166192 Improving Drug Prescribing for Oral Anti-diabetic Agents through Information Technology

Monday, November 5, 2007

Aman Bhandari, PhD , Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD
C. Daniel Mullins, PhD , Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD
Ebere Onukwugha, PhD , Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD
Sylvain DeLisle, MD, MBA , VA Maryland Health Care System, University of Maryland, Baltimore, MD
BACKGROUND: In January 2004, the Veterans Affairs (VA) Maryland Health Care System implemented an e-prescribing tool to improve the appropriateness of rosiglitazone (Avandia) prescribing for diabetic patients through decision support, automated laboratory review and documentation at the point of prescription. This study evaluated the impact of the tool on rosiglitazone prescribing rates and patterns, and hemoglobin A1c (HbA1c) monitoring rates and levels. METHODS: A pre-post intervention study design was used to examine changes in diabetes prescribing, and the likelihood of receiving a rosiglitazone prescription or an HbA1c test, in a sample of medicated diabetic veterans (n=10171) from 2002-2005. A generalized estimating equation approach was used to account for repeated measures. The logistic regression model adjusted for age, marital status, mean HbA1c and number of drugs. RESULTS: In 2003, 18% of patients received a rosiglitazone prescription. In 2004, there was an 11% lower odds of receiving rosiglitazone after the tool was introduced (95% CI: 0.83 –0.95). For patients receiving rosiglitazone and insulin (a combination specifically discouraged because it may lead to congestive heart failure) there was a 43% decrease. These trends were sustained through 2005. There was no significant change in HbA1c mean levels or monitoring rates. CONCLUSIONS: Following the e-prescribing tool implementation, rosiglitazone use decreased and prescribing patterns improved, despite the fact that use at the national VA level increased substantially over the same time period. In addition, the tool did not worsen physiological (HbA1c) outcomes. This research suggests that such a tool can be effective, safe and sustainable.

Learning Objectives:
1. Provide a background on prescribing patterns for diabetic patients in the Veterans Affairs Medical System, one of the largest single purchasers of drugs. 2. Inform the audience about innovative practices in the VA system that are targeted towards pharmaceutical care using information technology. 3. Describe the findings of using e-prescribing tools to manage medication utilization in the VA

Keywords: Diabetes, Information Technology

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.