The subject of drug utilization review (OUR) applications can be viewed both as a process and from the standpoint of application of criteria. The process of OUR can be applied in a variety of settings and circumstances; in most cases it can be viewed as an ongoing audit and facilitating process that has the goal of promoting the safest, most effective, and cost-efficient use of pharmaceuticals. There are several definitions of different types of processes in OUR that should be considered.Prospective and concurrent OUR allows an opportunity to modify the patient's prescription, if warranted, and may be carried out in either an outpatient or inpatient setting. In the outpatient setting, prospective OUR occurs before a prescription is dispensed to the patient. Currently, this would be at the point of sale of the prescription in the pharmacy; prospective OUR could also occur before dispensing if the physician were prescribing on-line. In the institutional setting, similarly, the drug order could be modified before dispensing or even at the time of prescribing, either by on-line feedback, which occurs in some settings abroad, or in settings where therapeutic decisions are discussed in multidisciplinary rounds (concurrent review).Retrospective OUR is "a process that occurs after the drug has been dispensed"t and "provides for the ongoing periodic examination of claims data and other records."] The application of OUR criteria may be specific to particular settings, patients, or drug types either in general or with respect to individual drugs.OUR criteria are based on judgments about behavior in the choice, prescribing, dispensing, and actual use (by a patient) of a pharmaceutical agent. These judgments can be developed by examination of empir-
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