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Executive Summary

DUR SHOULD EXAMINE COST ISSUES "ONLY AFTER CLINICAL AND PATIENT considerations are addressed," under a policy statement adopted by AMA on June 25 in Chicago. Proposed by the American Medical Association's board and approved by the House of Delegates, the "Principles of Drug Utilization Review" further states that the "primary emphasis" of DUR "must be to enhance quality of care for patients by assuring appropriate drug therapy," and "sufficient professional prerogatives should exist for individualized drug therapy." The document also addresses physician intervention strategies and retrospective DUR methods. DUR program "interventions must focus on improving therapeutic outcomes," AMA said, advising that "focused education to change professional or patient behavior should be the primary intervention strategy." In addition, all retrospective DUR reports "should be subjected to subsequent review by a committee of peers prior to intervention." Regarding online prospective DUR, the document maintains that services should be denied "only in cases of patient ineligibility, coverage limitations, or obvious fraud. In other instances, decisions regarding appropriate drug therapy should remain the prerogative of practitioners." The document notes that the principles "are intended to reflect the common views shared by the major professional associations of medicine and pharmacy on DUR." The American Pharmaceutical Association's Board of Trustees endorsed the principles June 12. AMA's delegates had discussed DUR issues at their December 1990 meeting in Orlando, Fla. The effort to develop a joint physician/pharmacy statement grew out of a meeting in Chicago earlier this year between AMA Exec VP James Todd, MD, and APhA Exec VP John Gans to identify common areas of concern. Regarding criteria and standards for DUR, the principles state that such tools should be developed by evaluating such resources as peer-reviewed literature and compendia, consensus-derived clinical guidelines developed by professional groups, experience of practitioners expert in drug therapy, information supplied by manufacturers, and experience obtained from DUR operations. Criteria should be "validated prior to use" and should "identify underutilization, as well as overutilization, and inappropriate utilization," the document advises. In addition, any criteria and standards "must be nonproprietary and must be developed and revised through an open professional consensus process." The document also indicates concern that DUR programs implement adequate safeguards for the security of databases and patient confidentiality. The document also maintains that any nationally-set review criteria for drug utilization should allow for "appropriate modification" at the state level. The delegates also asked AMA's board to examine reported use by claims processors of physician Drug Enforcement Administration numbers to collect prescribing information on individual physicians. A resolution that had been proposed by Missouri delegates contends that "pharmacists have begun to supply physician DEA numbers to unauthorized parties," and some claims processors have "begun to market physician prescribing profiles based on prescription information derived from computer data sorted by DEA number."

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