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DUR: What's New and Ongoing Projects
Rheumatoid Arthritis Project
DUR Board member Dr. Andrew Wong has been expanding pilot work on rheumatoid arthritis done in Los Angeles County on the Medi-Cal population. He has been looking at practice patterns, use of new biologic agents versus traditional disease-modifying anti-rheumatic drugs (DMARDs) for treatment of chronic inflammatory arthritis and rheumatoid arthritis, physician best practices, and weighing the costs involved with using these medications.
The Medi-Cal population was examined through two approaches: (1) Identifying patients through arthritis category, or (2) by the types of arthritis medications dispensed and matching the codes to diagnosis codes in the patients’ records. Patients could then be grouped and correlations can be made between those taking traditional DMARDs to those taking biologic agents. Data on this study is currently being analyzed.
Antidepressant Medication Use in Children and Adolescents Project
In 2004 the Food and Drug Administration (FDA) directed manufacturers of all antidepressant drugs to revise the labeling for their products to include a black boxed warning and to expand warning statements to alert health care providers on the increased risk of suicidality (suicidal thinking and behavior) in treated children and adolescents and to include additional information about the results of pediatric studies.
DUR Board members Drs. Finley and Stahl worked to develop a study that would investigate the impact of the 2004 FDA directive. The study relied on Medi-Cal data and analyzed utilization to determine if prescribing patterns for antidepressants had changed. In addition, the study analyzed whether prescribers were following FDA guidelines on follow-up visits after initiating drug therapy, or changes in dosage or medications. The impact of the FDA black box warning on utilization of antidepressants in children and adolescents is continuing to be studied to see if there has been a decrease in prescriptions and/or an increase in psychiatric visits for these patients.