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 |
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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. |
doi_str_mv | 10.1097/00005650-199807000-00008 |
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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. Lippincott-Raven Publishers</publisher><subject>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</subject><ispartof>Medical care, 1998-07, Vol.36 (7), p.1013-1021</ispartof><rights>Copyright 1998 Lippincott-Raven Publishers</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c331t-397ad72c49cd353b37e5696b2991768d4ecab7ed6a1ffd9735d1d37da5058fa13</citedby><cites>FETCH-LOGICAL-c331t-397ad72c49cd353b37e5696b2991768d4ecab7ed6a1ffd9735d1d37da5058fa13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/3767361$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/3767361$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27901,27902,57992,58225</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9674619$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Smith, David H.</creatorcontrib><creatorcontrib>Christensen, Dale B.</creatorcontrib><creatorcontrib>Stergachis, Andy</creatorcontrib><creatorcontrib>Holmes, Garth</creatorcontrib><title>A Randomized Controlled Trial of a Drug Use Review Intervention for Sedative Hypnotic Medications</title><title>Medical care</title><addtitle>Med Care</addtitle><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.</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 & numerical data</subject><subject>Drug Utilization Review - methods</subject><subject>Education, Medical, Continuing - methods</subject><subject>Female</subject><subject>Fractures, Bone - prevention & control</subject><subject>Humans</subject><subject>Hypnotics</subject><subject>Male</subject><subject>Medicaid</subject><subject>Medicaid - statistics & 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. B. 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 & numerical data</topic><topic>Drug Utilization Review - methods</topic><topic>Education, Medical, Continuing - methods</topic><topic>Female</topic><topic>Fractures, Bone - prevention & control</topic><topic>Humans</topic><topic>Hypnotics</topic><topic>Male</topic><topic>Medicaid</topic><topic>Medicaid - statistics & 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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