Abstract
Drug utilization is expected to increase in the years ahead, thereby fostering the use of cost control and quality assurance mechanisms in the form of drug utilization/peer review. An overview of the current status of drug utilization review (DUR) is presented, and an examination is made in terms of the relationship of DUR to assuring quality medical care. For the most part, existing drug utilization review systems are centrally based and retrospectively screen drug claims “by exception”, using quantity standards of appropriateness. The primary deficiency of current programs is the relative lack of “quality measures”, and secondarily, the need to integrate drug utilization review into the overall medical care review process. Recommendations for demonstration and research efforts are given.
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References
1.
Stolley
P. D.
: The Relationship Between Physician Characteristics and Prescribing Appropriateness , Med. Care
10 : 17 –18 (Jan.-Feb.) 1972 .
2.
Jick
H.
: Comprehensive Drug Surveillance , J. Am. Med. Assoc.
213 : 1455 –1460 (Aug. 31) 1970 .
3.Social Security Administration , Office of Research and Statistics: Prescription Drug Data Summary
1972 , DHEW Pub. No. (SSA) 73-11900, 1972.
4.
Maronde
R. F.
: A Study of Prescribing Patterns , Med. Care
9 : 383 –395 (Sept.-Oct.) 1971 .
5.National Disease and Therapeutic Index , Reference File: Diagnosis: The Common Cold, Lea Associates, Inc., Ambler, Pennsylvania (Oct.) 1967 — (Sept.) 1968.
6.
Stolley
P. D.
Lasagna
L.
: Prescribing Patterns of Physicians , J. Chronic Dis.
22 : 395 –405 (Dec.) 1969 .
7.U.S. Task Force on Prescription Drugs : Second Interim Report and Recommendations , Government Printing Office , 1968 .
8.
Brodie
D. C.
: Drug Utilization Review/Planning , J. Am. Hosp. Assoc.
46 : 103 –112 (June 1) 1972 .
9.
Anon.: PSROs Touted as Major Factor to Improve Prescribing Habits , U.S. Med. (Mar. 15) 1974 .
10.
Brodie
D. C.
: Drug Utilization and Drug Utilization Review and Control , DHEW Pub. No. (HSM) 72-3002, 1971 .
11.U.S. Task Force on Prescription Drugs : The Drug Prescribers , Government Printing Office , 1968 .
12.
Smith
M. C.
: Social Barriers to Rational Drug Therapy , Am. J. Hosp. Pharm.
29 : 121 –127 (Feb.) 1972 .
13.
Gouveia
W. A.
: Computer Applications in the Hospital Pharmacy , Hospitals
45 : 80 –83 (Jan. 1) 1971 .
14.
Maronde
R. F.
: A Study of Prescribing Patterns , Med. Care
9 : 383 –395 (Sept.-Oct.) 1971 .
15.
Maronde
R. F.
: Drug Utilization Review with On-Line Computer Capability , DHEW Pub. No. (SSA) 73-11853, 1972 .
16.
Laventurier
M.
: Utilization and Peer Review by, Pharmacists , J. Am. Pharm. Assoc.
NS12 : 166 –170 (Apr.) 1972 .
17.Michigan Blue Shield :
The Prescription Drug Program
, Research Reports , Volume I , Issue 2 , Detroit, 1971 .
18.
Hirschman
J. L.
: Final Report: PSRO Review of Prescription Drugs , Contract No. HSA 105-74-10, DHEW (July 15) 1975 .
19.
Dosher
R. A.
White
S. W.
: Ambulatory Care Drug Review System Baseline Study , Dikewood Corporation , Albuquerque (June) 1975 .
20.
Ebel
J. A.
: Drug Utilization Review/Selective Surveillance , Hospitals
46 : 108 –114 passim (July 1) 1972 .
21.
Deliganis
S. G.
Johnson
S. R.
: Computerless Drug Use Review , Hospitals
47 : 86 –93 passim (Dec. 1) 1973 .
22.
Jacinto
M. S.
: Pharmacist-Monitored, Computerized Drug Usage Review , Am. J. Hosp. Pharm.
31 : 508 –512 (May) 1974 .
23.
Freund
R. G.
: Evolution of a Computerized Drug Profile , Am. J. Hosp. Pharm.
