Drug Utilization Review (DUR) is an important component of pharmacoepidemiology and clinical pharmacy practice. It is a structured, ongoing, and systematic process of evaluating the use of medicines to ensure they are prescribed, dispensed, and used appropriately. DUR programs aim to improve patient outcomes, enhance safety, and promote rational drug use while minimizing medication-related problems and healthcare costs.
A well-executed DUR helps healthcare institutions identify inappropriate prescribing patterns, detect drug interactions, optimize therapy, and ensure that medication use aligns with evidence-based guidelines.
Definition of Drug Utilization Review
Drug Utilization Review (DUR) is defined as a systematic, criteria-based evaluation of drug use that helps identify and resolve medication-related problems and improve patient care. It involves reviewing prescriptions, medication profiles, and treatment patterns to determine whether therapy is appropriate for the patient’s clinical needs.
DUR is also known as Drug Utilization Evaluation (DUE) or Medication Use Evaluation (MUE) in clinical settings.
Objectives of DUR
- Ensure rational, safe, and effective use of medications
- Improve therapeutic outcomes
- Identify inappropriate prescribing and dispensing patterns
- Detect drug–drug, drug–food, and drug–disease interactions
- Reduce medication errors and adverse drug reactions
- Support cost-effective therapy and reduce unnecessary expenditure
- Promote adherence to clinical guidelines and standards
- Provide educational feedback to healthcare professionals
Types of Drug Utilization Review
DUR can be categorized into three major types based on the timing of review:
1. Prospective DUR
Conducted before a medication is dispensed.
It helps identify potential issues early, preventing harm before it occurs.
Activities include:
- Evaluating therapeutic duplication
- Checking for drug interactions
- Reviewing contraindications
- Assessing dose and frequency appropriateness
- Verifying patient allergies and medical history
2. Concurrent DUR
Conducted during the course of therapy. It is often performed in hospitalized or long-term care patients.
Activities include:
- Monitoring ongoing drug therapy
- Tracking response to treatment
- Detecting inappropriate dosing or adverse effects
- Ensuring timely lab investigations
- Identifying medication errors and intervening immediately
3. Retrospective DUR
Conducted after the medication has been dispensed and used. It involves reviewing accumulated data to analyze prescribing patterns and outcomes.
Activities include:
- Analyzing patient profiles and medical records
- Identifying trends in drug use
- Assessing adherence to guidelines
- Detecting patterns of misuse or overuse
- Evaluating the impact of DUR interventions
Components of Drug Utilization Review
DUR typically includes several key components that ensure a structured and comprehensive assessment of drug use:
1. Establishing Standards or Criteria
- Based on guidelines, clinical trials, formularies, or expert panels
- Includes dose, indication, frequency, duration, contraindications
2. Data Collection
- Prescription records
- Patient demographics
- Lab results
- Clinical outcomes
3. Evaluation
- Comparing actual drug use with established standards
- Identifying irrational or inappropriate drug use
4. Intervention
Corrective actions include:
- Physician education
- Pharmacist counseling
- Adjusting therapy
- Updating policies or protocols
5. Follow-Up
- Assessing effectiveness of interventions
- Measuring changes in prescribing behavior
- Ensuring sustained improvement
Common DUR Criteria
Drug therapy is evaluated against specific criteria such as:
- Correct indication
- Appropriate dose, route, and duration
- Potential drug–drug or drug–disease interactions
- Therapeutic duplication
- Clinical outcomes and laboratory results
- Risk of adverse drug reactions
- Cost-effectiveness
Methods Used in DUR
- Prescription audits – review of prescription records
- Patient medical chart review
- Medication profile analysis
- Drug-use indicators – e.g., DDD, PDD
- Interviews and surveys with healthcare professionals
- Computer-based screening for interactions and alerts
Benefits of Drug Utilization Review
For Patients
- Improved medication safety
- Better therapeutic outcomes
- Reduced risk of adverse reactions
- Prevention of medication errors
For Healthcare Providers
- Support in making evidence-based decisions
- Educational feedback to improve practice
- Greater monitoring of high-risk therapies
For Healthcare Systems
- Cost savings through decreased inappropriate use
- Improved quality of care
- Enhanced regulatory compliance
Examples of DUR Indicators
- Percentage of antibiotic prescriptions adhering to guidelines
- Number of high-alert drug interactions detected
- Use of NSAIDs in high-risk patients
- Opioid prescribing trends
Challenges in DUR
- Incomplete or inaccurate data
- Lack of standardized criteria across institutions
- Resistance from prescribers
- Limited resources and trained personnel
Detailed Notes:
For PDF style full-color notes, open the complete study material below:
PATH: PHARMD/ PHARMD NOTES/ PHARMD FIFTH YEAR NOTES/ PHARMACOEPIDEMIOLOGY AND PHARMACOECONOMICS/ DRUG UTILIZATION REVIEW.