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Horn A, Adgent MA, Osmundson SS, Wiese AD, Phillips SE, Patrick SW, Griffin MR, Grijalva CG. Risk of Death at 1 Year Following Postpartum Opioid Exposure. Am J Perinatol 2024; 41:949-960. [PMID: 35640619 PMCID: PMC9708936 DOI: 10.1055/s-0042-1745848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Opioids are commonly prescribed to women for acute pain following childbirth. Postpartum prescription opioid exposure is associated with adverse opioid-related morbidities but the association with all-cause mortality is not well studied. This study aimed to examine the association between postpartum opioid prescription fills and the 1-year risk of all-cause mortality among women with live births. METHODS In a retrospective cohort study of live births among women enrolled in Tennessee Medicaid (TennCare) between 2007 and 2015, we compared women who filled two or more postpartum outpatient opioid prescriptions (up to 41 days of postdelivery discharge) to women who filled one or fewer opioid prescription. Women were followed from day 42 postdelivery discharge through 365 days of follow-up or date of death. Deaths were identified using linked death certificates (2007-2016). We used Cox's proportional hazard regression and inverse probability of treatment weights to compare time to death between exposure groups while adjusting for relevant confounders. We also examined effect modification by delivery route, race, opioid use disorder, use of benzodiazepines, and mental health condition diagnosis. RESULTS Among 264,135 eligible births, 216,762 (82.1%) had one or fewer maternal postpartum opioid fills and 47,373 (17.9%) had two or more fills. There were 182 deaths during follow-up. The mortality rate was higher in women with two or more fills (120.5 per 100,000 person-years) than in those with one or fewer (57.7 per 100,000 person-years). The risk of maternal death remained higher in participants exposed to two or more opioid fills after accounting for relevant covariates using inverse probability of treatment weighting (adjusted hazard ratio: 1.46 [95% confidence interval: 1.01, 2.09]). Findings from stratified analyses were consistent with main findings. CONCLUSION Filling two or more opioid prescriptions during the postpartum period was associated with a significant increase in 1-year risk of death among new mothers. KEY POINTS · Opioid prescribing in the postpartum period is common.. · Prior studies show that >1 postnatal opioid fill is associated with adverse opioid-related events.. · > 1 opioid fill within 42 days of delivery was associated with an increase in 1-year risk of death..
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Affiliation(s)
- Arlyn Horn
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Margaret A. Adgent
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah S. Osmundson
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew D. Wiese
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Sharon E. Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Stephen W. Patrick
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Marie R. Griffin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Veterans’ Health Administration Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Nashville, TN
| | - Carlos G. Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Veterans’ Health Administration Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Nashville, TN
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Patel KJ, Yang D, Best JR, Chambers C, Lee PE, Henri‐Bhargava A, Funnell CR, Foti DJ, Pettersen JA, Feldman HH, Nygaard HB, Hsiung GR, DeMarco ML. Clinical value of Alzheimer's disease biomarker testing. Alzheimers Dement (N Y) 2024; 10:e12464. [PMID: 38596484 PMCID: PMC10999950 DOI: 10.1002/trc2.12464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION In the Investigating the Impact of Alzheimer's Disease Diagnostics in British Columbia (IMPACT-AD BC) study, we aimed to understand how Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarker testing-used in medical care-impacted medical decision-making (medical utility), personal decision-making (personal utility), and health system economics. METHODS The study was designed as an observational, longitudinal cohort study. A total of 149 patients were enrolled between February 2019 and July 2021. Patients referred to memory clinics were approached to participate if their dementia specialist ordered AD CSF biomarker testing as part of their routine medical care, and the clinical scenario met the appropriate use criteria for lumbar puncture and AD CSF biomarker testing. For the medical utility pillar, detailed clinical management plans were collected via physician questionnaires pre- and post-biomarker disclosure. RESULTS Patients with completed management questionnaires (n = 142) had a median age of 64 (interquartile range: 59-69) years, 48% were female, and 60% had CSF biomarker profiles on the AD continuum. Clinical management changed in 89.4% of cases. AD biomarker testing was associated with decreased need for other diagnostic procedures, including brain imaging (-52.0%) and detailed neuropsychological assessments (-63.2%), increased referrals and counseling (57.0%), and guided AD-related drug prescriptions (+88.4% and -50.0% in biomarker-positive and -negative cases, respectively). DISCUSSION AD biomarker testing was associated with significant and positive changes in clinical management, including decreased health care resource use, therapy optimization, and increased patient and family member counseling. While certain changes in management were linked to the AD biomarker profile (e.g., referral to clinical trials), the majority of changes were independent of baseline clinical presentation and level of cognitive impairment, demonstrating a broad value for AD biomarker testing in individuals meeting the appropriate use criteria for testing.
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Affiliation(s)
- Khushbu J. Patel
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverCanada
| | - David Yang
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverCanada
| | - John R. Best
- Gerontology Research CentreSimon Fraser UniversityVancouverCanada
| | - Colleen Chambers
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverCanada
| | - Philip E. Lee
- Division of NeurologyDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- Djavad Mowafaghian Centre for Brain HealthDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- UBC Hospital Clinic for Alzheimer Disease and Related DisordersUniversity of British ColumbiaVancouverCanada
| | - Alexandre Henri‐Bhargava
- Division of NeurologyDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- Division of Medical SciencesUniversity of VictoriaVictoriaCanada
| | - Clark R. Funnell
- Division of NeurologyDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- Djavad Mowafaghian Centre for Brain HealthDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- UBC Hospital Clinic for Alzheimer Disease and Related DisordersUniversity of British ColumbiaVancouverCanada
| | - Dean J. Foti
- Division of NeurologyDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- Djavad Mowafaghian Centre for Brain HealthDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- UBC Hospital Clinic for Alzheimer Disease and Related DisordersUniversity of British ColumbiaVancouverCanada
| | - Jacqueline A. Pettersen
- Division of NeurologyDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- Division of Medical SciencesUniversity of Northern British ColumbiaPrince GeorgeCanada
| | - Howard H. Feldman
- Department of NeurosciencesUniversity of California San DiegoSan DiegoCaliforniaUSA
- Alzheimer Disease Cooperative StudyUniversity of California San DiegoSan DiegoCaliforniaUSA
- Alzheimer's and Related Neurodegenerative ResearchUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Haakon B. Nygaard
- Division of NeurologyDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- Djavad Mowafaghian Centre for Brain HealthDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- UBC Hospital Clinic for Alzheimer Disease and Related DisordersUniversity of British ColumbiaVancouverCanada
| | - Ging‐Yuek R. Hsiung
- Division of NeurologyDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- Djavad Mowafaghian Centre for Brain HealthDepartment of MedicineUniversity of British ColumbiaVancouverCanada
- UBC Hospital Clinic for Alzheimer Disease and Related DisordersUniversity of British ColumbiaVancouverCanada
| | - Mari L. DeMarco
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverCanada
- Department of Pathology and Laboratory MedicineSt. Paul's HospitalProvidence Health CareVancouverCanada
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Menzies-Gow AN, Tran TN, Stanley B, Carter VA, Smolen JS, Bourdin A, Fitzgerald JM, Raine T, Chapaneri J, Emmanuel B, Jackson DJ, Price DB. Trends in Systemic Glucocorticoid Utilization in the United Kingdom from 1990 to 2019: A Population-Based, Serial Cross-Sectional Analysis. Pragmat Obs Res 2024; 15:53-64. [PMID: 38505738 PMCID: PMC10949995 DOI: 10.2147/por.s442959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/23/2024] [Indexed: 03/21/2024] Open
Abstract
Purpose Associations between systemic glucocorticoid (SGC) exposure and risk for adverse outcomes have spurred a move toward steroid-sparing treatment strategies. Real-world changes in SGC exposure over time, after the introduction of steroid-sparing treatment strategies, reveal areas of successful risk mitigation as well as unmet needs. Patients and Methods A population-based ecological study was performed from the Optimum Patient Care Research Database to describe SGC prescribing trends of steroid-sparing treatment strategies in primary care practices before and after licensure of biologics in the United Kingdom from 1990 to 2019. Each analysis year included patients aged ≥5 years who were registered for ≥1 year with a participating primary care practice. The primary analysis was SGC exposure, defined as total cumulative SGC dose per patient per year, for asthma, severe asthma, chronic obstructive pulmonary disease (COPD), nasal polyps, Crohn's disease, rheumatoid arthritis, ulcerative colitis, and systemic lupus erythematosus. Secondary outcomes were percentages of patients prescribed SGCs and number of SGC prescriptions per patient per year. Results The number of patients who met study inclusion criteria ranged from 219,862 (1990) to 1,261,550 (2019). At the population level, patients with asthma or COPD accounted for 67.7% to 73.2% of patients per year with an SGC prescription. Over three decades, decreases in SGC total yearly dose ≥1000 mg have been achieved in multiple conditions. Patients with COPD prescribed SGCs increased from 5.8% (1990) to 34.8% (2017). SGC prescribing trends for severe asthma, Crohn's disease, and ulcerative colitis show decreased prescribing trends after the introduction of biologics. Conclusion Decreases in total yearly SGC doses have been shown in multiple conditions; however, for conditions such as severe asthma and COPD, an unmet need remains for increased awareness of SGC burden and the adoption or development of SGC-sparing alternatives to reduce overuse.
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Affiliation(s)
- Andrew N Menzies-Gow
- Royal Brompton and Harefield Hospitals, Guys & St Thomas’ NHS Foundation Trust, London, UK
- AstraZeneca, Cambridge, UK
| | | | | | | | | | - Arnaud Bourdin
- Université de Montpellier, CHU Montpellier, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - J Mark Fitzgerald
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim Raine
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
| | | | | | - David J Jackson
- Guy’s Severe Asthma Centre, Guy’s & St Thomas’ NHS Trust, London, UK
- School of Immunology & Microbial Sciences, King’s College London, London, UK
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Rodríguez-Cano R, Lotre K, von Soest T, Rognli EB, Bramness JG. Loneliness in adolescence and prescription of psychotropic drugs in adulthood: 23-year longitudinal population-based and registry study. BJPsych Open 2024; 10:e61. [PMID: 38465662 PMCID: PMC10951847 DOI: 10.1192/bjo.2024.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The role of adolescent loneliness in adult mental health and prescriptions of psychotropic drugs remains underexplored. AIMS We aim to determine whether (a) experiencing loneliness in adolescence and (b) changes in loneliness from adolescence to adulthood are prospectively associated with prescriptions for a variety of psychotropic drugs in adulthood. METHOD We used data from a Norwegian population-based sample with 2602 participants, collected across four waves between 1992 and 2006. Loneliness was assessed at each wave, with survey data linked to medicinal drug prescription records from the Norwegian Prescription Database. We identified prescription histories of antipsychotics, mood stabilisers, antidepressants and benzodiazepines from 2007 to 2015, for each participant. We use latent growth curve analyses to model the relationship of adolescent loneliness and loneliness change from adolescence to adulthood, with subsequent psychotropic drugs prescription. RESULTS Adolescents with heightened loneliness, and adolescents whose loneliness increased into young adulthood, had a greater likelihood of being prescribed antipsychotics, mood stabilisers and antidepressants in adulthood. These associations remained significant after adjustment for confounders such as sociodemographic characteristics, conduct problems, substance use and mental health problems. CONCLUSIONS Loneliness in adolescence and its adverse development over a span of 15 years was linked to higher risk of receiving prescriptions for antipsychotics, mood stabilisers and antidepressants later in life. The findings may indicate that loneliness increases the risk for developing psychotic disorders, bipolar disorders and major depression.
