IMPACT OF PROSPECTIVE DRUG USE REVIEW ON HEALTH

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DESCRIPTION: 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. There is no provision for pharmacist overrides of ProDUR alerts. A ProDUR system - characterized as informational - was implemented in Pennsylvania's Medicaid program in June 1994. Medicaid s ProDUR system does allow pharmacist overrides. There are two specific aims in this proposed project. The first is to conduct a descriptive epidemiological analysis of psychotropic drug use, prescribing patterns, and yield of ProDUR screen failures. This arm of the study examines two 24 month periods, before and after the ProDUR interventions, and computes estimates of drug-related outcome measures (first order outcomes). The second aim is to evaluate the independent effects of two different ProDUR procedures on health outcomes, including both drug use (first order outcomes) and consequent (or second order) outcomes from changes in prescribing practices, including differential mortality, morbidity, and service utilization. There are two studies in the proposed research which correspond to these aims: 1) a descriptive epidemiological analysis of DUR prescribing patterns and DUR screen failure rates associated with Regulatory and Informational ProDUR procedures applied to psychotropic drug therapies (The Profile Study), and 2) outcomes associated with informational and regulatory proDUR systems as applied to psychotropic drug therapies (The Outcomes Study). Measures to be computed for each individual for each month over the 48 month observation period include the following: - Psychotropic use by month: yes/no for any use - Therapeutic class use by month: yes/no by class - Drug-specific psychotropic use by month - Drug dosage-specific psychotropic use by month - How accurate are the days supply, hence dosage data? - New use of psychotropics by month - Increased psychotropic dosage within episode of therapy, by month. How is an episode of therapy "defined"? - Failure of PACE ProDur Screens, by month - Using the Penn State DUR Screener should allow estimation of ProDUR screen failure rates in Medicaid files that will be directly comparable to PACE rates. - Total number of new claims by month - Total number of refills by month - Total number of therapeutic classes in regimen by month-as a proxy for co-morbidities. The PI anticipates also developing a number of measures related to use of non-psychotropic drugs as part of the examination of intentional and unintentional impacts of ProDUR: