A Randomized Controlled Trial of a Drug Use Review Intervention for Sedative Hypnotic Medications

Objectives. Drug use review is used by both the public and private sector to influence prescribing behavior and patient drug use. Past interventions mailed to prescribers have had mixed results. The objective was to evaluate the effect of a one-time, mailed intervention on subsequent use of sedative...

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Veröffentlicht in:Medical care 1998-07, Vol.36 (7), p.1013-1021
Hauptverfasser: Smith, David H., Christensen, Dale B., Stergachis, Andy, Holmes, Garth
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container_end_page 1021
container_issue 7
container_start_page 1013
container_title Medical care
container_volume 36
creator Smith, David H.
Christensen, Dale B.
Stergachis, Andy
Holmes, Garth
description Objectives. Drug use review is used by both the public and private sector to influence prescribing behavior and patient drug use. Past interventions mailed to prescribers have had mixed results. The objective was to evaluate the effect of a one-time, mailed intervention on subsequent use of sedative hypnotic medication. Methods. An experimental design was used. The intervention contained guidelines for the use of sedative hypnotics, a prescriber profile detailing sedative hypnotic prescribing, and a patient profile. Clustering of patients and their shared prescribes was done to avoid contamination bias and statistical problems associated with a lack of independence of observations. Subjects were 189 Washington State Medicaid recipients who had received at least one tablet per day of a sedative hypnotic medication for 1 year and their prescribing physicians or (when information about the physician was lacking) the dispensing pharmacy. Results. A significant reduction in the use of targeted sedative hypnotic medications was measured in the intervention group (-27.6%) versus the control group (-8.5%). In the intervention group, 9.4% of patients began a new prescription for a benzodiazepine not targeted by the drug use review, whereas no control patients had new use of nontarget benzodiazepines. Conclusions. The intervention achieved a statistically significant decrease in targeted drug use, and the amount of reduction is likely to have decreased the risk of fractures associated with benzodiazepine use. This study adds to the recent evidence that mailed drug use review interventions can have a desirable impact on patient drug use.
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Drug use review is used by both the public and private sector to influence prescribing behavior and patient drug use. Past interventions mailed to prescribers have had mixed results. The objective was to evaluate the effect of a one-time, mailed intervention on subsequent use of sedative hypnotic medication. Methods. An experimental design was used. The intervention contained guidelines for the use of sedative hypnotics, a prescriber profile detailing sedative hypnotic prescribing, and a patient profile. Clustering of patients and their shared prescribes was done to avoid contamination bias and statistical problems associated with a lack of independence of observations. Subjects were 189 Washington State Medicaid recipients who had received at least one tablet per day of a sedative hypnotic medication for 1 year and their prescribing physicians or (when information about the physician was lacking) the dispensing pharmacy. Results. A significant reduction in the use of targeted sedative hypnotic medications was measured in the intervention group (-27.6%) versus the control group (-8.5%). In the intervention group, 9.4% of patients began a new prescription for a benzodiazepine not targeted by the drug use review, whereas no control patients had new use of nontarget benzodiazepines. Conclusions. The intervention achieved a statistically significant decrease in targeted drug use, and the amount of reduction is likely to have decreased the risk of fractures associated with benzodiazepine use. This study adds to the recent evidence that mailed drug use review interventions can have a desirable impact on patient drug use.