Outcomes of prospective drug-use review of beta-agonist inhaler use in an elderly Medicaid population

In 1990 Congress mandated that all state Medicaid programs implement both r etrospective and prospective drug-use review (DUR), Nearly a decade later i mplementation of prospective DUR (ProDUR) remains incomplete, and few of th e implemented systems have been rigorously evaluated. This study was undert aken to analyze the impact of ProDUR screening of teta-agonist inhaler use in the Maryland Medicaid program from 1994 through 1996. The study used a p re/postcomparison series cohort design with data from Maryland, Georgia, an d Iowa. Regression analysis was used to control for population differences between states in the year before the ProDUR intervention. The analysis use d Medicaid and Medicare enrollment and claims data to select the study coho rts, assess exposure to the ProDUR intervention, develop patient risk profi les, and tabulate rates of adverse clinical outcomes for each subject. The study compared incidence rates for adverse outcomes for 2 1/2 years after i mplementation of the beta-agonist screens in Maryland, Georgia, and Iowa. D escriptive time plots and regression models were used to test the hypothesi s that ProDUR screening reduces the incidence of adverse effects associated with misuse of beta-agonist inhalers. The study end points included 10 cli nical outcomes related to therapeutic duplication and drug-drug interaction s involving beta-agonist inhaler use by elderly individuals with chronic lu ng disease. No significant changes in the incidence of these outcomes could be linked to ProDur screening.