Auditing prescription practice using explicit criteria and computerized drug benefit claims data

Area of Science:

• Geriatric Medicine
• Pharmacology
• Health Services Research

Background:

• Improving healthcare quality requires aligning current practices with established guidelines.
• Drug prescribing patterns in the elderly are a key area for quality improvement.

Purpose of the Study:

• To estimate the prevalence of potentially inappropriate drug prescribing in the elderly population.
• To identify physician characteristics associated with inappropriate prescribing.

Main Methods:

• Utilized computerized claims data from a comprehensive drug benefit plan for the elderly.
• Applied explicit criteria for appropriate prescribing to identify instances of potentially inappropriate drug use.
• Analyzed the association between prescribing practices and physician demographics.

Main Results:

• 38% of elderly antidepressant recipients, 19% of oral hypoglycemic users, 18% of sedative hypnotic users, and 13% of NSAID users received potentially inappropriate drugs.
• Older physicians and those without specialty certification were more likely to prescribe potentially inappropriate medications.

Conclusions:

• Criteria-based audits of drug claims databases can identify population-level prescribing issues.
• Physician characteristics can predict suboptimal prescription practices.
• Claims data audits should be combined with other measures to fully assess care appropriateness and guide improvement strategies.