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Effects of Medicaid drug utilization review intervention letters
1College of Pharmacy, Division of Pharmacy Administration, University of Texas at Austin, USA.
Insights
Texas physicians received intervention letters regarding concurrent prescribing of histamine2 (H2)-antagonists or H2A with omeprazole and sucralfate. Physician feedback showed mixed agreement, highlighting the need for targeted drug utilization review interventions.
Area of Science:
- Pharmacoeconomics
- Health Services Research
- Clinical Pharmacy
Background:
- The Texas Drug Utilization Review (DUR) Board implements retrospective DUR to optimize medication use.
- Concurrent prescribing of certain gastrointestinal medications, like histamine2 (H2)-antagonists (H2As) or H2A with omeprazole and sucralfate, was identified as a potential area for intervention.
Purpose of the Study:
- To evaluate physician feedback on intervention letters concerning specific concurrent medication prescribing.
- To assess the impact of these intervention letters on physician prescribing patterns for H2As or H2A with omeprazole and sucralfate.
Main Methods:
- A retrospective analysis of Texas Medicaid prescription claims identified physicians prescribing targeted concurrent therapies.
- Physicians were randomized to receive an intervention letter detailing prescribing patterns or serve as a control group.
- Physician responses to the intervention letters were analyzed, and patient profiles were reviewed post-intervention.
Main Results:
- 190 physicians were identified for concurrent prescribing of H2A or H2A with omeprazole and sucralfate.
- A 67.5% response rate was achieved from physicians who received intervention letters.
- Nearly half (49.4%) of responding physicians agreed with the intervention letter, while 29.1% disagreed.
Conclusions:
- Physician feedback on DUR intervention letters is varied, indicating a need for careful communication strategies.
- Targeted drug utilization review interventions can identify prescribing patterns and elicit physician responses.
- Further analysis is needed to determine the long-term impact on patient profiles and medication adherence.
Abstract:
The state of Texas Drug Utilization Review (DUR) Board, composed of six physicians and six pharmacists, meets quarterly to determine criteria for implementing retrospective DUR. The board agreed to send intervention letters to physicians concurrently prescribing: (1) two histamine2 (H2)-antagonists (H2As) or (2) either any H2A or omeprazole with sucralfate. To measure the effect of these intervention letters, approximately half of these physicians were randomly chosen to receive a letter while the others served as a control group and did not receive letters. This project focused on the H2A or omeprazole with sucralfate intervention letters in a two-step process. Data on concurrent therapy involving two H2As were analyzed separately and these results are not included in this report. Objective one was to examine feedback from the physicians who received the letters, and objective two was to review and compare patient profiles 6 months after the letters were sent. Analysis of Medicaid prescription claims indicated that 190 physicians had concurrently prescribed either an H2A or omeprazole with sucralfate for 222 patients. Ninety-seven physicians (from 117 identified patient profiles) were selected to receive an intervention letter with their patient's profile or profiles, a response form, and a stamped envelope addressed to the Texas Department of Human Services. A 67.5% response rate was obtained. Of these responses, 49.4% agreed with the letter and 29.1% disagreed with the letter. The remaining indicated responses such as "not my patient," they were no longer seeing the patient, or that they did not prescribe the medication in question. (ABSTRACT TRUNCATED AT 250 WORDS)
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