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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

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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.


Questions

Questions???


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