To our knowledge, this is the first statewide examination of small area variations in the use of prescription drugs. This is a timely examination, given the recent rise in health care costs, much of which is attributable to the increased use of new and costly prescription drugs.

Unlike surgery or diagnostic examinations, prescription drugs are routinely required to demonstrate "proof of efficacy" to the Food and Drug Administration before they are brought to market. In virtually all cases, the evidence of efficacy is obtained experimentally through randomized placebo-controlled clinical trials. But such evidence does not, per se, ensure that pharmaceuticals are always used rationally.

First, the FDA does not require that new (and often more expensive) drugs be compared to existing therapies.

Second, once new drugs are available in everyday practice, they can be used for conditions or levels of illness that are quite different from those of the patients enrolled in clinical trials. In everyday practice, for example, antibiotics are commonly used for a variety of infectious diseases, including some that are caused by viruses (for which antibiotics are ineffective). And patients with mild dyspepsia are sometimes treated with expensive drugs, such as proton pump inhibitors, when less costly and equally effective alternatives are available.

This chapter examines the variation in the prescription of nine drugs or classes of drugs and briefly discusses their clinical uses. Included are analyses of variation in pharmaceutical use among BCBSM members with prescription coverage:

• Beta blockers and angiotensin-converting enzyme (ACE) inhibitors given to adult BCBSM members
• Lipid lowering drugs
• Anti-anxiety medications
• Proton pump inhibitors to reduce stomach acid secretion
• Antihistamines for allergies
• Selective serotonin re-uptake inhibitors for treatment of depression
• Antibiotics given to child BCBSM members
• Drugs used to treat attention deficit disorders given to child BCBSM members

To read chapter
To view and print the complete chapter on Practice Variations and the Use of Prescription Drugs in Adobe Acrobat PDF format, click on the link further below. You will need Adobe Acrobat Reader to view and print this file.

To download this file to your computer's hard drive, follow the directions applicable to your computer system.

• For Windows users running Microsoft Internet Explorer, click on the mouse's right button and select "Save Target As . . . "
  
  
• For Windows users running Netscape, click on the mouse's right button and select "Save Link As . . . "
  
  
• For Macintosh users running Microsoft Internet Explorer, control-click and select "Download Link to Disk . . . "
  
  
• For Macintosh users running Netscape, control-click and select "Save this Link as . . . "

To get Adobe Acrobat Reader
If you need Adobe Acrobat Reader, you can get a free copy from the Adobe Web site.

Back to top

NOTICE TO ATLAS READERS
While not giving answers, the atlas raises questions about health care service use that merit careful consideration. "High" rates of use are not necessarily bad and "low" volumes good (or vice versa). Our goal is to move toward rates that are consistent with high quality health care, which need to be determined with local clinical, community and patient discussion and dialogue.

The atlas is not a physician or hospital report card. When reviewing data, note that the Hospital Service Areas in the atlas were defined by the atlas author. They may differ significantly from what a hospital considers its market area.