Identification of inappropriate drug prescribing by computerized, retrospective DUR screening in Korea.
BACKGROUND
In Korea, the drug use process has changed significantly since the new pharmacy law was implemented in 2000, separating the prescribing and dispensing functions between physicians and pharmacists and mandating prospective drug use review (DUR) practice by pharmacists immediately before dispensing medications. However, a high prevalence of inappropriate prescribing has been suspected by the public, pharmacists, and health insurance managers, possibly due to suboptimal DUR practice by pharmacists.


OBJECTIVE
To assess overall patterns of drug usage and potential problems of inappropriate use in outpatient settings by analyzing prescription data that were electronically submitted to the national health insurance manager with a computerized DUR system and develop a computerized adjudication system model for drug claims.


METHODS
The national prescription drug claims data that were submitted electronically by pharmacies located in the northern part of Korea during 15 days in 2002 were retrospectively screened against the predetermined DUR standards of the selected criteria on drug dosage, duration of therapy, and drug interaction using the DUR screening system. The results of all the DUR conflicts were further validated manually by an expert panel and statistically analyzed to determine drug use patterns.


RESULTS
Of 31,994,260 drugs prescribed, 3,325,760 (10.4%) items showed a conflict with at least one of the DUR standards. The average number of drugs prescribed on each prescription was 4.07, and even more troubling was the high incidence of under-dosing, over-dosing, and contraindicated drug prescribing.


CONCLUSIONS
It is evident that inappropriate drug prescribing is very common in Korea; thus, a great deal of attention is urgently needed in the country with respect to proper prescribing and supportive interventions.
Yeom
Jong Hun
JH
College of Medicine, Han Yang University, Seoul, Korea.
Yeom
Jong Hum
JH
Park
Ji Sun
JS
Oh
Ock-Hee
OH
Shin
Hyun Taek
HT
Oh
Jung Mi
JM
D000328:Adult; D003195:Computer Communication Networks; D016208:Databases, Factual; D004347:Drug Interactions; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D017723:Drug Utilization Review / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D007723:Korea; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies