COMMUNITY PRACTICE

Pharmacy task force tackles DUR messaging

Pharmacists fed up with fighting DUR messages should take heart. Groups representing pharmacy and pharmacy benefit managers have formed a task force to tackle ways to improve drug utilization review messaging to smooth out dispensing operations and reduce medication errors.

An outgrowth of a white paper issued in August 1999 by three pharmacy groups, the new task force is being spearheaded by the American Pharmaceutical Association and the Pharmaceutical Care Management Association (PCMA), whose members include PBM executives. Mindful that many pharmacists complain that a lot of DUR messages merely create "noise" that slows down the system, the task force's goal is to explore ways to improve DUR systems.

Working with PCMA and other key players, including software and database vendors, to improve DUR messaging is APhA's "highest workplace strategy" for 2001, and we're very excited about it," said Lucinda Maine, senior v.p. for professional and public affairs. "We continue to hear from pharmacists that their largest set of aggravations is interacting with these systems that just aren't working for them. We're putting a lot of muscle behind [the task force] to see if we can't help make some near-term meaningful changes."

Slated to convene sometime this month, the DUR task force was publicly proposed at the PCMA's annual meeting last October by outgoing chairman John Thornton, who is also v.p. of clinical services at Walgreens Health Initiatives. He told PBM executives in attendance that while their firms have a large role to play in DUR systems, "we can't do it alone. Designing and implementing the kind of improved DUR systems that will be capable of significantly reducing medication errors will require the co-operation of every segment of American health care."

Having PBMs acknowledge that they are looking for opportunities to improve DUR messaging is a "highly significant" development, said Maine. PCMA and APhA agreed it was time to work on improving the system and decrease some of the erroneous and unhelpful DUR messages, as well as the hard edits that stop the dispensing process cold, she added.

Bringing PBMs to the table is a very positive step for pharmacists, agreed Michael T. Rupp, Ph.D., professor of pharmacy administration and director of pharmacy practice research, Midwestern University College of Pharmacy-Glendale Campus in Arizona. As a task force member and longtime DUR messaging researcher, he sees an opportunity that will be good for the patient's health and good for the quality of the R.Ph.'s work and work life. "I'm probably most optimistic simply because we're going to be looking at it at all," he told Drug Topics. "The fact that PCMA has recognized this in a formal way as an issue and area of concern is a good thing. It's a real win for pharmacy organizations, pharmacists, and pharmacy researchers."

Pharmacists in PBM networks and PCMA's own members share at least one thing in common: They think the current DUR messaging systems can be improved, said Patrick Donoho, PCMA v.p. of government affairs and public policy. "Our goal is basically to get the messaging down so we can have some sort of standardization and make it useful. This is no small matter because the bottom line is patient safety."

The task force's first order of business is DUR messaging, but attention will eventually turn to the first link in the drug use chain. "We can't just say we're going to do DUR because we'll have to look at electronic prescribing," Donoho said. "It all has to come together." And APhA's Maine added that the task force will also target unit-of-use packaging as a way to improve efficiency and patient safety.

Every time pharmacy personnel have to intervene on a third-party on-line prospective DUR message, it costs the pharmacy $3, according to a 1998 study conducted by one of Rupp's former graduate students at Purdue University (Drug Topics, Nov. 16, 1998). Alerts that were merely ignored still cost $1.20 per override. And pharmacy personnel overrode 88% of those on-line alerts, most often because they were already aware of the problem, the problem didn't exist, or the problem wasn't clinically significant.

Looking beyond the task force, Rupp is involved in research suggesting that pharmacists need formal training in how to use DUR more effectively. "Every pharmacist to my knowledge just kind of picks up DUR as they go along, or there's some kind of casual approach to training them," he said. "We're looking at maybe developing a more standardized, almost algorithmic, approach to training to prepare pharmacists to do good, consistent prospective DUR and how to interact with the systems and databases."

Carol Ukens

Carol Ukens. Pharmacy task force tackles DUR messaging.

Drug Topics

2001;2:37.