The Medicine, Health, and Aging Project
Impact of Prospective Drug Use Review on Health Outcomes
Funding
Agency for Health Care Policy and Research (AHCPR)
Period
7/1/96-6/30/99
Principle Investigator
Frank M.Ahern, Ph.D.
Co-Investigators
Debra Heller, Ph.D.
Toni Miles, MD., Ph.D.
Background
Drug Utilization Review (DUR) is the process by which prescribed medications are evaluated against explicit criteria to improve the quality of drug therapy and reduce unnecessary expenditures. Prospective DUR (ProDUR) procedures, conducted at the point of sale, are potentially the most effective form of DUR to prevent mis-prescribing of prescription drugs and to prevent unnecessary risks for adverse drug effects. The Pennsylvania PACE program, a state-level outpatient pharmaceutical assistance program for the elderly, implemented psychotropic ProDUR in March, 1995. PACE's ProDUR system can be characterized as Regulatory in nature, with no provision for pharmacist overrides of ProDUR alerts. A similar ProDUR system--characterized as Informational--was implemented in Pennsylvania's Medicaid program in June of 1994. Medicaid's ProDUR system does allow pharmacist overrides. The availability of two large outpatient populations, each subjected to different ProDUR procedures, provides an opportunity to evaluate outcomes associated with the two different ProDUR systems.
Objectives
The specific aims and methods of research are to: (1) conduct a descriptive epidemiological analysis of psychotropic drug use, prescribing patterns, and yield of ProDUR screen failures and (2) evaluate the independent effects of two different ProDUR procedures on health outcomes including both drug use and consequent outcomes from changes in prescribing practices including differential mortality, morbidity, and health service utilization.