A framework for drug utilization evaluation in depression: insights from outcomes research.

BACKGROUND: Drug utilization evaluation (DUE) offers the prospect of improving the quality of care in depression by focusing on drug-related problems (DRPs). Outcomes research in depression can provide a basis on which to address difficulties in implementing DUE programs in the outpatient environment of managed care. OBJECTIVE: The purpose of this paper is to facilitate the development of a drug utilization evaluation program for depressed patients receiving care in an outpatient environment. METHODS: The literature was reviewed in the area of depression treatment, drug-related problems, and current outcomes research. This information was synthesized into a framework with potential DUE criteria. CONCLUSION: The quality of care for depression can be improved if these efforts are focused on solving DRPs. Outcomes research findings may be used as the basis for developing DUE criteria and as a first step in selecting and targeting interventions.

Measuring and monitoring outcomes of disease management programs.

After a brief analysis of the financial and health care motives that have led to the current boom in disease management (DM) programs, this paper discusses the pragmatic realities of a particular DM program for treating asthma. A model of the institutional structures necessary for DM to work is presented, emphasizing a process of continuous quality improvement in technical, clinical, and managerial processes. Significant differences between the conventions of controlled clinical trials and the realities of actual patient care may lead to unrealistic expectations about DM, making sound managerial practices and effective communication even more important. A "data warehouse" can help health care systems master the intricacies of programwide data collection and analysis, making possible sound decisions regarding treatment regimens and changes in physician and patient behavior. This paper concludes with a discussion of how the Prudential Health Care DM program for asthma makes use of the practices and systems discussed above.

Modeling physicians' prescribing decisions for patients with panic disorder.

The authors asked general and family practitioners to rate the importance of several items relating to the prescribing of drug products for patients with panic disorder. Physicians preferred to use benzodiazepines alone and in combination with antidepressants for treatment, regardless of the presence or absence of phobic avoidance. Adverse drug events, efficacy, and patient characteristics were found to be important considerations when physicians prescribe medication. Educational and promotional strategies for pharmaceutical manufacturers and marketers are discussed.

Formularies: the role of pharmacy-and-therapeutics (P&T) committees.

Pharmacy-and-therapeutics (P&T) committees have been established by most hospitals and serve as the primary formal communications link between pharmacy and the medical staff. The P&T committee is responsible for all matters related to the use of medications in the institution, including the development and maintenance of the formulary (the continually revised compilation of drug products available to the medical staff). The basic objectives of a P&T committee are to specify drugs of choice and alternatives, based on safety and efficacy; to minimize therapeutic redundancies; and to maximize cost-effectiveness. Procedures necessary to strengthen the role of P&T committees and improve their decision-making processes are discussed. The increasing concern with controlling health care costs will support the continued expansion of P&T committees, formularies, and the formulary system.