A system for drug utilization review in ambulatory care.
BACKGROUND
It is more difficult to conduct drug utilization reviews in ambulatory care settings than in inpatient care settings. This is true for several reasons: it is harder to identify outpatients who are receiving specific medications; often there is less evidence on which to base clinical standards for drug use; and it is more difficult to ensure patient compliance with drug therapy.


METHODS
This article describes a drug utilization review system designed to operate in ambulatory care clinics. The system consists of (1) a computerized database for efficient identification of patients who receive prescriptions for a specific medication, (2) clinic-wide consensus guidelines, (3) reminders in the medical record, (4) regular chart audits, and (5) feedback to physicians.


RESULTS
Experience in monitoring the use of serum theophylline assays illustrates how this system can be used in an ambulatory care clinic. According to guidelines adopted in our clinic, overuse of assays is not a problem. The system of physician reminders and chart audits can help prevent underuse.


CONCLUSIONS
Despite the difficulties in conducting drug utilization reviews in the ambulatory setting, a system based on clinic-wide guidelines is feasible and should be an integral part of quality assurance programs.
DeNeef
P
P
Department of Family Medicine, School of Medicine, University of Washington, Seattle 98195.
Ellsworth
A
A
Schneeweiss
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards*; D000555:Ambulatory Care Information Systems; D002648:Child; D002675:Child, Preschool; D004358:Drug Therapy / Q000592:standards; D004363:Drug Utilization; D005568:Forms and Records Control; D006801:Humans; D008722:Methods; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010349:Patient Compliance; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D013806:Theophylline / Q000097:blood
D013806:Theophylline