Lecture 5 Flashcards
approximately how many americans are uninsured?
25-30 million
moral hazard leads to…
adverse selection. ins charging more.
ie: ins charges higher premium for customers who smoke
without obamacare…..
only those who need insurance will buy it
what do UM and UR stand for
UM = utilization management
UR = utilization review
give some examples of UM/UR
prior auth
step therapy
pharmacy based utilization management = DUR
pharmacy based utilization management =
DUR
In nursing home, DUR is called _______, but it’s the same concept
DRR (drug regimen review)
what is the purpose of insurances implementing UM’s (prior auths, step therapy)
to control COSTS and to enhance QUALITY
Why are UM’s/Ur’s implemented by insurances controversial?
lot of paperwork for DR.
makes dr’s upset bc it seems that insurance is questioning their professional judgment on what med the pt needs
what are the 3 times of “DUR” (drug utilization review)
proseptive – dr prescribing
concurrent – during
retrospective – looking back
what are the 5 R’s?
right…
drug
dose
route
time
patient
what are the 3 levels of prevention from a PHARMACIST POV
DRP - primary. Drug related problem
DRM - secondary. drug related morbidity
DRM - tertiary. drug related mortality
explain DRP
Drug related problem - primary prevention.
catching any potential adverse events/drug interactions
from something as simple as nausea all the way to something like vision loss
explain DRM (secondary)
DRP aims to prevent DRM(morbidity)
the interaction that occurs
Explain DRM (tertiary)
drug related mortality/QOL/palliative care
palliative care – maintain QOL when someone is dying
