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Table 5. Relevance of COER-funded OPT Projects to Current Policy Issue

Current Policy Issues Identified at OASPE Conference on Pharmaceutical Pricing Practices, Utilization and Costs, August, 2000 (Source: Conference Binder)COER OPT Studies
High growth drugs

The drug categories that are expected to account for the most growth in future drug spending include those in the areas of:

  • The central nervous system (CNS).
  • Cardiovascular and hypertension.
  • Respiratory.
  • Pain.
  • Gastroenterology.92

Nine COER-funded projects involved research on drugs in these areas:

  • CNS: Garrard, Tierney, Hanlon.
  • Cardiovascular and hypertension: Lau, Platt, Soumerai, Testa, Tierney.
  • Respiratory: Stergachis, Tierney.
  • Pain: Ray, Chewning, Hanlon.
  • Gastroenterology: Lau, Tierney.
NSAIDsBetween 1996 and 1999 expenditures for the NSAID class, including Cox-2, increased by 50 percent. "Understanding the extent to which the appropriate medications are used by the population most at risk and in an effective manner is the next step in understanding the impact of prescription drugs on the health care system."93Ray looked at the potential role of pre-authorization in controlling NSAID use and cost including the use of generic versus non-generic brands. Ray also developed guidelines for treatment of osteoarthritis including recommendation of acetominophen where appropriate instead of NSAIDs.
Drug effects in the elderlyThere is poor information on drug effects in the elderly.... With respect to chronic illness, there is evidence of under-prescribing.94

Projects that addressed drug use in the elderly population include those by Lau, Soumerai, Garrard, Gardner and Hanlon. For example:

  • Hanlon found that cognitively impaired elderly were less likely to be users of prescription or OTC drugs.
  • Soumerai found that although the beneficial effects of beta-blockers post-MI were found to extend to the elderly, rates of use were very low among Medicare enrollees.
Side effects and special populations

"The side effects of drugs must be considered more carefully... A well-documented example is of an older patient who complains of insomnia being given a long-acting benzodiazepine, then falls out of bed one morning and breaks a hip."

"Inadequate clinical trial information on use in special patient populations is an issue for potentially harmful medication....One difficulty in selecting appropriate drugs for the elderly has been the lack of randomized study data establishing minimum effectiveness guidelines.... Without age-adjusted efficacy information, physicians are left to guess how best to use medicines in older patients." 94

Soumerai and Ray looked at alternative drug regimens with respect to side effects and safety in elderly patients.


 

Lau's meta-analysis work created opportunities for conducting small-size RCTs.

Physician training"In cases where prescribers must be guided by experience rather than data, research shows that the more formal training physicians undergo the better."94Berman identified differences in prescribing and treatment patterns for otitis media by physician specialty (family practice versus pediatrics), as well as across practice settings.
Compliance"The portion of patients who are given the right medication but take it the wrong way is believed to be...large.... Definitive research here is lacking due to the complex features of individual prescriptions (e.g., dose, daily schedule and duration)."94Platt analyzed factors associated with prescription adherence as well as the relative accuracy of different monitoring approaches.
Disease management"The implications of disease management programs are that better outcomes can reduce overall health care costs. However, PBMs typically do not have access to other health care cost information...[also] few evaluations of the effects of disease management programs were found in the literature." 95

Stergachis identified factors likely to be important in pharmacist-run disease management programs.

Ray looked at the impact of changes in drug use on the total cost of care.

Drug utilization review"Concurrent drug utilization review (DUR) has been increasingly used by both HMO and employer clients of Pharmacy Benefit Service companies."95

Tierney identified factors important to the design and success of computerized guidelines and drug utilization review.

Stergachis identified factors important in pharmacist-run concurrent review and patient education about drug use.

Ray looked at the impact of prior authorization on drug use.

Ahern's study will compare two different models of outpatient prospective drug utilization review.

The patient's role"A...contributing factor is the pivotal role of the patient whose willingness and ability to follow the recommended regimen are rarely assessed and documented."94

Testa demonstrated that current health-state levels influence how patients value decrements and improvements in health.

Chewning found that for arthritis patients there is a significant need to prepare patients as partners in decisionmaking about changes in drug regimens and in gathering information about related symptoms and side effects. She found that side effects influence patients' choice of drugs, while cost influences adherence.

Garber explored approaches to educating patients and eliciting their treatment preferences.

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Current as of October 2001
Internet Citation: Table 5. Relevance of COER-funded OPT Projects to Current Policy Issue. October 2001. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/pharmaceutical-outcomes-research/table5.html