Perceptions on Drug Utilization Review among Hospital Pharmacists in

Baguio City

Gambulao, Analyn P., Sapitola, Arriane N.

Abstract

Prescribing errors that occur in hospitals have been a source of patient’s harm. Errors in
prescribing can be irrational prescribing, inappropriate prescribing, ineffective prescribing,
underprescribing, overprescribing, and errors in writing the prescription. By implementing
drug utilization review programs in hospitals, pharmacists can identify prescribing trends
in patient populations and initiate corrective action to improve drug therapy for groups of
patients as well as individuals. Perceptions of the pharmacists on drug utilization review is
important as they are experts in the prescription and safe dispensing of medicines. A study
was conducted in hospitals of Baguio City to evaluate pharmacists perceptions which
utilizes survey method through questionnaires. The data obtained had analysis criteria and
were divided into 2 categories: Perceptions of the pharmacists regarding the importance of
drug utilization review and factors affecting implementation of DUR. The results were
calculated using weighted mean to determine the accurate sample of the population. The
purpose of the study is to acknowledge the importance of drug utilization review and
identify factors that hinder appropriate drug prescribing and dispensing.
Keywords: Perceptions, Prescribing errors, Drug therapy, Pharmacists, Hospitals

Introduction

Drugs as defined by (Ansel, 2014) are an agent intended for use in the diagnosis,

mitigation, treatment, cure or prevention of disease in humans and animals. One of the

most astounding qualities of drugs is the diversity of their actions and effects on the body.

However, usage of this agent may cause harm to our body with the improper and irrational

usage.

Irrational prescribing can greatly have a negative impact on patient care outcomes

if not assessed by a licensed health care professional or other health care providers such as
Perceptions on Drug Utilization Review
2

nurses and pharmacist. Now a days, the prescription prescribed has become just an

indication of medicine with some instruction of doses without consideration of its

rationality which may lead to increase morbidity and mortality rate.

Prescription order is an important transaction between the clinician and patient. It

is an order for scientific medication for a person at a particular time. (Adiga MN et. al

2009). According to the World Health Organization (WHO), more than 50% medications

are prescribed, dispensed, or sold inappropriately, and in that half of the patient took their

medicines wrongly. Inappropriate prescribing is known all over the world as a major

problem of health care delivery. (Tamuno I. And Fadare JO, 2012). The irrational use of

medications could be practiced in the form of overuse, underuse, and misuse of prescription

or over-the-counter drugs (Ahmad et al, 2012).

Drug use studies using aggregate data or health facility indicators may indicate that

there is over- or under-consumption of medicines, and qualitative studies may indicate why

certain health staff and patients behave the way they do. However, such studies do not

provide detail about the exact nature of the irrational use. Such details may concern

incorrect medicine choices, incorrect dose, prescribing drugs that cause ADRs or drug

interactions, and the use of expensive drugs when cheaper ones would do.

Hence drug utilization review (DUR) or also referred to as drug medication

utilization evaluations (MUE) helps the medical practitioner in knowing the drugs having

severe drug reactions, drug-drug interaction and also to reduce therapeutic cost. Through

this system it allows the health care provider to initiate an action in improving the drug
Perceptions on Drug Utilization Review
3

therapy of the patients to prolong their life. If therapy is deemed to be inappropriate,

interventions with providers or patients will be necessary to optimize drug therapy.

Drug Utilization Review (DUR) may simply be defined as the ongoing study of

frequency, duration of therapy, use and cost of drugs from which patterns for prescribing,

dispensing, administering and patient use can be compared against predetermined

standards. DUR should be capable of determining overall patterns for use at a specific

institution as well as provide data for in-depth studies of specific patients, practitioners,

diagnoses, prescribing trends, and more (Phillips MS., 1996).

The goal of DUR is to increase the quality of drug therapy by identifying problems

in prescribing habits and to educate health care practitioners to modify their prescribing,

dispensing, and administering habits. Education and alerts are made available to

prescribing providers and pharmacists both prospectively, retrospectively and concurrently

about: medication appropriateness, overutilization and underutilization, appropriate use of

generic products, therapeutic duplication, drug-disease contraindications, drug-drug

interactions, incorrect drug dosage or duration of drug treatment, drug-allergy interactions,

clinical abuse/misuse (Warholak TL, 2003).

