Drug utilization review (qualitative models) MCQs With Answer

Drug utilization review (qualitative models) MCQs With Answer

Drug utilization review (DUR) qualitative models help pharmacists and healthcare teams assess the appropriateness, safety, and effectiveness of medication therapy beyond simple volume metrics. This blog provides targeted MCQs for M.Pharm students to deepen understanding of implicit and explicit review methods, tools such as the Medication Appropriateness Index (MAI), Beers and STOPP/START criteria, peer-review processes, trigger tools, and retrospective versus concurrent reviews. Questions emphasize practical application in clinical audits, root-cause analysis of adverse drug events, and designing criteria-based drug use evaluations. Use these MCQs to sharpen decision-making skills for real-world pharmacoepidemiology and pharmacoeconomics practice.

Q1. Which statement best differentiates implicit from explicit qualitative DUR models?

• Implicit models use predefined criteria for automated checks while explicit models rely on expert clinical judgment.
• Implicit models are judgmental and rely on clinician expertise; explicit models use standardized, criterion-based tools.
• Implicit models are faster to implement because they use checklists; explicit models require case-by-case review.
• Implicit models are only used in retrospective reviews while explicit models are used only prospectively.

Correct Answer: (Implicit models are judgmental and rely on clinician expertise; explicit models use standardized, criterion-based tools.)

Q2. Which instrument is an example of an explicit criterion-based tool for evaluating medication appropriateness in older adults?

• Medication Appropriateness Index (MAI)
• Peer case review
• Beers Criteria
• Root cause analysis

Correct Answer: (Beers Criteria)

Q3. Which element is NOT one of the original Medication Appropriateness Index (MAI) criteria?

• Indication for the drug
• Cost-effectiveness compared to alternatives
• Practical directions for use
• Drug–drug interactions

Correct Answer: (Cost-effectiveness compared to alternatives)

Q4. STOPP/START criteria are primarily used to:

• Quantify defined daily doses across a population
• Identify potentially inappropriate prescriptions and potential prescribing omissions in older people
• Replace the Beers Criteria in all clinical settings globally
• Calculate medication adherence rates from pharmacy refill data

Correct Answer: (Identify potentially inappropriate prescriptions and potential prescribing omissions in older people)

Q5. Which DUR approach is most suitable for detecting evolving adverse drug events during a hospital stay?

• Retrospective DUR
• Prospective/concurrent DUR
• Population-level DDD analysis
• Pharmacoeconomic modeling

Correct Answer: (Prospective/concurrent DUR)

Q6. In a qualitative DUE focusing on antibiotic stewardship, which primary outcome best reflects appropriateness?

• Total grams of antibiotics dispensed
• Proportion of prescriptions compliant with evidence-based therapy guidelines
• Average cost per antibiotic prescription
• Defined daily dose per 1,000 patient-days

Correct Answer: (Proportion of prescriptions compliant with evidence-based therapy guidelines)

Q7. Which statement best describes a “trigger tool” used in qualitative DUR?

• It is an algorithm that computes DDD and cost per defined dose.
• It is a list of clues (triggers) in charts that prompt focused review for possible adverse events or inappropriate use.
• It is a patient survey measuring satisfaction with medication counseling.
• It is a regulatory checklist used for reimbursement claims only.

Correct Answer: (It is a list of clues (triggers) in charts that prompt focused review for possible adverse events or inappropriate use.)

Q8. Which qualitative DUR method is most dependent on inter-rater reliability and explicit scoring rules?

• Implicit narrative review by a single expert
• Medication Appropriateness Index (MAI)
• Descriptive pharmacy dispensing counts
• Defined daily dose (DDD) calculations

Correct Answer: (Medication Appropriateness Index (MAI))

Q9. Root cause analysis in DUR is primarily used to:

• Assess cost-effectiveness of competing drugs
• Identify system-level causes contributing to medication errors or adverse drug events
• Calculate prescription volume trends over time
• Determine exact pharmacokinetic parameters of a drug

Correct Answer: (Identify system-level causes contributing to medication errors or adverse drug events)

Q10. Which of the following is a limitation of explicit criteria-based qualitative DUR models?

