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8. Using a National Drug Utilization Database to Support Outcomes Research in the Department of Veterans Affairs

FE Cunningham, PharmD, PBM/SHG; M Valentino, MHSA, PBM/SHG; LE Kazis ScD, CHQOER; K Stroupe, PhD, MCHSPR; D Hynes, PhD, VIREC

Workshop Objectives: The need to assess differences in outcomes among various drug treatment options has become increasingly important in the health care arena. Beginning in December 1999, The VHA PBM/SHG successfully established a patient-specific national drug utilization database. The Pharmacy Benefits Management (PBM) Version 3.0 database captures prescription information for all VA patients who obtain their prescriptions within the VA system. This centralized database allows for a comprehensive review of complete prescription information to enable the identification of nationwide, regional, and institutional trends in drug therapy and to provide guidance in the management of disease states and health outcomes. The purpose of this workshop is to describe the PBM v.3 database with respect to content, access by researchers, extractable components, and applications.

Workshop Activities: Data in PBM v.3 are extracted directly from the local clinical systems at all VA medical facilities in the VHA. Data are downloaded to the PBM monthly where the extractions are compiled, processed, and converted to a national database format. In addition to pharmaceutical agents, data extracted include limited patient demographic information, including real social security numbers, as well as limited data on providers who prescribe medications. The system includes comparative data for all VA facilities nationwide and data can be analyzed nationally, by region, station, or by individual VA clinics at monthly, quarterly, or annual intervals. The database is a valuable resource for timely retrieval of prescription information in response to queries. Investigators can use the database for: pharmacoeconomic trials, evaluation of pharmacologic/disease state management algorithms, post-marketing surveillance trials, appropriate use evaluations and individual queries. Investigators can also use the database to evaluate compliance, or population prescribing and dosage modifications because of changes in lab values or diagnosis.

This workshop will be divided into two segments. Part I of the workshop will consist of a description of the contents of the pharmacy database. An actual output will be available for the participants to view. The method for how the data are transferred and maintained will be discussed. The process for how investigators can obtain access will also be reviewed. The second part of the workshop will consist of HSR&D investigators presenting research where prescription data from PBM v.3 has been used. The first study will examine prescription patterns of an antidepressant for treatment of depression and anxiety among mental health care specialists and primary care physicians using data from the PBM database. Another study will present information on determining the extent of inappropriate medication supplies using a measure of medication possession calculated from data in the PBM administrative database.

Target Audience: This workshop is intended for health services and clinical researchers, VA clinicians and administrators interested in using prescription data to evaluate trends and determine outcomes.

Audience Familiarity: The participants should have knowledge of basic pharmacy concepts.