</description><identifier>ISSN: 0025-7079</identifier><identifier>DOI: 10.1097/00005650-199807000-00008</identifier><identifier>PMID: 9674619</identifier><language>eng</language><publisher>United States: J. B. 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Drug use review is used by both the public and private sector to influence prescribing behavior and patient drug use. Past interventions mailed to prescribers have had mixed results. The objective was to evaluate the effect of a one-time, mailed intervention on subsequent use of sedative hypnotic medication. Methods. An experimental design was used. The intervention contained guidelines for the use of sedative hypnotics, a prescriber profile detailing sedative hypnotic prescribing, and a patient profile. Clustering of patients and their shared prescribes was done to avoid contamination bias and statistical problems associated with a lack of independence of observations. Subjects were 189 Washington State Medicaid recipients who had received at least one tablet per day of a sedative hypnotic medication for 1 year and their prescribing physicians or (when information about the physician was lacking) the dispensing pharmacy. Results. A significant reduction in the use of targeted sedative hypnotic medications was measured in the intervention group (-27.6%) versus the control group (-8.5%). In the intervention group, 9.4% of patients began a new prescription for a benzodiazepine not targeted by the drug use review, whereas no control patients had new use of nontarget benzodiazepines. Conclusions. The intervention achieved a statistically significant decrease in targeted drug use, and the amount of reduction is likely to have decreased the risk of fractures associated with benzodiazepine use. This study adds to the recent evidence that mailed drug use review interventions can have a desirable impact on patient drug use.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ambulatory Care</subject><subject>Anti-Anxiety Agents - therapeutic use</subject><subject>Benzodiazepines</subject><subject>Bias</subject><subject>Cluster Analysis</subject><subject>Control groups</subject><subject>Correspondence as Topic</subject><subject>Dosage</subject><subject>Drug prescriptions</subject><subject>Drug Prescriptions - statistics &amp; numerical data</subject><subject>Drug Utilization Review - methods</subject><subject>Education, Medical, Continuing - methods</subject><subject>Female</subject><subject>Fractures, Bone - prevention &amp; control</subject><subject>Humans</subject><subject>Hypnotics</subject><subject>Male</subject><subject>Medicaid</subject><subject>Medicaid - statistics &amp; numerical data</subject><subject>Middle Aged</subject><subject>Physicians</subject><subject>Practice Guidelines as Topic</subject><subject>Prescription drugs</subject><subject>Regression Analysis</subject><subject>Sedatives</subject><subject>United States</subject><subject>Washington</subject><subject>Writing tablets</subject><issn>0025-7079</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kMtOwzAQRb0AlVL4A5C8Yhew48aPZVUerQRCKu06cuIJcpXExU6Kytfj0tLZeDz33rF8EMKU3FOixAOJlfGMJFQpSUS8JfuRPENDQtIsEUSoC3QZwpoQKliWDtBAcTHmVA2RnuCFbo1r7A8YPHVt511dx3bpra6xq7DGj77_xKsAeAFbC9943nbgt9B21rW4ch5_gNGd3QKe7Tat62yJ38DYUu8N4QqdV7oOcH08R2j1_LSczpLX95f5dPKalIzRLmFKaCPScqxKwzJWMAEZV7xIlaKCSzOGUhcCDNe0qoyK_zDUMGF0RjJZacpG6O6wd-PdVw-hyxsbSqhr3YLrQy4jDCJVGo3yYCy9C8FDlW-8bbTf5ZTke6L5P9H8RPRvJGP09vhGXzRgTsEjzqjfHPR16Jw_yUxwwThlv1czfRk</recordid><startdate>19980701</startdate><enddate>19980701</enddate><creator>Smith, David H.</creator><creator>Christensen, Dale B.</creator><creator>Stergachis, Andy</creator><creator>Holmes, Garth</creator><general>J. 