IMPACT OF PROSPECTIVE DRUG USE REVIEW ON HEALTH

前瞻性药物使用审查对健康的影响

• 批准号: 2460255
• 负责人: FRANK M AHERN
• 金额: $ 18.41万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-08-01 至 2000-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2460255
• 关键词: Medicare /Medicaid; clinical research; dosage; drug adverse effect; drug controls; drug screening /evaluation; health care model; health care service evaluation; health care service utilization; human old age (65+); human subject; human therapy evaluation; longitudinal human study; mental disorder chemotherapy; mental health epidemiology; outcomes research; pharmacy administration; psychotropic drugs; relapse /recurrence

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:

描述：宾夕法尼亚州的PACE计划，一个州一级的门诊病人 老年人药物援助计划，实施精神 1995年3月生产。 PACE的ProDUR系统可以描述为 监管性质。 没有规定药剂师可以推翻 ProDUR警报。 一个ProDUR系统-以信息为特征-被 1994年6月在宾夕法尼亚州的医疗补助计划中实施。 医疗补助 ProDUR系统允许药剂师超控。 这一拟议项目有两个具体目标。 一是 对精神药物使用情况进行描述性流行病学分析， 处方模式和ProDUR筛选失败率。 这只手臂 研究检查了两个24个月的时期，在ProDUR之前和之后 干预措施，并计算药物相关的结果措施的估计 （一阶结果）。 第二个目标是评估独立的 两种不同的ProDUR程序对健康结果的影响，包括 药物使用（一阶结果）和后果（或二阶结果） 处方实践变化的结果，包括差异 死亡率、发病率和服务利用率。 有两项研究， 建议的研究，符合这些目标：1）描述性 DUR处方模式与DUR筛查失败的流行病学分析 与应用的监管和信息性ProDUR程序相关的发生率 精神药物治疗（概况研究），和2）结果 与信息和监管proDUR系统相关联， 精神药物治疗（结果研究）。 48个月内每个月为每个人计算的措施 观察期包括： - 按月分列的精神药物使用情况：是/否 - 按月列出的治疗类别使用情况：按类别列出的是/否 - 按月分列的特定毒品精神药物使用情况 - 按月分列的特定剂量精神药物使用情况 - 供应天数和剂量数据的准确性如何？ - 按月分列的精神药物新用途 - 按月列出的治疗期内精神药物剂量增加。 如何 一段治疗是“定义”的吗 - PACE ProDur屏幕故障（按月）-使用Penn State DUR 筛选器应允许估计ProDUR筛选失败率， 医疗补助文件将直接与PACE费率相比较。 - 按月分列的新索赔总数 - 按月列出的再填充总数 - 按月列出的治疗方案中的治疗类别总数-作为替代 为 合并症 PI预计还将制定一些与使用 非精神药物作为审查故意和 ProDUR的意外影响：