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Affiliation(s)
- Rubén Rodríguez-Cano
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Norway; and PROMENTA Research Center, Department of Psychology, University of Oslo, Norway
| | - Karianne Lotre
- Institute for Clinical Medicine, UiT – The Arctic University of Norway, Norway
| | - Tilmann von Soest
- PROMENTA Research Center, Department of Psychology, University of Oslo, Norway; and Norwegian Social Research (NOVA), OsloMet – Oslo Metropolitan University, Norway
| | - Eline Borger Rognli
- Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Jørgen Gustav Bramness
- Institute for Clinical Medicine, UiT – The Arctic University of Norway, Norway; Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Trondheim, Norway; and Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway
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Schloegel V, Harris L, Harris A, Dropkin B. Evaluation of Potential Urologic Prescription Drug Savings With Mark Cuban Cost Plus Drug Company. Urol Pract 2024; 11:276-282. [PMID: 38377158 DOI: 10.1097/upj.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/01/2023] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Mark Cuban Cost Plus Drug Company (MCCPDC) launched in 2022 with a goal to decrease prescription drug costs. Thus far, research has focused on possible savings if Medicare purchased its annual volume of drugs at MCCPDC prices. The aim of this study is to analyze if MCCPDC can offer savings directly to urologic patients compared with other mail-order pharmacies, local pharmacies, and with patients using health insurance. METHODS Twelve drugs used to treat urological diseases available on MCCPDC were analyzed. Pricing data of 30-tab and 90-tab prescriptions from MCCPDC, other mail-order pharmacies, and local in-person pharmacies near our zip code 40508 (Lexington, Kentucky) were compiled. To compare if MCCPDC could offer savings to patients using health insurance to fill their prescriptions, out-of-pocket drug costs for patients from the 2020 and 2021 Medical Expenditure Panel Survey and the 2021 Medicare Part D spending data were extracted. RESULTS Greater savings at MCCPDC were found at 90-tab prescriptions, but overall variability in prices existed. When comparing without health insurance, 9 of 12 drugs at MCCPDC were cheaper at 90 tabs with solifenacin and tadalafil saving $20 and $12 per prescription. When considering patients using insurance, abiraterone, sildenafil, and tadalafil offered savings on out-of-pocket costs at 30- and 90-tab prescriptions. CONCLUSIONS MCCPDC may offer cheaper prices for patients filling urologic medications, especially at 90-tab prescriptions. This study is the first to show patients could save money using MCCPDC and has implications for physician counseling when prescribing common urologic drugs.
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Affiliation(s)
- Van Schloegel
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Loyall Harris
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Andrew Harris
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - Benjamin Dropkin
- Department of Urology, University of Kentucky, Lexington, Kentucky
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Jackson AB, Lewis M, Meek R, Kim-Blackmore J, Khan I, Deng Y, Vallejo J, Egerton-Warburton D. Regular Medications in the Emergency Department Short Stay Unit (ReMedIES): Can Prescribing be Improved Without Increasing Resources? Hosp Pharm 2024; 59:110-117. [PMID: 38223859 PMCID: PMC10786055 DOI: 10.1177/00185787231194999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Background: Hospital medication errors are frequent and may result in adverse events. Data on non-prescription of regular medications to emergency department short stay unit patients is lacking. In response to local reports of regular medication omissions, a multi-disciplinary team was tasked to introduce corrective emergency department (ED) process changes, but with no additional financing or resources. Aim: To reduce the rate of non-prescription of regular medications for patients admitted to the ED Short Stay Unit (SSU), through process change within existing resource constraints. Methods: A pre- and post-intervention observational study compared regular medication omission rates for patients admitted to the ED SSU. Included patients were those who usually took regular home medications at 08:00 or 20:00. Omissions were classified as clinically significant medications (CSMs) or non-clinically significant medications (non-CSMs). The intervention included reinforcement that the initially treating acute ED doctor was responsible for prescription completion, formal checking of prescription presence at SSU handover rounds, double-checking of prescription completeness by the overnight SSU lead nurse and junior doctor, and ED pharmacist medication reconciliation for those still identified as having regular medication non-prescription at 07:30. Results: For the 110 and 106 patients in the pre- and post-intervention periods, there was a non-significant reduction in the CSM omission rate of -11% (95% CI: -23 to 2), from 41% (95% CI: 32-50) to 30% (95% CI: 21-39). Conclusion: Non-prescription of regular CSMs for SSU patients was not significantly reduced by institution of work practice changes within existing resource constraints.
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Affiliation(s)
- Aidan B. Jackson
- St Vincent’s Hospital Melbourne, Fitzroy, Melbourne, VIC, Australia
| | - Mark Lewis
- Monash Health, Melbourne, VIC, Australia
| | - Robert Meek
- Monash Health, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | | | - Irim Khan
- Monash Health, Melbourne, VIC, Australia
| | - Yong Deng
- Monash Health, Melbourne, VIC, Australia
- University of Melbourne, Parkville, VIC, Australia
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Jensen MLV, Aabenhus RM, Holzknecht BJ, Bjerrum L, Siersma V, COrdoba G, Jensen JN. Sociodemographic characterisation of antibiotic heavy users in the Danish elderly population. Scand J Public Health 2024; 52:31-38. [PMID: 36076357 DOI: 10.1177/14034948221119638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The development of effective interventions to reduce inappropriate use of antibiotics in the elderly population requires knowledge on who can benefit from such interventions. Thus, we aimed to identify and characterise antibiotic heavy users among elderly patients in general practice with respect to sociodemographic variables. METHODS We conducted a retrospective nationwide register-based study on all Danish elderly citizens (⩾65 years) who redeemed an antibiotic prescription in 2017. Heavy users were defined as the 10% with the highest excess use, that is, their recorded use minus the average use for their sex, age group and comorbidity level as estimated from a linear regression model. Comparative analyses of sociodemographic characteristics (civil status, employment status, urbanity, educational level and country of origin) of heavy users and non-heavy users were performed using logistic regression models. RESULTS The study population consisted of 251,733 elderly individuals, who in total redeemed 573,265 prescriptions of antibiotics. Heavy users accounted for 68% of all excess use of antibiotics. In multivariable analyses, individuals with an educational level above basic schooling, non-retired, residing in an urban municipality and being born in a country outside Scandinavia all had lower odds of being a heavy user. Widowed, divorced or single individuals had higher odds of being a heavy user compared with married individuals. Relative importance analyses showed that civil status and educational level contributed considerably to the explained variance. CONCLUSIONS This study found an association between sociodemographic characteristics and risk of being a heavy user, indicating that sociodemographic variation exists with regard to antibiotic prescribing.
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Affiliation(s)
- Maria L V Jensen
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark
- The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Denmark
| | - Rune M Aabenhus
- The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Denmark
| | - Barbara J Holzknecht
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Lars Bjerrum
- The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Denmark
| | - Gloria COrdoba
- The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Denmark
| | - Jette N Jensen
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark
- Capital Region Committee for the Prevention of Hospital Infections, Copenhagen, Denmark
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Nokhodian Z, Boroumandfar Z, Rostami S, Ataei B. Overuse of Antibiotics: Who is to Blame? A Qualitative Study. Int J Prev Med 2024; 14:133. [PMID: 38449691 PMCID: PMC10916410 DOI: 10.4103/ijpvm.ijpvm_287_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 05/17/2023] [Indexed: 03/08/2024] Open
Abstract
Background The irrational use of antibiotics seriously threatens global health. Clinicians undoubtedly play an essential role in consuming antibiotics in hospitals and communities, and their attitudes may help the health system's optimal treatment of antibiotics. In this study, we reported clinicians' experiences with antibiotics used in Isfahan, Iran. Methods In a qualitative study conducted from October 2020 to March 2021, the experiences of 13 clinicians with different clinical specialties were collected through one-to-one interviews. Participants were selected through purposive sampling until data saturation; data collection was conducted through semi-structured interviews. Conventional content analysis was used to analyze the transcribed interviews. The main category was recognized and subcategorized and coded by three researchers. Results Eight women and five men with a mean work experience of 12.54 ± 10.047 years participated in the study. All of them worried about the overuse of antibiotics and antibiotic resistance. Clinicians believe that the antimicrobial stewardship committee is not active in our country. Laboratory challenges, healthcare providers, the poor performance of the health system, and marketing and business were the main categories of the study. Subcategrories of main categories included inefficiency in the function of laboratories, harmful profit, challenges in medical education, ups and downs of disease treatment, the unacceptable performance of hospitals, failure to upgrade the health system, threats and opportunities, and jobbery. Conclusions The participants of this study believed that excessive use of antibiotics is a serious challenge in our country. Physicians were concerned about antibiotic resistance and believed that the pattern of antibiotic resistance was not routinely reported. Therefore, in our region, we should make more efforts to collect data in this field and provide this information to physicians. Also, this study confirmed many obstacles to implementing the antimicrobial stewardship program, and the infrastructure needs strengthening. There is also a need for cultural changes and the views of physicians.
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Affiliation(s)
- Zary Nokhodian
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Boroumandfar
- Reproductive Science and Sexual Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Soodabeh Rostami
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrooz Ataei
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Mehrizi R, Golestani A, Malekpour MR, Karami H, Nasehi MM, Effatpanah M, Ranjbaran H, Shahali Z, Sari AA, Daroudi R. Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data. Front Public Health 2023; 11:1280434. [PMID: 38164450 PMCID: PMC10758044 DOI: 10.3389/fpubh.2023.1280434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Background Different medication prescription patterns have been associated with varying course of disease and outcomes in COVID-19. Health claims data is a rich source of information on disease treatment and outcomes. We aimed to investigate drug prescription patterns and their association with mortality and hospitalization via insurance data for a relatively long period of the pandemic in Iran. Methods We retrieved hospitalized patients' data from Iran Health Insurance Organization (IHIO) spanning 26 months (2020-2022) nationwide. Included were patients with ICD-10 codes U07.1/U07.2 for confirmed/suspected COVID-19. A case was defined as a single hospitalization event for an individual patient. Multiple hospitalizations of a patient within a 30-day interval were aggregated into a single case, while hospitalizations with intervals exceeding 30 days were treated as independent cases. The Anatomical Therapeutic Chemical (ATC) was used for medications classification. The two main study outcomes were general and intensive care unit (ICU) hospitalization periods and mortality. Besides, various demographic and clinical associate factors were analyzed to derive the associations with medication prescription patterns and study outcomes using accelerated failure time (AFT) and logistic regression models. Results During the 26 months of the study period, 1,113,678 admissions with COVID-19 diagnosis at hospitals working in company with IHIO were recorded. 917,198 cases were detected from the database, among which 51.91% were females and 48.09% were males. Among the main groups of medications, antithrombotics (55.84% [95% CI: 55.74-55.94]), corticosteroids (54.14% [54.04-54.24]), and antibiotics (42.22% [42.12-42.32]) were the top used medications among cases with COVID-19. Investigation of the duration of hospitalization based on main medication groups showed antithrombotics (adjusted median ratio = 0.94 [0.94-0.95]) were significantly associated with shorter periods of overall hospitalization. Also, antithrombotics (adjusted odds ratio = 0.74 [95%CI, 0.73-0.76]), corticosteroids (0.97 [0.95-0.99]), antivirals (0.82 [0.80-0.83]), and ACE inhibitor/ARB (0.79 [0.77-0.80]) were significantly associated with lower mortality. Conclusion Over 2 years of investigation, antithrombotics, corticosteroids, and antibiotics were the top medications for hospitalized patients with COVID-19. Trends in medication prescription varied based on various factors across the country. Medication prescriptions could potentially significantly impact the trends of mortality and hospitalization during epidemics, thereby affecting both health and economic burdens.
