ASSESSMENT OF METHODS AND OUTCOMES - USING MODIFIED INPATIENT CIPROFLOXACIN CRITERIA IN COMMUNITY-BASED DRUG-USE EVALUATION

OBJECTIVE: To determine if published drug use evaluation (DUE) criteri a for inpatients could be modified to describe and evaluate drug thera py in outpatients. DESIGN: Retrospective review of drug profiles and d iagnostic codes in outpatients included in the Iowa Medicaid Managemen t Information System database. METHODS: Criteria specifying clinical i ndication, process indicators, complications, and outcomes were modifi ed from existing inpatient DUE criteria for ciprofloxacin. The Iowa Me dicaid database provided demographics, drug profiles, and diagnostic c odes for outpatients prescribed ciprofloxacin between March 1 and Marc h 15, 1993. RESULTS: 539 patients were evaluated. Mean (+/-SD) age was 62.1 +/- 23.8 years; 70.9 percent were women, 44.9 percent were nursi ng home patients who received lower doses (p=0.04). Of 146 patients (2 7.1 percent) with infection-related International Classification of Di seases-Clinical Modification, 9th Revision (ICD-9CM) codes, 43.8 perce nt did not meet indication for use criteria, 15.8 percent met criteria , and 40.4 percent were equivocal/other. Process indicators in 539 pat ients revealed that 2.4 percent were <18 years old and potential inter actions existed for theophylline (9.3 percent), iron (9.7 percent), wa rfarin (4.8 percent), sucralfate (2.2 percent). Two patients (0.4 perc ent) received prenatal vitamins. Dosage and duration of therapy could not be linked to disease severity. Complications of therapy were not e valuable. Outcomes were assessed indirectly by using concurrent antibi otic histories. These histories showed that patients received a mean 2 .7 +/- 2.4 (median 2, range 1-16) ciprofloxacin prescriptions during t he study period. There was frequent concurrent use of antibiotics, and 29 percent of prescriptions were preceded or followed by additional q uinolone therapy within 30 days. CONCLUSIONS: Evaluating appropriatene ss of therapy with this methodology is feasible if validated ICD-9CM c odes are reported consistently in sufficient numbers of patients. Low levels of reporting of relevant disease codes require that large numbe rs of patients be screened to use this method effectively. Descriptive use data are readily obtained. Data obtained by this method indicated several apparent deficiencies in ciprofloxacin therapy.