medicaid patients and evaluate practitioner receptiveness to intervention letters concerning sedative/hypnotic prescribing generated by the Texas Medicaid Drug Utilization Review (DUR) Board. DESIGN: Retrospective DUR. SETTING: Texas Medicaid retrospective DUR program. PATIENTS OR OTHER PARTICIPANTS: 244 Texas Medicaid patients and 291 Texas physicians. INTERVENTION: Patient profiles for Texas Medicaid patients were reviewed retrospectively to quantify sedative/hypnotic prescribing practices. Intervention letters were prepared and sent to physicians directly involved in the care of patients receiving excessive sedative/hypnotic therapy. Physician responses were categorized based on information presented in the intervention letter and circumstances surrounding the identified patient. Prescribing practices were assessed approximately 1 year after the intervention to determine the impact of intervention letters on prescribing. MAIN OUTCOME MEASURE: Physician response to intervention letter. RESULTS: Responses were received from 208 of 291 physicians (71.5%). Approximately 40% of physicians agreed in principle with the suggestions offered by the Texas Medicaid DUR Board to minimize chronic sedative/hypnotic use. Almost one-half of these physicians had discontinued sedative/hypnotic therapy for the identified patients 1 year after the intervention. Approximately 9% justified continued sedative/hypnotic use based on patient diagnosis or refractory response to treatment, and 55 physicians (26.4%) were unwilling to alter therapy because of patient-specific factors. CONCLUSION: Through the use of retrospective DUR, Texas Medicaid patients receiving excessive amounts of sedative/hypnotic agents were identified and improvements in sedative/hypnotic therapy were initiated. DUR can be useful not only in identifying problem areas, but also in encouraging physicians to modify prescribing practices through educational means.

Adolescent↗
PubMed1996

A primer on drug utilization review.

Many health care organizations evaluate drug utilization to improve the quality of patient care, reduce pharmaceutical expenditures, and enhance therapeutic outcomes. The Drug Regimen Review, instituted in 1974 as part of a quality assurance program for the care of Medicaid recipients, has reduced medication use, medication errors, adverse drug reactions, and drug-drug interactions. The Drug Usage Evaluation, a sophisticated analysis of drugs, their uses, and their contributions to various patient outcomes, is performed by member institutions of the Joint Commission on Accreditation of Healthcare Organizations. The 1990 Omnibus Budget Reconciliation Act (OBRA '90) established the Drug Utilization Review (DUR), which was implemented by state Medicaid outpatient prescription programs in 1993. Pharmacists performing DURs must review past patterns of drug misuse, monitor current therapy, and offer patient counseling. Drug utilization reviews have reduced inappropriate drug use and decreased drug costs.

Drug Utilization Review↗
PubMed2000

Edmonton Quality Assessment Tool for Drug Utilization Reviews: EQUATDUR-2: the development of a scale to assess the methodological quality of a drug utilization review.

OBJECTIVE: The objective of this study was to develop an instrument that will assist in evaluating the methodological quality of drug utilization reviews (DURs) and studies of prescribing appropriateness. DESIGN: An expert committee followed accepted steps for developing and testing new instruments. Consultations on content, face validity, and scoring of items were solicited from external experts. Seven raters tested an initial version; subsequently, a refined instrument was designed. The Edmonton Quality Assessment Tool for Drug Utilization Reviews (EQUATDUR-2) evaluates 3 domains: sample selection (1 item), data collection (1 item), and data analysis (3 items). Sixteen raters tested EQUATDUR-2 on a random sample of DURs. MEASURES: The study measures were reliability-using random effects interclass correlation coefficients for ratings by individual raters (ICC2,1) and the mean of ratings (ICC2,k)-and variability between DUR quality levels and rater groups. RESULTS: There were significant differences in methodological quality (P <0.001) and in mean scores comparing low-, moderate-, and high-quality DURs. Nonmethodologists' ratings exhibited significant variability (P = 0.03) and tended to be higher. Agreement varied for individual items (ICC2,1, 0.22 to 0.44; ICC2,k, 0.81 to 0.91) and for mean summary ratings (ICC2,1, 0.42 [95% CI, 0.28 to 0.61]; ICC2,k, 0.92 [95% CI, 0.86 to 0.96]). The average time to rate each DUR was 10.0 minutes (95% CI, 9.2 to 10.9). CONCLUSIONS: EQUATDUR-2 is a succinct, self-administered instrument with evidence of validity and reliability. We recommend that > or =2 raters independently assess each DUR and resolve disagreements by consensus. EQUATDUR-2 will help clinicians and decision makers to evaluate the quality of DUR studies and provide a framework for enhancing rigor in the design, conduct, and reporting of DURs.