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Affiliation(s)
- Reza Mehrizi
- National Center for Health Insurance Research, Tehran, Iran
| | - Ali Golestani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Karami
- National Center for Health Insurance Research, Tehran, Iran
| | - Mohammad Mahdi Nasehi
- National Center for Health Insurance Research, Tehran, Iran
- Pediatric Neurology Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Effatpanah
- National Center for Health Insurance Research, Tehran, Iran
- School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ranjbaran
- National Center for Health Insurance Research, Tehran, Iran
- Immunogenetics Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Shahali
- National Center for Health Insurance Research, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Hasan W, Kennett J, Bentounsi Z, Amir-Ghasemi A, Jones H, Biggs T. Improving otitis externa management in secondary care through a standardised treatment algorithm. J Laryngol Otol 2023:1-6. [PMID: 38057288 DOI: 10.1017/s002221512300227x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Otitis externa is a common condition managed by junior doctor-led ENT clinics in secondary/tertiary care, but no national guidelines exist for presentations in these settings. The aim of this study was to implement a treatment algorithm to support junior doctors and improve otitis externa management. METHODS Baseline data were retrospectively collected for 16 weeks. A standardised otitis externa treatment algorithm was then implemented, and 16 weeks of data prospectively gathered. A second improvement cycle was completed thereafter focusing on topical antibiotics and water precaution advice. RESULTS Overall, 202 cases of otitis externa managed between November 2021 to October 2022 were reviewed. Following the interventions, topical antibiotic prescribing improved (p = 0.01) as well as the provision of water precaution advice (p < 0.01). Junior doctors trended towards reviewing patients more frequently but required less senior support. CONCLUSION Our treatment algorithm empowers junior doctors to become more independent in their management of otitis externa and improves overall otitis externa treatment.
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Affiliation(s)
- Waseem Hasan
- Department of Otolaryngology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Jessica Kennett
- Department of Otolaryngology, Portsmouth Hospital University NHS Trust, Portsmouth, UK
| | - Zineb Bentounsi
- Department of Otolaryngology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Aria Amir-Ghasemi
- Department of Otolaryngology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Huw Jones
- Department of Otolaryngology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Timothy Biggs
- Department of Otolaryngology, Portsmouth Hospital University NHS Trust, Portsmouth, UK
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11
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Wang GHM, Morris E, Vouri SM, Keshwani S, Schmidt S, Pepine CJ, Smith SM. Modifiable statin characteristics associated with potential statin-related prescribing cascades. Pharmacotherapy 2023; 43:1307-1316. [PMID: 37771303 DOI: 10.1002/phar.2883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/11/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
STUDY OBJECTIVE Clinicians may prescribe new medications (marker drug) to treat statin-related (index drug) adverse events, constituting a prescribing cascade. We aimed to identify modifiable statin characteristics (intensity and individual statin agents) associated with lower risk of prescribing cascades to inform clinical decisions in the presence of statin-related adverse events. DESIGN A secondary analysis based on our previous work, a high-throughput sequence symmetry analysis screening for potential statin-related prescribing cascades. DATA SOURCE MarketScan Commercial and Medicare Supplemental Insurance claims databases between 2005 and 2019. PATIENTS Adults who initiated a statin between 2007 and 2018, and who were continuously enrolled in the same healthcare plan for at least 720 days before and 360 days after statin initiation. INTERVENTION Among the previously identified 57 potential prescribing cascades, 42 statin-marker class dyad with a sample size of ≥ 500 were assessed in this study. MEASUREMENTS We measured patients' baseline characteristics within -360 days of statin initiation and reported by modifiable statin characteristics. We also performed logistic regression and reported the adjusted odds ratios (aOR) with 95% confidence intervals (CI) of modifiable statin characteristics after adjusting for baseline characteristics. MAIN RESULTS We identified 1,307,867 statin initiators who met the study criteria (21% elderly, 52% female). Compared with patients initiating low-intensity statins, those initiating moderate- or high-intensity statins had significantly greater odds to develop 29 (69%) prescribing cascades, including antidiabetic drugs such as dipeptidyl peptidase 4 (DPP-4) inhibitors (aOR 1.22; 95% CI, 1.11-1.35) and glucagon-like peptide-1 (GLP-1) analogs (aOR 1.31; 95% CI, 1.16-1.47), and opioids (aOR 1.18; 95% CI, 1.13-1.23). Individual statin agent selection also had a differential effect on 34 (81%) of the prescribing cascades. For example, compared with simvastatin initiators, the probability of initiating osmotically acting laxatives was significantly higher for lovastatin initiators (aOR 1.09; 95% CI, 1.03-1.15) and significantly lower in atorvastatin initiators (aOR 0.92; 95% CI, 0.89-0.94). CONCLUSION Compared with low-intensity statins, high-intensity statins are associated with increased risk in many potential prescribing cascades, while the choice of individual statin agents affects the risk of prescribing cascades bidirectionally.
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Affiliation(s)
- Grace Hsin-Min Wang
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Earl Morris
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
| | - Scott M Vouri
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
| | - Shailina Keshwani
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Stephan Schmidt
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Orlando, Florida, USA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, Florida, USA
| | - Steven M Smith
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, Florida, USA
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12
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Grimmsmann T, Himmel W. [Private Prescriptions In East And West Germany - A Secondary Data Analysis]. Gesundheitswesen 2023; 85:1213-1219. [PMID: 38081175 PMCID: PMC10713339 DOI: 10.1055/a-2160-2679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Benzodiazepines and Z-drugs are prescribed to a considerable extent as private prescription also for persons insured by a statutory health insurance (SHI), with formerly large differences between East and West Germany. The aim of the present study was to investigate whether these differences still exist today. METHOD This secondary data analysis used anonymized prescription data from general practitioners (GPs), community neurologists, and psychiatrists. SHI-insured patients with at least one prescription for a benzodiazepine or Z-substance between 2014 and 2020 were included. Differences between East and West Germany in the proportion of private prescriptions were the central outcome. Multiple regression analyses were performed to test whether the factors region (eastern vs. western Germany) and specialist group (GPs vs. neurologists/psychiatrists) were statistically significant predictors of the proportion of private prescriptions - taking into account the age and gender composition of patients in a practice. RESULTS From 867 practices, 2,200,446 prescriptions for Z-substances, benzodiazepine anxiolytics, and benzodiazepine hypnotics/sedatives were evaluated. More than 38% of these prescriptions were issued as private prescriptions: 53.6% in eastern Germany and 34.8% in western Germany. For Z-substances, the proportion of private prescriptions was particularly high (70.7% in eastern and 43.0% in western Germany). GPs issued private prescriptions far more frequently than neurologists and psychiatrists. The proportion of private prescriptions increased during the study period, comparatively strongly in the western states (from 33% to 39%) and slightly in the eastern states (from 53% to 54%). In the multivariate model, practice area (east/west) and specialist group were similarly strong predictors of the extent of private prescriptions, especially for Z-substances. CONCLUSION Contrary to a general alignment in life expectancy, morbidity risks, and health behaviour in East and West Germany, there is, despite convergence, still a significant difference in the proportion of private prescriptions for benzodiazepines and especially for Z-substances between the two regions. The groups of physicians who mainly prescribe these substances, namely neurologists and psychiatrists, on the one hand, and GPs, on the other, also differ considerably in the proportion of their private prescriptions for these substances.
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Affiliation(s)
- Thomas Grimmsmann
- Referat Arzneimittel und Methoden, Medizinischer Dienst
Mecklenburg-Vorpommern, Schwerin, Deutschland
| | - Wolfgang Himmel
- Institut für Allgemeinmedizin, Universitätsmedizin
Göttingen, Gottingen, Deutschland
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13
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Mokrzecki SM, Mallett A, Sen Gupta T, Perks S, Pain T. Do educational interventions improve prescribing skills of medical students compared to no additional learning? A systematic review. Med Educ Online 2023; 28:2259166. [PMID: 37722675 PMCID: PMC10512866 DOI: 10.1080/10872981.2023.2259166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/11/2023] [Indexed: 09/20/2023]
Abstract
Research suggests that medical students are not confident and may be ill-prepared to prescribe competently. Therefore, changes to standard education may be required to fortify medical student prescribing skills, confidence, and competence. However, specific education to write a safe and legal prescription is generally lacking. Furthermore, the term prescribe and the skill thereof is not clearly defined. This review compares additional education for medical students to no identified additional education or another educational modality on the skill of prescription writing. Secondary aims include review of education modalities, prescribing skill assessments, educator professional background, and timing of education within the medical curriculum. This systematic review was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Databases searched included: CINAHL, Cochrane Library, EMBASE, Emcare (Ovid), MEDLINE (Ovid), PubMed and Scopus. Search terms included: medical education, medical undergraduate, medical student, medical school, and prescriptions. The search was conducted in February 2023, and quantitative outcomes were reported. Of the 5197 citations identified, 12 met the inclusion criteria. Eleven studies reported significant improvements in prescribing skills of medical students after additional educational intervention(s). Various educational modalities were implemented, including case-based teaching (n=3), patient-based teaching (n=1), tutorial-based teaching (n=2), didactic teaching (n=1), and mixed methods (n=6). There were no commonalities in the professional background of the educator; however, five studies used faculty members. There was no consensus on the best assessment type and time to implement prescription writing education during medical training. There are a range of interventions to educate and assess prescribing competencies of medical students. Despite heterogenous study designs, there is evidence of the superiority of additional prescription writing education versus no identified additional education to develop prescription writing skills. The introduction of formal teaching and standardised assessment of prescribing skills for medical students is recommended.
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Affiliation(s)
- Sophie M. Mokrzecki
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Pharmacy Department, Townsville University Hospital, Townsville, Queensland, Australia
| | - Andrew Mallett
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Department of Renal Medicine, Townsville University Hospital, Townsville, Queensland, Australia
- Institute for Molecular Bioscience and Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Stephen Perks
- Pharmacy Department, Townsville University Hospital, Townsville, Queensland, Australia
| | - Tilley Pain
- Allied Health Governance Office, Townsville University Hospital, Townsville, Queensland, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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14
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Gagliotti C, Banchelli F, De Paoli A, Buttazzi R, Narne E, Ricchizzi E, Schievano E, Bellio S, Pitter G, Tonon M, Canziani LM, Rolli M, Tacconelli E, Berti E, Russo F, Moro ML. The incidence and risk factors of selected drug prescriptions and outpatient care after SARS-CoV-2 infection in low-risk subjects: a multicenter population-based cohort study. Front Public Health 2023; 11:1241401. [PMID: 37860802 PMCID: PMC10582710 DOI: 10.3389/fpubh.2023.1241401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023] Open
Abstract
Background Knowledge about the dynamics of transmission of SARS-CoV-2 and the clinical aspects of COVID-19 has steadily increased over time, although evidence of the determinants of disease severity and duration is still limited and mainly focused on older adult and fragile populations. Methods The present study was conceived and carried out in the Emilia-Romagna (E-R) and Veneto Regions, Italy, within the context of the EU's Horizon 2020 research project called ORCHESTRA (Connecting European Cohorts to increase common and effective response to SARS-CoV-2 pandemic) (www.orchestra-cohort.eu). The study has a multicenter retrospective population-based cohort design and aimed to investigate the incidence and risk factors of access to specific healthcare services (outpatient visits and diagnostics, drug prescriptions) during the post-acute phase from day-31 to day-365 after SARS-CoV-2 infection, in a healthy population at low risk of severe acute COVID-19. The study made use of previously recorded large-scale healthcare data available in the administrative databases of the two Italian Regions. The statistical analysis made use of methods for competing risks. Risk factors were assessed separately in the two Regions and results were pooled using random effects meta-analysis. Results There were 35,128 subjects in E-R and 88,881 in Veneto who were included in the data analysis. The outcome (access to selected health services) occurred in a high percentage of subjects in the post-acute phase (25% in E-R and 21% in Veneto). Outpatient care was observed more frequently than drug prescriptions (18% vs. 12% in E-R and 15% vs. 10% in Veneto). Risk factors associated with the outcome were female sex, age greater than 40 years, baseline risk of hospitalization and death, moderate to severe acute COVID-19, and acute extrapulmonary complications. Conclusion The outcome of interest may be considered as a proxy for long-term effects of COVID-19 needing clinical attention. Our data suggest that this outcome occurs in a substantial percentage of cases, even among a previously healthy population with low or mild severity of acute COVID-19. The study results provide useful insights into planning COVID-19-related services.
