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Drug Utilization Review (DUR)

Course name: Clinical and Hospital Pharmacy
Course code: PHRM 311

Meena Afroze Shanta
Department of Pharmacy
East West University

Zenifar Karim (ID: 2010-1-70-042)
Rumman Akter (ID: 2010-3-70-004)
Sharmin Sheikh (ID: 2010-3-70-007)
Debasree Paul (ID: 2010-3-70-036)
Samiya Khondaker Rinta (ID: 2010-3-70-048)
Priyanka Lyla Habib (ID: 2010-3-70-052)

Submission date: 23
February, 2014
ABOUT DRUG UTILIZATION REVIEW (DUR) -----------------------------------------------------1
PURPOSE OF DUR------------------------------------------------------------------------------------------1
DRUG UTILIZATION REVIEW BOARD---------------------------------------------------------------3
RESPONSIBILITIES OF DUR BOARD (DURB) -----------------------------------------------------3
IMPORTANCE OF DUR FOR PHARMACISTS-------------------------------------------------------3
BENEFITS OF DUR-----------------------------------------------------------------------------------------4


Drug Utilization Reviews (DUR), also referred to as Drug Utilization Evaluations (DUE) or
Medication Utilization Evaluations (MUE), are defined as an authorized, structured, ongoing
review of healthcare provider prescribing, pharmacist dispensing, and patient use of medication.
In short DUR is a system used by pharmacists and pharmacies to check or monitor the
frequency, type, appropriateness and use of prescription medications (Navarro, 2008).
DUR programs help to ensure that prescriptions for outpatient drugs are appropriate, medically
necessary, and not likely to result in adverse medical consequences. DUR programs use
professional medical protocols and computer technology and data processing to assist in the
management of data regarding the prescribing of medicines and the dispensing of prescriptions
over periods of time (Navarro, 2008).
To ensure drugs are used appropriately, safely and effectively to improve patient health
To ensures and enables continual improvement in the appropriate, safe and effective use
of drugs.
To prevent adverse drug reactions.
To avoid therapeutic duplications.
To determine whether a more cost-effective alternative is available (Navarro, 2008).
DURs are classified into three categories:
1. Prospective DUR: It is the process performed to evaluate a patient's therapy and medical
history before medication is dispensed. Issues commonly addressed by prospective DUR are:
o Clinical abuse/misuse.
o Drug-disease contraindications (when a prescribed drug should not be used with certain
o Drug dosage modification.

o Drug-drug interactions (when two or more different drugs interact and alter their intended
effects, often causing adverse events).
o Drug-patient precautions (due to age, allergies, gender, pregnancy, etc.).
o Formulary substitutions (e.g., therapeutic interchange, generic substitution).
o Drug allergy interaction.
o Inappropriate duration of drug treatment (Navarro, 2008).
2. Concurrent DUR: It is the ongoing monitoring of drug therapy during the course of
treatment. This type of review allows therapy for a patient to be altered if necessary. Issues
commonly addressed by concurrent DUR are:
o Drug-disease interactions.
o Drug-drug interactions.
o Drug dosage modifications.
o Drug-patient precautions (age, gender, pregnancy, etc.).
o Over and underutilization.
o Therapeutic interchange.
o Duplicate therapy (Navarro, 2008).
3. Retrospective DUR: It is the reviewing of therapy after the patient has received the
medication gains the patients profile and evidence-based guidelines to alert the prescribing
physician by mail to important, drug-specific, patient-specific health, safety and utilization
issues. Issues commonly addressed by retrospective DUR are:
o Appropriate generic use.
o Clinical abuse/misuse.
o Drug-disease contraindications.
o Drug-drug interactions.
o Inappropriate duration of treatment.
o Incorrect drug dosage.
o Use of formulary medications whenever appropriate.
o Over and underutilization.
o Therapeutic appropriateness and/or duplication (Navarro, 2008).


The Board reviews drug therapy, drug studies and utilization information, thus enabling the
Department to identify the most cost-effective policies for its members. The board, appointed by
the DCH Commissioner, is composed of:
Members of the academic community
A consumer advocate
Meetings are held quarterly or as needed (Georgia Department of Community Health, 2013).
Responsibilities of the DURB include:
1. The establishment and implementation of medical standards and criteria for the
retrospective and prospective DUR program (New York Social Services Law, 2013).
2. The development, selection, application, and assessment of educational interventions for
physicians, pharmacists and recipients that improve care.
3. The collaboration with managed care organizations to address drug utilization concerns and
to implement consistent management strategies across the fee-for-service and managed
care pharmacy benefits.
4. The review of therapeutic classes subject to the Preferred Drug Program (Department of
Health, 2014).
DUR programs play a key role in helping managed health care systems understand, interpret, and
improve the prescribing, administration, and use of medications. Pharmacists play a key role in
this process because of their expertise in the area of pharmaceutical care. DURs afford the
managed care pharmacist the opportunity to identify trends in prescribing within groups of
patients such as those with asthma, diabetes, or high blood pressure. Pharmacists can then, in
collaboration with other members of the health care team, initiate action to improve drug therapy
for both individual patients and covered populations (Navarro, 2008). DURs serve as a means of