Alberta↗
PubMed1996

The Drug Utilization Review Network of Quebec.

Drug utilization review programs have been recognized as an effective way to control health care spending while maintaining quality services. This article describes the structure, mandate and activities of Quebec's Drug Utilization Review Network. This 112-member network, which represents 45% of health care facilities in the province, was established to promote the optimal utilization of drugs through the provision of support to pharmacology committees, therapeutic committees and pharmacy departments. The network's main role is to coordinate multi-centre drug utilization studies. Future challenges include maintaining member interest and evaluating the clinical and economic impact of the network's efforts.

Cost Control↗
PubMed1990

Ciprofloxacin drug utilization review and prospective drug use evaluation.

Ciprofloxacin is a fluoroquinolone antimicrobial with activity against both gram-negative and -positive bacteria including pseudomonal and staphylococcal species. It is the only available oral agent possessing this unique spectrum of activity that achieves serum concentrations adequate to treat a variety of systemic infections. A retrospective drug utilization review and a prospective drug use evaluation of ciprofloxacin were performed to determine if the agent was being used for appropriate indications, to ensure correct dosing and appropriate monitoring, and to determine whether its use is cost effective at the Veterans Administration Medical Center, Cleveland (VAMCC). For the retrospective review, 40 patients' charts were randomly chosen for review from computerized inpatient and outpatient prescription records. Drug use review criteria were developed by the Pharmacy Service and Infectious Disease Section. For the prospective evaluation, data were collected for all inpatient and outpatient requests for ciprofloxacin during a six-month period (May to November 1988) using the same criteria as in the retrospective study. Cost analysis was performed by identification and cost comparison of alternative therapy and by estimating the number of days saved by using appropriate oral therapy. All charts from the retrospective review were found to meet criteria for appropriate use. All patients for whom documented follow-up was performed had microbiologic or clinical cures. In the prospective evaluation, 168 patients were started on ciprofloxacin. Ninety-five percent of patients had appropriate justification for use according to criteria. Drug cost savings for the six-month period was +14,962.54 or +29,925.08/year. This covered drug and minibag acquisition costs only. An estimated 127 hospital days were saved (shortened length of +71,717.00 or +143,434.00/year.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗
PubMed1988

Quality control and drug utilization review.

The impact of drug utilization review on quality control is outlined. Special attention is given to a drug utilization review at the individual patient level for which the methodology for implementation and maintenance are described, with special emphasis on the cyclic character of the process.

Drug Utilization↗
PubMed1988

The development and implementation of a drug utilization review program.

In response to rising drug expenditures and pressure from hospital administration to contain drug costs, the department of pharmaceutical services at The Mississauga Hospital initiated a Drug Utilization Review (DUR) Program. The main purpose of this program was to contain the escalating drug budget through identifying and correcting areas of drug misuse, without compromising the quality of patient care. This article will describe the procedures involved in developing and implementing such a DUR program at our hospital and our experience to date. Both structured and informal strategies have been implemented, which have identified factual and potential cost savings. Overall, the DUR program has been well accepted by the medical staff and hospital administration.

Concurrent Review↗
PubMed1986

The defined daily dose system (DDD) for drug utilization review.

The defined daily dose (DDD) system for use in utilization studies is presented for consideration by pharmacy and therapeutics committee members as an additional tool for drug utilization review and drug regimen review activities. The article describes the development and nature of the DDD system and provides examples of its format, benefits, and limitations. Essentially, the DDD system was devised by the Nordic Council on Medicines, and the early work was done in Norway with the Anatomical Therapeutic Chemical (ATC) diagnostic code system. Whereas consumption andutilization studies in North America have focused on the prescribing by an individual physician and drug utilization for an individual patient, the Scandinavians have attempted a macroscopic focus on the total consumption of drugs for a county or country or other definable political or geographic region. The sale of the drugs is divided by what is agreed on as an average daily dose to yield a unit of measure called the DDD, which is valuable for comparative studies. The DDD system and its component aspects are presented so that hospital pharmacists may evaluate its benefits for potential use in North America.

Drug Utilization↗
PubMed1984

Drug utilization review of parenteral clindamycin therapy.

A concurrent drug utilization review was conducted to evaluate the appropriateness of parenteral clindamycin use, the incidence of gastrointestinal side effects, and to implement, if necessary, corrective actions to improve parenteral clindamycin use. Criteria for the appropriate use of clindamycin were prepared, reviewed, and approved by the P & T Committee of the City of Memphis Hospital (CMH) and University of Tennessee Medical Center/William F. Bowld Hospital (UTMCH). Forty-five patients were included in the audit. Overall, in 43/45 (96%) of the patients audited, clindamycin use was deemed appropriate. This audit provided the opportunity for positive reinforcement of physician prescribing practices and helped to foster a cooperative, rather than an adversarial relationship, between pharmacists and physicians involved in drug utilization review.