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Affiliation(s)
- Carlo Gagliotti
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | - Federico Banchelli
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | | | - Rossella Buttazzi
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | | | - Enrico Ricchizzi
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | | | | | | | - Michele Tonon
- Directorate of Prevention, Food Safety, and Veterinary Public Health, Venezia, Italy
| | | | - Maurizia Rolli
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | - Evelina Tacconelli
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elena Berti
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | - Francesca Russo
- Directorate of Prevention, Food Safety, and Veterinary Public Health, Venezia, Italy
| | - Maria Luisa Moro
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
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15
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Mitra B, Roman C, Wu B, Luckhoff C, Goubrial D, Amos T, Bannon-Murphy H, Huynh R, Dooley M, Smit DV, Cameron PA. Restriction of oxycodone in the emergency department (ROXY-ED): A randomised controlled trial. Br J Pain 2023; 17:491-500. [PMID: 38107754 PMCID: PMC10722107 DOI: 10.1177/20494637231189031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Background The prescription of opioids in emergency care has been associated with harm, including overdose and dependence. The aim of this trial was to assess restriction of access to oxycodone (ROXY), in combination with education and guideline modifications, versus education and guideline modifications alone (standard care) to reduce oxycodone administration in the Emergency Department (ED). Methods An unblinded, active control, randomised controlled trial was conducted in an adult tertiary ED. Participants were patients aged 18-75 years who had analgesics administered in the ED. The primary intervention was ROXY, through removal of all oxycodone immediate release tablets from the ED imprest, with availability of a small supply after senior clinician approval. The intervention did not restrict prescription of discharge medications. The primary outcome measure was oxycodone administration rates. Secondary outcomes were administration rates of other analgesic medications, time to initial analgesics and oxycodone prescription on discharge. Results There were 2258 patients eligible for analysis. Oxycodone was administered to 80 (6.1%) patients in the ROXY group and 221 (23.3%) patients in the standard care group (relative risk (RR) 0.26; 95% CI: 0.21 to 0.33; p < .001). Tapentadol was prescribed more frequently in the ROXY group (RR 2.17; 95% CI: 1.71-2.74), while there were no differences in prescription of other analgesic medications. On discharge, significantly fewer patients were prescribed oxycodone (RR 0.51; 95% CI: 0.39-0.66) and no differences were observed in prescription rates of other analgesic medications. There was no difference in time to first analgesic (HR 0.94; 95% CI: 0.86-1.02). Conclusions Restricted access to oxycodone was superior to education and guideline modifications alone for reducing oxycodone use in the ED and reducing discharge prescriptions of oxycodone from the ED. The addition of simple restrictive interventions is recommended to enable rapid changes to clinician behaviour to reduce the potential harm associated with the prescribing of oxycodone in the ED.
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Affiliation(s)
- Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Cristina Roman
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Bertha Wu
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Carl Luckhoff
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Diana Goubrial
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Timothy Amos
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Ronald Huynh
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Michael Dooley
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - De Villiers Smit
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter A. Cameron
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Qadhi OA, Albothi GK, Fallatah R, Anazi M, Al-Rawi MBA, Syed W. Navigating Health Literacy and Practices: A Cross-Sectional Study on Nursing Undergraduates in Riyadh, Saudi Arabia. Med Sci Monit 2023; 29:e941632. [PMID: 37751420 PMCID: PMC10541790 DOI: 10.12659/msm.941632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND This study aimed to assess the health literacy (HL) and health practices (HP) among nursing undergraduates at King Saud University in Riyadh, Saudi Arabia. MATERIAL AND METHODS A cross-sectional survey-based study was conducted in 2023 to assess how nursing students perceive HL and HP. HL is the ability of individuals to acquire, interpret, assess, and act on information to promote and maintain good health, while HP involves the application of knowledge and skills. HL was assessed using a total of 16 items, subdivided into 4 domains (understanding, evaluating, accessing, and utilizing health information) while HP was assessed using 11 items on a 5-point Likert scale. RESULTS In this study, 53.9% of the students were found to have poor HP, while 40.9% (n=166) reported moderate HP, and 5.2% (n=21) reported good HP. With regards to HL, 38.9% (n=158) of students were found to have good HL while 52.2% (n=212) reported moderate HL, and 8.9% (n=36) reported poor HL. The findings indicated that there was a relationship between age and HP, indicating that age is a major predictor of HP (P=0.001). Other comparisons, including year of study, income source, marital status, and the prevalence of chronic conditions, were discovered to have a significant relationship (P=0.001) with HP levels. CONCLUSIONS According to these findings, most students reported poor HP, while one-third claimed good HL. Therefore, there is a need to address the factors related to poor HP while also recommending methods to support good HP among students.
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Affiliation(s)
- Omaimah A. Qadhi
- Department of Medical-Surgical, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Gada Khalid Albothi
- Department of Medical-Surgical, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Reem Fallatah
- Department of Medical-Surgical, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Maryam Anazi
- Department of Medical-Surgical, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Mahmood Basil A. Al-Rawi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Wajid Syed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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17
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Santos LGD, Santos JGD, Iser BM, Kock KDS, Bó KD. Prescription of off-label and unlicensed medication for newborns hospitalized in the Intensive Care Unit. Rev Paul Pediatr 2023; 42:e2023023. [PMID: 37729244 PMCID: PMC10508043 DOI: 10.1590/1984-0462/2024/42/2023023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/05/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To analyze the prevalence of off-label and unlicensed prescriptions for a population of neonates admitted to the Neonatal Intensive Care Unit in a hospital in southern Santa Catarina. METHODS Observational study with a cross-sectional design. All neonates admitted to the Intensive Care Unit during the period from March 2020 to March 2021 were included. Data collection was performed through a questionnaire made by the authors and the classification of drugs based on the Electronic Drug Description (Bulário Eletrônico) of the Brazilian Health Regulatory Agency and Drug Dex-Micromedex. RESULTS Data from 296 neonates were evaluated. The prevalence was 50,7% for prescribing off-label medications and 37,2% for unlicensed medications. The use of drugs was higher in preterm neonates, with low birth weight, 1st minute Apgar between 6-8, 5th minute Apgar between 7-8, and in need of invasive procedures. The most used off-label drugs were ampicillin, gentamicin and fentanyl (92.6, 92.0 and 26.6%, respectively), whereas the most used unlicensed drugs were caffeine, phenobarbital and bromopride (78.1, 16.3 and 10.9%, respectively). CONCLUSIONS This study showed a large percentage of prescriptions made in the off-label (50.7%) and unlicensed (37.2%) form in the Neonatal Intensive Care Unit, corroborating the worrying world scenario. The most exposed neonates were precisely the most vulnerable ones and, among the most commonly prescribed medications, ampicillin and gentamicin stood out in off-label form and caffeine in unlicensed form.
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Affiliation(s)
| | | | | | | | - Karla Dal Bó
- Universidade do Sul de Santa Catarina, Tubarão, SC, Brazil
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18
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Kosteniuk JG, Morgan DG, Osman BA, Islam N, O’Connell ME, Kirk A, Quail JM, Osman M. Utilization of Health Services Before and After Diagnosis in a Specialist Rural and Remote Memory Clinic. Can Geriatr J 2023; 26:350-363. [PMID: 37662065 PMCID: PMC10444530 DOI: 10.5770/cgj.26.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Background Limited research exists on the use of specific health services over an extended time among rural persons with dementia. The study objective was to examine health service use over a 10-year period, five years before until five years after diagnosis in the specialist Rural and Remote Memory Clinic (RRMC). Methods Clinical and administrative health data of RRMC patients were linked. Annual health service utilization of the cohort (N = 436) was analyzed for 416 patients pre-index (57.5% female, mean age 71.2 years) and 419 post-index (56.3% female, mean age 70.8 years). Approximately 40% of memory clinic diagnoses were Alzheimer's disease (AD), 20% non-AD dementia, and 40% mild or subjective cognitive impairment or other condition. Post-index, 188 patients (44.9%) moved to permanent long-term care and were retained in the sample; 121 patients died (28.9%) and were removed yearly. Results Over the ten-year study period, a significant increase occurred in the average number of FP visits, all-type drug prescriptions, and dementia-specific drug prescriptions (all p <.001). The highest proportion of patients hospitalized was observed one year pre-index, the highest average number of specialist visits was observed one year post-index, and both demonstrated a significant decreasing trend in the five-year post-index period (p = .037). Conclusions A pattern of increasing FP visits and drug prescriptions over an extended period before and after diagnosis in a specialist rural and remote memory clinic highlights a need to support FPs in post-diagnostic management. Further research of longitudinal patterns in health service utilization is merited.
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Affiliation(s)
- Julie G. Kosteniuk
- Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, Saskatoon
| | - Debra G. Morgan
- Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, Saskatoon
| | - Beliz Acan Osman
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, Saskatoon
| | - Naorin Islam
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon
| | | | - Andrew Kirk
- Department of Medicine, University of Saskatchewan, Saskatoon
| | - Jacqueline M. Quail
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, Saskatoon
| | - Meric Osman
- Saskatchewan Medical Association, Saskatoon, SK, Canada
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Zheng M, Soumya, Begum M, Bernardo CDO, Stocks N, Jahan H, Gonzalez-Chica D. Do patients with prediabetes managed with metformin achieve better glycaemic control? A national study using primary care medical records. Diabet Med 2023; 40:e15170. [PMID: 37381113 DOI: 10.1111/dme.15170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 06/30/2023]
Abstract
AIMS To estimate the effectiveness of metformin on glycaemic parameters among participants with incident prediabetes attending Australian general practices. METHODS This retrospective cohort study used electronic health records of regular participants (3+ visits in two consecutive years) attending 383 Australian general practices (MedicineInsight). Participants with 'incident' prediabetes (newly recorded diagnosis between 2012 and 2017) and their glycaemic parameters (haemoglobin A1c [HbA1c] or fasting blood glucose [FBG]) at 6-, 12-, and 18-24 months post diagnosis (unexposed) or post-management with metformin (treatment) were identified from the database. We estimated the average treatment effect (ATE) of metformin management on glycaemic parameters using both linear regression and augmented inverse probability weighting. RESULTS Of the 4770 investigated participants with 'incident' prediabetes, 10.2% were managed with metformin. Participants on metformin had higher HbA1c levels at the baseline than those unexposed (mean 45 mmol/mol [6.2%] and 41 mmol/mol [5.9%], respectively), but no differences were observed at 6-12 months (mmol/mol ATE 0.0, 95% CI -0.4; 0.7) or 12-18 months (ATE -0.3, 95% CI -1.2; 0.3). However, participants on metformin had lower mean HbA1c mmol/mol at 18-24 months (ATE -1.1, 95% CI -2.0; 0.1) than those unexposed. Consistent results were observed for FBG (ATE at 6-12 months -0.14 [95% CI -0.25; -0.04], 12-18 months 0.02 [95% CI -0.08; 0.13] and 18-24 months -0.07 [95% CI -0.25; 0.12]). CONCLUSION The higher HbA1c and FBG baseline levels among participants with 'incident' prediabetes managed with metformin improved after 6-12 months of starting pharmacological management, and the effect persisted for up to 24 months. Management with metformin could prevent further deterioration of glycaemic levels.
