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Letter from the Agency for Healthcare Research and Quality

Dear Colleague:

This report from the Agency for Healthcare Research and Quality (AHRQ) outlines the work of the Centers for Education & Research on Therapeutics (CERTs) in their seventh year. We are pleased to present this summary of CERTs contributions to the optimal use of medical therapeutics.

Optimal use of medicines and devices involves many components dealing with safe and effective prescribing or use by clinicians and patients. The CERTs research summarized in this report illustrates multiple CERTs efforts, in consultation with the Food and Drug Administration (FDA), to identify risks and/or the most effective use of medications and devices. Relative to devices, a preliminary CERTs study suggested children with diabetes who use continuous glucose monitoring systems could improve their hemoglobin A1c without increased risk of hypoglycemia. The CERTs also convened a multidisciplinary expert workshop on the evaluation of diagnostic imaging technologies and therapeutics devices and published the key issues that were identified.

From a medication safety standpoint, the CERTs studied the consequences of using ACE inhibitors early in pregnancy. Adverse events of antidepressants and steroids were examined for children and adolescents as well. Other CERTs research aimed to determine how often dosing errors occur when medicines are prescribed (for pediatric medicines or for treating gout). Research on safe prescribing dealt with computerized alert systems, including those on PDAs (personal digital assistants) and in drug alert systems in pharmacies. In addition, CERTs research addressed optimal prescribing in situations where pretesting of patients is needed to avoid adverse consequences, such as TB testing in association with prescribing infliximab, a medication for rheumatoid arthritis and Crohn's disease. Pretesting can determine whether patients are harboring latent TB infection that could be activated by use of the medicine.

As always, AHRQ is focused on the needs of consumers. One CERTs study evaluated the quality of online consumer drug information and provided a list of recommended sites providing free information. And, while it is important that medicines be prescribed appropriately, it is also important that patients take their prescribed medicines as directed, a subject examined this year in relation to medicines for myocardial infarction, heart failure, and osteoporosis. Likewise, the CERTs examined methods of patient education to increase adherence to statins (which help prevent heart attacks and strokes.)

With the addition of four new CERTs research centers in 2006, we look forward to even greater productivity and impact of the CERTs Program.

Carolyn M. Clancy, M.D.
Director

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