Drug Utilization Review, or DUR, is a systematic process in pharmacy designed to ensure medications are used safely and effectively. It involves a detailed examination of a patient’s medication and health history at various stages of treatment. This review helps prevent potential issues before they arise or addresses them during or after medication use. DUR programs aim to improve the quality of care by preventing inappropriate drug therapy and adverse drug reactions.
The Core Purpose of DUR
DUR is performed to enhance patient safety and optimize medication therapy. Its primary goals include preventing medication errors, ensuring appropriate drug use, and promoting cost-effective therapy. By systematically reviewing medication information, DUR helps healthcare professionals identify potential problems that could negatively impact patient health.
This process helps ensure that prescribed medications are medically necessary and align with established treatment guidelines. It reduces the likelihood of adverse drug events, which can lead to complications, additional medical visits, or even hospitalizations. DUR also contributes to overall healthcare efficiency by reducing inappropriate drug use and related expenditures.
Different Types of DUR
DUR is categorized into three main types based on when the review occurs in relation to medication dispensing and patient treatment. Each type serves a distinct purpose in ensuring medication safety and efficacy.
Prospective DUR takes place before a prescription is dispensed to a patient. Pharmacists conduct this review to identify and resolve potential issues in real-time, such as drug interactions or incorrect dosages. This immediate assessment is often supported by computerized systems that alert pharmacists to potential problems at the point of sale.
Concurrent DUR occurs during a patient’s course of treatment, often in institutional settings like hospitals. This type of review involves ongoing monitoring of drug therapy to ensure patient outcomes remain positive. Pharmacists can intervene to address issues like over or underutilization, or to adjust therapy based on laboratory results.
Retrospective DUR is conducted after medication has been dispensed and used by the patient. This involves reviewing past claims data and patient records to identify patterns of inappropriate use, potential fraud, or other problems across a larger population. The findings from retrospective reviews can inform the development of future prescribing standards and educational interventions.
Common Issues Identified Through DUR
DUR is designed to identify a range of specific problems that could compromise patient safety or treatment effectiveness. These checks help ensure each patient receives the most suitable and safest medication regimen by flagging potential conflicts or deviations from accepted standards of care.
One common issue identified is drug-drug interactions, where two or more medications taken together can alter their effects or cause adverse reactions (e.g., internal bleeding when warfarin is combined with certain arthritis medications). Drug-allergy interactions are also detected, preventing patients from receiving medications to which they have a known allergic response.
DUR also flags contraindications, which are medical conditions or patient characteristics (like age or pregnancy) that make a drug unsafe for an individual. Duplicate therapy, where a patient is prescribed multiple medications for the same condition without added benefit, is another concern. Incorrect dosage or duration of therapy, deviating from established guidelines, is frequently identified.
The review also uncovers potential for drug abuse or misuse, such as excessive quantities of controlled substances. It also identifies issues of underutilization or non-adherence, where patients may not be taking their medications as prescribed, which can lead to worsening medical conditions. These comprehensive checks aim to optimize individual patient care and broader public health.
The DUR Process and Patient Safety
Pharmacists play a central role in conducting DUR, especially the prospective type, which directly impacts the general public. When a new prescription is presented, the pharmacist accesses the patient’s medication history and profile. This review often involves computerized systems that automatically screen for potential issues based on predefined criteria.
If a DUR alert occurs, the pharmacist thoroughly reviews the patient’s individual profile, considering their complete medical history and current medications. Depending on the nature and severity of the alert, the pharmacist may contact the prescribing physician to discuss the concern, suggest alternative therapies, or recommend dosage adjustments.
The pharmacist also counsels the patient, explaining the medication, its proper use, potential side effects, and any necessary precautions. This direct communication ensures the patient understands their therapy and can adhere to it safely. This comprehensive process directly contributes to ensuring the patient receives the safest and most effective medication therapy.