DUR: What's New and Ongoing Projects

Academic Detailing

Educational interventions are the key to improving prescribing patterns. Over the years, the California 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.

In 2016, the DUR Board furthered these efforts by setting an ambitious goal: to establish a learning collaborative with Managed Care Plans (MCPs) and other agencies in order to promote best practices using academic detailing.

On October 20, 2016, the Department of Health Care Services (DHCS) held the first annual academic detailing conference at DHCS. DHCS was 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 U.S. Department of Veterans Affairs (VA). DUR Board members Randall Stafford, MD, PhD, and Andrew Wong, MD, also presented at the conference and played a vital role in turning the ambitious goal of the DUR Board into a reality.

Due to the overwhelming success of the first annual academic detailing conference, DHCS will continue to host this conference each October. This web page will continue to provide information about prior and upcoming academic detailing conferences.

Upcoming Academic Detailing Conference:

  Date: October 12, 2017
  Time: 10 a.m. – 3 p.m.
  Location: Department of Health Care Services
1500 Capitol Avenue
Training Rooms B+C
Sacramento, CA  95814
  2017 Agenda , Conference Faculty

Prior Academic Detailing Conference Agendas:
  2016 Agenda

Prior Academic Detailing Conference Presentations:
  2017 Presentation: Academic Detailing Implementation: Support and Practical Steps
  2016 Presentation: Academic Detailing in 2016: Challenges & Opportunities
  2016 Presentation: Reaching Physicians Despite the Realities of Clinical Practice

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:

  1. 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).

  2. 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.