Using feedback letters to influence the use of antiulcer agents in a Medicaid program

OBJECTIVE:To determine the impact of printed patient-specific feedback rega rding potential misprescribing of antiulcer agents (AUAs). Measures of impa ct included improvements in patients' dispensing profiles, assessed accordi ng to predetermined criteria, and decreases in cost and quantity of AUAs di spensed. DESIGN: Controlled study. After evaluation for compliance with predetermine d criteria, prescribers identified as having one or two patient profiles wi th potential errors were assigned alternatively to control or experimental groups. An intervention was mailed to the experimental group. SETTING:Outpatient setting in the New Mexico Medicaid population. PARTICIPANTS: Patients and prescribers identified as having potential mispr escribing of AUAs. INTERVENTION: The intervention consisted of a cover letter describing the p urpose of the drug utilization review program, an educational fact sheet re garding prescribing AUAs, patient profiles with potential misprescribing, a nd physician response forms. MEASUREMENTS AND MAIN RESULTS: There were greater improvements in dispensin g to patients in the intervention group (chi(2), p < .001). Significant odd s ratios for the intervention group were 2.29 for AUAs discontinued, 1.98 f or all improvements combined, 13.13 for improvement in listing of proper di agnosis for AUAs, and 2.84 for appropriate indication when prescribing the higher acute daily dosage. Using data from 3 months before and after the in tervention, we found greater decreases in mean monthly costs (p = .044) and mean monthly quantity of AUAs dispensed (p = .049) in the intervention gro up. CONCLUSIONS: This intervention significantly decreased AUA dispensing to pa tients whose prescribers were mailed the patient-specific feedback interven tion.