Skip to main content
PMC home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1996 Mar 1;154(5):635–640.

Variability in prescription drug utilization: issues for research.

A H Anis 1, S G Carruthers 1, A O Carter 1, J Kierulf 1
PMCID: PMC1487542  PMID: 8603319

Abstract

The authors report the results of a literature review to identify research issues relating to physician prescribing practices and evaluate the potential for existing Canadian databases to support initiatives to improve prescribing practices. Methodologies such as small-area variation analysis and drug utilization reviews are discussed, and Canadian data sources relating to drug prescribing are assessed. The authors conclude that small-area variation analysis can be used to identify differences in drug utilization rates. A ranking method to identify drugs with the greatest variability in utilization can then be used to establish priorities for further analysis. After statistically significant factors associated with prescribing patterns are identified, intervention and policy formation will be possible. This will involve a more sophisticated integration of existing provincial information sources and the adoption of uniform guidelines to promote rational prescribing practices.

Full text

PDF
640

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anis A. H. Substitution laws, insurance coverage, and generic drug use. Med Care. 1994 Mar;32(3):240–256. doi: 10.1097/00005650-199403000-00005. [DOI] [PubMed] [Google Scholar]
  2. Beers M. H., Fingold S. F., Ouslander J. G., Reuben D. B., Morgenstern H., Beck J. C. Characteristics and quality of prescribing by doctors practicing in nursing homes. J Am Geriatr Soc. 1993 Aug;41(8):802–807. doi: 10.1111/j.1532-5415.1993.tb06173.x. [DOI] [PubMed] [Google Scholar]
  3. Blais R. Variations in the use of health care services: why are more studies needed? CMAJ. 1994 Dec 15;151(12):1701–1703. [PMC free article] [PubMed] [Google Scholar]
  4. Davidson W., Molloy D. W., Bédard M. Physician characteristics and prescribing for elderly people in New Brunswick: relation to patient outcomes. CMAJ. 1995 Apr 15;152(8):1227–1234. [PMC free article] [PubMed] [Google Scholar]
  5. Davidson W., Molloy D. W., Somers G., Bédard M. Relation between physician characteristics and prescribing for elderly people in New Brunswick. CMAJ. 1994 Mar 15;150(6):917–921. [PMC free article] [PubMed] [Google Scholar]
  6. Diehr P., Cain K. C., Kreuter W., Rosenkranz S. Can small-area analysis detect variation in surgery rates? The power of small-area variation analysis. Med Care. 1992 Jun;30(6):484–502. doi: 10.1097/00005650-199206000-00003. [DOI] [PubMed] [Google Scholar]
  7. Erwin W. G. The definition of drug utilization review: statement of issues. Clin Pharmacol Ther. 1991 Nov;50(5 Pt 2):596–599. doi: 10.1038/clpt.1991.188. [DOI] [PubMed] [Google Scholar]
  8. Folland S., Stano M. Small area variations: a critical review of propositions, methods, and evidence. Med Care Rev. 1990 Winter;47(4):419–465. doi: 10.1177/107755879004700403. [DOI] [PubMed] [Google Scholar]
  9. Jones J. K. A view from the drug utilization review management organization sector. Clin Pharmacol Ther. 1991 Nov;50(5 Pt 2):620–625. doi: 10.1038/clpt.1991.195. [DOI] [PubMed] [Google Scholar]
  10. Kaplan B., Farris K. B., Kirking D. M. Assessing physician choice of nonsteroidal antiinflammatory drugs in a health maintenance organization. Ann Pharmacother. 1993 Nov;27(11):1393–1399. doi: 10.1177/106002809302701115. [DOI] [PubMed] [Google Scholar]
  11. Kralewski J., Wertheimer A., Ratner E. Prescription drug utilization review in the private sector. Health Care Manage Rev. 1994 Spring;19(2):62–71. [PubMed] [Google Scholar]
  12. Lexchin J. Doctors and detailers: therapeutic education or pharmaceutical promotion? Int J Health Serv. 1989;19(4):663–679. doi: 10.2190/HUFK-5Y54-QX1E-AD62. [DOI] [PubMed] [Google Scholar]