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Affiliation(s)
- Mingyue Zheng
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Soumya
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mumtaz Begum
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carla De Oliveira Bernardo
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Habiba Jahan
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - David Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
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Batista AM, Gama ZADS, Hernández PJS, Souza D. Quality of prescription writing in Brazilian primary health care. Prim Health Care Res Dev 2023; 24:e49. [PMID: 37522367 PMCID: PMC10466202 DOI: 10.1017/s1463423623000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE To evaluate the quality of prescription writing in the context of public primary health care. BACKGROUND Prescription errors are one of the leading patient safety problems in primary care and can be caused by errors in therapeutic decisions or in the quality of prescription writing. METHODS Cross-sectional observational study conducted in a municipality in Northeastern Brazil. The assessment instrument (including 13 indicators and one composite indicator) was applied to a representative sample of drug prescriptions from the 24 Family Health Teams providing Primary Health Care in the municipality, dispensed in January 2021. Estimates of compliance and their 95% confidence intervals and graphical analysis of frequencies are assessed globally and stratified by dispensing units and prescribers. FINDINGS The average composite prescription writing quality on a 0-100 scale was 60.2 (95% CI 57.8-62.6). No quality criteria had 100% compliance. The highest compliance rates were found for 'frequency of administration' (98.9%) and 'identification of the prescriber' (98.9%). On the other hand, 'recorded information on allergy' (0.0%), 'patient's date of birth' (1.7%), 'nonpharmacological recommendations' (1.7%), and 'guidance on the use of the drug' (25%) were the indicators with lower compliance, contributing to 69% of the noncompliances found. The type and frequency of the errors in the quality of prescription writing uncovered in this study confirm the continuing need to tackle this problem to improve patient safety. The results identify priority aspects for interventions and further studies on the quality of prescription writing in the context of Primary Health Care in Brazil.
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Affiliation(s)
- Almária Mariz Batista
- Multicampi School of Medical Sciences, Federal University of Rio Grande do Norte, Caicó, Brazil
- Instituto Nacional de Salud Pública, Cuernavaca, México
| | | | | | - Dyego Souza
- Department of Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Graduate Programme in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
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21
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Te Winkel MT, Damoiseaux-Volman BA, Abu-Hanna A, Lissenberg-Witte BI, van Marum RJ, Schers HJ, Slottje P, Uijen AA, Bont J, Maarsingh OR. Personal Continuity and Appropriate Prescribing in Primary Care. Ann Fam Med 2023; 21:305-312. [PMID: 37487715 PMCID: PMC10365882 DOI: 10.1370/afm.2994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE Personal continuity between patient and physician is a core value of primary care. Although previous studies suggest that personal continuity is associated with fewer potentially inappropriate prescriptions, evidence on continuity and prescribing in primary care is scarce. We aimed to determine the association between personal continuity and potentially inappropriate prescriptions, which encompasses potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), by family physicians among older patients. METHODS We conducted an observational cohort study using routine care data from patients enlisted in 48 Dutch family practices from 2013 to 2018. All 25,854 patients aged 65 years and older having at least 5 contacts with their practice in 6 years were included. We calculated personal continuity using 3 established measures: the usual provider of care measure, the Bice-Boxerman Index, and the Herfindahl Index. We used the Screening Tool of Older Person's Prescriptions (STOPP) and the Screening Tool to Alert doctors to Right Treatment (START) specific to the Netherlands version 2 criteria to calculate the prevalence of potentially inappropriate prescriptions. To assess associations, we conducted multilevel negative binomial regression analyses, with and without adjustment for number of chronic conditions, age, and sex. RESULTS The patients' mean (SD) values for the usual provider of care measure, the Bice-Boxerman Continuity of Care Index, and the Herfindahl Index were 0.70 (0.19), 0.55 (0.24), and 0.59 (0.22), respectively. In our population, 72.2% and 74.3% of patients had at least 1 PIM and PPO, respectively; 30.9% and 34.2% had at least 3 PIMs and PPOs, respectively. All 3 measures of personal continuity were positively and significantly associated with fewer potentially inappropriate prescriptions. CONCLUSIONS A higher level of personal continuity is associated with more appropriate prescribing. Increasing personal continuity may improve the quality of prescriptions and reduce harmful consequences.
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Affiliation(s)
- Marije T Te Winkel
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Birgit A Damoiseaux-Volman
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Rob J van Marum
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam, The Netherlands
| | - Henk J Schers
- Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Pauline Slottje
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemarie A Uijen
- Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Jettie Bont
- Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Department of General Practice, Amsterdam, The Netherlands
| | - Otto R Maarsingh
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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22
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Feldmeier G, Löffler C, Altiner A, Wollny A, Garbe K, Kronsteiner D, Köppen M, Szecsenyi J, Leyh M, Voss A, Kamradt M, Poß-Doering R, Wensing M, Kaufmann-Kolle P. Optimizing Antibiotic Prescribing for Acute Respiratory Tract Infections in German Primary Care: Results of the Regional Intervention Study CHANGE-3 and the Nested cRCT. Antibiotics (Basel) 2023; 12:antibiotics12050850. [PMID: 37237753 DOI: 10.3390/antibiotics12050850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
Within primary care, acute respiratory tract infections (ARTIs) are the most common reason for prescribing antibiotics. The aim of the CHANGE-3 study was to investigate how antibiotic prescribing for non-complicated ARTIs can be reduced to a reasonable level. The trial was conducted as a prospective study consisting of a regional public awareness intervention in two regions of Germany and a nested cluster randomised controlled trial (cRCT) of a complex implementation strategy. The study involved 114 primary care practices and comprised an intervention period of six winter months for the nested cRCT and two times six winter months for the regional intervention. The primary outcome was the percentage of antibiotic prescribing for ARTIs between baseline and the two following winter seasons. The regression analysis confirmed a general trend toward the restrained use of antibiotics in German primary care. This trend was found in both groups of the cRCT without significant differences between groups. At the same time, antibiotic prescribing was higher in routine care (with the public campaign only) than in both groups of the cRCT. With regard to secondary outcomes, in the nested cRCT, the prescribing of quinolones was reduced, and the proportion of guideline-recommended antibiotics increased.
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Affiliation(s)
- Gregor Feldmeier
- Institute of General Practice, Rostock University Medical Center, 18055 Rostock, Germany
| | - Christin Löffler
- Institute of General Practice, Rostock University Medical Center, 18055 Rostock, Germany
| | - Attila Altiner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Anja Wollny
- Institute of General Practice, Rostock University Medical Center, 18055 Rostock, Germany
| | - Katharina Garbe
- Institute of General Practice, Rostock University Medical Center, 18055 Rostock, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry, University Hospital Heidelberg, 69117 Heidelberg, Germany
| | - Martina Köppen
- aQua-Institute for Applied Quality Improvement and Research in Health Care GmbH, 37073 Göttingen, Germany
| | - Joachim Szecsenyi
- aQua-Institute for Applied Quality Improvement and Research in Health Care GmbH, 37073 Göttingen, Germany
| | - Mirko Leyh
- Department of Communication Design and Media, University of Applied Sciences, Technology, Business and Design, 23966 Wismar, Germany
| | - Arwed Voss
- Department of Communication Design and Media, University of Applied Sciences, Technology, Business and Design, 23966 Wismar, Germany
| | - Martina Kamradt
- Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Regina Poß-Doering
- Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Petra Kaufmann-Kolle
- aQua-Institute for Applied Quality Improvement and Research in Health Care GmbH, 37073 Göttingen, Germany
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Villalobos-Madriz JA, Serrano-Arias B, Arguedas-Chacón S, Zavaleta-Monestel E, Rodríguez-Miranda R, Chaverri-Fernández JM, Covarrubias-Gómez A. Prescribing Trends in Psychotropic Medications Among Outpatients of a Latin American Healthcare Setting: A Five-Year Retrospective Study. Cureus 2023; 15:e37832. [PMID: 37213996 PMCID: PMC10198243 DOI: 10.7759/cureus.37832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Mental health problems affect millions worldwide, and the prescription of psychotropic drugs is increasing globally. The World Health Organization (WHO) has emphasized the need for proper monitoring of psychotropic drug prescriptions. This study aims to characterize and find trends in the prescription of psychotropics in a Latin American General Hospital. Methods The study analyzed the dispensation of psychotropic prescriptions to outpatients at three pharmacies in the central headquarters of Hospital Clínica Bíblica in San José, Costa Rica, from 2017 to 2021. Psychotropic drugs were classified by the Anatomical Therapeutic Chemical (ATC) code, and the amount of each medication dispensed was standardized using the defined daily dose per 10,000 population per day metric. Patients' ages were categorized into four groups: under 18 years, 18 to 39 years, 40 to 64 years, and 65 years and above. The prescriptions were categorized according to medical specialty. Regression analyses were performed to determine the significance of trends observed in the data Results A total of 5793 psychotropic prescriptions were recorded. The average age of the patients was 58 years. The total consumption of psychotropics decreased by 33.94% from 2017 to 2021, with the most significant decline until 2020. However, there was an increase in consumption in 2021. Clonazepam was the most consumed medication, followed by bromazepam and alprazolam, which was the sole drug to exhibit an escalation in usage between 2017 and 2021. Regression analysis showed that only alprazolam and zopiclone had statistically significant trends. The highest number of prescriptions was dispensed to patients aged between 40 and 64 years, followed by those aged over 65 years. Anxiolytics were also the most commonly prescribed group of drugs. General medicine (20.22%), psychiatry (19.95%), and internal medicine (12.73%) were the primary specialties that prescribed psychotropic; 38.6% of prescriptions were associated with the 10th decile of patients, and 44.9% of prescriptions were issued by the 10th decile of physicians. Conclusion The consumption of psychotropic drugs decreased from 2017 to 2020 but increased in 2021, with alprazolam being the only drug that showed an increase in consumption throughout the entire period. General practitioners and psychiatrists were found to be the specialties that most commonly prescribe these medications. The study found significant trends only for the consumption of alprazolam and zopiclone and for prescription patterns among psychiatrists and internal medicine physicians.
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Affiliation(s)
| | | | | | | | | | - José M Chaverri-Fernández
- Department of Pharmacology, Toxicology, and Pharmacodependency, Universidad de Costa Rica, San José, CRI
| | - Alfredo Covarrubias-Gómez
- Department of Pain and Palliative Medicine, National Institute of Medical Sciences and Nutrition Salvador Zubirán, México City, MEX
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Cortese BD, Chang SS, Talwar R. Urological Drug Price Stewardship: Potential Cost Savings Based on the Mark Cuban Cost Plus Drug Company Model. J Urol 2023; 209:309-11. [PMID: 36413174 DOI: 10.1097/JU.0000000000003083] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Berhane H, Moss J, Koh E. Effect of a Delirium Screening Tool on Antipsychotic Medication Use in a Pediatric Intensive Care Unit. J Pediatr Pharmacol Ther 2023; 28:156-160. [PMID: 37139246 PMCID: PMC10150905 DOI: 10.5863/1551-6776-28.2.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/17/2022] [Indexed: 05/05/2023]
Abstract
Objective Intensive care unit (ICU) delirium has been associated with increased length of hospital stay, morbidity, mechanical ventilation, and health care resource utilization. Antipsychotics are frequently used for ICU delirium management, despite a lack of robust evidence in the literature to support their benefit. Delirium screening may result in pharmacologic or non-pharmacologic treatment. Methods In January 2019 we began screening patients admitted to the pediatric ICU (PICU) for delirium using the Cornell Assessment for Pediatric Delirium (CAPD). We compared prescribing rates of antipsychotic medications before and after implementation. We also assessed length of hospital and ICU stay prior to initiating therapy, delirium score prior to initiation of therapy, time after initiation of therapy until score decreased to a level not suggestive of delirium, and continuation of antipsychotics outside of the PICU. Results We did not observe a difference in the rate of antipsychotics use. There was, however, an increase in variability between pre- and post-intervention rates of prescribing. Patients who received an antipsychotic medication were hospitalized for an average of 18 days and in the ICU for 14 days prior to the first dose of an antipsychotic agent. They had an average CAPD score of 16, and had an average of 4 scores above 8 prior to starting treatment. Conclusion This study highlights the need for additional research to demonstrate the role of antipsychotic medications in managing delirium in the PICU.