Prospective DUR (Pro DUR) is a review of a person’s medication record and

prescription drug orders prior to dispensing. The Pro DUR review of drug therapy is

performed before each prescription is filled or delivered to the person, typically at the

point-of-sale or point of distribution. This process assists the pharmacist by addressing

situations in which potential drug problems may exist. Pro DUR performed prior to

dispensing helps pharmacists ensure that the person receives appropriate medications. This
Perceptions on Drug Utilization Review
4

is accomplished by providing information through messaging from the claim submission

system to the dispensing pharmacist that may not have been previously available

particularly if the person is using more than one pharmacy (Kidder D. et al, 1999).

Retrospective DUR provides for the ongoing periodic examination of claims data

and other records to identify patterns of fraud, abuse, gross overuse, or inappropriate or

medically unnecessary care among prescribing providers, pharmacists, and people

associated with specific drugs or groups of drugs. The retrospective review also allows for

active and ongoing educational outreach in the form of letters or face-to-face discussions

to educate prescribing providers on common drug therapy problems with the aim of

improving prescribing or dispensing practices (Gibson, JT. et al, 1995).

Concurrent review is performed during the course of treatment and involves the

ongoing monitoring of drug therapy to foster positive patient outcomes. It presents

pharmacists with the opportunity to alert prescribers to potential problems and intervene in

areas such as drug-drug interactions, duplicate therapy, over or underutilization and

excessive or insufficient dosing. This type of review allows therapy for a patient to be

altered if necessary. As electronic prescribing becomes more widely adopted, the

concurrent DUR process may be performed by the prescriber at the time of prescription

transmission to the pharmacy, allowing interventions before the drug is dispensed. An

important component of DUR will require complete and current drug and allergy records

for the patient, as well as knowledge of appropriate therapeutic interchanges for

individuals. As a safety net, pharmacists will perform a similar role as prescribers on the

dispensing side of these transactions (Agrawal JM. et al, 2014).

Perceptions on Drug Utilization Review
5

Thus implementation of this system is done one step at a time to ensure drug

optimal therapy. In conducting DUR in a hospital, one must identify or determine optimal

use against the actual use of a certain drug to a group of individual or people suffering from

the same illness. A standard would be established to health care practitioner in assessing

the effectiveness of the individual patients.

Data was then gathered to enable the health practitioners in measuring the actual

use of the medication through the medical and prescription records of each individual. This

will show the individuals who will fit the criteria in showing sign of effectiveness during

the course of the therapy.

Individuals who are identified in not responding to treatment would then be

evaluated for any discrepancies and will then be interpreted. The health care providers will

then take a corrective action to be implemented to a target areas of concern such as

prescribing patterns, medication misadventures, and quality of drug therapy or economic

consideration.

Perceptions on drug utilization review among hospital pharmacists is important to

evaluate the outcomes and document reasons for positive and negative results as per

conducted in a hospital. This will then result in changing some protocols in implementing

DUR program and continuous observation will take place. This finding would then be

reported to the appropriate team within the hospital which includes the pharmacy,

physician, nurses and other health care committee (Carver, N. et al, 2018).

Thus, the overall objective of this study is to evaluate perceptions of Pharmacists

on drug utilization review among hospitals in Baguio City.1.) Does implementing the DUR
Perceptions on Drug Utilization Review
6

program in the hospital helpful in prolonging the patient’s life? 2.) Do the perceptions of

the pharmacists on the importance of DUR influence the implementation of DUR’s in the

hospital? 3.) What is the outcome of reducing the factors affecting the implementation of

DUR to the healthcare professionals and patient?

Implementation of the program in a hospital setting is successful since the role of

individual health care professional varies. This organizational body responsible for the

medication use evaluation process should have, at a minimum, prescriber, pharmacist,

nurse and others. To deliver the appropriate action in conducting the program, data are

frequently collected for further research among the ADRs that was reported by the health

care provider.

DUR programs play a key role in helping managed health care systems understand,

interpret, and improve the prescribing, administration, and use of medications. Employers

and health plans find DUR programs valuable because the results are used to foster more

efficient use of scarce health care resources. Pharmacists play a key role in this process

because of their expertise in the area of pharmaceutical care.

DURs afford the managed care pharmacist the opportunity to identify trends in

prescribing within groups of patients such as those with asthma, diabetes, or high blood

pressure. Pharmacists can then, in collaboration with other members of the health care

team, initiate action to improve drug therapy for both individual patients and covered

populations. DURs serve as a means of improving the quality of patient care, enhancing

therapeutic outcomes, and reducing inappropriate pharmaceutical expenditures, thus

reducing overall health care costs.

