November 29, 1998: Alan Lyles, Johns Hopkins University School of Hygiene and Public Health

This letter is in response to the "Call for Ideas and Study Topics for New Therapeutic Research Program."

Although the broad area of organization and financing of Centers for Education and Research on Therapeutics (CERTs) contains numerous policy and implementation features, I want to focus on two consequences of this activity: (1) creation of Drug Use Review (DUR) criteria that are both free of conflict-of-interest yet focus on clinically significant alerts, and (2) development of DUR criteria that permit comparisons of pharmaceutical use across health plans or providers.

The initial areas of emphasis should be conditions for which (1) there is reasonable agreement on pharmacotherapy treatment, such as depression, diabetes or asthma; (2) significant drug interactions exist and the probability of harm is high if not detected, or substantial underuse has been documented; (3) alert criteria are logistically feasible using computerized systems; (4) the number/proportion of false positive alerts is minimized; and (5) the use of CERT-developed criteria can be evaluated against outcomes.

Furthermore, higher priority should be given to demonstrations that include participation of managed care or DUR vendors and that evaluate the feasibility of using DUR measures for quality comparisons.

Alan Lyles, Sc.D., M.P.H., R.Ph.
Assistant Professor
Johns Hopkins University School of Hygiene and Public Health
624 N. Broadway, Room 609
Baltimore, Maryland 21205-1901
Telephone: (410) 614-4047
Fax: (410) 955-0470
alyles@hsr.jhsph.edu

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