Drug use and prescribing problems in the community-dwelling elderly: a study of three state Medicaid programs

This paper describes a study of drug use and drug-related problems in community-dwelling elderly (> or =65 years) Medicaid recipients in Maryland, Iowa, and Washington from 1989 through 1996. A claim-by-claim review of Medicaid prescriptions was conducted to detect 5 types of prescribing problems (dose, duration of therapy, duplicative therapy, drug-drug interactions, and contraindications or initial therapy). The study examined 8 drug categories: angiotensin-converting enzyme (ACE) inhibitors, antidepressant agents, antipsychotic agents, benzodiazepines, calcium channel blockers, digoxin, histamine2-receptor antagonists, and nonsteroidal anti-inflammatory drugs. The total number of persons with prescriptions in any of the 8 drug classes increased over the 8-year period, with the greatest growth in ACE inhibitors. Mean annual drug use per person declined in Maryland but increased in Washington and Iowa. Despite increasing use, the overall incidence of prescribing problems fell dramatically in all 3 states, particularly for dose- and duration-related criteria. Except in the area of drug-drug interactions, this elderly population was less likely to have received a prescription falling outside commonly accepted drug utilization review criteria for 8 major drug classes in 1996 than in 1989.

Drug use and prescribing problems in four state Medicaid programs

In this article the authors present population-level prevalence rates for 61 specific drug-related problems occurring in three State Medicaid programs (Maryland, Iowa, and Washington) from 1989 through 1996 and a fourth (Georgia) from 1994 through 1996. The findings represent the first application of a consistent drug utilization review (DUR) screener program to Medicaid data across States. The study finds major differences in DUR failure rates among the four States with the lowest rates in Georgia and the highest in Washington. Only Iowa showed any population-level reduction in DUR failure rates during the study period, however, rates for community-dwelling elderly fell in most States.

The role of insurance claims databases in drug therapy outcomes research

The use of insurance claims databases in drug therapy outcomes research holds great promise as a cost-effective alternative to post-marketing clinical trials. Claims databases uniquely capture information about episodes of care across healthcare services and settings. They also facilitate the examination of drug therapy effects on cohorts of patients and specific patient subpopulations. However, there are limitations to the use of insurance claims databases including incomplete diagnostic and provider identification data. The characteristics of the population included in the insurance plan, the plan benefit design, and the variables of the database itself can influence the research results. Given the current concerns regarding the completeness of insurance claims databases, and the validity of their data, outcomes research usually requires original data to validate claims data or to obtain additional information. Improvements to claims databases such as standardisation of claims information reporting, addition of pertinent clinical and economic variables, and inclusion of information relative to patient severity of illness, quality of life, and satisfaction with provided care will enhance the benefit of such databases for outcomes research.