DUE and DUR - Hospital Pharmacy

1. PRESENTED BY
ANJALI RARICHAN
M. Pharm Pharmacy Practice

2. DRUG USE EVALUATION(DUE)
Drug Use Evaluation is a system ongoing, systematic,
criteria-based evaluation of drug use that will help to
ensure that medicines are used appropriately.(at
individual patient level).
 Drug or disease specific and it will assess the actual
process of prescribing, dispensing, or administration
of a drug( indications, dose, drug interactions etc..)
DUE is almost same as DRUG UTILIZATION
REVIEW (DUR) and these terms are used
synonymously.

3. MEDICATION USE EVALUATION(MUE)
 MEDICATION USE EVALUATION is similar to DUE
but emphasis improving patient outcomes and
individual quality of life.
 It is highly dependent on a multidisciplinary
approach.
 It will assess clinical outcomes(cured infections ,
decreased lipid levels.)

4. GOALS AND OBJECTIVES
 GOALS
 The goal of a drug use evaluation or medication use
evaluation is to ;
1) Promote optimal medication therapy
2) To Ensure that drug therapy meet current
standards of care.

5.  OBJECTIVES
1) Creating guidelines(criteria) for appropriate drug
utilization
2) Evaluating the effectiveness of medication therapy.
3) Enhancing responsibility or accountability in the
medicine use process.
4) Controlling medicine cost.
5) Preventing medication related problems, ex: adverse
drug reactions, treatment failures, over-use etc..
6) Identifying areas in which further information and
education may be needed by health care providers.

6. STEPS OF DRUG USE EVALUATION
 STEP 1 : Establish responsibility
It is the responsibility of the DTC is to establish
procedures for the implementation of DUE programme;
this includes appointing a responsible member of the
DTC or a subcommittee to monitor and supervise the
DUE process in the hospital or clinics.

7.  STEP 2 : Develop the scope of activities and
define the objectives.
The DTC should decide the objectives of the DUE and
the scope of the necessary activities. The scope can be
very extensive or it can focus on a single aspect of drug
therapy depend upon the problem identified.
Ex: overuse a more expensive medicine when a cheaper
equivalent is available, incorrect use, inappropriate use
of antibiotics, poor dispensing process.

8.  STEP 3 : Establish criteria for review of the
medicine
It is extremely important and it is the responsibility of
the DTC. DUE criteria are statements that define correct
drug usage with regard to various components. It should
be established using the hospital STG’s (STANDARD
TREATMENT GUIDEINES).

9.  STEP 4 : Data collection
Data may be collected retrospectively, from patient
charts and other records(open questions , dispensing
records, medication administration records, lab reports,
ADR reports ), or prospectively, at the time of medicine
is prepared or dispensed. Retrospective data collection
may be quicker and is accomplished away from the
patient care areas and distractions. Prospective review
helps prevent errors in dosage, indications, interactions
or other mistakes.

10.  STEP 5 : Data analysis
Data are tabulated in a form that corresponds to the
criteria chosen for the DUE. The percentages of cases
that meet the threshold for each criteria should be
calculated and summarized for presentation to the DTC.
A report of all DUE programmes that are being
conducted should be prepared on a quarterly basis.

11.  STEP 6 : Feedback to the prescribers and making
a plan of action
After information is presented , the DTC should
develop conclusions about the differences between
actual and desired results. The DTC should then decide
what follow-up action is necessary and whether to
continue , discontinue or expand the functions of the
DUE.

12. STEP 7 : Follow-up
Follow-up is a critical step to ensure appropriate
resolution of any problems. If an intervention is not
evaluated, or drug use problems are not resolved, then
the DUE will have been of no use. DUE activities
should be evaluated regularly (at least annually) and
determine the need to continue , modify or discontinue
the DUE. If follow-up is adequate , prescribers are
likely to improve their performance in all areas knowing
that they may be reviewed in the future.

13.  COMPONENTS OF DRUG USE FOR DUE CRITERIA
1. Uses: appropriate indication for drug, absence of
contraindications.
2. Selection: appropriate drug for clinical condition.
3. Dosing: indication-specific dosing intervals and duration
of treatment.
4. Interactions: absence of interactions (drug-drug, drug-
food).
5. Preparation: steps involved with preparation.
6. Administration: steps involved in administration.
7. Patient education: instructions given to patients.
8. Monitoring: clinical and laboratory data monitoring. Ex:
decreased blood pressure, blood glucose etc..

14.  DRUG UTILIZATION REVIEW(DUR)
Drug Utilization Review(DUR) is defined as an
authorized, structured, ongoing review of prescribing,
dispensing and use of medication. DUR encompasses a
drug review against predetermined criteria that results in
changes to drug therapy when the criteria are not met. It
involves a comprehensive review of patients prescription
and medication data before ,during and after dispensing to
ensure appropriate medication decision-making and
positive patient outcomes.

15. DUR IS CLASSIFIED INTO:
1. PROSPECTIVE DUR
2. CONCURRENT DUR
3. RETROSPECTIVE DUR

16. 1) PROSPECTIVE DUR:
It involves evaluation of a patients drug therapy before
medication is dispensed. These are mainly done by
pharmacist in their daily practice
Issues commonly addressed by prospective DUR:
 Clinical abuse/ misuse
 Drug-disease contraindication
 Drug dosage modification
 Drug- drug interactions
 Drug-patient precautions
 Formulary substitutions
 Inappropriate duration of drug treatment

17. 2) CONCURRENT DUR:
It involves ongoing monitoring of drug therapy during
the course of treatment. It gives opportunity to alert
prescribers about potential problems and intervene in
areas such as interactions, duplicate therapy, excessive
or insufficient dosing.
Issues commonly addressed by concurrent DUR:
 Drug –disease/drug interactions
 Drug dosage modifications
 Drug –patient precautions
 Over and underutilization
 Therapeutic interchange

18. 3) RETROSPECTIVE DUR:
It reviews drug therapy after the patient has received medication.
It aims to detect patterns in prescribing, dispensing or
administering drugs. Outcomes of this review may aid
prescribers in improving the care of their patients , either
individually or within a certain target population.
Issues commonly addressed by Retrospective DUR:
 Appropriate generic use, clinical abuse/misuse
 Inappropriate duration of treatment
 Drug-drug interactions, drug-disease contraindications
 Incorrect drug dosage
 Over and underutilization
 Therapeutic appropriateness or duplication

19. Why DUR is important?
 It plays a key role in helping managed healthcare systems
understand , interpret, evaluate and improve the prescribing,
administration and use of medications.
 DUR programmes valuable since the results are used to foster
more efficient use of health care resources.
 DUR helps to identify trends in prescribing within groups of
patients, pharmacist play a key role because they are expertise
in the area of medication therapy management.
 Pharmacist can then, in collaboration with prescribers and
other members of health care team, initiate action to improve
drug therapy for patients.