Impact of drug use evaluation upon ambulatory pharmacy practice

OBJECTIVE: To review the expansion of ambulatory drug use evaluation (DUE). A description of ambulatory DUE characteristics and methodology is included. In addition, DUE computer usage, documentation concerns, and future research issues are addressed. DATA SOURCES: A MEDLINE search was used to identify pertinent literature, including reviews. STUDY SELECTION: Primary and secondary literature describing ambulatory DUE was selected. Articles describing inpatient DUE were excluded. DATA EXTRACTION: Rigorous studies evaluating current ambulatory DUE programs are limited, but the available literature and a description of existing program characteristics are included. All studies available at the time of publication were reviewed. DATA SYNTHESIS: Ambulatory DUE can provide useful information to assist in providing pharmaceutical care. The Omnibus Budget Reconciliation Act of 1990 has prompted an expansion of DUE programs, and most of the formalized programs are retrospective in design. Prospective programs provide online, patient-specific drug use assessment whenever new prescriptions are entered into point-of-service databases. CONCLUSIONS: Although more well-designed evaluations of existing ambulatory DUE programs are needed, initial results indicate these programs may be extremely useful in identifying significant medication therapy problems and improving patients' drug therapy.