How pharmacists respond to on-line, real-time DUR alerts.

OBJECTIVE

To quantify the type and frequency of drug utilization review (DUR) alerts sent by one claims processor to pharmacists; identify how pharmacists respond to these on-line, real-time DUR messages; and quantify the interventions taken by these pharmacists as a result of these alerts.

DESIGN

Retrospective analysis of Medicaid claims from July 1, 1995, through June 30, 1996.

SETTING

State of Delaware.

PARTICIPANTS

55,000 Medicaid recipients served by 170 participating pharmacies and 2,000 physicians.

INTERVENTIONS

All on-line DUR alerts sent to pharmacists and the pharmacists' responses were categorized by alert type and analyzed by drug class.

MAIN OUTCOME MEASURES

Pharmacists' response (dispensed prescription, contacted prescriber, talked with patient, consulted own reference sources) and drug classes.

RESULTS

During the study period, 807,017 claims generated 83,260 DUR alerts involving 73,554 (9.1%) prescriptions. Prescriptions were not dispensed in 20.9% of cases because of the DUR message. Prescriptions were dispensed 17.7% of the time after the pharmacist contacted the prescriber, in 20.6% of cases after the pharmacist talked with the patient, and 37.2% of the time after reviewing internal resources. Action taken by pharmacists varied among and within DUR criteria categories. Specific examples of alerts generated in high-frequency and high-profile areas are reviewed, some of which generated inconsistent responses.

CONCLUSION

Among Delaware Medicaid providers, drug alerts resulted in pharmacists not dispensing prescriptions in a surprising percentage of situations. Pharmacists' responses varied according to the drug class involved and the type of alert received.