Perceptions on Drug Utilization Review
7

Methodology

This chapter presents the research design, methods and procedures. This research

concentrated on the perceptions on drug utilization review among hospital Pharmacists in

Baguio City.

A descriptive research methodology is used in this study. A survey is administered

to a selected sample from a specific population identified by the National School Board

Association. The term ‘survey’ is commonly applied to a research methodology designed

to collect data from a specific population, or a sample from that population, and typically

utilizes a questionnaire or an interview as the survey instrument (Robson, 1993).

The purpose of employing the descriptive method is to describe the nature of a

condition, as it takes place during the time of the study and to explore the cause or causes

of a particular condition. The researcher opted to use this kind of research considering the

desire to acquire first hand data from the respondents so as to formulate rational and sound

conclusions and recommendations for the study. According to Creswell (1994), the

descriptive method of research is to gather information about the present existing

condition. Since this study is focused on the perception on drug utilization review among

hospital pharmacists in Baguio City, the descriptive method is the most appropriate method

to use.

The study utilizes a survey method by distribution of questionnaire to the

respondent. Survey question is a method that aims at knowing what a big number of people

think and feel about some sociological issues. The data it collects from this people serving
Perceptions on Drug Utilization Review
8

as “representatives or informants” explain or describe the society’s thought, attitudes and

feelings towards environmental issues (Sullivan, 1992).

This study was conducted in hospitals in Baguio City to evaluate perceptions of

pharmacists regarding drug utilization review. Questionnaires was floated to the entire

pharmacist in the hospital to gather data to prove the objective of this study.

Data gathering was conducted through the questionnaire that was floated to the

pharmacist in a hospital setting for us to be able to come up with a result and draw a

conclusion.

The researchers send a request letter to hospitals for approval to evaluate the

perceptions of the Pharmacists regarding the importance and factors affecting the

implementation of DUR in their hospital through the survey by giving out questionnaires.

After the request letter was signed by the Medical Director, the researchers scheduled a

date to float the questionnaires to all the pharmacist. Their response was then tallied

through the use of Statistical tool.

The research was subjected to statistical treatment to determine the Perceptions on

Drug Utilization Review among Hospital Pharmacists’ in Baguio City.

With the use of Likert Scale, the importance of DUR and the factors affecting the

implementation of DUR was examined through the following equivalent and range of each

scale (Goddard, 2007).

Weighted Mean formula was used to determine or calculate the accurate sample of

the population for the said study. Computation was stated in Appendix B.
Perceptions on Drug Utilization Review
9

Weighted Mean formula is a random sampling techniques formula to estimate

sampling size with the formula of:

WT = W1n1+W2n2+W3n3+W4n4

Where:

WT- Weighted Mean

W- Value of item

n- number of respondents

N- Total number of respondents

RESULTS AND DISCUSSION

The research employs descriptive method of data gathering. The data below are the

total from the questionnaire given to the hospital pharmacists. The data gathered are

summarized in the tables presented below.

Table 1. Perceptions of Pharmacists Regarding the Importance of Drug Utilization

Review

4 3 2 1 W.M. Interpretation

(SA) (A) (D) (SD)

1.Drug utilization review 12 9 0 0 3.57 Strongly Agree

prevents medication –related
errors.

2.The DUR program assures 12 9 0 0 3.57 Strongly Agree

that prescriptions for out-patient
drugs are appropriate, medically
Perceptions on Drug Utilization Review
10

necessary and are not likely to

result in adverse medical results

3.DUR improve prescribing and 11 10 0 0 3.52 Strongly Agree

dispensing practices of
physicians and pharmacists.

4.DUR helps eliminate, identify 14 7 0 0 3.67 Strongly Agree

and reduce the frequency of
patients of fraud, abuse and
gross overuse of the prescriber.

5.DUR detect co-administration 13 8 0 0 3.62 Strongly Agree

incompatibilities between
prescription issued by different
departments in the healthcare
institution.

6.Results from DUR foster 15 6 0 0 3.71 Strongly Agree

more efficient use of scarce
health care resources.

