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Do practice guidelines augment drug utilisation review?

E A Chrischilles1, K Gondek

  • 1Department of Preventive Medicine and Environmental Health, College of Medicine, University of Iowa, Iowa City, USA. e-chrischilles@uiowa.edu

Pharmacoeconomics
|November 3, 1997
PubMed
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Drug utilisation review (DUR) or drug use evaluation (DUE) approaches differ in focus. Disease management DUR/DUE, unlike traditional methods, prioritizes evaluating if any drug therapy is needed, aligning with practice guidelines.

Area of Science:

  • Pharmacoeconomics
  • Health Services Research
  • Clinical Pharmacy

Background:

  • Drug utilisation review (DUR) and drug use evaluation (DUE) programs aim to identify and rectify inappropriate medication use.
  • Appropriateness is assessed across three levels: necessity of drug therapy (Level 1), choice of drug (Level 2), and regimen details (Level 3).
  • Traditional DUR/DUE focuses on post-prescription evaluation, while evolving healthcare models support disease-management approaches.

Purpose of the Study:

  • To compare the focus of traditional DUR/DUE with disease-management or health-maintenance approaches.
  • To test the hypothesis that disease-management DUR/DUE is more likely to evaluate Level 1 drug therapy issues.
  • To assess the alignment between practice guidelines and the evaluation levels addressed in DUR/DUE studies.

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Main Methods:

  • Review of 56 practice guidelines related to drug therapy.
  • Analysis of research studies published between 1992 and 1996 focusing on DUR/DUE.
  • Categorization of studies based on their approach (traditional vs. disease-management) and the levels of drug therapy appropriateness evaluated.

Main Results:

  • Traditional DUR/DUE studies primarily assessed Level 3 issues, rarely addressed Level 1, and often used non-published guidelines.
  • Disease-management DUR/DUE studies predominantly evaluated Level 1 issues, seldom addressed Level 3, and consistently used published practice guidelines.
  • Approximately 40% of studies evaluated Level 2 issues, irrespective of the approach. Practice guidelines more frequently addressed Level 1 and 2 than Level 3 recommendations.

Conclusions:

  • Practice guidelines are valuable for enhancing DUR/DUE, particularly for Level 1 and 2 issues.
  • Guideline recommendations for Level 2 and 3 may lack the precision needed for evaluative studies.
  • Drug compendia may require revision to include comprehensive recommendations across all three levels of drug therapy issues. Optimizing guideline use requires addressing currency, provider acceptance, and accessibility.