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Drug Utilization Review (DUR) Cheat Sheet by

Reviewing drug Effectiveness & if Appropriate
review     snf     healthcare     drug     utilization     dur     drr     pharmacist

Introd­uction: Drug Utiliz­ation Review (DUR)

DUR is an authorized and structured ongoing review of practi­tioner rescri­bing, pharmacist dispensing and patient use of medica­tions. The purpose of DUR is to ensure drugs are used approp­ria­tely, safely and effect­ively to improve patient health status. Predet­ermined criteria for approp­riate drug therapy are compared against a patient’s or a popula­tion’s records. Non-ad­herence to criteria results in drug therapy changes. In addition, continual improv­ement in the approp­riate, safe and effective use of drugs has the potential to lower
the overall cost of care.

DUR allows the pharmacist to document and evaluate the benefit of pharmacy interv­ention in improving therap­eutic and economic outcomes while demons­trating the overall value of the pharma­cist.
Note: Ask the nursing home for a copy of the patien­t/r­esi­dent's periodic Drug Utiliz­ation Review. This task performed usually by the pharmacy consul­tant.

Concurrent DUR:

Concurrent review is performed during the course of treatment and involves the ongoing monitoring of drug therapy to foster positive patient outcomes. It presents pharma­cists with the opport­unity to alert prescr­ibers to potential problems and intervene in areas such as drug-t­o-drug intera­ctions, duplicate therapy, over or underu­til­ization and excessive or insuff­icient dosing. This type of review allows therapy for a patient to be altered if necessary.

As electronic prescr­ibing becomes more widely adopted, the concurrent DUR process may be performed by the prescriber at the time of prescr­iption transm­ission to the pharmacy, allowing interv­entions before the drug is dispensed. An important component of DUR will require complete and current drug and allergy records for the patient, as well as knowledge of approp­riate therap­eutic interc­hanges for indivi­duals. As a safety net, pharma­cists will perform a similar role as prescr­ibers on the dispensing side of these transa­ctions

Issues Commonly Addressed by Concurrent DUR:
Drug-disease intera­ctions
Drug-drug intera­ctions
Drug dosage modifi­cations
Drug-patient precau­tions (age, gender, pregnancy, etc.)
Over and underu­til­ization
Therapeutic Interc­hange

AMR Drug Review

Prospe­ctive DUR:

Prospe­ctive review involves evaluating a patient's planned drug therapy before a medication is dispensed. This process allows the pharmacist to identify nd resolve problems before the patient has received the medica­tion. Pharma­cists routinely perform prospe­ctive reviews in their daily practice by assessing a prescr­iption medica­tions dosage and directions while reviewing patient inform­ation for possible drug intera­ctions or duplicate therapy. When part of an online claims adjudi­cation process, prospe­ctive DUR often relies on comput­erized algorithms to perform key checks including drug intera­ctions, duplic­ations or contra­ind­ica­tions with the patient’s disease state or condition

Retros­pective DUR:

A retros­pective DUR reviews drug therapy after the patient has received the medica­tion. A retros­pective review aims to detect patterns in prescr­ibing, dispensing or admini­stering drugs. Based on current patterns of medication use, prospe­ctive standards and target interv­entions can be developed to prevent recurrence of inappr­opriate medication use or abuse. Outcomes of this review may aid prescr­ibers in improving the care of their patients, either indivi­dually or within a certain target population (e.g., patients with diabetes, asthma, or high blood pressure)

Issues Commonly Addressed by Retros­pective DUR
Appropriate generic use
Clinical abuse/­misuse
Drug-disease contra­ind­ica­tions
Drug-drug intera­ctions
Inappropriate duration of treatment
Incorrect drug dosage
Use of formulary medica­tions whenever approp­riate
Over and underu­til­ization
Therapeutic approp­ria­teness and/or duplic­ation
Note: Usually used for revising policies and proced­ures.

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