DRUG UTILIZATION REVIEW IN AMBULATORY SETTINGS - STATE OF THE SCIENCEAND DIRECTIONS FOR OUTCOMES RESEARCH

There are escalating national pressures to analyze pharmaceutical outc omes and to develop drug-related clinical guidelines. These interests coincide with passage of the Medicaid Rebate Law (OBRA, 1990), which m andates the implementation of prospective and retrospective drug utili zation review (DUR) programs by Medicaid in 1993. This report investig ates DUR programs that target outpatient drug therapies. The authors p resent a conceptual framework that identifies the factors influencing drug prescribing and the range of potential patient outcomes. Current types of DUR interventions and their applications are described, in ad dition to problems that hinder implementation or evaluation of DUR pro grams. DUR evaluation studies are reviewed, and a critique identifies the limitations of available DUR research. The authors recommend an ex panded DUR policy research agenda, strongly suggesting that priority b e given to studies in the following areas: DUR criteria development an d validation; prevalence of prescribing problems and their association with patient outcomes; efficacy, toxicity and costs of therapeutic al ternatives; and DUR program evaluation. The overall conclusion is that the state of the science pertaining to DUR is not well developed. The potential of DUR may not be realized due to the lack of resources nee ded to design, implement, and evaluate effective programs. Instead, DU R efforts may be limited to cost-containment issues without due consid eration of quality-of-care outcomes. The authors call for rigorous eva luation efforts to inform DUR design and implementation, thereby assur ing more rational prescribing and enhancing patient outcomes.