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Affiliation(s)
- Helen Berhane
- Department of Pharmacy (HB), University of California San Diego Medical Center, San Diego, CA
| | - Jeffrey Moss
- Department of Pharmacy (JM), Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | - Eunice Koh
- Department of Pediatrics (EK), Stanford University School of Medicine, Stanford, CA
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Grimmsmann T, Himmel W. Role of private prescriptions in the long-term use of benzodiazepines and Z-drugs: A patient-related follow-up study. Pharmacoepidemiol Drug Saf 2023; 32:60-65. [PMID: 36039726 DOI: 10.1002/pds.5536] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/06/2022] [Accepted: 08/25/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyse (1) how often patients insured under the statutory health insurance (SHI) scheme received repeated prescriptions for benzodiazepines or Z-drugs as private prescriptions and (2) how often doctors switched from SHI prescriptions to private prescriptions and vice versa when issuing repeat prescriptions. METHODS On basis of anonymized prescriptions from 874 ambulatory practices in Germany, we analysed the percentage of private prescriptions for Z-drugs, benzodiazepines/anxiolytics, and benzodiazepines/hypnotics and sedatives over 6 years (2014 to 2020). RESULTS Of 2 200 446 prescriptions for a benzodiazepine or Z-drug, 38% were private prescriptions. In case of Z-drugs, the rate of private prescriptions was 44.1% for single prescriptions and 48.9% for refills. The difference was smaller for anxiolytics (23.3% vs. 26.0%) and, for benzodiazepine/hypnotics and sedatives, the proportion of private prescriptions for refills was even lower than for single prescriptions. In case of Z-drugs, the proportion of private prescriptions was, on average, 42.7% for the first prescription of a series of repeat prescriptions and 49.6% for the tenth prescription. The increase was smaller for anxiolytics and negligible for benzodiazepine/hypnotics and sedatives. Doctors stayed with their initial decision in more than three quarters of repeat prescriptions, be it a SHI or private prescription. CONCLUSION While we observed a large number of private prescriptions for benzodiazepines and Z-drugs, the proportion was only slightly higher for refills than for single prescriptions. Doctors do not seem to issue private prescriptions as a strategy to mask especially long-term use of these substances.
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Affiliation(s)
| | - Wolfgang Himmel
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
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27
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Valladales-Restrepo LF, Ospina-Cano JA, Aristizábal-Carmona BS, López-Caicedo DF, Toro-Londoño M, Gaviria-Mendoza A, Machado-Duque ME, Machado-Alba JE. Study of Prescription-Indication of Outpatient Systemic Anti-Fungals in a Colombian Population. A Cross-Sectional Study. Antibiotics (Basel) 2022; 11. [PMID: 36551462 DOI: 10.3390/antibiotics11121805] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
The inappropriate use of antifungals is associated with greater antimicrobial resistance, costs, adverse events, and worse clinical outcomes. The aim of this study was to determine prescription patterns and approved and unapproved indications for systemic antifungals in a group of patients in Colombia. This was a cross-sectional study on indications for the use of systemic antifungals in outpatients from a drug dispensing database of approximately 9.2 million people affiliated with the Colombian Health System. Sociodemographic, pharmacological, and clinical variables were considered. Descriptive, bivariate, and multivariate analyses were performed. A total of 74,603 patients with antifungal prescriptions were identified; they had a median age of 36.0 years (interquartile range: 22.0−53.0 years), and 67.3% of patients were women. Fluconazole (66.5%) was the most prescribed antifungal for indications such as vaginitis, vulvitis, and vulvovaginitis (35.0%). A total of 29.3% of the prescriptions were used in unapproved indications. A total of 96.3% of ketoconazole users used the medication in unapproved indications. Men (OR: 1.91; CI95%: 1.79−2.04), <18 years of age (OR: 1.20; CI95%: 1.11−1.31), from the Caribbean region (OR: 1.26; CI95%: 1.18−1.34), with chronic obstructive pulmonary disease (OR: 1.80; CI95%: 1.27−2.54), prescriptions made by a general practitioner (OR: 1.17; CI95%: 1.04−1.31), receiving comedications (OR: 1.58; CI95%: 1.48−1.69), and the concomitant use of other antimicrobials (OR: 1.77; CI95%: 1.66−1.88) were associated with a higher probability that the antifungal was used for unapproved indications; deep mycosis (OR: 0.49; CI95%: 0.41−0.58), prescribing fluconazole (OR: 0.06; CI95%: 0.06−0.06), and having diabetes mellitus (OR: 0.33; CI95%: 0.29−0.37), cancer (OR: 0.13; CI95%: 0.11−0.16), or HIV (OR: 0.07; CI95%: 0.04−0.09) reduced this risk. Systemic antifungals were mostly used for the management of superficial mycoses, especially at the gynecological level. In addition, more than a quarter of patients received these medications in unapproved indications, and there was broad inappropriate use of ketoconazole.
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Gill S, Bailey J, Nafees S, Poole R. A qualitative interview study of GPs' experiences of prescribing opioid medication for chronic pain. BJGP Open 2022; 6:BJGPO. [PMID: 36216370 DOI: 10.3399/BJGPO.2022.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prescribing of opioid medication has increased over the past 20 years. Most occurs in primary care for chronic pain. There is little evidence that these drugs are effective for this indication. There are concerns about the continuing prescribing of opioids, particularly in the long term and at high doses. AIM To explore GPs' experiences of prescribing opioids, problems encountered, and factors militating against good prescribing practice. DESIGN & SETTING Qualitative interviews with GPs who prescribe opioids in primary care in North East Wales. METHOD Semi-structured interviews with 20 GPs were transcribed and subjected to thematic analysis utilising the framework approach. RESULTS Participating GPs identified a range of problems associated with prescribed opioids. They were concerned about limited effectiveness of the drugs and what they perceived as addiction resulting from their use. They identified healthcare system factors that were obstacles to good prescribing practice such as lack of continuity of care, poor access to secondary care pain management support, and, most importantly, constant time pressure. They reported adverse effects on relationships with patients. Unrealistic expectations that pain could be eliminated resulted in pressure to prescribe stronger drugs and increased doses. It led to difficulties in establishing and maintaining trust and in persuading patients to agree to, and to carry out, dose reductions. CONCLUSION Themes emerging from this study suggest that GPs lack appropriate control of opioid prescribing. There is a need to develop methods to help patients and GPs to work together to manage chronic pain safely.
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29
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Rognli EB, Bramness JG, von Soest T. Smoking in early adulthood is prospectively associated with prescriptions of antipsychotics, mood stabilizers, antidepressants and anxiolytics. Psychol Med 2022; 52:3241-3250. [PMID: 33583454 PMCID: PMC9693672 DOI: 10.1017/s0033291720005401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Whether smoking should be regarded as a risk factor for mental disorders remains unresolved. Prescribed psychotropic drugs can be used as indications for mental disorders. We investigated how smoking was prospectively related to prescription of antipsychotics, mood stabilizers, antidepressants, and anxiolytics. METHODS Information about smoking, including the Fagerström Test for Nicotine Dependence, and relevant confounders, were obtained from the population-based Young in Norway Study (N = 2602), with four data collection waves between 1992 and 2006. These survey data were linked with information on prescriptions for psychotropic drugs from the comprehensive, nationwide Norwegian Prescription Database from 2007 to 2015. RESULTS Daily smoking with high dependence in 2006 at age 28.5 (s.d. = 2.0) was associated with filling prescriptions of antipsychotics (OR, 6.57, 95% CI 2.19-19.70, p = 0.001), mood stabilizers (OR, 7.11, 95% CI 2.51-20.15, p < 0.001) and antidepressants (OR, 1.91, 95% CI 1.13-3.23, p = 0.016) 1-9 years later. Associations remained significant after adjustment for a variety of potential confounders measured before the assessment of smoking, including sociodemographic background, conduct problems, cannabis use, mental distress, and previous prescriptions for psychotropic medications. The association between smoking and prescription of anxiolytics was weaker and more unstable. CONCLUSIONS In this study of young adults, daily smoking with high dependence was associated with later prescriptions of antipsychotics, mood stabilizers and antidepressants, indicating smoking as a risk factor for mental disorders treated with these drugs.
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Affiliation(s)
- Eline Borger Rognli
- Section for Clinical Addiction Research, Department on Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway
| | - Jørgen Gustav Bramness
- Norwegian Institute of Public Health, Oslo, Norway
- Institute for Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway
| | - Tilmann von Soest
- Department of Psychology, PROMENTA Research Center, University of Oslo, Oslo, Norway
- Norwegian Social Research (NOVA), OsloMet – Oslo Metropolitan University, Oslo, Norway
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Tafreshi S, Steiner A, Sud A. Shifting interpretations in evidence and guidance in pain and opioids research: A bibliometric analysis of a highly cited case series from 1986. J Eval Clin Pract 2022; 28:509-519. [PMID: 35445499 DOI: 10.1111/jep.13680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/30/2022]
Abstract
UNLABELLED RATIONALE, AIMS AND OBJECTIVES: Portenoy and Foley's 1986 landmark case series 'Chronic use of opioid analgesics in non-malignant pain: report of 38 cases' has been reproached for opening the floodgates of opioid prescribing for chronic non-cancer pain and the attendant harms. This influential article has been cited over 500 times in the scientific literature over the last four decades. This study seeks to understand the impact of Portenoy and Foley's article on subsequent discussions and research about opioids. METHODS We conducted a multi-method bibliometric analysis of all citations of this article from 1986 through 2019 using quantitative relational and qualitative content analysis to determine how uses and interpretations of this case series and associated prescribing guidance have changed over time, in relationship to the evolution of the North American opioid crises. RESULTS Using time series analysis, we identified three periods with distinct interpretations and uses of the index article. In the first 'exploration' period (1986-1996), the index article was well-received by the scientific community and motivated further study of the effects of opioids. In the second 'implementation' period (1997-2003, coinciding with the release of OxyContin®), this case series was used as evidence to support widespread prescribing of opioid analgesics, even while it was recognized that long-term effects had not yet been evaluated. The third 'reassessment' period (2004-2019) focused on how opioid-related harms had been overlooked, and in many cases, these harms were directly attributed to this article. CONCLUSION These changes in interpretation demonstrate shifting currents of the use and mobilization of evidence regarding pain and opioids, and how these currents both impact and are impacted by clinical practices and major sociohistorical phenomena such as the opioid crisis. Researchers and clinicians must account for these shifting dynamics when developing and interpreting scientific knowledge, including in the form of clinical practice guidelines.
