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Retrospective drug utilization review may not improve clinical outcomes or reduce the rate of potential prescribing errors

All State Medicaid programs and most private-sector drug benefit programs perform retrospective drug utilization review. These reviews interpret patterns of drug use in relation to predetermined criteria and attempt to minimize inappropriate prescribing. However, a recent study shows that researchers were unable to identify an effect of drug utilization review on the rate of potential prescribing errors or on clinical outcomes. Given the lack of evidence for effectiveness and suggestions of potential harm found in previous research, policymakers should consider the impact of retrospective drug utilization review programs, according to researchers at the Center for Education and Research in Therapeutics (CERTs) at the University of Pennsylvania School of Medicine.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award fellowship F32 HS00066 and CERTs project HS10399), the researchers used data on dispensed prescriptions from Medicaid programs in six States that used the same retrospective drug utilization review software vendor. For each State and for each month, they calculated the rate of potential prescribing errors (exceptions) per thousand prescriptions. They compared exceptions before and after implementation of utilization review.

The researchers found no reduction in the rate of exceptions coincident with retrospective drug utilization review implementation (rate increase, 0.064 exceptions per 1,000 prescriptions per month). They also found no effect of this review on two clinical outcomes: the incidence of all-cause hospitalization or cause-specific hospitalization. Results were consistent across subgroups, including high-dose subgroups where one would expect to find the largest effect.

See "Retrospective drug utilization review, prescribing errors, and clinical outcomes," by Sean Hennessy, Pharm.D., Ph.D., Warren B. Bilker, Ph.D., Lan Zhou, Ph.D., and others, in the September 17, 2003, Journal of the American Medical Association 290(11), pp. 1494-1499.

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