Effect of a retrospective drug utilization review on potentially inappropriate prescribing in the elderly.
BACKGROUND
Use of potentially inappropriate medications or drugs to be avoided in the elderly (DAE) continues to be widespread. Although the literature suggests DAE are associated with negative health outcomes, educational interventions have had a positive impact on inappropriate prescribing.


OBJECTIVE
The objectives of this study were to identify those members aged > or =65 years participating in a Medicare Part D Blue Cross and Blue Shield (BCBS) benefit plan who were receiving medications that may be inappropriate for use in older adults and, through a retrospective drug utilization review (RetroDUR), to notify their prcscribers of the possible safety concerns with continued use.


METHODS
The analysis used retrospective administrative pharmacy claims data from 3 Medicare Part D BCBS plans across 4 states. Plan members aged > or =65 years who had a claim for > or =1 DAE during a 30-day review period (August 15, 2007-September 14, 2007) with a minimum supply of 7 days of medication were identified. The National Committee for Quality Assurance 2007 Healthcare Effectiveness Data and Information Set measures for Medicare were used to determine DAE. A packet of information was mailed to prescribers identifying patients who had a claim for > or =1 DAE. Members were then assessed for the presence of a drug in the same drug class 6 months after the initial analysis.


RESULTS
Of a possible 328,000 eligible members, 16,973 (5.2%) had a claim for > or =1 DAE during the 30-day review period. A total of 7963 intervention prescriber letters were mailed, affecting 13,198 members with 14,267 DAE claims. The final analyzable intervention cohort consisted of 10,364 members with 11,062 DAE claims. Overall, 5403 claims (48.8%) for DAE were defined as discontinued after 6 months. The most common DAE in the study were estrogens, propoxyphene, muscle relaxants, anticholinergics, antihistamines, and nitrofurantoin, accounting for 9682 claims (87.5%). At the 6-month follow-up, reductions in claims for each of the top 6 drug/drug classes ranged from 31.3% to 66.7%. As a class, the anticholinergics had the highest rate of discontinuation.


CONCLUSIONS
The DAE RetroDUR was associated with a possible reduction in the use of potentially inappropriate prescription medications in these older adults. Further research, using a control population, is needed to show the impact on health care utilization and costs, adverse drug events, and health care and quality-of-life outcomes.
Starner
Catherine I
CI
Prime Therapeutics, Eagan, Minnesota, USA. cstarner@primetherapeutics.com
Norman
Sheila A
SA
Reynolds
Richard G
RG
Gleason
Patrick P
PP
D000368:Aged; D000369:Aged, 80 and over; D000075202:Contraindications; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data*; D017723:Drug Utilization Review / Q000592:standards*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D008297:Male; D054524:Medicare Part D / Q000706:statistics & numerical data; D004364:Pharmaceutical Preparations; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012189:Retrospective Studies; D014481:United States
D004364:Pharmaceutical Preparations