Examination of priorities for therapeutic drug utilization review

Therapeutic Drug Utilization Review (DUR) is an important component of state-level pharmaceutical assistance programs like Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE). Two separate studies were conducted to examine reviewers' priorities for screening drug- drug interactions within PACE; specific emphasis was placed on screening potentially adverse drug interactions. A group of 15 pharmacists and physicians serving on PACE DUR committees were asked to provide elderly- specific ratings on the 'clinical significance' and the 'need for action' for 122 specified drug interactions well-documented in the clinical pharmacy literature. In Study 1, reviewers were asked to provide ratings for each type of drug interaction shown in a one-page clinical description. In Study 2, reviewers were asked to evaluate a subset of the previously rated drug interactions, as they appeared in a set of selected PACE cardholders' drug use profiles. In both studies, considerable variability was found among DUR members' evaluations for both rating dimensions. Consensus was achieved for only a limited number of interactions. Implications of the findings for DUR within state-level pharmaceutical programs and the general issue of screening for adverse drug interactions in the elderly are discussed.