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Affiliation(s)
- Sina Tafreshi
- School of Medicine, University of St. Andrews, St. Andrews, UK
| | - Adam Steiner
- Faculty of Arts, McGill University, Montreal, Quebec, Canada
| | - Abhimanyu Sud
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Miller F, Zylbersztejn A, Favarato G, Adamestam I, Pembrey L, Shallcross L, Mason D, Wright J, Hardelid P. Factors predicting amoxicillin prescribing in primary care among children: a cohort study. Br J Gen Pract 2022; 72:BJGP.2021.0639. [PMID: 35817584 PMCID: PMC9282803 DOI: 10.3399/bjgp.2021.0639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/30/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Antibiotic prescribing during childhood, most commonly for respiratory tract infections (RTIs), contributes to antimicrobial resistance, which is a major public health concern. AIM To identify factors associated with amoxicillin prescribing and RTI consultation attendance in young children in primary care. DESIGN AND SETTING Cohort study in Bradford spanning pregnancy to age 24 months, collected 2007-2013, linked to electronic primary care and air pollution data. METHOD Amoxicillin prescribing and RTI consultation rates/1000 child-years were calculated. Mixed-effects logistic regression models were fitted with general practice (GP) surgery as the random effect. RESULTS The amoxicillin prescribing rate among 2493 children was 710/1000 child-years during year 1 (95% confidence interval [CI] = 677 to 744) and 780/1000 (95% CI = 745 to 816) during year 2. During year 1, odds of amoxicillin prescribing were higher for boys (adjusted odds ratio [aOR] 1.36, 95% CI = 1.14 to 1.61), infants from socioeconomically deprived households (aOR 1.36, 95% CI = 1.00 to 1.86), and infants with a Pakistani ethnic background (with mothers born in the UK [aOR 1.44, 95% CI = 1.06 to 1.94] and outside [aOR 1.42, 95% CI = 1.07 to 1.90]). During year 2, odds of amoxicillin prescribing were higher for infants with a Pakistani ethnic background (with mothers born in the UK [aOR 1.46, 95% CI = 1.10 to 1.94] and outside [aOR 1.56, 95% CI = 1.19 to 2.04]) and those born <39 weeks gestation (aOR 1.20, 95% CI = 1.00 to 1.45). Additional risk factors included caesarean delivery, congenital anomalies, overcrowding, birth season, and childcare attendance, with GP surgery explaining 7%-9% of variation. CONCLUSION Socioeconomic status and ethnic background were associated with amoxicillin prescribing during childhood. Efforts to reduce RTI spread in household and childcare settings may reduce antibiotic prescribing in primary care.
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Affiliation(s)
- Faith Miller
- Institute for Global Health, University College London, London
| | - Ania Zylbersztejn
- Great Ormond Street Institute of Child Health, University College London, London
| | - Graziella Favarato
- Great Ormond Street Institute of Child Health, University College London, London
| | - Imad Adamestam
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh
| | - Lucy Pembrey
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London
| | - Dan Mason
- Bradford Institute for Health Research, Bradford
| | - John Wright
- Bradford Institute for Health Research, Bradford
| | - Pia Hardelid
- Great Ormond Street Institute of Child Health, University College London, London
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Tanahashi I, Shiganami T, Iwayama T, Wake T, Kobayashi S, Yoshimasu H. Association between psychotropic prescriptions and the total amount of psychotropics ingested during an intentional overdose: A single-center retrospective study. Neuropsychopharmacol Rep 2022; 42:166-173. [PMID: 35174671 PMCID: PMC9216370 DOI: 10.1002/npr2.12242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Abstract
Aim To investigate the association between psychotropic prescriptions and the total amount of psychotropics ingested during a subsequent intentional overdose and to examine factors related to the number of psychotropic prescriptions. Methods The initial sample comprised 69 patients who were admitted to the emergency department of a general hospital in Japan following an intentional overdose via psychotropic medications. We performed retrospective hierarchical multiple regression analysis with the total amount of psychotropics ingested at the overdose as a dependent variable and factors related to deliberate self‐harm or overdose identified in previous studies as independent variables. We compared two models, one that did not (Step 1) and one that did (Step 2) include the number of different prescribed psychotropic medications as an independent variable in the analysis. Results Forty‐seven patients were eligible for the analysis. The number of different prescribed psychotropic medications was associated with the total amount of psychotropics ingested at the overdose in Step 2 (β = 0.40, P = .01). There was a trend toward an association between the past number of deliberate self‐harm events and the total amount of psychotropics ingested at the overdose in Step 1 (β = 0.30, P = .05), but this trend was weakened in Step 2 (β = 0.15, P = .33). Conclusion The number of different prescribed psychotropics appeared to influence the risk of subsequent intentional overdose through increasing the total amount of psychotropics ingested. Cumulative psychotropic prescriptions, particularly those delivered after deliberate self‐harm, might be indirectly related to this risk. The number of different prescribed psychotropics appeared to influence the risk of subsequent intentional overdose through increasing the total amount of psychotropics ingested. Cumulative psychotropic prescriptions, particularly those delivered after deliberate self‐harm, might be indirectly related to this risk.![]()
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Affiliation(s)
- Iori Tanahashi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.,The Maruki Memorial Medical and Social Welfare Center, Iruma, Japan
| | - Takafumi Shiganami
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Takayuki Iwayama
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.,Department of Psychology, Showa Women's University, Setagaya, Japan
| | - Taisei Wake
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Sayaka Kobayashi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Haruo Yoshimasu
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
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33
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Hunt NB, Emmens JE, Irawati S, de Vos S, Bos JH, Wilffert B, Hak E, de Boer RA. Sex disparities in the effect of statins on lipid parameters: The PharmLines Initiative. Medicine (Baltimore) 2022; 101:e28394. [PMID: 35029178 PMCID: PMC8758030 DOI: 10.1097/md.0000000000028394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/02/2021] [Indexed: 01/05/2023] Open
Abstract
Real-world evidence on a potential statin effect modification by sex is inconclusive, especially for the primary prevention of cardiovascular disease (CVD). We aimed to quantify the differences in the effect of statins on lipid parameters between men and women.The PharmLines Initiative linked the Lifelines Cohort Study and the IADB.nl prescription database. This database covers a representative population from the Netherlands. We selected participants aged ≥40 years at the index date: the date of the first prescription of any statin monotherapy in the study period 2006 to 2017. Multivariate regression modeling was used to compare the difference of the mean percentage change of lipid parameters (% mean difference [MD]) from baseline to follow-up measurement between the sexes.Out of 5366 statin users from approximately 50,000 participants available in the final linked database, 685 were statin initiators. At baseline, women had significantly higher levels of mean total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) than men (all P values <.01). At follow-up, women had a significantly higher mean percentage change of HDL-C compared to men (adjusted % MD 5.59, 95% confidence interval [CI] 2.42-8.75, P < .01). There was no significant sex difference in other parameters, nor in the proportion of men and women who achieved LDL-C ≤2.5 mmol/L.Statins appear to have a greater effect on increasing HDL-C levels in women than men while showing similar effect on other lipid parameters in both sexes. Men should not be treated differently than women.
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Affiliation(s)
- Nicholas B. Hunt
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Johanna E. Emmens
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sylvi Irawati
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
- Centre for Medicines Information and Pharmaceutical Care, Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
- Department of Clinical and Community Pharmacy, Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
| | - Stijn de Vos
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Jens H.J. Bos
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Bob Wilffert
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
- University of Groningen, Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Rudolf A. de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Vittrup I, Droitcourt C, Andersen YMF, Skov L, Egeberg A, Delevry D, Fenton MC, Thyssen JP. Family burden of hospital-managed pediatric atopic dermatitis: A nationwide registry-based study. Pediatr Allergy Immunol 2022; 33:e13693. [PMID: 34726312 DOI: 10.1111/pai.13693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Parents of children with atopic dermatitis (AD) report reduced quality of life and higher stress level, which could increase risk of psychiatric and pain disorders, and medication use. METHODS By use of Danish national registries, we identified family members of all first-born Danish children born between 1 January 1995 and 31 December 2013 with a hospital diagnosis of AD, matched them 1:10 with family members of children without AD, and followed the cohorts over time. RESULTS Mothers of children with hospital-managed AD had higher risk of filling a prescription for medications for depression, anxiety, pain and sleep problems, and of consulting a psychologist, but most associations disappeared after full adjustment. Siblings had higher risk of receiving a diagnosis for adjustment disorder, and fathers showed increased risk of filling a prescription for pain medication and of divorce, in crude but not adjusted models. CONCLUSIONS The increased risk of study endpoints seen in mothers of children with hospital-managed AD was not explained by pediatric AD alone. Rather, the total burden in these families including parent and child morbidity and socioeconomic resources seems to explain these observations. The burden in families of children with AD may potentially affect the overall management of their child's AD.
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Affiliation(s)
- Ida Vittrup
- Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.,Department of Dermatology and Venereology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Catherine Droitcourt
- Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.,Department of Dermatology, CHU Rennes, Rennes, France.,University of Rennes, EA 7449 REPERES "Pharmacoepidemiology and Health Services Research", Rennes, France
| | - Yuki M F Andersen
- Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | | | | | - Jacob P Thyssen
- Department of Dermatology and Venereology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
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35
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Hwang AS, Pollock JR, Buras MR, Mangold AR, Swanson DL. Medicare Part D Prescription Trends in Use and Cost of Dermatology Medications. J Am Acad Dermatol 2021; 87:916-918. [PMID: 34968633 DOI: 10.1016/j.jaad.2021.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Angelina S Hwang
- Students mayo Clinic Alix School of Medicine - Arizona campus, Scottsdale, Arizona
| | - Jordan R Pollock
- Students mayo Clinic Alix School of Medicine - Arizona campus, Scottsdale, Arizona
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36
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Lanz MJ, Gilbert IA, Gandhi HN, Goshi N, Tkacz JP, Lugogo NL. Demographics, Treatment Patterns, and Morbidity in Patients with Exercise-Induced Bronchoconstriction: An Administrative Claims Data Analysis. J Asthma Allergy 2021; 14:1485-1495. [PMID: 34924763 PMCID: PMC8674669 DOI: 10.2147/jaa.s338447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Exercise-induced bronchoconstriction (EIB) is generally treated with short-acting β2-agonists (SABA) before exercising, to prevent symptoms. Real-world data on treatments and outcomes for patients with EIB alone (EIBalone), or with asthma (EIBasthma), in the USA are limited. This study compared demographics, treatment patterns, morbidity, and costs of treating EIB between these two groups of patients. PATIENTS AND METHODS Administrative claims from US IBM® MarketScan® Research databases were analyzed retrospectively. Patients aged ≥4 years filling a SABA claim between 1/1/2011 and 12/31/2016 were evaluated. Patients were indexed on a random SABA claim and required to have 12 months' continuous eligibility pre- and post-index, ≥1 maintenance medication and/or SABA fill post-index, and were designated EIBalone or EIBasthma according to diagnostic codes (EIB only or EIB plus asthma, respectively). Descriptive statistics were used. RESULTS In total, 13,480 patients had EIBalone and 14,862 had EIBasthma. Compared with EIBasthma, the EIBalone group was older (mean[SD] 20.4[13.6] vs 17.8[13.6] years), had more females (60.7% vs 54.7%), and filled fewer SABA claims (1.9[1.4] vs 2.5[2.2]) (all p<0.001). A smaller proportion of patients in the EIBalone than EIBasthma group had maintenance therapy claims (79.9% vs 90.6%, p<0.001). The EIBalone group also had a lower proportion of patients with oral or injectable corticosteroid claims (29.4% vs 32.0%) and asthma and/or EIB-related emergency department (1.0% vs 13.0%) or outpatient visits (65.1% vs 72.3%; all p<0.0001). Annual days' supply of oral corticosteroids was similar between groups (mean[SD] EIBalone: 20.7[30.8] vs EIBasthma: 19.8[28] days). CONCLUSION Individuals with EIBalone or EIBasthma demonstrate considerable morbidity. New treatment paradigms may be needed to optimize outcomes for both patient groups.
