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Atkins N, Mukhida K. The relationship between patients’ income and education and their access to pharmacological chronic pain management: A scoping review. Can J Pain 2022; 6:142-170. [PMID: 36092247 PMCID: PMC9450907 DOI: 10.1080/24740527.2022.2104699] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Nicole Atkins
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karim Mukhida
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Won S, Cho SK, Kim D, Han M, Lee J, Jang EJ, Sung YK, Bae SC. Update on the prevalence and incidence of rheumatoid arthritis in Korea and an analysis of medical care and drug utilization. Rheumatol Int 2018; 38:649-656. [DOI: 10.1007/s00296-017-3925-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/29/2017] [Indexed: 02/04/2023]
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Pieringer H, Hintenberger R, Pohanka E, Steinwender C, Meier J, Gruber F, Auer-Hackenberg L. RABBIT risk score and ICU admission due to infection in patients with rheumatoid arthritis. Clin Rheumatol 2017; 36:2439-2445. [PMID: 28905133 DOI: 10.1007/s10067-017-3825-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/30/2017] [Accepted: 09/04/2017] [Indexed: 01/26/2023]
Abstract
Rheumatoid arthritis (RA) patients are at increased risk of infection. Aim of the present study was to investigate whether RA patients admitted to an intensive care unit (ICU) due to infection have higher Rheumatoid Arthritis Observation of Biologic Therapy (RABBIT) risk scores compared to control RA patients. Seventy-four RA patients (32.4% male) admitted to an ICU due to infection (from January 2002 to December 2013) and 74 frequency-matched control RA patients (16.2% male) were included in this cross-sectional study. There was strong evidence for a higher RABBIT risk score in ICU patients (median 2.0; IQR 1.3-3.2) as compared to controls (1.3; IQR 0.8-2.0; p < 0.0001). Traditional disease-modifying anti-rheumatic drugs (DMARDs) (82.4 vs 64.9%; p = 0.015) and biological DMARDs (28.4 vs 14.9%; p = 0.012) were more frequently given to RA patients without ICU admission. Glucocorticoid users were more frequently found in the ICU group (51.4 vs 31.1%; p = 0.012). In a multivariable analysis tDMARD use was associated with lower (OR 0.38; 95% CI 0.15-0.93; p = 0.034) and glucocorticoid use with borderline higher odds of ICU admission (OR 2.05; 95% CI 0.92-4.58; p = 0.078). Chronic obstructive pulmonary disease (OR 2.89; 95% CI 1.10-7.54; p = 0.03), chronic kidney disease (OR 16.08; 95% CI 2.00-129.48; p = 0.009), and age category (OR 2.67; 95% CI 1.46-4.87; p = 0.001) were strongly associated with ICU admission. There was a strong trend towards higher odds of ICU admission with increasing RABBIT risk score. Use of tDMARDs was associated with lower odds of ICU admission. In an adjusted analysis, bDMARDs were not associated with ICU admission. COPD, CKD, and age were strong risk factors for ICU admission.
