College of Pharmacy, Ajou University, Suwon, South Korea.
PLoS One. 2018 Apr 11;13(4):e0195434. doi: 10.1371/journal.pone.0195434. eCollection 2018.
A prospective Drug Utilization Review (DUR) program has been implemented in Korea to improve the quality and safety of medication use.
To evaluate the influence of the DUR program in reducing incidence of preventable adverse drug reactions (pADRs).
This study was performed using administrative data from the Health Insurance Review and Assessment Service (HIRA). The claims data for all adult patients with adverse drug events (ADE)-related diagnoses from 2009 to 2014 were obtained. Incidence rates of first-time and repeat pADRs prior to and after DUR program implementation were evaluated. Quarterly trends in incidence rates of overall ADE, allergic reactions, and ADRs were analyzed.
Data extraction covering the period from 2009 to 2014 led to the identification of 3,927,662 records. First-time pADR rates decreased gradually after implementation of the DUR program (change in slope: -0.016, p = 0.02). The program had a similar influence on repeat pADR rates (change in slope: -0.006, p≤0.01). The program did not decrease rates of first-time or repeat allergic reactions (change in slope: 0.018, p = 0.07 and 0.003, p = 0.04, respectively). In the cohort aged ≤65 years, first-time pADR rate reduction was significant (28.2% [27.1-29.3] in ≤18 years, and 19.8% [18.1-21.5] in 19-64 years). In contrast, first-time pADR rate was increased by 0.6% [-0.7-1.9] in patients ≥65 years.
Implementation of the prospective DUR program effectively reduced the number of pADRs. In the future, to reduce non-preventable ADRs such as allergic reactions, provision of clinical information including allergy history should be added to the DUR program.
韩国实施了一项前瞻性药物利用审查（DUR）计划，以提高药物使用的质量和安全性。
评估 DUR 计划对减少可预防药物不良反应（pADR）发生率的影响。
本研究使用了健康保险审查和评估服务（HIRA）的行政数据。从 2009 年到 2014 年，获得了所有与药物不良反应（ADE）相关诊断的成年患者的不良药物事件（ADE）的索赔数据。评估了 DUR 计划实施前后首次和重复 pADR 的发生率。分析了总体 ADE、过敏反应和 ADR 的季度趋势。
从 2009 年到 2014 年的数据提取确定了 3927662 条记录。DUR 计划实施后，首次 pADR 率逐渐下降（斜率变化：-0.016，p = 0.02）。该计划对重复 pADR 率也有类似的影响（斜率变化：-0.006，p≤0.01）。该计划并没有降低首次和重复过敏反应的发生率（斜率变化：0.018，p = 0.07 和 0.003，p = 0.04）。在≤65 岁的队列中，首次 pADR 率的降低具有统计学意义（≤18 岁为 28.2% [27.1-29.3]，19-64 岁为 19.8% [18.1-21.5]）。相比之下，≥65 岁患者的首次 pADR 率增加了 0.6% [-0.7-1.9]。
前瞻性 DUR 计划的实施有效减少了 pADR 的数量。在未来，为了减少非可预防的 ADR，如过敏反应，应在 DUR 计划中提供包括过敏史在内的临床信息。
