Prescription drug utilization reviews are less t...( ng physicians simply ignore these alert...),Health

ng physicians simply ignore these alert letters and find them to be useless," said Brian L. Strom, MPH, MD, Professor and Chair of Penn's Department of Biostatistics and Epidemiology, and co-author of the study. According to Strom, the drug utilization review programs do not account for the underlying reasons physicians must consider when prescribing specific drugs for their patients. "It is like one of those pesky "help" messages that pops up on your computer's word processor the software wants to help you write a letter, while you are trying to do something completely different," said Strom. "Eventually, you learn to ignore the message."

Drug utilization review programs are supposed to work through two mechanisms: "direct" effects and "spillover" effects. Direct effects apply to patients who are identified in alerts and benefit from a change in therapy. Since most alert notices are sent months after a given drug is prescribed, the spillover effect is thought to be the driving rationale behind the review program. The term spillover represents the possibility that physicians, once alerted to a particular drug interaction or alternative therapeutic, might apply the information to the care of other patients.

The Penn study aimed to find the spillover effect on the rate of prescribing errors identified by the drug utilization review process. That is, if a particular error notice triggers changes in the behavior of physicians, it would be seen as a decline in similar errors. The researchers reviewed data from six state Medicaid programs and, using the same computer rules that the states use, found no evidence to suggest that there is a spillover effect at all.

The researchers also cite a previous study that suggests these reviews could be harmful if they influence a prescribing physician to use an alternative drug that does not violate the rules but is nonetheless harmful, or if they abruptly discontinue drugs that should be tapered slowly, whi
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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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