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Was receipt of a drug widely considered to be inappropriate for use in the elderly Beers drug list ; .17 In order to engender participation and maximize the quality of the PDTP alerts, program administrators also elicited input from local physicians and consultant pharmacists. Thus, the second criterion was receipt of a drug on the Community Care of North Carolina Prescription Advantage List PAL ; , which encourages substitution of less expensive drugs within a therapeutic class. This voluntary preferred drug list was conceived and is maintained by a committee of practicing physicians in North Carolina specifically for NC Medicaid. There are 3 categories of PAL drug alerts. PAL-3 drugs are considered to incur "significant cost" to the Medicaid program e.g., Nexium, Prilosec, Zestril, Prinivil, as of November 2002 ; , while PAL-2 drugs offered "no clear cost advantage" e.g., Prevacid, Aciphex, Accupril, Monopril, Lotensin, Altace, as of November 2002 ; , and PAL-1 drugs offer "significant cost savings" to the Medicaid program e.g., Protonix, lisinopril, enalapril, captopril, as of November 2002 ; . The third criterion was the appearance of a drug on a "Clinical Initiatives" list. The Clinical Initiatives list was developed by consultant pharmacists participating in the NCPP Initiative and included 16 drugs and or drug classes e.g., COX-2 inhibitors, statin drugs, sleep aids, low-sedating antihistamines ; that had the potential for quality improvement and cost savings. Program administrators offered 2 additional alerts: therapeutic duplication and a "consider length of therapy" alert that was derived from classes of drugs considered appropriate only for short-term use e.g., antibiotics, injectable enoxaparin ; . Research Design We first evaluated pharmacist action and reporting by reconciling the response to alerts with downstream prescribing activity using the Medicaid dispensed prescription claims database. Using a before-after, study-comparison-group design, we compared prescription use during the 3 months before intervention JuneAugust 2002 ; with a period of equal length at the end of Phase 1 March-June 2003 ; . Second, we assessed whether or not PDTP alerts were reduced during the follow-up period compared with usual-care controls nonrandomized comparison group ; . Third, we describe the economic consequences of pharmacist activities in terms of changes in drug cost using pharmacy paid claims data. Study-group patients were Medicaid recipients residing in participating nursing homes who received a completed profile review by a consultant pharmacist. The comparison group consisted of patients in nursing homes not responding to the invitation for inclusion in Phase 1 of the intervention. Inclusion of patients in comparison-group homes was determined by criteria identical to study-group patients i.e., more than 18 prescription fills in 90 days, Figure 1 ; . Several of the nursing homes in the comparison group became participants in later phases of the project, but only after the 6-month study window in this and proventil.

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JL-J and GF were responsible for the study design. JL-J co-ordinated the study, analyzed and interpreted the data with CF ; and drafted the paper. EM-B, AS, CU, IL, RC, MA and DG-B contributed to changes in CRF and design of the study, were responsible for the clinical management of patients and collection of data and critically reviewed the final version of the paper. The order of authorship is based on the number of patients included per center. The authors report no potential conflicts of interest except for GF, who is an employee of Merck Sharp & Dohme, Spain. This study was supported by a Medical School Grant from Merck Sharp & Dohme, Madrid, Spain. The authors wish to thank the following physicians for their participation in the study and or helpful comments regarding the manuscript: Dr. Rafael de la Cmara H. de la Princesa, Madrid ; , Dr. Jordi Sierra H. Santa Creu y Sant Pau, Barcelona ; , Dr. Enric Carreras H. Clinic, Barcelona ; , Dr. M. Angel Sanz H. La Fe, Valencia ; , Dr. Besalduc H. Son Dureta, Mallorca ; and Dr. Odriozola H. Ramn y Cajal, Madrid ; . They also are grateful to Mrs. Nieves Blanco for her excellent help in typing and producing the figures and to the nurses of the hematology hematopoietic transplant wards who participated in the study. Manuscript received July 1, 2005. Accepted October 24, 2005.

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Senate Committee on Health and Human Services 141. 142. 143. TAC 720.1005 d ; 2002 ; . TEX . HEALTH & SAFETY CODE 464.002 2002 ; . 40 TAC 148.11 2002 ; . 40 TAC 148.313 a ; 2002 ; . Ibid. 40 TAC 148.313 c ; 2002 ; . 40 TAC 148.313 e ; 2002 ; . 40 TAC 148.313 e ; 1 ; 2002 ; . 40 TAC 148.313 j ; 2002 ; . 40 TAC 148.203 f ; 2002 ; . 40 TAC 148.113 a ; 8 ; 2002 ; . 40 TAC 148.313 h ; 2002 ; . 40 TAC 148.113 b ; , f ; 2002 ; . Texas Legislature Online. n.d. ; : capitol ate.tx Texas Senate Committee on Human Services. 2000, September ; . Interim Report to the 77th Legislature Committee Report, 2000 ; . Page 26. copy on file with the Senate Committee on Health and Human Services ; . Ibid. Committee Report, 2000. Advocacy, Inc. 2002, July ; . Deaths Subsequent to Emergency Behavioral Interventions. Report to the Senate Committee on Health and Human Services staff. copy on file with the Senate Committee Health and Human Services ; . Texas Legislature Online. n.d. ; : capitol ate.tx United States General Accounting Office, Mental Health. GAO ; 1999, September ; . Improper Restraint or Seclusion Use Places People At Risk. GAO HEHS-99-176 Page 3. 8.40, for example, prevacid ingredients.