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Abstract
The state of Texas Drug Utilization Review (DUR) Board, composed of six physicians
and six pharmacists, meets quarterly to determine criteria for implementing retrospective
DUR. The board agreed to send intervention letters to physicians concurrently prescribing:
(1) two histamine2 (H2)-antagonists (H2As) or (2) either any H2A or omeprazole with sucralfate. To measure the effect of these intervention letters,
approximately half of these physicians were randomly chosen to receive a letter while
the others served as a control group and did not receive letters. This project focused
on the H2A or omeprazole with sucralfate intervention letters in a two-step process. Data on
concurrent therapy involving two H2As were analyzed separately and these results are not included in this report. Objective
one was to examine feedback from the physicians who received the letters, and objective
two was to review and compare patient profiles 6 months after the letters were sent.
Analysis of Medicaid prescription claims indicated that 190 physicians had concurrently
prescribed either an H2A or omeprazole with sucralfate for 222 patients. Ninety-seven physicians (from 117
identified patient profiles) were selected to receive an intervention letter with
their patient's profile or profiles, a response form, and a stamped envelope addressed
to the Texas Department of Human Services. A 67.5% response rate was obtained. Of
these responses, 49.4% agreed with the letter and 29.1% disagreed with the letter.
The remaining indicated responses such as “not my patient,” they were no longer seeing
the patient, or that they did not prescribe the medication in question. Results of
objective two indicated that 57.9% of the experimental group and 75.3% of the control
were still receiving H2A or omeprazole with sucralfate concurrent therapy after the 6-month postintervention
observation period. This statistically significant reduction (P = 0.011) in the percentage of patients receiving concurrent therapy for the experimental
group, when compared with the control group, along with the high physician response
rate and moderately high agreement rate, indicate that intervention letters are an
appropriate way to inform physicians of potentially inappropriate prescribing.
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References
- Drug utilization review: A component of drug quality assurance.in: The APhA Pharmacy Commission on Third-Party Programs, Final Report. American Pharmaceutical Association, Washington, DC1986: 81-91
- Therapeutic drug-use review for the Florida Medicaid program.Am J Hosp Pharm. 1985; 42: 316-319
- DUR intervention letters: How pharmacists respond.Am Pharm. 1993; NS33: 58-64
- Presentation of drug prescribing guidelines and physician response.Qual Rev Bull. 1992; 18: 461-470
- Evaluation of a DUR intervention: A case study of histamine antagonists.Inquiry. 1994; 31: 89-101
- Improving antibiotic prescribing in office practice: A controlled trial of three educational methods.JAMA. 1983; 240: 1728-1732
- Improving drug-therapy decisions through educational outreach: A randomized controlled trial of academically based detailing.NEJM. 1983; 308: 1457-1463
- Improving drug prescribing in primary care: A critical analysis of the experimental literature.Milbank Q. 1989; 67: 268-317
- Does co-prescription of sucralfate with ranitidine therapy enhance the healing of gastric ulcers?.Am J Gastroenterol. 1993; 88: 675-679
- Combination therapy of sucralfate and cimetidine, compared with sucralfate monotherapy, in patients with peptic reflux esophagitis.Am J Med. 1989; 86: 77-80
- Combination therapy of sucralfate and ranitidine, compared with sucralfate monotherapy, in patients with peptic reflux esophagitis.Scand J Gastroenterol. 1992; 27: 81-84
- Comparison of sucralfate and ranitidine in gastroprotection against alcohol in humans.Am J Med. 1989; 86 (Suppl 6A): 55-59
- The effects of combined therapy with ranitidine and sucralfate in duodenal ulcer disease.Gastroenterology. 1991; 100 (Abstract): A97
- Effect of treatment of Helicobacter pylori infection on the long-term recurrence of gastric or duodenal ulcer.Ann Intern Med. 1992; 116: 705-708
- Effect of ranitidine and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer.NEJM. 1993; 328: 308-312
- Drug utilization review and Medicaid pharmacy.Medicaid Pharm Bull. 1988; 2: 1-8
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© 1995 Published by Elsevier Inc.
