Effect of drug utilization reviews on the quality of in-hospital prescribing: a quasi-experimental study.
BACKGROUND
Drug utilization review (DUR) programs are being conducted in Canadian hospitals with the aim of improving the appropriateness of prescriptions. However, there is little evidence of their effectiveness. The objective of this study was to assess the impact of both a retrospective and a concurrent DUR programs on the quality of in-hospital prescribing.


METHODS
We conducted an interrupted time series quasi-experimental study. Using explicit criteria for quality of prescribing, the natural history of cisapride prescription was established retrospectively in three university-affiliated hospitals. A retrospective DUR was implemented in one of the hospitals, a concurrent DUR in another, whereas the third hospital served as a control. An archivist abstracted records of all patients who were prescribed cisapride during the observation period. The effect of DURs relative to the control hospital was determined by comparing estimated regression coefficients from the time series models and by testing the statistical significance using a 2-tailed Student's t test.


RESULTS
The concurrent DUR program significantly improved the appropriateness of prescriptions for the indication for use whereas the retrospective DUR brought about no significant effect on the quality of prescribing.


CONCLUSIONS
Results suggest a retrospective DUR approach may not be sufficient to improve the quality of prescribing. However, a concurrent DUR strategy, with direct feedback to prescribers seems effective and should be tested in other settings with other drugs.
Grégoire
Jean-Pierre
JP
Population Health Research Unit, Centre hospitalier affilié universitaire de Québec, 1050 Chemin Ste-Foy, Québec, Qc, G1S 4L8, Canada. jean-pierre.gregoire@pha.ulaval.ca
Moisan
Jocelyne
J
Potvin
Louise
L
Chabot
Isabelle
I
Verreault
René
R
Milot
Alain
A
D020117:Cisapride / Q000627:therapeutic use*; D003211:Concurrent Review; D035061:Control Groups; D011307:Drug Prescriptions / Q000592:standards*; D017723:Drug Utilization Review / Q000379:methods*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D008485:Medical Audit; D010607:Pharmacy Service, Hospital; D010818:Practice Patterns, Physicians'; D011792:Quebec; D012189:Retrospective Studies
D005765:Gastrointestinal Agents; D020117:Cisapride