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Prescription drug utilization reviews are less than useful

(Philadelphia, PA) After examining data from six state Medicaid programs, researchers from the University of Pennsylvania School of Medicine have concluded that drug utilization review programs do not improve patient health or reduce the rate of prescription errors. Their findings, presented in the September 17 issue of JAMA, the journal of the American Medical Association, represent the first published study of the clinical effectiveness of such review programs.

Drug utilization review is required of all state Medicaid programs and is also used by most private-sector prescription programs. In theory, these reviews examine prescription records in order to alert physicians to possible drug interactions or the availability of alternative perhaps safer or cheaper drugs. The Penn researchers, however, have not been able to identify any positive effects that these programs have, either in terms of clinical outcomes or in preventing errors.

"We compared the rate of drug review alerts over a four-year period and found that the existing system has no detectable effect in changing the way drugs are prescribed," said Sean Hennessy, PharmD, PhD, Assistant Professor in Penn's Department of Biostatistics and Epidemiology, and lead author of the report. "No matter how many notice letters are sent out, the rate of prescribing errors never changes. Given the lack of effectiveness and the potential for harm cited in previous research there is not much to recommend for keeping these costly review programs."

Typically, a review program uses computers to screen prescription information for potential drug interaction conflicts, based on a pre-established set of guidelines. When the software spots a violation of these rules, it marks the record for review. The program staff then sorts these marked records to determine whether or not an alert notice, usually a letter, should be sent to the prescribing physician.

"Anecdotal evidence suggests that most practici
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Contact: Greg Lester
lesterg@uphs.upenn.edu
215 349 5658
University of Pennsylvania School of Medicine
16-Sep-2003


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