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Mental Health Quality Advisory Committee April 18, 2013. Retro-DUR Intervention Outcomes Assessments for: Duplicate Sedatives & Hypnotics Atypical Antipsychotic Utilization in Children & Adolescents Indiana Family and Social Services Administration. Outcomes Assessment:.

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mental health quality advisory committee april 18 2013

Mental Health Quality Advisory Committee April 18, 2013

Retro-DUR Intervention Outcomes Assessments for:

Duplicate Sedatives & Hypnotics

Atypical Antipsychotic Utilization in Children & Adolescents

Indiana Family and Social Services Administration

outcomes assessment

Outcomes Assessment:

Duplicate Sedatives & Hypnotics

background
Background
  • The majority of anti-anxiety and sedative/hypnotic medications are similar in terms of their pharmacology and mechanism of action.
  • Barbiturates, benzodiazepines (BZD), or non-benzodiazepines produce their clinical effects by interacting with the GABA/Chloride receptor complex.
  • Use of multiple anti-anxiety and sedative/hypnotic medications concurrently increases the risk of additive effects at the receptor complex and may result in over sedation or other adverse effects.
  • Whenever possible, therapy with these agents should be simplified to use of a single agent.
  • The Office of Medicaid Policy & Planning (OMPP) implemented the Duplicate Sedative Hypnotic & BZD Smart PA rule in 2010 and followed with this retro-DUR intervention to emphasize importance of single agent therapy.
intervention
Intervention
  • Purpose:
    • The intervention was intended to address the safety concerns associated with the duplicate use of sedative hypnotic and BZD medications.
  • Intervention Type
    • Population-based mailing
    • Mailing date: January 2012
    • Total of 1646 letters mailed to physicians
    • Total of 2602 letters sent to adjusted target patients*

*Adjusted Target Patients – All patients of physicians who were included in the intervention had pharmacy claims and were active plan members throughout the post-intervention time period. When outcomes were assessed, these patients’ pre-intervention (baseline) hits were re-evaluated to make certain that the status of clinical indicators had not changed due to late pharmacy and medical claims.

methodology
Methodology
  • Pharmacy drug claims from July 2011 through December 2011 were reviewed for the following:
    • Changes in intervention-related pharmacy dollars paid
    • Pharmacy dollars paid per patient per month (PPPM)
    • Number of pharmacy claims
  • The intervention consisted of education outreach to physicians whose patients were targeted
  • Physicians with at least one patient that met the criteria below were mailed an intervention letter:
    • Duplicate Anti-Anxiety Medication Therapy
    • Duplicate Sedative/Hypnotic Medication Therapy
    • Duplicate Anti-Anxiety and Sedative/Hypnotic Medication Therapy
results
Results
  • Changes in Clinical Indicators:
results1
Results
  • Savings:
conclusions
Conclusions
  • The intervention focused on improving prescribing practice and reducing the risk due to duplication.
  • The intervention was successful in reducing the total number of duplicate therapies for sedative hypnotics and BZDs within targeted patients by 55.1%.
  • The intervention decreased the amount paid for targeted drugs by $5.55 as measured in the post-intervention period.
  • The intervention yielded an estimated savings of nearly $87,000 in targeted drug expenditures as measured in the six-month post-intervention period.
outcomes assessment1

Outcomes Assessment:

Atypical Antipsychotic Utilization in Children & Adolescents

background1
Background
  • The use of psychotropic medications in children and adolescents have become increasingly more common in recent years.
  • Indiana participated in the AHRQ-Rutgers study on antipsychotic use in children and adolescents in Indiana Medicaid.
  • OMPP conducted this retro-DUR to emphasize the importance of limiting antipsychotic prescribing in children and adolescents.
intervention1
Intervention
  • Purpose:
    • To encourage physicians to evaluate atypical antipsychotic medication use in children and adolescents.
    • The goal was to reduce the risks and adverse outcomes associated with antipsychotic use.
  • Intervention Type
    • Population-based mailing
    • Mailing date: June 2012
    • Total of 1638 letters mailed to physicians
    • Total of 2675 letters sent to adjusted target patients*

*Adjusted Target Patients – All patients of physicians who were included in the intervention had pharmacy claims and were active plan members throughout the post-intervention time period. When outcomes were assessed, these patients’ pre-intervention (baseline) hits were re-evaluated to make certain that the status of clinical indicators had not changed due to late pharmacy and medical claims.

methodology1
Methodology
  • Pharmacy drug claims from December 2011 through May 2012 were reviewed for the following:
    • Changes in intervention-related pharmacy dollars paid
    • Pharmacy dollars paid PPPM
    • Number of pharmacy claims
  • The intervention consisted of education outreach to physicians whose patients were targeted
  • Physicians with at least one patient that met the criteria below were mailed an intervention letter:
    • Atypical Antipsychotic in Children
    • Higher than Recommended Dosage of Atypical Antipsychotic in Children and Adolescents
results2
Results
  • Changes in Clinical Indicator (Age):
results3
Results
  • Savings:
conclusions1
Conclusions
  • The intervention focused on improving prescribing practice and reducing the risks associated with antipsychotic therapy.
  • The intervention was successful in reducing atypical antipsychotic therapy within targeted patients by 43.2%.
  • The intervention decreased the amount paid for targeted drugs by $91.83 as measured in the post-intervention period.
  • The intervention yielded an estimated savings of nearly $1.5 million in targeted drug expenditures as measured in the six-month post-intervention period.
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