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Lippincott-Raven Publishers</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19980701</creationdate><title>A Randomized Controlled Trial of a Drug Use Review Intervention for Sedative Hypnotic Medications</title><author>Smith, David H. ; Christensen, Dale B. ; Stergachis, Andy ; Holmes, Garth</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c331t-397ad72c49cd353b37e5696b2991768d4ecab7ed6a1ffd9735d1d37da5058fa13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Ambulatory Care</topic><topic>Anti-Anxiety Agents - therapeutic use</topic><topic>Benzodiazepines</topic><topic>Bias</topic><topic>Cluster Analysis</topic><topic>Control groups</topic><topic>Correspondence as Topic</topic><topic>Dosage</topic><topic>Drug prescriptions</topic><topic>Drug Prescriptions - statistics &amp; numerical data</topic><topic>Drug Utilization Review - methods</topic><topic>Education, Medical, Continuing - methods</topic><topic>Female</topic><topic>Fractures, Bone - prevention &amp; control</topic><topic>Humans</topic><topic>Hypnotics</topic><topic>Male</topic><topic>Medicaid</topic><topic>Medicaid - statistics &amp; numerical data</topic><topic>Middle Aged</topic><topic>Physicians</topic><topic>Practice Guidelines as Topic</topic><topic>Prescription drugs</topic><topic>Regression Analysis</topic><topic>Sedatives</topic><topic>United States</topic><topic>Washington</topic><topic>Writing tablets</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Smith, David H.</creatorcontrib><creatorcontrib>Christensen, Dale B.</creatorcontrib><creatorcontrib>Stergachis, Andy</creatorcontrib><creatorcontrib>Holmes, Garth</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Medical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Smith, David H.</au><au>Christensen, Dale B.</au><au>Stergachis, Andy</au><au>Holmes, Garth</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Randomized Controlled Trial of a Drug Use Review Intervention for Sedative Hypnotic Medications</atitle><jtitle>Medical care</jtitle><addtitle>Med Care</addtitle><date>1998-07-01</date><risdate>1998</risdate><volume>36</volume><issue>7</issue><spage>1013</spage><epage>1021</epage><pages>1013-1021</pages><issn>0025-7079</issn><abstract>Objectives. Drug use review is used by both the public and private sector to influence prescribing behavior and patient drug use. Past interventions mailed to prescribers have had mixed results. The objective was to evaluate the effect of a one-time, mailed intervention on subsequent use of sedative hypnotic medication. Methods. An experimental design was used. The intervention contained guidelines for the use of sedative hypnotics, a prescriber profile detailing sedative hypnotic prescribing, and a patient profile. Clustering of patients and their shared prescribes was done to avoid contamination bias and statistical problems associated with a lack of independence of observations. Subjects were 189 Washington State Medicaid recipients who had received at least one tablet per day of a sedative hypnotic medication for 1 year and their prescribing physicians or (when information about the physician was lacking) the dispensing pharmacy. Results. A significant reduction in the use of targeted sedative hypnotic medications was measured in the intervention group (-27.6%) versus the control group (-8.5%). In the intervention group, 9.4% of patients began a new prescription for a benzodiazepine not targeted by the drug use review, whereas no control patients had new use of nontarget benzodiazepines. Conclusions. The intervention achieved a statistically significant decrease in targeted drug use, and the amount of reduction is likely to have decreased the risk of fractures associated with benzodiazepine use. This study adds to the recent evidence that mailed drug use review interventions can have a desirable impact on patient drug use.</abstract><cop>United States</cop><pub>J. B. Lippincott-Raven Publishers</pub><pmid>9674619</pmid><doi>10.1097/00005650-199807000-00008</doi><tpages>9</tpages></addata></record>
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subjects Adult
Aged
Aged, 80 and over
Ambulatory Care
Anti-Anxiety Agents - therapeutic use
Benzodiazepines
Bias
Cluster Analysis
Control groups
Correspondence as Topic
Dosage
Drug prescriptions
Drug Prescriptions - statistics & numerical data
Drug Utilization Review - methods
Education, Medical, Continuing - methods
Female
Fractures, Bone - prevention & control
Humans
Hypnotics
Male
Medicaid
Medicaid - statistics & numerical data
Middle Aged
Physicians
Practice Guidelines as Topic
Prescription drugs
Regression Analysis
Sedatives
United States
Washington
Writing tablets
title A Randomized Controlled Trial of a Drug Use Review Intervention for Sedative Hypnotic Medications
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