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Affiliation(s)
- Herwig Pieringer
- Academic Research Unit, 2nd Department of Internal Medicine, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria. .,Paracelsus Private Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Rainer Hintenberger
- Academic Research Unit, 2nd Department of Internal Medicine, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
| | - Erich Pohanka
- Academic Research Unit, 2nd Department of Internal Medicine, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
| | - Clemens Steinwender
- Paracelsus Private Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.,1st Department of Internal Medicine, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
| | - Jens Meier
- Department of Anesthesiology and Operative Intensive Care Medicine, Kepler University Hospital Linz, Krankenhausstr. 9, Linz, Austria
| | - Franz Gruber
- Department of Neurology 2, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, Linz, Austria
| | - Lorenz Auer-Hackenberg
- Academic Research Unit, 2nd Department of Internal Medicine, Kepler University Hospital, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
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Hwang SH, Han S, Choi H, Park C, Kim SM, Kim TH. Trends in the prescription of benzodiazepines for the elderly in Korea. BMC Psychiatry 2017; 17:303. [PMID: 28830488 PMCID: PMC5567896 DOI: 10.1186/s12888-017-1467-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/14/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study examined trends in the prescription of benzodiazepines for the elderly (age over 65 years) in Korea, a country with a higher level of spending on pharmaceuticals compared to that in other Organization for Economic Cooperation and Development (OECD) countries, and identified factors related to the inappropriate use of such drugs. METHODS We used the National Health Insurance Claims Data (NHICD) for the period 2009-2013, including all reimbursed drug-prescribing information. Following the OECD's prescribing quality indicators (PQIs), we looked at the prevalence, quantities, durations, and inappropriate (long-term or high-quantity) use of benzodiazepines, some of the most widely prescribed, but potentially inappropriate, drugs for the elderly. We also performed multivariate logistic regression analyses to identify factors related to the inappropriate use of these drugs. RESULTS The annual prevalence of benzodiazepine prescribing for elderly subjects decreased slightly over time but remained high (37.9% in 2009 and 35.1% in 2013). There were also small decreases in the inappropriate long-term use of benzodiazepines over the five years, with a 0.6 decrease in the Defined Daily Dose and a 4.1 per 1,000 decreases in elderly user-days. The proportion of subjects using long-acting benzodiazepines also fell from 263.6 to 220.4 per 1,000 elderly patients. The regression analyses found that the inappropriate long-term use of benzodiazepines in the elderly was significantly related to the patients visiting several institutions and physicians prescribing more than 30 days' worth of medication. CONCLUSIONS The prevalence of prescribing potentially inappropriate drugs, such as benzodiazepines, remains high in Korea. Policy efforts, such as a periodic assessment of prescribing, restricting prescribing days, and more practical guidelines, are needed to improve the quality of prescribing.
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Affiliation(s)
- Soo-Hee Hwang
- 0000 0004 0647 5429grid.467842.bHealth Insurance Review and Assessment Service (HIRA), Wonju, Republic of Korea
| | - Seungjin Han
- 0000 0004 0647 5429grid.467842.bHealth Insurance Review and Assessment Service (HIRA), Wonju, Republic of Korea
| | - Hyojung Choi
- 0000 0004 0647 5429grid.467842.bHealth Insurance Review and Assessment Service (HIRA), Wonju, Republic of Korea
| | - Choonseon Park
- 0000 0004 0647 5429grid.467842.bHealth Insurance Review and Assessment Service (HIRA), Wonju, Republic of Korea
| | - Sun Min Kim
- 0000 0004 0647 5429grid.467842.bHealth Insurance Review and Assessment Service (HIRA), Wonju, Republic of Korea
| | - Tae Hyun Kim
- Department of Hospital Administration, Graduate School of Public Health, Institute of Health Services Research, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, 03711, Seoul, Republic of Korea.
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Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance. Drugs Aging 2017; 33:387-98. [PMID: 27154398 DOI: 10.1007/s40266-016-0374-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The population of older individuals with rheumatoid arthritis (RA) is rapidly expanding, mainly due to increased life expectancy. While targeted biological therapies are well established for the treatment of this disease, their use may be lower in older patients (age > 65 years) and very old patients (age > 75 years) as a result of perceived higher risks for adverse events in this population, taking into account comorbidity, polypharmacy, and frailty. In this review, we discuss the available evidence for the use of biological therapies in this growing patient group with specific attention towards the eventual reasons for biological treatment failure or withdrawal. The majority of data is found in secondary analyses of clinical trials and in retrospective cohorts. The most information available is on tumor necrosis factor (TNF) blockers. Older patients seem to have a less robust response to anti-TNF agents than a younger population, but drug survival as a proxy for efficacy does not seem to be influenced by age. Despite an overall rate of adverse effects comparable to that in younger patients, older RA patients are at higher risk of serious infections. Other biologics appear to have an efficacy similar to anti-TNF agents, also in older RA patients. Again, the drug survival rates for tocilizumab, rituximab, and abatacept resemble those in young RA patients with good general tolerability and safety profiles. The cardiovascular risk and the risk of cancer, increased in RA patients and in the older RA patients, do not appear to be strongly influenced by biologicals.