  13. Lipton H. L., Bird J. A. Drug utilization review in ambulatory settings: state of the science and directions for outcomes research. Med Care. 1993 Dec;31(12):1069–1082. doi: 10.1097/00005650-199312000-00001. [DOI] [PubMed] [Google Scholar]
  14. Lipton H. L., Bird J. A. Drug utilization review: state of the art from an academic perspective. Clin Pharmacol Ther. 1991 Nov;50(5 Pt 2):616–619. doi: 10.1038/clpt.1991.194. [DOI] [PubMed] [Google Scholar]
  15. McIsaac W., Naylor C. D., Anderson G. M., O'Brien B. J. Reflections on a month in the life of the Ontario Drug Benefit Plan. CMAJ. 1994 Feb 15;150(4):473–477. [PMC free article] [PubMed] [Google Scholar]
  16. McPherson K., Wennberg J. E., Hovind O. B., Clifford P. Small-area variations in the use of common surgical procedures: an international comparison of New England, England, and Norway. N Engl J Med. 1982 Nov 18;307(21):1310–1314. doi: 10.1056/NEJM198211183072104. [DOI] [PubMed] [Google Scholar]
  17. Paul-Shaheen P., Clark J. D., Williams D. Small area analysis: a review and analysis of the North American literature. J Health Polit Policy Law. 1987 Winter;12(4):741–809. doi: 10.1215/03616878-12-4-741. [DOI] [PubMed] [Google Scholar]
  18. Phelps C. E. Diffusion of information in medical care. J Econ Perspect. 1992 Summer;6(3):23–42. doi: 10.1257/jep.6.3.23. [DOI] [PubMed] [Google Scholar]
  19. Phelps C. E., Parente S. T. Priority setting in medical technology and medical practice assessment. Med Care. 1990 Aug;28(8):703–723. doi: 10.1097/00005650-199008000-00004. [DOI] [PubMed] [Google Scholar]
  20. Pickering T. D., Gurwitz J. H., Zaleznik D., Noonan J. P., Avorn J. The appropriateness of oral fluoroquinolone-prescribing in the long-term care setting. J Am Geriatr Soc. 1994 Jan;42(1):28–32. doi: 10.1111/j.1532-5415.1994.tb06069.x. [DOI] [PubMed] [Google Scholar]
  21. Rosholm J. U., Hallas J., Gram L. F. Outpatient utilization of antidepressants: a prescription database analysis. J Affect Disord. 1993 Jan;27(1):21–28. doi: 10.1016/0165-0327(93)90092-x. [DOI] [PubMed] [Google Scholar]
  22. Schulke D. G. A congressional perspective on inappropriate drug therapy and drug utilization review. Clin Pharmacol Ther. 1991 Nov;50(5 Pt 2):606–611. doi: 10.1038/clpt.1991.191. [DOI] [PubMed] [Google Scholar]
  23. Schwartz R. K., Soumerai S. B., Avorn J. Physician motivations for nonscientific drug prescribing. Soc Sci Med. 1989;28(6):577–582. doi: 10.1016/0277-9536(89)90252-9. [DOI] [PubMed] [Google Scholar]
  24. Tamblyn R. M., McLeod P. J., Abrahamowicz M., Monette J., Gayton D. C., Berkson L., Dauphinee W. D., Grad R. M., Huang A. R., Isaac L. M. Questionable prescribing for elderly patients in Quebec. CMAJ. 1994 Jun 1;150(11):1801–1809. [PMC free article] [PubMed] [Google Scholar]
  25. Vermeulen L. C., Jr, Matuszewski K. A., Ratko T. A., Butler C. D., Burnett D. A., Vlasses P. H. Evaluation of ondansetron prescribing in US academic medical centers. Arch Intern Med. 1994 Aug 8;154(15):1733–1740. [PubMed] [Google Scholar]
  26. Wennberg J. E. Dealing with medical practice variations: a proposal for action. Health Aff (Millwood) 1984 Summer;3(2):6–32. doi: 10.1377/hlthaff.3.2.6. [DOI] [PubMed] [Google Scholar]
  27. Wennberg J. E. Future directions for small area variations. Med Care. 1993 May;31(5 Suppl):YS75–YS80. doi: 10.1097/00005650-199305001-00012. [DOI] [PubMed] [Google Scholar]
  28. Wennberg J., Gittelsohn Small area variations in health care delivery. Science. 1973 Dec 14;182(4117):1102–1108. doi: 10.1126/science.182.4117.1102. [DOI] [PubMed] [Google Scholar]
  29. Wertheimer A. I., Kralewski J. DUR programs: current trends and future directions. Am Pharm. 1993 Feb;NS33(2):37–42. doi: 10.1016/s0160-3450(15)30860-6. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES