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DUR: What's New and Ongoing Projects
Educational intervention is key to improving drug utilization, and these interventions may improve prescribing patterns. In recent years, the Drug Use Review (DUR) Board has spearheaded many initiatives to disseminate information to providers in an effort to improve prescribing. In addition to publishing educational bulletins, the DUR Board initiated several controlled studies aimed at identifying the most effective way to deliver messages, including writing letters and obtaining written feedback from prescribers.
For 2016 – 2017, the DUR Board will further these efforts by setting an ambitious goal: To establish a learning collaborative with managed care plans (MCPs) and other agencies to promote best practices using academic detailing.
The Department of Health Care Services (DHCS) is excited to announce the first academic detailing conference schedule, agenda, topics and faculty. This conference is to be held on October 20, 2016, at DHCS. DHCS is honored to have a number of nationally-renowned experts speak at the conference, including Michael Fischer, MD, MS, Director of the National Resource Center for Academic Detailing (NaRCAD) and Melissa Christopher, PharmD, the National Director of Academic Detailing Services at the United States Department of Veterans Affairs.
DHCS would like to acknowledge and thank Board Member Randall Stafford, MD, PhD, and Board Immediate Past Chair, Andrew Wong, MD, for their time and efforts in making this first conference a reality.
The following links provide information about the agenda and the faculty for this conference. As this is an ongoing project, future activities and follow-up information will be posted on this web page.
Rheumatoid Arthritis Study
DUR Board member Dr. Andrew Wong expanded the pilot work on rheumatoid arthritis (RA) done in Los Angeles County on the Medi-Cal population. The Los Angeles pilot study looked at practice patterns, use of new biologic agents versus traditional Disease Modifying Anti-rheumatic Drugs (DMARDs) for treatment of chronic inflammatory arthritis/rheumatoid arthritis, and physician best practices and then compared them with the costs involved with using those medications.
Dr. Wong provided a summary on the utilization of different DMARDs and biologic agents, which came from a large database that collected 10 years worth of data from 1995 – 2005.
Two abstracts have been submitted/published:
- Patterns of Medication Use in California Medicaid Population for Rheumatoid Arthritis: Twelve-Year Period 1995-2006. Conclusion: While biologic anti-TNF usage has gradually increased since 1999, traditional DMARD utilization in this indigent Medi-Cal population was appropriately substantial and remained stable in recent years. The overall use of glucocorticoids and NSAIDs decreased (including COX-2 inhibitors, which decreased significantly in 2004 after the first COX-2 was taken off the market) over this study period. Patients who were significantly more likely to be prescribed the anti-TNF drugs were those who had a longer duration of rheumatoid arthritis, had access to a rheumatologist, and who had dual eligibility for Medicare and Medi-Cal. Ann Rheum Dis 2011;70(Suppl 3):281(310).
- Racial Disparities in Utilization of Biologic and Disease-Modifying Anti-Rheumatic Drugs in a California Medicaid Population with Rheumatoid Arthritis. Conclusion: Biologic anti-TNF drugs and DMARDs were used disproportionately in Blacks and Hispanics across 1999 to 2006. In addition to race, clinical/treatment factors, comorbidity, and Medicare eligibility have a significant impact on utilization of biologic anti-TNF. Value Health 2011;14(3):A132(PMS51).
The overall summary of the data was that biologic agents are being appropriately utilized and are not over-utilized, since about 25% of the RA population is utilizing them. There could be improvement in utilization of biologic agents among patients with certain ethnic/racial backgrounds.
Antidepressants and Pregnancy Study
DUR Board member Dr. Patrick Finley was interested in looking at the detection rates of depression and treatment patterns for depression during pregnancy and postpartum. Evidence appears to suggest women are at higher risk for depression during pregnancy and postpartum.
Dr. Finley has an approved study to use the Medi-Cal database for women who gave birth and will compare them to women who are now pregnant. The groups will be age and gender matched. The study will be looking at detection rates and how they are treated.
Dr. Finley reported that, based on preliminary data, depression in pregnant and post-partum females in the Medi-Cal population was under-recognized. A formal report will be presented in the future.