Drug utilization is expected to increase in the years ahead, thereby fostering the use of cost control and quality assurance mechanisms in the form of drug utilization/peer review. An overview of the current status of...
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Drug utilization is expected to increase in the years ahead, thereby fostering the use of cost control and quality assurance mechanisms in the form of drug utilization/peer review. An overview of the current status of drug utilization review (DUR) is presented, and an examination is made in terms of the relationship of DUR to assuring quality medical care. For the most part, existing drug utilization review systems are centrally based and retrospectively screen drug claims “by exception”, using quantity standards of appropriateness. The primary deficiency of current programs is the relative lack of “quality measures”, and secondarily, the need to integrate drug utilization review into the overall medical care review process. Recommendations for demonstration and research efforts are given.
Background TennCare, beginning in January 1994, channeled all Medicaid-eligible patients into managed core while expanding Medicaid coverage to large numbers of previously uninsured patients. We assessed the impact of...
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Background TennCare, beginning in January 1994, channeled all Medicaid-eligible patients into managed core while expanding Medicaid coverage to large numbers of previously uninsured patients. We assessed the impact of TennCare on (1) coronary revascularization of patients who had had an acute myocardial infarction (AMI), (2) the likelihood of the patient having a usual provider of care after discharge from the hospital, and (3) health and functional status 1 to 3 years after the index AMI. Methods and Results with the use of 1996 to 1997 survey data from 438 patients hospitalized for AMI in 1993 and 1995 who were under age 65 years at the index admission, multivariate analysis was used to calculate effects of TennCare on utilization and outcomes. TennCare patients were as likely as privately insured patients to have received coronary revascularization within 30 days of the index AMI (odds ratio 0.87, P = .69). Persons enrolled in TennCare and in traditional Medicaid who received a revascularization procedure were much less likely to have received coronary angioplasty than coronary bypass surgery than were the privately insured (TennCare: odds ratio 0.37, P = .05;Medicaid: odds ratio 0.28, P = .08). Virtually all TennCare enrollees (94%) reported having a usual provider of care in the year before the survey versus 85% for privately insured patients with AMI in 1995 (P = .05). On health and functional status, TennCare enrollees overall fared as well as those with private insurance. Conclusions Our results suggest that TennCare brought patients who otherwise would have been uninsured or enrolled in Medicaid into the medical mainstream, measured both in terms of utilization of services and health and functional status.
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