30 : 160 –164 (Feb.) 1973 .
24.
Vogel
D. P.
Holland
B. F.
: Electronic Data Processing in Hospital Dispensing , Am. J. Hosp. Pharm.
26 : 218 –223 (Apr.) 1969 .
25.
Goldman
G.
: A Computer-Based Medication System for Cancer Chemotherapy Patients , Am. J. Hosp. Pharm.
29 : 305 –311 (Apr.) 1972 .
26.
Derewicz
H. J.
Zellers
D. D.
: The Computer-Based Unit Dose System in the Johns Hopkins Hospital , Am. J. Hosp. Pharm.
30 : 206 –212 (Mar.) 1973 .
27.
Bartel
G. J.
Fahey
J. J.
: Nursing Station is Home Base for Phone-Printer System , Mod. Hosp.
113 : 85 –88 (Nov.) 1969 .
28.
Almquist
D. D.
: The Computer Never Forgets , Hospitals
46 : 152 –156 (Mar. 1) 1972 .
29.
Anon.: Computer Receives Orders from Doctor, Sends Information Back to Everyone , Mod. Hosp.
19 : 68 –71 (Dec.) 1972 .
30.
Lee
R. I.
Jones
L. W.
: The Fundamentals of Good Medical Care , Publications of the Committee on the Costs of Medical Care, Chicago University Press , 1933 .
31.
Rosenfeld
L. S.
: Standards for Assessing Quality of Care, Quality Assurance of Medical Care
, Monograph, Regional Medical Programs Service, DHEW, 1973 .
32.
Donabedian
A.
: Evaluating the Quality of Medical Care , Milbank Mem. Fund Q.
44 : 106 –203 , Part 2 (July) 1966 .
33.
Brook
R. H.
Appel
F. A.
: Quality-of-Care Assessment: Choosing a Method for Peer Review , N. Engl. J. Med.
288 : 1323 –1329 (June 21) 1973 .
34.
Johnson
R. E.
: An Approach to Assessing the Quality of Pharmaceutical Services , Drugs Health Care
2 : 8 –20 (Winter) 1975 .
35.
Donabedian
A.
: Promoting Quality through Evaluating the Process of Patient Care , Med Care
6 : 181 –202 (May-June) 1968 .
36.
Brodie
D. C.
: Drug Utilization Review/Planning , J. Am. Hosp. Assoc.
46 : 103 –112 (June 1) 1972 .
37.
Knapp
D. A.
: Development and Application of Criteria in Drug Use Review Programs , Am. J. Hosp. Pharm.
37 : 648 –656 (July) 1974 .
38.
Johnson
R. E.
: Quality Assurance of Pharmaceutical Services in Hospitals , Am. J. Hosp. Pharm.
31 : 640 –647 (July) 1974 .
39.
Myers
R. S.
: Antibiotic Study Shows Need for Therapy Audit in Hospitals , Bull. Am. Coll. Surg.
48 : 61 –63 (Mar.-Apr.) 1963 .
40.
Muller
C. F.
: Medical Review of Prescribing , J. Chronic Dis.
18 : 689 –696 (July) 1965 .
41.
Muller
C. F.
: The Study of Prescribing as a Technic of Examining a Medical Care System , Am. J. Pub. Health
57 : 2117 –2126 (Dec.) 1967 .
42.
Blum
H. L.
: Evaluating Health Care , Med. Care
12 : 999 –1011 (Dec.) 1974 .
43.
Cathcart
H. R.
: Peer Review Control of Drug Utilization in Teaching Hospitals , J. Clin. Pharmacol.
12 : 407 –410 (Oct.) 1972 .
44.Ibid .
45.Social Security Administration: Conditions of Participation — Hospitals and Nursing Facilities , Fed. Regist.
Volume 39 , No. 231, Part 2 (Nov. 29) 1974 .
46.Social and Rehabilitation Service: Medicaid Utilization Control of Care and Services , Fed. Regist.
Volume 39 , No. 231, Part 3 (Nov. 29) 1974 .
47.
Schoeni
P. Q.
: Utilization Review Regulations News Release , HEW News (Nov. 29) 1974 .
48.Statement of Assistant Secretary for Health, DHEW, before the Subcommittee on Health , U. S. Senate (May 20) 1974 .