Current status of prospective drug utilization review.

Thomas R. Fulda, Alan Lyles, Mark C. Pugh, Dale B. Christensen

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The Omnibus Budget Reconciliation Act of 1990 offered the promise that prospective drug utilization review (pDUR) systems would improve the quality of drug prescribing and patient drug use. There is little evidence that this promise has been fulfilled. To the contrary, there is growing evidence that suboptimal use of drugs (in terms of preventable drug-related morbidity) is at least as costly as the prescription drugs themselves. Online computerized pDUR has been the subject of numerous critical examinations in the pharmacy and medical literature. Recent publications have sought to illustrate perceived shortcomings in the DUR systems currently in use. OBJECTIVE: We focus on the state of the art with regard to pDUR, what is known about its effectiveness, and how emerging technologies may change pDUR and consider the work that may be needed to establish its effectiveness. SUMMARY: A growing body of literature documents numerous problems and concerns with respect to the quality of DUR criteria, DUR alerts, and the response of health care professionals to these alerts. Problems with the current pDUR "system" can be grouped into those involving technical aspects (e.g., duplicate messaging from in-store and online systems, or message text limitations) and into those involving human aspects, specifically how pharmacists and other health care providers interpret and respond to potential drug therapy problem alerts generated by the electronic systems. CONCLUSION: DUR is a quality assurance system that holds promise as a tool that, if implemented effectively, could enhance appropriate drug use. We believe a more systematic approach to DUR is needed. Evaluation and management of public and private pDUR systems must link documentation of processes of care, such as pharmacists. cognitive services, patient interventions, etc. To address technical aspects, we strongly recommend (a) a national effort to validate DUR screen criteria relying upon evidence-based studies and (b) adoption of a minimal set of.critical. pDUR screen criteria by pharmacy service providers and third-party intermediaries, including pharmacy benefit managers. To address the human component of pDUR systems, we advocate (a) adoption of performance standards for pharmacists and (b) explicit remuneration for time spent identifying and responding to drug therapy problems.

Original languageEnglish (US)
Pages (from-to)433-441
Number of pages9
JournalJournal of Managed Care Pharmacy
Volume10
Issue number5
StatePublished - Sep 2004
Externally publishedYes

Fingerprint

Drug Utilization Review
Pharmaceutical Preparations
Pharmacists
Drug therapy
Text Messaging
Remuneration
Online Systems
Drug Prescriptions
Drug Therapy
Pharmaceutical Services
Health care
Prescription Drugs
Budgets
Documentation
Health Personnel
Online systems
Bioelectric potentials
Technology
Morbidity
Delivery of Health Care

ASJC Scopus subject areas

  • Pharmaceutical Science
  • Health Policy
  • Pharmacy

Cite this

Fulda, T. R., Lyles, A., Pugh, M. C., & Christensen, D. B. (2004). Current status of prospective drug utilization review. Journal of Managed Care Pharmacy, 10(5), 433-441.

Current status of prospective drug utilization review. / Fulda, Thomas R.; Lyles, Alan; Pugh, Mark C.; Christensen, Dale B.

In: Journal of Managed Care Pharmacy, Vol. 10, No. 5, 09.2004, p. 433-441.

Research output: Contribution to journalArticle

Fulda, TR, Lyles, A, Pugh, MC & Christensen, DB 2004, 'Current status of prospective drug utilization review.', Journal of Managed Care Pharmacy, vol. 10, no. 5, pp. 433-441.
Fulda TR, Lyles A, Pugh MC, Christensen DB. Current status of prospective drug utilization review. Journal of Managed Care Pharmacy. 2004 Sep;10(5):433-441.
Fulda, Thomas R. ; Lyles, Alan ; Pugh, Mark C. ; Christensen, Dale B. / Current status of prospective drug utilization review. In: Journal of Managed Care Pharmacy. 2004 ; Vol. 10, No. 5. pp. 433-441.
@article{e7d1ed5591194b5386136b10eea0b8ce,
title = "Current status of prospective drug utilization review.",
abstract = "BACKGROUND: The Omnibus Budget Reconciliation Act of 1990 offered the promise that prospective drug utilization review (pDUR) systems would improve the quality of drug prescribing and patient drug use. There is little evidence that this promise has been fulfilled. To the contrary, there is growing evidence that suboptimal use of drugs (in terms of preventable drug-related morbidity) is at least as costly as the prescription drugs themselves. Online computerized pDUR has been the subject of numerous critical examinations in the pharmacy and medical literature. Recent publications have sought to illustrate perceived shortcomings in the DUR systems currently in use. OBJECTIVE: We focus on the state of the art with regard to pDUR, what is known about its effectiveness, and how emerging technologies may change pDUR and consider the work that may be needed to establish its effectiveness. SUMMARY: A growing body of literature documents numerous problems and concerns with respect to the quality of DUR criteria, DUR alerts, and the response of health care professionals to these alerts. Problems with the current pDUR {"}system{"} can be grouped into those involving technical aspects (e.g., duplicate messaging from in-store and online systems, or message text limitations) and into those involving human aspects, specifically how pharmacists and other health care providers interpret and respond to potential drug therapy problem alerts generated by the electronic systems. CONCLUSION: DUR is a quality assurance system that holds promise as a tool that, if implemented effectively, could enhance appropriate drug use. We believe a more systematic approach to DUR is needed. Evaluation and management of public and private pDUR systems must link documentation of processes of care, such as pharmacists. cognitive services, patient interventions, etc. To address technical aspects, we strongly recommend (a) a national effort to validate DUR screen criteria relying upon evidence-based studies and (b) adoption of a minimal set of.critical. pDUR screen criteria by pharmacy service providers and third-party intermediaries, including pharmacy benefit managers. To address the human component of pDUR systems, we advocate (a) adoption of performance standards for pharmacists and (b) explicit remuneration for time spent identifying and responding to drug therapy problems.",
author = "Fulda, {Thomas R.} and Alan Lyles and Pugh, {Mark C.} and Christensen, {Dale B.}",
year = "2004",
month = "9",
language = "English (US)",
volume = "10",
pages = "433--441",
journal = "Journal of managed care & specialty pharmacy",
issn = "2376-0540",
publisher = "Academy of Managed Care Pharmacy (AMCP)",
number = "5",