• High objectivity and reproducibility across settings
• May not capture patient-specific clinical nuances or exceptions
• Easy to implement electronically with rule-based alerts
• Provide standardized benchmarks for auditing

Correct Answer: (May not capture patient-specific clinical nuances or exceptions)

Q11. During a peer-review qualitative DUR, which activity is essential to ensure constructive outcomes?

• Anonymous individual blame without feedback
• Structured, multidisciplinary case discussion with predefined evaluation criteria
• Use of only administrative claims data without clinical context
• Exclusion of pharmacists from the review panel

Correct Answer: (Structured, multidisciplinary case discussion with predefined evaluation criteria)

Q12. Which indicator is most characteristic of a qualitative assessment rather than a quantitative one?

• Proportion of prescriptions that were clinically appropriate according to guideline standards
• Total number of tablets dispensed
• Defined daily dose per 1,000 inhabitants per day
• Monthly expenditure on a drug class

Correct Answer: (Proportion of prescriptions that were clinically appropriate according to guideline standards)

Q13. Which of the following best defines “preventability” in the context of qualitative DUR of adverse drug events?

• An adverse event that could not have been predicted by any reasonable clinician
• An adverse event that would have been unlikely to occur if established standards of care had been followed
• An adverse event that always results from drug pharmacology even with perfect care
• An adverse event that is costlier than the expected budget

Correct Answer: (An adverse event that would have been unlikely to occur if established standards of care had been followed)

Q14. Which qualitative DUR tool integrates explicit criteria but still requires clinical judgment for final decisions?

• Automated DDD report
• STOPP/START combined with case-level clinician review
• Pure administrative billing audit with no chart review
• Population-level cost-minimization analysis

Correct Answer: (STOPP/START combined with case-level clinician review)

Q15. In designing a qualitative DUR audit, which step ensures validity of the review instrument?

• Skipping pilot testing to save time
• Conducting pilot testing and revising criteria based on inter-rater agreement and clinical feedback
• Using criteria developed for a different patient population without adaptation
• Relying only on a single reviewer’s opinion for all cases

Correct Answer: (Conducting pilot testing and revising criteria based on inter-rater agreement and clinical feedback)

Q16. Which outcome measure would best reflect improvement after implementing a pharmacist-led qualitative DUR for polypharmacy in geriatrics?

• Reduction in the number of potentially inappropriate medications (PIMs) per patient
• Total units of medication dispensed to the ward
• Increase in hospital formulary size
• Short-term revenue from medication sales

Correct Answer: (Reduction in the number of potentially inappropriate medications (PIMs) per patient)

Q17. Which approach is most appropriate when a qualitative DUR identifies frequent deviations from clinical guidelines?

• Ignore the findings since guidelines are not mandatory
• Implement targeted education, update local protocols, and monitor change through re-audit
• Immediately remove prescribing privileges from all clinicians
• Switch to quantitative DDD reporting only

Correct Answer: (Implement targeted education, update local protocols, and monitor change through re-audit)

Q18. Which category from the NCC MERP Index is most relevant when classifying harm severity in qualitative DUR?

• Categories A–I describing the range from no error to patient death
• Only financial loss categories
• Only medication stock-out categories
• Dosage form preference categories

Correct Answer: (Categories A–I describing the range from no error to patient death)

Q19. When assessing medication appropriateness in complex patients, why might an implicit review be preferred over an explicit checklist?

• Implicit review ignores clinical context and speeds up decisions.
• Implicit review allows clinicians to integrate individual patient factors, comorbidities, and goals that rigid checklists may miss.
• Implicit review is fully automatable and requires no expert input.
• Implicit review eliminates subjectivity by relying solely on algorithms.

Correct Answer: (Implicit review allows clinicians to integrate individual patient factors, comorbidities, and goals that rigid checklists may miss.)

Q20. Which statement best describes the role of qualitative DUR in pharmacoeconomic evaluations?

• Qualitative DUR only provides cost figures and ignores clinical value.
• Qualitative DUR supplies clinical appropriateness and outcome context that helps interpret cost and value in pharmacoeconomic analyses.
• Qualitative DUR replaces the need for cost-effectiveness studies.
• Qualitative DUR is irrelevant to pharmacoeconomic decision-making.

Correct Answer: (Qualitative DUR supplies clinical appropriateness and outcome context that helps interpret cost and value in pharmacoeconomic analyses.)

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