처방사유 분석을 통한 병용금기 DUR 개선방안 제시 = Analysis on Alert Override Reasons of Contraindicated Drug-Drug Interaction in the DUR and the Suggestions for Improvement

다국어 초록 (Multilingual Abstract)

Background : Drug Utilization Review (DUR) offers patients’ medication records and real-time alerts by prescreening for inappropriate drug use in prescriptions and dispensing, aiming to enhance drug safety and prevent misuse. Since 2004, Samsung Medical Center (SMC) has implemented its own DUR system to manage contraindicated drugs. This system has undergone continuous modifications in line with the expansions of the DUR system by the Health Insurance Review & Assessment Service (HIRA). However, a systematic retrospective evaluation of the appropriateness of override reasons has yet to be conducted. The purpose of this study is to analyze the patterns of DUR override reasons related to contraindicated drug-drug interactions and identify ways to improve the SMC DUR system.
Methods : We conducted a retrospective analysis of 67,291 DUR override cases for contraindicated drug drug interactions submitted to HIRA from January to December 2023. Key texts of the override reasons were extracted and classified into four standard categories: Significant, Insufficient, Inappropriate, and Meaningless reasons. The severity of contraindicated combinations was assessed using Micromedex and Lexicomp Online.
Results : The most frequently encountered contraindicated combination for inpatients was ketorolac-NSAIDs (60.2%), while for outpatients, it was cyclosporine-statins (22.0%). The analysis of the appropriateness of override reasons revealed that 95.7% were categorized as significant reasons, while 4.3% were insufficient reasons.
Notably, 69.6% of the insufficient reasons were associated with combinations that had high interaction severity.
Conclusion : This study retrospectively analyzed data from the SMC DUR system to evaluate the appropriateness of override reasons for contraindicated drug-drug interactions. Based on the findings, we recommend reorganizing the operational criteria for high-severity interactions and specifying the override reasons for prescriptions. These improvements are anticipated to enhance the appropriateness of override reasons for contraindicated drug-drug interactions and strengthen the SMC DUR system.