Anti-Bacterial Agents↗
PubMedDate not supplied

Inter- and intrarater reliability of retrospective drug utilization reviewers.

OBJECTIVE: To assess inter- and intrarater reliability among 23 pharmacist and physician retrospective drug utilization reviewers and to assess interrater reliability after a reviewer training session. DESIGN: Exploratory study. SETTING: Maryland Medicaid's retrospective drug utilization review (DUR) program. PARTICIPANTS: 23 physician and pharmacist retrospective drug utilization reviewers. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Profiles rated as "intervention indicated" or "intervention not indicated." Cochran's Q test, overall percent agreement, and the unweighted kappa statistic were used in the analysis of review consistency. RESULTS: Intrarater reliability showed substantial consistency among the 23 reviewers; the percent agreement was 82.9% with kappa = 0.66. Interrater reliability, however, was poor, with an overall agreement of 69.6% and kappa = 0.16. Interrater reliability was also poor after a one-hour reviewer training session (agreement 81.8%, kappa = -0.19). CONCLUSION: The implicit review process used in the retrospective DUR program that we evaluated was unreliable. Since reliability is a necessary but not sufficient condition for validity of an indicator of inappropriate drug use, the validity of the DUR implicit review process is in question.

Data Interpretation, Statistical↗
PubMed1999

Evaluation results from prospective drug utilization review: Medicaid demonstrations.

In 1992 HCFA awarded two cooperative agreements for demonstrations of prospective drug utilization review (PDUR). Iowa tested an on-line prospective drug utilization review (OPDUR) system. Washington tested payments to pharmacists for providing non-dispensing "cognitive services" (CS). In this article the authors report on an evaluation of these demonstrations and on three assessments of retrospective drug utilization review (RDUR) interventions. The evaluation failed to detect effects of either State PDUR demonstration on the frequency of drug problems, utilization of prescription drugs and other health services, and clinical outcomes. However, the State RDUR interventions had immediate effects on prescribing physicians.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Effects of Medicaid drug utilization review intervention letters.

The state of Texas Drug Utilization Review (DUR) Board, composed of six physicians and six pharmacists, meets quarterly to determine criteria for implementing retrospective DUR. The board agreed to send intervention letters to physicians concurrently prescribing: (1) two histamine2 (H2)-antagonists (H2As) or (2) either any H2A or omeprazole with sucralfate. To measure the effect of these intervention letters, approximately half of these physicians were randomly chosen to receive a letter while the others served as a control group and did not receive letters. This project focused on the H2A or omeprazole with sucralfate intervention letters in a two-step process. Data on concurrent therapy involving two H2As were analyzed separately and these results are not included in this report. Objective one was to examine feedback from the physicians who received the letters, and objective two was to review and compare patient profiles 6 months after the letters were sent. Analysis of Medicaid prescription claims indicated that 190 physicians had concurrently prescribed either an H2A or omeprazole with sucralfate for 222 patients. Ninety-seven physicians (from 117 identified patient profiles) were selected to receive an intervention letter with their patient's profile or profiles, a response form, and a stamped envelope addressed to the Texas Department of Human Services. A 67.5% response rate was obtained. Of these responses, 49.4% agreed with the letter and 29.1% disagreed with the letter. The remaining indicated responses such as "not my patient," they were no longer seeing the patient, or that they did not prescribe the medication in question. (ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

A system for drug utilization review in ambulatory care.

BACKGROUND: It is more difficult to conduct drug utilization reviews in ambulatory care settings than in inpatient care settings. This is true for several reasons: it is harder to identify outpatients who are receiving specific medications; often there is less evidence on which to base clinical standards for drug use; and it is more difficult to ensure patient compliance with drug therapy. METHODS: This article describes a drug utilization review system designed to operate in ambulatory care clinics. The system consists of (1) a computerized database for efficient identification of patients who receive prescriptions for a specific medication, (2) clinic-wide consensus guidelines, (3) reminders in the medical record, (4) regular chart audits, and (5) feedback to physicians. RESULTS: Experience in monitoring the use of serum theophylline assays illustrates how this system can be used in an ambulatory care clinic. According to guidelines adopted in our clinic, overuse of assays is not a problem. The system of physician reminders and chart audits can help prevent underuse. CONCLUSIONS: Despite the difficulties in conducting drug utilization reviews in the ambulatory setting, a system based on clinic-wide guidelines is feasible and should be an integral part of quality assurance programs.

Adolescent↗