薬物の使用に関する遡及的レビュー,処方誤り,および臨床結果
Sean Hennessy1, Warren B Bilker, Lan Zhou
1Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia 19104-6021, USA. shenness@cceb.med.upenn.edu
JAMA
|September 18, 2003
まとめ
薬物の使用に関する遡及的レビュー (DUR) は,処方誤差を軽減したり,患者のアウトカムを改善したりしませんでした. 政策立案者は,この必要審査プロセスの権限を再検討すべきである.
科学分野:
- 医療サービス 研究 医療サービス
- 薬学経済学 薬学経済学
- クリニック薬局 臨床薬局
背景:
- 薬物の使用に関する遡及的レビュー (DUR) は,州のメディケイドプログラムに義務付けられており,民間部門では一般的です.
- 現在の証拠は,遡及的なDURが臨床的結果を改善するか,処方誤差 (例外) を軽減することを証明していません.
研究 の 目的:
- 処方誤差の割合に対する遡及的なDURの影響を評価する.
- 処方誤差のある患者の臨床結果に対する遡及的なDURの効果を評価する.
主な方法:
- 縦断的な生態学的研究では,介入前の傾向と時間を制御して,例外の割合を分析しました.
- コホート研究では,例外のある患者の入院を調査し,6つのメディケイドプログラムにおける混同要因をコントロールしました.
主要な成果:
- 遡及的なDUR導入は例外の割合を減少させなかったが,増加が観察された (1000処方箋/月あたり0.064).
- すべての原因または特定の原因による入院に遡及的なDURの有意な効果は見つかりませんでした.
- 医者の警報は,全州間の例外の1~25%しか使用されなかった.
結論:
- 薬物の使用に関する遡及的レビューでは,処方誤差率や臨床結果に測定可能な影響はないことが示されました.
- 効果が証明されていないことや,有害な可能性がないことを考えると,政策立案者は,遡及的なDURの法的権限を撤廃することを検討すべきである.
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