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In Reply: Dr Berringer and colleagues identify a number of perceived weaknesses of the retrospective drug utilization review programs that we studied (eg, failure to use diagnosis data to identify diseases, and overly simplified criteria), and wonder whether improvements might make retrospective drug utilization review programs effective. In fact, the software used by the programs that we studied did use diagnosis data to identify drug-disease interactions, and those deciding which exceptions should result in alerts did have access to patient-specific factors such as those mentioned by Berringer et al. We agree that the low alert rate that we found could well explain a lack of effect, as we stated in our article, but this reflects how such programs were implemented. Furthermore, we did not find a dose-response relationship with numbers of alerts.

The articles cited by Berringer et al as evidence of the effectiveness of such programs deserve clarification. The . . . [Full Text of this Article]

Sean Hennessy, PharmD, PhD; Warren B. Bilker, PhD; Anita L. Weber, PhD; Colleen Brensinger, MS; Brian L. Strom, MD, MPH
Department of Biostatistics & Epidemiology
University of Pennsylvania School of Medicine
Philadelphia

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