}

TY - JOUR

T1 - Current status of prospective drug utilization review.

AU - Fulda, Thomas R.

AU - Lyles, Alan

AU - Pugh, Mark C.

AU - Christensen, Dale B.

PY - 2004/9

Y1 - 2004/9

N2 - BACKGROUND: The Omnibus Budget Reconciliation Act of 1990 offered the promise that prospective drug utilization review (pDUR) systems would improve the quality of drug prescribing and patient drug use. There is little evidence that this promise has been fulfilled. To the contrary, there is growing evidence that suboptimal use of drugs (in terms of preventable drug-related morbidity) is at least as costly as the prescription drugs themselves. Online computerized pDUR has been the subject of numerous critical examinations in the pharmacy and medical literature. Recent publications have sought to illustrate perceived shortcomings in the DUR systems currently in use. OBJECTIVE: We focus on the state of the art with regard to pDUR, what is known about its effectiveness, and how emerging technologies may change pDUR and consider the work that may be needed to establish its effectiveness. SUMMARY: A growing body of literature documents numerous problems and concerns with respect to the quality of DUR criteria, DUR alerts, and the response of health care professionals to these alerts. Problems with the current pDUR "system" can be grouped into those involving technical aspects (e.g., duplicate messaging from in-store and online systems, or message text limitations) and into those involving human aspects, specifically how pharmacists and other health care providers interpret and respond to potential drug therapy problem alerts generated by the electronic systems. CONCLUSION: DUR is a quality assurance system that holds promise as a tool that, if implemented effectively, could enhance appropriate drug use. We believe a more systematic approach to DUR is needed. Evaluation and management of public and private pDUR systems must link documentation of processes of care, such as pharmacists. cognitive services, patient interventions, etc. To address technical aspects, we strongly recommend (a) a national effort to validate DUR screen criteria relying upon evidence-based studies and (b) adoption of a minimal set of.critical. pDUR screen criteria by pharmacy service providers and third-party intermediaries, including pharmacy benefit managers. To address the human component of pDUR systems, we advocate (a) adoption of performance standards for pharmacists and (b) explicit remuneration for time spent identifying and responding to drug therapy problems.

AB - BACKGROUND: The Omnibus Budget Reconciliation Act of 1990 offered the promise that prospective drug utilization review (pDUR) systems would improve the quality of drug prescribing and patient drug use. There is little evidence that this promise has been fulfilled. To the contrary, there is growing evidence that suboptimal use of drugs (in terms of preventable drug-related morbidity) is at least as costly as the prescription drugs themselves. Online computerized pDUR has been the subject of numerous critical examinations in the pharmacy and medical literature. Recent publications have sought to illustrate perceived shortcomings in the DUR systems currently in use. OBJECTIVE: We focus on the state of the art with regard to pDUR, what is known about its effectiveness, and how emerging technologies may change pDUR and consider the work that may be needed to establish its effectiveness. SUMMARY: A growing body of literature documents numerous problems and concerns with respect to the quality of DUR criteria, DUR alerts, and the response of health care professionals to these alerts. Problems with the current pDUR "system" can be grouped into those involving technical aspects (e.g., duplicate messaging from in-store and online systems, or message text limitations) and into those involving human aspects, specifically how pharmacists and other health care providers interpret and respond to potential drug therapy problem alerts generated by the electronic systems. CONCLUSION: DUR is a quality assurance system that holds promise as a tool that, if implemented effectively, could enhance appropriate drug use. We believe a more systematic approach to DUR is needed. Evaluation and management of public and private pDUR systems must link documentation of processes of care, such as pharmacists. cognitive services, patient interventions, etc. To address technical aspects, we strongly recommend (a) a national effort to validate DUR screen criteria relying upon evidence-based studies and (b) adoption of a minimal set of.critical. pDUR screen criteria by pharmacy service providers and third-party intermediaries, including pharmacy benefit managers. To address the human component of pDUR systems, we advocate (a) adoption of performance standards for pharmacists and (b) explicit remuneration for time spent identifying and responding to drug therapy problems.

UR - http://www.scopus.com/inward/record.url?scp=6044230556&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=6044230556&partnerID=8YFLogxK

M3 - Article

C2 - 15369426

AN - SCOPUS:6044230556

VL - 10

SP - 433

EP - 441

JO - Journal of managed care & specialty pharmacy

JF - Journal of managed care & specialty pharmacy

SN - 2376-0540

IS - 5

ER -