title: Appropriateness of the use of intravenous immune globulin before and after the introduction of a utilization control program.
abstract: BACKGROUND
  Intravenous immune globulin (IVIG) is an expensive and sometimes scarce blood product that carries some risk. It may often be used inappropriately. We evaluated the appropriateness of IVIG use before and after the introduction of an utilization control program to reduce inappropriate use.
  
  
  METHODS
  We used the RAND/UCLA Appropriateness Method to measure the appropriateness of IVIG use in the province of British Columbia (BC) in 2001 and 2003, before and after the introduction of a utilization control program designed to reduce inappropriate use. For comparison, we measured the appropriateness of use during the same periods in the province of Alberta, which had no control program.
  
  
  RESULTS
  Of 2256 instances of IVIG use, 54.1% were deemed to be appropriate, 17.4% were of uncertain benefit, and 28.5% were deemed inappropriate. The frequency of inappropriate use in BC after the introduction of the utilization control program did not differ significantly from the frequency before the program or the frequency in Alberta.
  
  
  CONCLUSIONS
  Almost half of IVIG use in BC and Alberta was judged to be inappropriate or of uncertain benefit, and the frequency of inappropriate use did not decrease after implementation of a utilization control program in BC. More effective utilization controls are necessary to prevent wasted resources and unnecessary risk to patients.
authors.affiliation: Faculty of Medicine, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta. feasby@ucalgary.ca
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Feasby
authors.forename: Hude
authors.initials: H
authors.lastname: Quan
authors.forename: Michelle
authors.initials: M
authors.lastname: Tubman
authors.forename: David
authors.initials: D
authors.lastname: Pi
authors.forename: Alan
authors.initials: A
authors.lastname: Tinmouth
authors.forename: Lawrence
authors.initials: L
authors.lastname: So
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000416:Alberta; D000465:Algorithms; D001955:British Columbia; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D017598:Efficiency, Organizational; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016730:Program Development / Q000379:methods / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012306:Risk; D013997:Time Factors; D055815:Young Adult
chemical_list: D016756:Immunoglobulins, Intravenous