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Evaluating the impact of a novel restricted reimbursement policy for quinolone antibiotics: A time series analysis

BACKGROUND: Publicly-funded drug plans often use prior authorization policies to limit drug prescribing. To guide physician prescribing of a class of antibiotics with broad antimicrobial activity (quinolone antibiotics) in accordance with new prescribing guidelines, Alberta’s provincial health minis...

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Autores principales: Manns, Braden, Laupland, Kevin, Tonelli, Marcello, Gao, Song, Hemmelgarn, Brenda
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470979/
https://www.ncbi.nlm.nih.gov/pubmed/22935100
http://dx.doi.org/10.1186/1472-6963-12-290
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author Manns, Braden
Laupland, Kevin
Tonelli, Marcello
Gao, Song
Hemmelgarn, Brenda
author_facet Manns, Braden
Laupland, Kevin
Tonelli, Marcello
Gao, Song
Hemmelgarn, Brenda
author_sort Manns, Braden
collection PubMed
description BACKGROUND: Publicly-funded drug plans often use prior authorization policies to limit drug prescribing. To guide physician prescribing of a class of antibiotics with broad antimicrobial activity (quinolone antibiotics) in accordance with new prescribing guidelines, Alberta’s provincial health ministry implemented a new mechanism for formulary restriction entitled the optional special authorization (OSA) program. We conducted an observational study to determine the impact of this new formulary restriction policy on antimicrobial prescription rates as well as any clinical consequences. METHODS: Quinolone antibiotic use, and adherence with quinolone prescribing guidelines, was assessed before and after implementation of the OSA program in patients with common outpatient infections using an administrative data cohort and a chart review cohort, respectively. At the same time this policy was implemented to limit quinolone prescribing, two new quinolone antibiotics were added to the formulary. Using administrative data, we analysed a total of 397,534 unique index visits with regard to overall antibiotic utilization, and through chart review, we analysed 1681 charts of patients with infections of interest to determine the indications for quinolone usage. RESULTS: Using segmented regression models adjusting for age, sex and physician enrollment in the OSA program, there was no statistically significant change in the monthly rate of all quinolone use (−3.5 (95% CI −5.5, 1.4) prescriptions per 1000 index visits) following implementation of the OSA program (p = 0.74). There was a significant level change in the rate of quinolone antibiotic use for urinary tract infection (−33.6 (95% CI: -23.8, -43.4) prescriptions and upper respiratory tract infection (−16.1 (95%CI: -11.6, -20.6) prescriptions per 1000 index visits. Among quinolone prescriptions identified on chart review, 42.5% and 58.5% were consistent with formulary guidelines before and after the implementation of the OSA program, respectively (p = 0.002). There was no change in hospitalization, mortality or use of physician services after implementation of the OSA program. CONCLUSIONS: Despite the addition of two new quinolone antibiotics to the formulary, we found that there was no change in the use of quinolones after implementation of a new formulary restriction policy for outpatients with common outpatient infections.
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spelling pubmed-34709792012-10-16 Evaluating the impact of a novel restricted reimbursement policy for quinolone antibiotics: A time series analysis Manns, Braden Laupland, Kevin Tonelli, Marcello Gao, Song Hemmelgarn, Brenda BMC Health Serv Res Research Article BACKGROUND: Publicly-funded drug plans often use prior authorization policies to limit drug prescribing. To guide physician prescribing of a class of antibiotics with broad antimicrobial activity (quinolone antibiotics) in accordance with new prescribing guidelines, Alberta’s provincial health ministry implemented a new mechanism for formulary restriction entitled the optional special authorization (OSA) program. We conducted an observational study to determine the impact of this new formulary restriction policy on antimicrobial prescription rates as well as any clinical consequences. METHODS: Quinolone antibiotic use, and adherence with quinolone prescribing guidelines, was assessed before and after implementation of the OSA program in patients with common outpatient infections using an administrative data cohort and a chart review cohort, respectively. At the same time this policy was implemented to limit quinolone prescribing, two new quinolone antibiotics were added to the formulary. Using administrative data, we analysed a total of 397,534 unique index visits with regard to overall antibiotic utilization, and through chart review, we analysed 1681 charts of patients with infections of interest to determine the indications for quinolone usage. RESULTS: Using segmented regression models adjusting for age, sex and physician enrollment in the OSA program, there was no statistically significant change in the monthly rate of all quinolone use (−3.5 (95% CI −5.5, 1.4) prescriptions per 1000 index visits) following implementation of the OSA program (p = 0.74). There was a significant level change in the rate of quinolone antibiotic use for urinary tract infection (−33.6 (95% CI: -23.8, -43.4) prescriptions and upper respiratory tract infection (−16.1 (95%CI: -11.6, -20.6) prescriptions per 1000 index visits. Among quinolone prescriptions identified on chart review, 42.5% and 58.5% were consistent with formulary guidelines before and after the implementation of the OSA program, respectively (p = 0.002). There was no change in hospitalization, mortality or use of physician services after implementation of the OSA program. CONCLUSIONS: Despite the addition of two new quinolone antibiotics to the formulary, we found that there was no change in the use of quinolones after implementation of a new formulary restriction policy for outpatients with common outpatient infections. BioMed Central 2012-08-30 /pmc/articles/PMC3470979/ /pubmed/22935100 http://dx.doi.org/10.1186/1472-6963-12-290 Text en Copyright ©2012 Manns et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Manns, Braden
Laupland, Kevin
Tonelli, Marcello
Gao, Song
Hemmelgarn, Brenda
Evaluating the impact of a novel restricted reimbursement policy for quinolone antibiotics: A time series analysis
title Evaluating the impact of a novel restricted reimbursement policy for quinolone antibiotics: A time series analysis
title_full Evaluating the impact of a novel restricted reimbursement policy for quinolone antibiotics: A time series analysis
title_fullStr Evaluating the impact of a novel restricted reimbursement policy for quinolone antibiotics: A time series analysis
title_full_unstemmed Evaluating the impact of a novel restricted reimbursement policy for quinolone antibiotics: A time series analysis
title_short Evaluating the impact of a novel restricted reimbursement policy for quinolone antibiotics: A time series analysis
title_sort evaluating the impact of a novel restricted reimbursement policy for quinolone antibiotics: a time series analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470979/
https://www.ncbi.nlm.nih.gov/pubmed/22935100
http://dx.doi.org/10.1186/1472-6963-12-290
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