Comprehensive Drug Utilization Review: Adding Physician Outreach to Concurrent and Retrospective Drug Utilization Review

Communication about drug selection and use between physicians and pharmacists has changed in the last two decades. The enhanced clinical education offered to pharmacists and the recognition by many physicians that keeping up with advances in drug therapy is exceedingly difficult and time consuming has facilitated the change. Accordingly, hospitals and long-term care facilities have formalized the clinical role of the pharmacist in drug selection, use, and/or monitoring through the use of drug utilization review (DUR) programs, specifically called drug use evaluation (DUE) and drug regimen review (DRR), respectively, in these environments. A majority of drug therapy decisions, however, occur outside of these closed environments where the physician's drug information is often provided by representatives of the pharmaceutical manufacturers and where comprehensive DUR programs are in their infancy. As a source of information on drug products available from their company, sales representatives perform a valuable service, but their information, understandably, is focused on the advantages of their products. Making appropriate choices from alternative therapies that are more plentiful, complex and expensive than ever requires the physician to have access to current, scientifically valid, objective and unbiased information. Building on the value inherent in concurrent and retrospective DUR programs and on research conducted in the early 1980s, Medco Containment Services has developed a program that brings this type of prescribing information directly to physicians in their offices. Called the Optimal Therapeutics Program^SM (OTP^SM), Medco's program is fully operational in the Commonwealth of Massachusetts and is the vehicle for bringing clinically relevant, objective, and cost-effective prescribing information to physicians for application in the ambulatory care marketplace. This innovative program augments concurrent and retrospective DUR, delivering truly comprehensive DUR services. OTP also provides an opportunity for highly motivated and skilled pharmacists to shape their emerging role as drug information consultants.