Analysis of medication use patterns:apparent overuse of antibiotics and underuse of prescription drugs for asthma, depression, and CHF.
OBJECTIVE
To assess the appropriateness of prescription medication use based upon widely accepted treatment guidelines.


METHODS
We analyzed administrative claims for the period October 1, 1998, through September 20, 1999, supplied by 3 California health plans to determine medication use patterns for outpatient prescriptions. We compared these patterns to those expected in the presence of adherence to treatment guidelines.


RESULTS
During the study period, only 27.5% of antidepressant users received the recommended 6 months of continuous therapy, only 49.0% of diagnosed asthma patients received at least one inhaled corticosteroid prescription (compared to 67.1% who received at least one inhaled beta-agonist prescription), and only 54.5% of patients diagnosed with congestive heart failure (CHF) received an angiotensin-converting enzyme (ACE) inhibitor. Of patients who had a diagnosis of common cold or upper respiratory tract infection, 35.7% received antibiotics.


CONCLUSIONS
There is a remarkable degree of apparent overuse and underuse of prescription medications despite the existence of clinical guidelines to support appropriate use in the conditions studied. Effective medications appear to be underused for patients with asthma, CHF, and depression. Antibiotics appear to be overused for the common cold and upper respiratory infections. More effective efforts must be made to address appropriate use of medications. Without these efforts, improved quality of care and decreased total health system costs are unlikely to be realized.
Gilberg
Karen
K
Protocare Sciences, Santa Monica, Ca 90404, USA.
Laouri
Marianne
M
Wade
Sally
S
Isonaka
Sharon
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy; D002140:California; D002648:Child; D002675:Child, Preschool; D003139:Common Cold / Q000188:drug therapy; D003863:Depression / Q000188:drug therapy; D017723:Drug Utilization Review; D005260:Female; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000188:drug therapy
D000806:Angiotensin-Converting Enzyme Inhibitors; D018927:Anti-Asthmatic Agents; D000900:Anti-Bacterial Agents; D000928:Antidepressive Agents