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Salway SM, Payne N, Rimmer M, Buckner S, Jordan H, Adams J, Walters K, Sowden SL, Forrest L, Sharp L, Hidajat M, White M, Ben-Shlomo Y. Identifying inequitable healthcare in older people: systematic review of current research practice. Int J Equity Health 2017; 16:123. [PMID: 28697768 PMCID: PMC5505033 DOI: 10.1186/s12939-017-0605-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/13/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is growing consensus on the importance of identifying age-related inequities in the receipt of public health and healthcare interventions, but concerns regarding conceptual and methodological rigour in this area of research. Establishing age inequity in receipt requires evidence of a difference that is not an artefact of poor measurement of need or receipt; is not warranted on the grounds of patient preference or clinical safety; and is judged to be unfair. METHOD A systematic, thematic literature review was undertaken with the objective of characterising recent research approaches. Studies were eligible if the population was in a country within the Organisation for Economic Co-operation and Development and analyses included an explicit focus on age-related patterns of healthcare receipt including those 60 years or older. A structured extraction template was applied. Extracted material was synthesised in thematic memos. A set of categorical codes were then defined and applied to produce summary counts across key dimensions. This process was iterative to allow reconciliation of discrepancies and ensure reliability. RESULTS Forty nine studies met the eligibility criteria. A wide variety of concepts, terms and methodologies were used across these studies. Thirty five studies employed multivariable techniques to produce adjusted receipt-need ratios, though few clearly articulated their rationale, indicating the need for great conceptual clarity. Eighteen studies made reference to patient preference as a relevant consideration, but just one incorporated any kind of adjustment for this factor. Twenty five studies discussed effectiveness among older adults, with fourteen raising the possibility of differential effectiveness, and one differential cost-effectiveness, by age. Just three studies made explicit reference to the ethical nature of healthcare resource allocation by age. While many authors presented suitably cautious conclusions, some appeared to over-stretch their findings concluding that observed differences were 'inequitable'. Limitations include possible biases in the retrieved material due to inconsistent database indexing and a focus on OECD country populations and studies with English titles. CONCLUSIONS Caution is needed among clinicians and other evidence-users in accepting claims of healthcare 'ageism' in some published papers. Principles for improved research practice are proposed.
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Affiliation(s)
- Sarah M. Salway
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Nick Payne
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Melanie Rimmer
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Stefanie Buckner
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
| | - Hannah Jordan
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, CB2 0QQ UK
| | - Kate Walters
- Centre for Ageing & Population Studies, Department of Primary Care & Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Sarah L. Sowden
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon, Tyne NE2 4AX UK
| | - Lynne Forrest
- Administrative Data Research Centre, University of Edinburgh, Edinburgh Bioquarter, 9 Little France Road, Edinburgh, EH16 4UX UK
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon, Tyne NE2 4AX UK
| | - Mira Hidajat
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, CB2 0QQ UK
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon, Tyne NE2 4AX UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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Zayas CE, He Z, Yuan J, Maldonado-Molina M, Hogan W, Modave F, Guo Y, Bian J. Examining Healthcare Utilization Patterns of Elderly Middle-Aged Adults in the United States. PROCEEDINGS OF THE ... INTERNATIONAL FLORIDA AI RESEARCH SOCIETY CONFERENCE. FLORIDA AI RESEARCH SYMPOSIUM 2016; 2016:361-366. [PMID: 27430035 PMCID: PMC4946167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Elderly patients, aged 65 or older, make up 13.5% of the U.S. population, but represent 45.2% of the top 10% of healthcare utilizers, in terms of expenditures. Middle-aged Americans, aged 45 to 64 make up another 37.0% of that category. Given the high demand for healthcare services by the aforementioned population, it is important to identify high-cost users of healthcare systems and, more importantly, ineffective utilization patterns to highlight where targeted interventions could be placed to improve care delivery. In this work, we present a novel multi-level framework applying machine learning (ML) methods (i.e., random forest regression and hierarchical clustering) to group patients with similar utilization profiles into clusters. We use a vector space model to characterize a patient's utilization profile as the number of visits to different care providers and prescribed medications. We applied the proposed methods using the 2013 Medical Expenditures Panel Survey (MEPS) dataset. We identified clusters of healthcare utilization patterns of elderly and middle-aged adults in the United States, and assessed the general and clinical characteristics associated with these utilization patterns. Our results demonstrate the effectiveness of the proposed framework to model healthcare utilization patterns. Understanding of these patterns can be used to guide healthcare policy-making and practice.
