Impact of an educational intervention for secondary prevention of myocardial infarction on Medicaid drug use and cost.
OBJECTIVE
The objectives of this drug utilization review program were (1) to increase beta-blocker prescribing to fee-for-service post-acute myocardial infarction (AMI) Medicaid patients; (2) to improve compliance among patients who were prescribed beta-blockers post-AMI; and (3) to evaluate the economic implications of increased beta-blocker prescribing.


METHODS
Pre-post nonequivalent group design.


METHODS
The intervention targeted physicians of Pennsylvania Medicaid recipients who had an AMI between November 1, 1998, and November 1, 1999. Educational materials were sent to the physicians of post-AMI patients not receiving beta-blockers. Preintervention and postintervention rates of beta-blocker prescribing in the Medicaid program within 7 and 30 days of discharge after an AMI hospitalization were compared. Similarly, pre- and postintervention compliance rates were compared for AMI patients who were prescribed beta-blockers. Cost savings and number of avoided deaths also were calculated.


RESULTS
There was a 5.5%, to 6.9% increase in beta-blocker prescribing after the intervention, depending on the follow-up period. Postintervention AMI patients were 16% more likely to be prescribed a beta-blocker. There was an 8.3% increase in patient compliance with beta-blocker therapy from preintervention to postintervention. In the first 2 years of the intervention, the estimated cost savings to the Pennsylvania Medicaid program ranged from 71,970 dollars to 76,678 dollars, respectively. An estimated 3 deaths were avoided.


CONCLUSIONS
The intervention resulted in increased appropriate prescribing and compliance with beta-blockers among post-AMI patients. There also were estimated cost savings to Pennsylvania Medicaid as a result of reduced hospitalization, and fewer deaths.
Center on Drugs and Public Policy, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA. izuckerm@rx.umaryland.edu
Ilene H
IH
Zuckerman
Sheila R
SR
Weiss
Diane
D
McNally
Barbara
B
Layne
C Daniel
CD
Mullins
Junling
J
Wang
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D016527:Drug Costs; D017723:Drug Utilization Review; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000517:prevention & control*; D010353:Patient Education as Topic / Q000458:organization & administration*; D010414:Pennsylvania; D014481:United States
D000319:Adrenergic beta-Antagonists