Total 77 49 0 0 3.61 Strongly Agree

Legend:

Arbitrary Values Descriptive Equivalent

3.28 – 4.00 Strongly Agree

2.52 – 3.27 Agree

1.76 – 2.51 Disagree

1.00 – 1.75 Strongly Disagree

Table 1 shows the perceptions of the Pharmacists regarding the importance of Drug

Utilization Review.
Perceptions on Drug Utilization Review
11

Based on the data above, an average of 3.71 stated that results from DUR foster

more efficient use of scarce health care resources. As stated by Nicki Carver ,2019, DUR can

be simply informative, such as collecting data to guide decision making, or be used to

measure the effect of interventions, such as the addition of a new agent to the formulary or

the implementation of a new medication use policy.

With an average of 3.67, the respondents strongly agree that DUR helps eliminate,

identify and reduce the frequency of patients of fraud, abuse and gross overuse of the

prescriber. Although not generally seen as forming part of the DUR process, it is possible

to identify and attempt to control fraud and abuse when performing drug utilization review

since many aspects involved in fraud and abuse relate to the quality of care and cost issues.

An average of 3.62 stated that the DUR program detect co-administration

incompatibilities between prescription issued by different departments in the healthcare

institution followed by the DUR program assures that prescriptions for out-patient drugs

are appropriate, medically necessary and are not likely to result in adverse medical results

with an average of 3.57.

An average of 3.57 also stated that drug utilization review prevents medication-

related errors. According to Lee et al, 2017, drug utilization review system is a valuable

tool for improving patient ‘s safety and quality of care by diminishing medication –related

errors and adverse events, monitoring drug prescriptions from healthcare institutions for

co-administration incompatibilities and is concerned with drug-drug interactions, drug

pregnancy warnings and drug age conflicts.

Perceptions on Drug Utilization Review
12

And an average of 3.52 stated that DUR program improve prescribing and

dispensing practices of physicians and pharmacists. Prescription drugs constitute an

important component of health care. However, drugs can only benefit to patients if they

are used appropriately which involves that physicians prescribe them according to

evidence. One common method of assessing and correcting the appropriateness of drug

prescription is drug utilization review (DUR) programs. Pharmacists participating in DUR

programs can directly improve the quality of care for patients, individually and as

populations, by striving to prevent the use of unnecessary or inappropriate drug therapy,

prevent adverse drug reactions and improve overall drug effectiveness (Gregoire et

al,2000).Overall, the respondents strongly agreed on all the importance of DUR in a

hospital.

Table 2. Factors Affecting Implementation of Drug Utilization Review

4 3 2 1 W.M. Interpretation

(SA) (A) (D) (SD)

1. Lack of trainings and 13 8 0 0 3.62 Strongly

education drives for Agree
pharmacists with regards to
implementation of a DUR.

2. Lack of pharmacy 7 11 0 0 3.39 Strongly

computer systems needed Agree
for the implementation of a
DUR program.

3. Access to large amount 11 9 1 0 3.48 Strongly

of information about Agree
patients raises important
privacy issues.
Perceptions on Drug Utilization Review
13

4. Maintaining a DUR 4 14 1 1 3.05 Agree

program have high coasts
and it is resource intensive.

5. The costs of a DUR 3 17 0 1 3.04 Agree

program and the quality of
service provided may not be
balanced.

6. DUR program is too 3 12 5 1 2.81 Agree

focused on physicians and
pharmacists education and
seldom encourage patient
education.

Total 41 71 7 3 3.23 Agree

Legend:

Arbitrary Values Descriptive Equivalent

3.28 – 4.00 Strongly Agree

2.52 – 3.27 Agree

1.76 – 2.51 Disagree

1.00 – 1.75 Strongly Disagree

Table 2 shows the factors affecting the implementation of Drug Utilization Review.
Perceptions on Drug Utilization Review
14

The data above with an average of 3.62 shows that lack of trainings and education

drives for pharmacists with regards to implementation of a DUR. Pharmacists reported that

their current assignments are mainly logistical. This generates dissatisfaction, as some of

their clinical activities are not recognized by other health team professionals, perceptions

also reported in other studies. Bermond et al., also stated that the pharmacist still takes

predominantly administrative actions at the expense of health education actions such as

guidance and promotion of responsible use of medicines. With the training of health

professionals based on the biomedical paradigm does not complement the pharmacists with

the clinical skills. This can result in dissatisfaction and lack of appreciation of pharmacists

by patients and the health team, as has been reported in some studies (Alcantara T. et al)

