An Examination of Histamine-2 Receptor Antagonist Use by Medicaid Recipients in Wisconsin Long-term Care Facilities

Abstract

The Wisconsin Drug Utilization Review Project used Medicaid claims data to examine the use of long-term, full doses histamine-2 receptor antagonists (H2RAs) among long-term care facility (LTCF) residents, ie, doses exceeding 800 mg per day of cimetidine or 150 mg per day of ranitidine for 12 weeks or more. Additional information about a small but representative sample of patients was obtained from consultant pharmacists by mail questionnaire. Of approximately 35,000 residents, there were 1,046 receiving long-term, full-dose H2RAs during 1984 at a cost of +405,848. No differences were noted between treated patients and the overall LTCF population by gender, age, level of care, or geographic locality. Among 387 patients receiving therapy for the last 3 months of 1984, over one half received antacids and over 20% received nonsteroidal anti-inflammatory drugs concurrently. According to survey respondents, almost one half of the patients had no diagnosis amenable to treatment by H2RAs. Diagnostic procedures conducted within 30 days prior to the initiation of H2RAs were hemoglobin/hematocrit assessment (performed on 53% of patients), stool testing (34%), radiological exam (23%) and endoscopy (8%). The results suggest that there is widespread use of long-term full-dose H2RAs in LTCFs for undocumented, inappropriate, and poorly supported diagnoses. Such findings are of concern to all persons charged with monitoring drug use in nursing homes because of the implications for both quality and cost of care. Information from this study will be used in designing a program to reduce inappropriate utilization of H2RAs, and Medicaid claims data will be used to monitor trends in utilization.