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   DoD Pharmaceutical Operations Directorate Pharmacy Outcomes Research Team (PORT)


  Mission
 
The mission of the Pharmacy Outcomes Research Team (PORT) is to improve patient outcomes and enhance the quality of the Military Health System pharmacy benefit through research and education.

The Pharmacy Outcomes Research Team (PORT) was established in January 2008 to perform and disseminate findings from research regarding drug therapy outcomes in the Military Health System (MHS). The PORT serves multiple functions: it provides cost-effectiveness and budget impact analyses to support the Uniform Formulary decision-making process at the quarterly meetings of the DoD Pharmacy & Therapeutics (P&T) Committee; assesses the effect of Uniform Formulary decisions on DoD beneficiaries; assists with utilization management analysis and projections; and collaborates with other government and academic entities to perform and facilitate research into drug-related outcomes within DoD.

The MHS Formulary Management Cycle
  • The DoD Pharmacoeconomic Center (PEC) conducts clinical and cost effectiveness evaluations to support the DoD Pharmacy & Therapeutics Committee (P&T), which maintains the MHS formularies.

  • The Pharmacy Operations Center (POC) implements formulary changes and supports day-to-day operations.
  • The PORT conducts research to support decision making and evaluate the outcomes of drug therapy.


  The PORT is organized under the DoD Pharmaceutical Operations Directorate. The research team is co-located at TRICARE Management Activity headquarters in Falls Church, VA, and the PEC at Fort Sam Houston in San Antonio, TX. Studies are conducted in collaboration with other research entities, such as the DoD Patient Safety Center, the DoD Health Program Analysis and Evaluation Division, the DoD Pharmacovigilance Center, the MHS Scientific Advisory Panel, and the United States Air Force Clinical Informatics Branch.
  Peer-Reviewed Publications
 
  1. Smith N, Trice S, Cowan M, Devine J, Morris M. Initial use of fluticasone/salmeterol and adherence to clinical practice guidelines for obstructive lung disease. Submitted for publication Aug 2011.

  2. Devine JW, Trice ST, Finney Z, et al. A retrospective analysis of extended-interval dosing and the impact on bisphosphonate compliance in the US Military Health System. Osteoporosis Int. (in press).

  3. Linton A, Bacon TA, Trice S, et al. Results from a mailed promotion of medication reviews among Department of Defense beneficiaries receiving 10 or more chronic medications. J Manag Care Pharm. 2010;16(8):578-92.

  4. Devine JW, Trice S, Spridgen S, Bacon TA. Trends in prescription drug utilization and spending for the Department of Defense, 2002-2007. Military Medicine 2009;174(9):958–963.

  5. Devine JW, Linton A, Mistry H, Napier J, Trice S, Bacon TA. Increase in lipid-lowering treatment rates among TRICARE beneficiaries: a population-based study. Pharmacoepidemiology and Drug Safety 2009;18(10):891-899. DOI: 10.1002/pds.1786.

  6. Linton A, Garber M, Fagan NK, Peterson MR. Examination of multiple medication use among TRICARE beneficiaries aged 65 years and older. J Managed Care Pharm 2007;13(2):155–162. http://www.amcp.org/data/jmcp/p155-62.pdf.

  7. Linton A, Garber M, Fagan NK, Peterson M. Factors associated with choice of pharmacy setting among DoD health care beneficiaries aged 65 years or older. J Managed Care Pharm 2007;13(8):677–686. http://www.amcp.org/data/jmcp/JMCPMaga_677-686.pdf.

  8. Linton A, Bacon TA, Peterson M. Proton-pump inhibitor utilization associated with the change to nonpreferred formulary status for esomeprazole in the TRICARE formulary. J Managed Care Pharm 2009;15(1):42–54. http://www.amcp.org/data/jmcp/042-054.pdf.

  9. Trice S, Devine JW, Mistry H, Moore E, Linton A. Formulary management in the Department of Defense. J Managed Care Pharm 2009;15(2):133–146. http://www.amcp.org/data/jmcp/133-146.pdf.

  10. Casscells SW, Granger E, Kress AM, Linton A, Cottrell L. Use of oseltamivir after influenza infection is associated with reduced incidence of recurrent adverse cardiovascular outcomes among Military Health System beneficiaries with prior cardiovascular diseases. Circ Cardiovasc Qual Outcomes 2009;2:108–115; originally published online Mar 5, 2009. DOI: 10.1161/CIRCOUTCOMES.108.820357.

  Peer-Reviewed Presentations
 
  1. Nwokeji E, Yarger S, Trice S, et al. Examining medication adherence among TRICARE beneficiaries receiving statin therapy for secondary prevention of coronary heart disease in US military treatment facilities. (Poster, International Society of Pharmacoeconomics and Outcomes Research [ISPOR] 16th Annual International Meeting, Baltimore, MD, May 2011).

  2. Yarger S, Nwokeji E, Trice S, et al. Examining potentially harmful drug-disease interactions in the elderly: chronic renal failure and NSAID use. (Poster, ISPOR, Baltimore, MD, May 2011).

  3. Trice S, Devine J, Carlson M, et al. Initial use of inhaled corticosteroid/long-acting beta agonist inhalers: adherence to national guidelines and persistence/compliance on therapy. (Poster, Joint Forces Pharmacy Seminar [JFPS], October 2010, Chattanooga, TN).