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Affiliation(s)
- Cilia E. Zayas
- Health Outcomes and Policy, University of Florida, Gainesville, FL
| | - Zhe He
- School of Information, Florida State University, Tallahassee, FL
| | - Jiawei Yuan
- Department of ECSSE, Embry-Riddle Aeronautical University, Daytona Beach, FL
| | | | - William Hogan
- Health Outcomes and Policy, University of Florida, Gainesville, FL
| | - François Modave
- Health Outcomes and Policy, University of Florida, Gainesville, FL
| | - Yi Guo
- Health Outcomes and Policy, University of Florida, Gainesville, FL
| | - Jiang Bian
- Health Outcomes and Policy, University of Florida, Gainesville, FL
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Waljee J, Zhong L, Baser O, Yuce H, Fox DA, Chung KC. The incidence of upper and lower extremity surgery for rheumatoid arthritis among Medicare beneficiaries. J Bone Joint Surg Am 2015; 97:403-10. [PMID: 25740031 PMCID: PMC4344595 DOI: 10.2106/jbjs.n.00802] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND For elderly patients with rheumatoid arthritis, aggressive immunosuppression can be difficult to tolerate, and surgery remains an important treatment option for joint pain and deformity. We sought to examine the epidemiology of surgical reconstruction for rheumatoid arthritis among older individuals who were newly diagnosed with the disorder. METHODS We identified a 5% random sample of Medicare beneficiaries (sixty-six years of age and older) newly diagnosed with rheumatoid arthritis from 2000 to 2005, and followed these patients longitudinally for a mean of 4.6 years. We used univariate analysis to compare the time from the diagnosis of rheumatoid arthritis to the first operation among the 360 patients who underwent surgery during the study period. RESULTS In our study cohort, 589 procedures were performed among 360 patients, and 132 patients (37%) underwent multiple procedures. The rate of upper extremity reconstruction was 0.9%, the rate of lower extremity reconstruction was 1.2%, and knee arthroplasty was the most common procedure performed initially (31%) and overall (29%). Upper extremity procedures were performed sooner than lower extremity procedures (fourteen versus twenty-five months; p = 0.02). In multivariable analysis, surgery rates declined with age for upper and lower extremity procedures (p < 0.001). CONCLUSIONS Knee replacement remains the most common initial procedure among patients with rheumatoid arthritis. However, upper extremity procedures are performed earlier than lower extremity procedures. Understanding the patient and provider factors that underlie variation in procedure rates can inform future strategies to improve the delivery of care to patients with rheumatoid arthritis.
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Affiliation(s)
- Jennifer Waljee
- Section of Plastic Surgery, Department of Surgery (J.W., L.Z., and K.C.C.), and Department of Internal Medicine (O.B. and D.A.F.), University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340. E-mail address for K.C. Chung:
| | - Lin Zhong
- Section of Plastic Surgery, Department of Surgery (J.W., L.Z., and K.C.C.), and Department of Internal Medicine (O.B. and D.A.F.), University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340. E-mail address for K.C. Chung:
| | - Onur Baser
- Section of Plastic Surgery, Department of Surgery (J.W., L.Z., and K.C.C.), and Department of Internal Medicine (O.B. and D.A.F.), University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340. E-mail address for K.C. Chung:
| | - Huseyin Yuce
- Department of Mathematics, New York City College of Technology, 300 Jay Street, N826, Brooklyn, NY 11201
| | - David A. Fox
- Section of Plastic Surgery, Department of Surgery (J.W., L.Z., and K.C.C.), and Department of Internal Medicine (O.B. and D.A.F.), University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340. E-mail address for K.C. Chung:
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery (J.W., L.Z., and K.C.C.), and Department of Internal Medicine (O.B. and D.A.F.), University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340. E-mail address for K.C. Chung:
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