improving the quality of patient care, enhancing therapeutic outcomes, and reducing
inappropriate pharmaceutical expenditures, thus reducing overall health care costs.
1. In Prospective DUR: This process allows the pharmacist to identify and 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. For
example, a patient being treated with warfarin to prevent blood clots may be prescribed a
new drug by another specialist to treat arthritis. If taken together, the patient could
experience internal bleeding. Since a common outcome of a prospective DUR is
identification of drug-drug interactions, so upon reviewing the patient's prescriptions, the
pharmacist would note the potential drug interaction and contact the prescriber to alert
him/her to the problem (Navarro, 2008).
2. In Concurrent DUR: It presents pharmacists with the opportunity to alert prescribers to
potential problems and intervene in areas such as drug-drug interactions, duplicate therapy,
over or under utilization and excessive or insufficient dosing. For example, DUR often
occurs in institutional settings, where patients often receive multiple medications. Periodic
review of patient records can detect actual or potential drug-drug interactions or duplicate
therapy. It can alert the pharmacist to the need for changes in medications, such as
antibiotics, or the need for dosage adjustments based on laboratory test results. The key
prescriber(s) must then be alerted to the situation so corrective action can be taken.
3. In Retrospective DUR: An example of the importance of a retrospective DUR for
pharmacists may be the identification of a group of patients whose therapy does not meet
approved guidelines. For example, a pharmacist may identify a group of patients with
asthma, who according to their medical and pharmacy history, should be using orally
inhaled steroids. Using this information, the pharmacist can then encourage prescribers to
utilize the indicated drugs. So based on current patterns of medication use, prospective
standards and target interventions can be developed to prevent recurrence of inappropriate
medication use or abuse using retrospective DUR (Navarro, 2008).
By following all the criteria of DUR the following benefits can be easily obtained:

1. Protects patients from possible harmful drug interactions and harmful duplicate therapies
2. Detects and reduces the number of inappropriately used medications and non-compliance
to prescribed regimens.
3. Tracks and identifies over-consumption and under-consumption.
4. Detects fraud and prescription drug abuse.
5. Checks against the plan members drug claim profile and therefore provide a more
comprehensive review (Holloway and Green, 2004).
6. Keeps physicians well informed.
7. Allows refined practice guidelines.
8. Improve overall healthcare and patient safety.
9. Improve therapy management for chronically ill patients.
10. Cost containment (Health Information Designs, 2014).
Drug Utilization Reviews help pharmacists fulfill their professional responsibility and ensure
that medication is dispensed safely. It also assists in monitoring compliance with the physician's
intended drug regimen. When possible harmful drug interactions are detected, alternative drug
therapies may be recommended after discussions with the prescribing physician. This may take
the form of dosage adjustments, alteration of medication administration and/or additional patient
monitoring (Navarro, 2008).
Still the process of DUR is still evolving. Using DUR information, managed care pharmacists
can identify prescribing trends in patient populations and initiate corrective action to improve
drug therapy for groups of patients as well as individuals. As the variety of health care
professionals (e.g., pharmacists, prescribers, nurses, optometrists, naturopaths, chiropractors)
involved in the medication use process expands, DUR will require a more multidisciplinary
approach to improving patient care. In addition, rapidly improving data systems will soon
provide the methodology for combining medical and pharmacy data with patient outcome data.
This will lead to the next logical step, the evolution of DUR into a more comprehensive health
care utilization evaluation (Navarro, 2008).


Department of Health (2014) Drug Utilization Review (DUR) Available from: [Accessed 22
Georgia Department of Community Health (2013) Drug Utilization Review Board. Available
from: [Accessed 22nd February 2014].
Health Information Designs (2014) Retrospective Drug Utilization Review. Available from:
utilization-review1.html [Accessed 22nd February 2014].
Holloway, K. and Green, T. (2004) Drug and Therapeutics Committees - A Practical Guide: 6.5
Drug use evaluation (DUE) (drug utilization review) WHO: Department of Essential Drugs
and Medicines Policy.
Navarro, R. (2008) Chapter 8: Drug Utilization Review Strategies. Managed Care Pharmacy
Practice, pp. 215 229.
New York Social Services Law (2013) Section 369-bb: Drug utilization review board. Available
[Accessed 22nd February 2014].