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To the Editor. Dr Hennessy and colleagues¹ concluded that "Given the lack of evidence for effectiveness and the suggestions from previous research for possible harm, policymakers should consider withdrawing the legislative mandate for retrospective drug use review." It is possible, however, that their negative results were related either to a lack of effectiveness of that particular intervention, or to inappropriate choice of outcome measures. Thus, we do not believe that their results warrant such a sweeping conclusion about drug utilization review in principle.

We have several specific concerns. First, the authors compared the rate of possible errors with the entire number of drug problem-alert criteria cross-sectionally at 2 different time periods. However, only a small fraction of these errors generated alert letters to physicians (ie, 1%-8% in 5 states, and 25% in only 1 state). To expect so few alert letters to affect the overall error rate is both statistically . . . [Full Text of this Article]

Dale B. Christensen, PhD; William H. Campbell, PhD
School of Pharmacy
University of North Carolina
Chapel Hill

Thomas R. Fulda, MA
Center for the Advancement of Patient Safety
Columbia, Md (retired)

Mark C. Pugh, PharmD
Anthem Blue Cross & Blue Shield
Richmond, Va

David H. Smith, PhD
Kaiser Center for Health Research
Portland, Ore

Earlene E. Lipowski, PhD
College of Pharmacy
University of Florida
Gainesville

Elgene W. Jacobs, PhD
University of Oklahoma College of Pharmacy
Oklahoma City

Julie W. Kuhle, RPh
Iowa Pharmacy Association
Des Moines

Robert A. Crittenden, MD, MPH
Harborview Medical Center
Seattle, Wash

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