  4. Nwokeji E, Yarger S, Trice S, et al. Assessing low-density lipoprotein cholesterol goal attainment for patients receiving statins in U.S. Military Treatment Facilities for secondary coronary heart disease prevention. (Poster, JFPS, October 2010, Chattanooga, TN).

  5. Trice S. Pharmacy outcomes research in the MHS: 2 years of experience. (Platform presentation, American Pharmacists Association Federal Forum, Washington, DC, March 11-12, 2010).

  6. Trice S, Bacon T, Hoerner P, et al. An automated intervention to decrease inappropriate prescribing of fentanyl patches to opioid-naοve patients in the Military Health System. (Poster, MHS Conference, January 2010).

  7. Devine JW, Trice S, Hoerner P, Bacon TA. A novel approach to reduce inappropriate prescribing of transdermal fentanyl in the Military Health System. Presented at the 137th APhA Meeting and Exposition, San Antonio, TX, April 3–6, 2009. Awarded: Best of Conference.

  8. Moore E, Devine J, Trice S, et al. Cost effectiveness of oral bisphosphonates administered on extended dosing intervals. Value Health 2009;12:A163. http://www.ispor.org/RESEARCH_STUDY_DIGEST/research_index.asp.

  9. Devine J, Trice S, Allerman A, Bacon T. The effect of a prior authorization program for proton-pump inhibitors on medication persistence among the elderly. Value Health 2009;12:A60. http://www.ispor.org/RESEARCH_STUDY_DIGEST/research_index.asp.

  10. Cota JM, Bretzke DR, Allerman AA, et al. Comparison of epoetin alfa and darbepoetin alfa doses routinely used in clinical practice in Department of Defense beneficiaries. Value Health 2007;10:A154. http://www.ispor.org/RESEARCH_STUDY_DIGEST/research_index.asp.

  11. Devine JW, Moore E, Tiller KW, et al. Economic evaluation of long acting treatments for attention-deficit/hyperactivity disorder in the Military Health System. Value Health 2007;10:A78. http://www.ispor.org/RESEARCH_STUDY_DIGEST/research_index.asp.

  12. Trice S, Meade DJ, Napier J, et al. Prescribing of fentanyl patches to non-opioid tolerant patients in the Military Health System (MHS). Value Health 2007;10:A176. http://www.ispor.org/RESEARCH_STUDY_DIGEST/research_index.asp.

  13. Devine J, Conrad RC, Tiller KW. The effect of three-tier formulary adoption for alpha-blockers on drug utilization in the Department of Defense. Value Health 2008;11:A23. http://www.ispor.org/RESEARCH_STUDY_DIGEST/research_index.asp.

  Presentations to DoD Pharmacy & Theraputics (P&T) Committee
 
Pharmacoeconomic & Budget Impact Analyses (2010-2011)
[Approximate annual expenditures, all points of service]

  • Aug 2011 – Contraceptives [$163M]

  • Aug 2011 – Non-steroidal anti-inflammatory drugs [$150M]

  • Aug 2011 – New drugs: Butrans, Staxyn, Edarbi, Amturnide, Cycloset

  • May 2011 – Atypical antipsychotics [$218M]

  • May 2011 – Nasal allergy drugs [$95M]

  • May 2011 – New drugs: Kombiglyze XR, Bromday, Jalyn

  • Feb 2011 – Antilipidemic-2 agents (Fibrates, omega-3 fatty acid, bile acid sequestrants) [$140M]

  • Feb 2011 – Gastrointestinal-1 agents (aminosalicylates, pancreatic enzymes, misc) [$66M]

  • Feb 2011 – New drugs: Aricept 23mg, Tekamlo, Tribenzor, blood glucose test strips

  • Nov 2010 – Non-insulin antidiabetics [$336M]

  • Nov 2010 – New drugs: Dulera, Livalo, Silenor, Exalgo, Fibricor, Natazia

  • Aug 2010 – Renin-angiotensin antihypertensive agents [$300M]

  • Aug 2010 – Topical ophthalmic anti-allergy drugs (antihistamine, mast cell stabilizers, NSAIDs) [$18M]

  • May 2010 – Antilipidemic-I products (statins, niacin, ezetimibe) [$489M]

  • May 2010 – BPH alpha blockers [$80M]

  • May 2010 – New drugs: Sumavel, Onsolis

  • Feb 2010 – Basal insulins [$80M]

  • Feb 2010 – Antihemophilic agents [$38]

  • Feb 2010 – New drugs: Edluar, Embeda, Intuniv, Twynsta, Valturna



Patterns of Use/Effect of Formulary Interventions (2010-2011)

  • Aug 2011 – Closing the loop: effects of step therapy on beneficiary behavior in 7 major drug classes

  • Aug 2011 – Indications for use: montelukast (Singulair)

  • May 2011 – Utilization of atypical antipsychotics in the MHS

  • Feb 2011 – Utilization of antidiabetics in the MHS: HbA1cs at start of oral antidiabetic therapy

  • Nov 2010 – Utilization of antidiabetics in the MHS: new users and step therapy estimates

  • Nov 2010 – Closing the loop: early results of statin step therapy; utilization of PDE-5s

  • Aug 2010 – Renin-angiotensin antihypertensives in the MHS: diagnoses, prior and concomitant use

  • Aug 2010 – Closing the loop: following up on P&T decisions

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