An average of 3.48 shows that access to large amount of information about patient

‘s raises important privacy issues. Prater V. S.2014 stated that there are three important and

related concepts often used in discussing protection of health information within the U.S.

healthcare system: confidentiality, privacy and security. Confidentiality in health care

refers to the obligation of professionals who have access to patient records or

communication to hold that information in confidence. Privacy, as distinct from

confidentiality, is viewed as the right of the individual client or patient to be let alone and

to make decisions about how personal information is shared (Brodnik, 2012). Security

refers directly to protection, and specifically to the means used to protect the privacy of

health information and support professionals in holding that information in

confidence. The concept of security has long applied to health records in paper form;

locked file cabinets are a simple example.

Perceptions on Drug Utilization Review
15

DUR program is too focused on physicians and Pharmacists education and seldom

encourage patient education got the lowest average of 2.81. According to Wisconsin 2001,

a number of educational programs are generated by the DUR program. One of the primary

means of education is the distribution of educational newsletters to prescribers and

pharmacists. Topics for newsletters have included: Current treatment protocols, how to

best use the information received in the intervention letter, new drug/drug interactions,

utilization and cost data for selected therapeutic classes of drugs, comparison of efficacy

and cost of drugs within a therapeutic class. In addition, the intervention letters sent out

generate additional calls to the DUR pharmacy staff that provide an opportunity for a one-

to -one educational activity with the prescriber.

Second to the lowest average is 3.04 which states that the cost of DUR program

and the quality of service provided may not be balanced. Truter Ilse,2008 stated that Drug

utilization review can examine costs by patient, provider, individual drug, or a combination

of the three aspects. Although not necessarily the main objective of all drug utilization

review, the containment of medical care costs is receiving increasing interest. It must also

be taken into account that health care professionals are often not preoccupied with cost. In

recent years, however, it became a reality that cost must be a factor in diagnostic and

therapeutic.

One pharmacist disagree with the access to large amount of information about

patients raises important privacy issues and maintaining DUR program have high costs and

it is resource intensive. Five pharmacists disagree with the DUR program is too focused on

physicians and Pharmacists education and seldom encourage patient education. One

pharmacist strongly disagree with maintaining DUR program have high costs and it is
Perceptions on Drug Utilization Review
16

resource intensive, the cost of a DUR program and the quality of service provided may not

be balanced.

The twenty-one Pharmacists that participated in our research works in private and

government hospitals. Sixteen Pharmacists works in private and five Pharmacists works in

a government hospital. Most of the pharmacists surveyed are one year in service, the

shortest is one month and the longest is 22 years in service. The other Pharmacists choose

not to indicate their years in service.

Implementation of the drug utilization review in the hospital is helpful in prolonging the

patient’s life as proven by its importance which are: DUR foster more efficient use of

scarce health care resources followed by DUR helps eliminate, identify and reduce the

frequency of patients of fraud, abuse and gross overuse of the prescriber, it can also detect

co-administration incompatibilities between prescription issued by the different

departments in the healthcare institutions, it prevents medication-related errors, it assures

that prescriptions for –outpatient drugs are appropriate, medically necessary and are not

likely to result in adverse medical results and it improves prescribing and dispensing

practices of physicians and pharmacists with the mean of 3.71, 3.67, 3.62, 3.57, 3.57 and

3.52.
Perceptions on Drug Utilization Review
17

Conclusion and Recommendation

The hospital Pharmacists strongly agree with the importance of implementing DUR in

hospitals and finding solutions to the factors that affect its implementation improves drug

therapy for patient in collaboration with physicians and other members of health care team.

DUR is a quality assurance system that holds promise as a tool that, if implemented

effectively, could enhance appropriate drug use. The Pharmacists believe a more

systematic approach to DUR is needed. It is recommended to educate health care providers

to improve their levels of knowledge about prescribing and dispensing and potential drug

errors, to educate patients on their drug therapy through brochures and leaflets, to provide

pharmacy computer systems for faster processing of patient’s documents and to set-up

interdisciplinary team that continuously review the drug delivery process and feeds back

findings to hospital staff.

