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Drug use and prescribing problems in four state Medicaid programs.
B Stuart1, B A Briesacher, F Ahern
1University of Maryland School of Pharmacy, Baltimore 21201, USA. bstuart@rx.umaryland.edu
Health Care Financing Review
|November 11, 1999
Summary
Drug utilization review (DUR) failure rates varied significantly across four State Medicaid programs. While most states saw no overall reduction, rates for community-dwelling elderly decreased in several programs.
Area of Science:
- Health Services Research
- Pharmaceutical Policy
- Medicaid Program Analysis
Background:
- Drug-related problems pose a significant burden on healthcare systems, particularly within large public programs like Medicaid.
- Consistent application of drug utilization review (DUR) screeners is crucial for identifying and mitigating these problems.
- Previous analyses lacked cross-state consistency, limiting comparative insights into DUR effectiveness.
Purpose of the Study:
- To determine population-level prevalence rates for 61 specific drug-related problems across four State Medicaid programs.
- To assess the effectiveness of a consistent drug utilization review (DUR) screener program applied across different states.
- To identify variations in DUR failure rates and trends over time within these Medicaid populations.
Main Methods:
- Analysis of population-level prevalence rates for 61 drug-related problems using Medicaid data from Maryland, Iowa, Washington, and Georgia.
- Application of a consistent drug utilization review (DUR) screener program across all four states for the periods 1989-1996 and 1994-1996.
- Comparison of DUR failure rates between states and examination of population-level trends during the study duration.
Main Results:
- Significant differences in drug utilization review (DUR) failure rates were observed, with Georgia exhibiting the lowest and Washington the highest rates.
- Only the Iowa Medicaid program demonstrated a population-level reduction in DUR failure rates over the study period.
- Rates of drug-related problems among community-dwelling elderly populations showed a decline in most of the studied states.
Conclusions:
- State-specific factors significantly influence drug-related problem prevalence and the effectiveness of drug utilization review (DUR) programs within Medicaid.
- Targeted interventions may be necessary to address variations in DUR failure rates and improve medication safety across diverse state programs.
- The findings highlight the need for ongoing monitoring and consistent application of DUR criteria to protect vulnerable populations, such as the elderly.