Perceptions on Drug Utilization Review
18

REFERENCE

Allen, L. V., Popovich, N. G., & Ansel, H. C. (2011). Ansel's pharmaceutical dosage forms
and drug delivery systems. Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins.
American Society of Hospital Pharmacists. ASHP guidelines on the pharmacist’s role in
drug-use evaluation. Am J Hospital Pharmacy (1988).
Ansel, H. (2014). Ansel’s Pharmaceutical Dosage Forms and Drug Delivery
System. 10th Edition. Wolter Kluwer Health/Lippincott Williams & Wilkins

Badar, V. A., & Navale, S. B. (2012). Study of prescribing pattern of antimicrobial agents
in medicine intensive care unit of a teaching hospital in Central India. The Journal
of the Association of Physicians of India, 60, 20–23.
George, G. (2001). Introducing weighted mean. 2nd Edition. Oaks Publication

Goddard et al. (2007). Research Methodology: An Introduction. 2nd Edition.

Kanish, R., Gupta, K., Juneja, S., Bains, H. S., & Kaushal, S. (2015). Prescribing pattern
and pharmacoeconomics of antibiotic use in the department of pediatrics of a
tertiary care medical college hospital in northern India. Annals of Tropical
Medicine & Public Health, 8(4), 101–104.
Navarro, Robert (2008). Drug Utilization Review Strategies. In Managed Care Pharmacy
Practice, pp. 215 -229.

Purnima Ashok and Vijeesh Tholur Subramanian (2017). Importance of Drug Utilization
Evaluation Studies in Patient Health Care. Indian Journal of Pharmacy Practice,
Vol 10, Issue 3. ijopp.org/sites/default/files/IJPharmacyPractice_3_157_0.pdf.
Retrieved March 09, 2019

Seung-Mi Lee Soo-Ok Lee Dong-Sook Kim (2017). Physicians’ and pharmacists’
perceptions on real-time drug utilization review system: a nationwide survey

Thakolkaran, N., Shetty, A. V., D’Souza, N. D. R., & Shetty, A. K. (2017). Antibiotic
prescribing knowledge, attitudes, and practice among physicians in teaching
hospitals in South India. Journal of Family Medicine and Primary Care, 6(3), 526–
532.
Warholak TL, Rupp MT, Zale A, Hines M, Park S. (2003). A practical tool for improving
medication safety. J Am Pharm Association, 55(6):621-
625. https://www.ncbi.nlm.nih.gov/books/NBK441869/. Retrieved November 29,
2018.
Perceptions on Drug Utilization Review
19

APPENDIX A

FLOWCHART OF THE PROCEDURES

Researchers send a request letter to the hospitals

Approval of Request Letter by the Medical Director

of the hospitals

Scheduled a date to float the questionnaires to the

pharmacist

Tabulation of the data obtained

Results was calculated by weighted mean

Draw conclusion base on the data tallied

Perceptions on Drug Utilization Review
20

APPENDIX D

PHOTO DOCUMENTATION

Figure 1. Pines City Doctors Hospital

Perceptions on Drug Utilization Review
21

Figure 2. Pines City Doctors Hospital

Perceptions on Drug Utilization Review
22

APPENDIX E

QUESTIONNAIRES

Table 1. Perceptions of Pharmacists Regarding the Importance of Drug Utilization

Review

4 3 2 1

(SA) (A) (D) (SD)

1.Drug utilization review prevents medication –

related errors

2.The DUR program assures that prescriptions for

out-patient drugs are appropriate, medically
necessary and are not likely to result in adverse
medical results

3.DUR improve prescribing and dispensing

practices of physicians and pharmacists

4.DUR helps eliminate, identify and reduce the

frequency of patients of fraud, abuse and gross
overuse of the prescriber

5.DUR detect co-administration incompatibilities

between prescription issued by different
departments in the healthcare institution

6.Results from DUR foster more efficient use of

scarce health care resources

Table 2. Factors Affecting Implementation of Drug Utilization Review

4 3 2 1

(SA) (A) (D) (SD)

Perceptions on Drug Utilization Review
23

1.Lack of trainings and education drives for

pharmacists with regards to implementation of a
DUR

2.Lack of pharmacy computer systems needed for

the implementation of a DUR program

3.Access to large amount of information about

patients raises important privacy issues

4.Maintaining a DUR program have high coasts

and it is resource intensive

5.The costs of a DUR program and the quality of

service provided may not be balanced

6.DUR program is too focused on physicians and

pharmacists education and seldom encourage
patient education
Perceptions on Drug Utilization Review
24