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Affiliation(s)
- Miguel J Lanz
- Allergy and Asthma, AAADRS Clinical Research Center, Coral Gables, FL, USA
| | - Ileen A Gilbert
- BioPharmaceuticals Medical – US, AstraZeneca, Wilmington, DE, USA
| | - Hitesh N Gandhi
- BioPharmaceuticals Medical – US, AstraZeneca, Wilmington, DE, USA
| | - Nadia Goshi
- BioPharmaceuticals Global Medicines Development – US, AstraZeneca, Wilmington, DE, USA
| | | | - Njira L Lugogo
- Pulmonary Clinic, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Bro T, Wickström K, Lindén C. The future is old - Patients with topical ocular hypotensive treatment in the Nordic region between 2008 and 2017 with projections for 2040. Acta Ophthalmol 2021; 99:e1442-e1448. [PMID: 33720517 DOI: 10.1111/aos.14848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The primary objective was to evaluate prescribing trends for topical ocular hypotensive treatment in the Nordic region during the last decade and, by population projections, estimate the glaucoma burden in 2040. A secondary objective was to analyse national variations in prescription patterns across the Nordic region. METHODS A retrospective analysis of national pharmacy data between 2008 and 2017 on the dispensation of topical ocular hypotensive treatment in the Nordic region was performed. Predictions of the glaucoma burden in 2040 were calculated from official population projections. RESULTS The total number of patients with ocular hypotensive treatment in the Nordic region increased from 346 000 to 418 000 (21%) between 2008 and 2017. The number of patients with ocular hypotensive treatment in the age group of 50 years and older increased from 3.6% to 3.9%. The daily defined dose (DDD) per patient and day during the study period increased from 1.22 to 1.26. Adjusted for beta-blocker combinations, the same value increased from 1.49 to 1.67. Across the Nordic countries, Finland had almost twice as many DDD per patient and day in 2017 (2.1) compared with Iceland (1.1). Between 2008 and 2017, the annual treatment cost for ocular hypotensive treatment in the Nordic region decreased from 96 million to 87 million Euro (-9%). In 2040, the number of patients with ocular hypotensive treatment in the Nordic region is estimated to 633 000 individuals (+51% compared with 2017). CONCLUSIONS The study revealed an increased use of glaucoma medications in the Nordic region the last decade. This was mainly caused by an increased number of patients with ocular hypotensive treatment, but also because of a more intensive treatment. Marked national differences were detected. Due to the introduction of generic medications, the total cost for ocular hypotensive treatment did however decrease during the last decade. In 2040, the current number of individuals with ocular hypotensive treatment is estimated to have increased with an additional 50% due to a growing number of ageing individuals. This will lead to higher costs, not only for medications but also for diagnosing, monitoring and other aspects of glaucoma care.
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Affiliation(s)
- Tomas Bro
- Department of Ophthalmology Eksjö Sweden
- Section for Ophthalmology Department of Clinical Sciences Lund University Lund Sweden
| | | | - Christina Lindén
- Department of Clinical Sciences Ophthalmology Umeå University Umeå Sweden
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Ferner RE, Mason J, Vallance HK, Choudhary T, Marriott JF, Coleman JJ, Pontefract SK. Coping with COVID: Preparing prescribers during the pandemic. Br J Clin Pharmacol 2021; 88:2437-2440. [PMID: 34806194 PMCID: PMC9011708 DOI: 10.1111/bcp.15153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022] Open
Abstract
In response to the COVID-19 pandemic, Health Education England (HEE) and the University of Birmingham provided National Health Service (NHS) staff free access to SCRIPT, a national eLearning programme for safer prescribing and therapeutics. The eLearning was particularly for those returning to work or being redeployed. In the year March 2020-21, 3412 users registered to access portfolios and opened an aggregate of 17 198 modules. Each user completed a median of 2 (range 1-50, interquartile range [IQR] 1-7) assessed learning modules. Marks improved from pre-test to post-test by a median of 2 (IQR 0-3) marks out of 10. The most frequently selected modules were Adherence and Concordance (1109 users), Fluids (981 users) and Diabetic Emergencies (818 users). A total of 878 users accessed the unassessed COVID-19 module. The SCRIPT modules provided standardised education in core principles relating to prescribing and therapeutics, and were used by professionals from many healthcare disciplines.
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Affiliation(s)
- Robin E Ferner
- Birmingham Medical School, Institute of Clinical Sciences, College of Medical and Dental Sciences, Medical School Building, University of Birmingham, Edgbaston, United Kingdom
| | - Julie Mason
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Hannah K Vallance
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Tanvi Choudhary
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John F Marriott
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jamie J Coleman
- Birmingham Medical School, Institute of Clinical Sciences, College of Medical and Dental Sciences, Medical School Building, University of Birmingham, Edgbaston, United Kingdom
| | - Sarah K Pontefract
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Mokrzecki S, Pain T, Mallett A, Perks S. Pharmacist-Led Education for Final Year Medical Students: A Pilot Study. Front Med (Lausanne) 2021; 8:732054. [PMID: 34631750 PMCID: PMC8496736 DOI: 10.3389/fmed.2021.732054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Prescribing is a core skillset for medical officers. Prescribing errors or deficiencies can lead to patient harm and increased healthcare costs. There is an undefined role for pharmacist-led education to final year medical students to improve prescribing skills. Aim: Assess if pharmacist-led education on prescription writing improves the quality and safety of final year medical students' prescribing skills. Method: Participants and Intervention: Final year medical students were randomised into tutorial (TG) or non-tutorial groups (NTG) and assessed pre- and post- intervention. TG received education by a clinical pharmacist and pharmacy educator using case-based learning. NTG received no additional training as per usual practice. Following the pre-test, all students completed a 3-week tertiary hospital medical ward placement. Students completed the post-test following placement and after the TG participated in the intervention. Student Assessment: Assessment included writing Schedule 4 (S4, prescription only), Schedule 8 (S8, controlled drug), S4 streamline (S4SL), and Mixed case (S4 and S8) prescriptions. Results: At baseline, there were no significant differences between TG and NTG for overall scores or proportion of passes. Post intervention scores significantly improved in TG (p = 0.012) whereas scores significantly decreased in the NTG (p = 0.004). The overall proportion of passes was significantly higher in the TG than NTG (p < 0.001). Conclusion: Education by a clinical pharmacist improved short-term prescribing skills of final year medical students in this study. Students learning primarily experientially from peers and rotational supervisors showed decreased prescribing skills. We propose pharmacist-led education on prescription writing should be further evaluated in larger studies across more student cohorts and for longer periods of follow up time to clarify whether such an educational model could be included in future medical school curricula.
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Affiliation(s)
- Sophie Mokrzecki
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,Pharmacy Department, Townsville University Hospital, Townsville, QLD, Australia
| | - Tilley Pain
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,Allied Health Department, Townsville University Hospital, Townsville, QLD, Australia
| | - Andrew Mallett
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,Institute of Health Research and Innovation, Townsville University Hospital, Townsville, QLD, Australia
| | - Stephen Perks
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,Pharmacy Department, Townsville University Hospital, Townsville, QLD, Australia
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Jones ME, Pourali SP, Kohn AH, Gutierrez Y, Rajkumar JR, Armstrong AW. Differences in acne therapy prescribing patterns between dermatologists and pediatricians: A population-based study. Pediatr Dermatol 2021; 38:1150-1156. [PMID: 34514637 DOI: 10.1111/pde.14778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Acne is a common skin condition that may be treated by both dermatologists and pediatricians. However, the treatments provided by dermatologists and pediatricians may differ. We aimed to describe acne therapy prescribing patterns of dermatologists and pediatricians. METHODS We performed a population-based, cross-sectional analysis using data from the National Ambulatory Medical Care Survey from 2006 to 2016 for pediatric patients (age ≤ 18 years). RESULTS There were approximately 30.5 million (weighted) outpatient acne visits between 2006 and 2016 for pediatric patients; 52% of visits were conducted by dermatologists, 29% by pediatricians, and 19% by other providers. Compared to pediatricians, dermatologists saw older patients (mean age 15.5 ± 0.12 vs 13.5 ± 0.35; P < .001), as well as a higher proportion of white patients (92.5% vs 76.3%; P < .001), non-Hispanic patients (89.5% vs 81.6%; P < .001), and patients with private insurance (84.6% vs 67.8%; P < .001). Compared to patients seen by dermatologists, patients seen by pediatricians were 68% less likely to receive topical retinoids (aOR 0.32, 95% CI 0.22-0.46), 38% less likely to receive topical antibiotics (aOR 0.62, 95% CI 0.41-0.95), and 48% less likely to receive oral antibiotics (adjusted aOR 0.52, 95% CI 0.36-0.75). CONCLUSIONS Our findings demonstrate that pediatricians prescribe topical retinoids, topical antibiotics, and oral antibiotics less frequently compared to dermatologists. It is important to understand these differences in prescribing patterns for acne and to identify potential educational gaps.
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Affiliation(s)
- Madison E Jones
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Sarah P Pourali
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Alison H Kohn
- Florida Atlantic University Charles E Schmidt College of Science, Boca Raton, FL, USA
| | - Yasmin Gutierrez
- University of California Riverside School of Medicine, Riverside, CA, USA
| | | | - April W Armstrong
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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Hayes KN, Gomes T, Tadrous M. Greater than the Sum: Applying Daily-Dose Equivalents to Antipsychotic Prescription Claims to Study Real-World Effects. Front Pharmacol 2021; 12:709349. [PMID: 34421603 PMCID: PMC8378135 DOI: 10.3389/fphar.2021.709349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Traditional methods to standardize exposures in pharmacoepidemiologic studies, like defined daily-doses, may be inadequate to capture drug class effects when there are many in-class medications, formulations, and administration routes. Antipsychotic medications are one example of a drug class with these complexities. Direct dose conversion methods are pharmacologically-based but often overlooked, potentially for lack of real-world guidance and examples of their implementation. The purpose of this article is to describe a method to implement dose conversion, using an example study that quantifies antipsychotic use among a cohort of older adults with dementia. We identified 45,442 older adults (aged ≥66 years) with dementia initiating antipsychotic therapy between January 1, 2009 and December 31, 2012 in Ontario, Canada using linked administrative healthcare databases. We developed and applied a data cleaning and dose conversion algorithm to quantify antipsychotic exposure in chlorpromazine dose equivalents at initiation, month 6, and month 12 of therapy. Results were stratified by route of administration. At initiation, 14% of patients received multiple antipsychotic prescriptions simultaneously. Patients initiating regular injectable and multiple administration routes received the highest median chlorpromazine equivalent daily-doses. Data cleaning changed 3, 16, 36, and 42% of total equivalent daily-doses in patients initiating oral, regular injectable, long-acting injectable, and multiple administration routes, respectively. Dose conversion of prescription claims data was a feasible method to quantify and present antipsychotic drug exposures. Dose conversion methods can be considered for drug effects studies of antipsychotic therapies and other medication classes with complex use.
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Affiliation(s)
- Kaleen N Hayes
- Dalla Lana School of Public Health, Department of Public Health Sciences, University of Toronto, Toronto, ON, Canada
| | - Tara Gomes
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON, Canada
| | - Mina Tadrous
- ICES, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON, Canada.,Women's College Hospital, Toronto, ON, Canada
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Blok AC, Ignacio RV, Geraci MC, Kim HM, Barnett PG, Duffy SA. Provider and clinical setting characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration. Tob Induc Dis 2021; 19:65. [PMID: 34429727 PMCID: PMC8349177 DOI: 10.18332/tid/140091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/04/2021] [Accepted: 07/08/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION While initiation rates of tobacco cessation pharmacotherapy have improved both inside and outside the Department of Veteran Affairs (VA), prescribing rates remain low. The objective of this study was to examine correlation of the characteristics of providers, clinics, and facilities with initiation of tobacco cessation pharmacotherapy. METHODS This retrospective, observational study used VA outpatient electronic medical record data from federal fiscal year 2011. Logistic regression models estimated the adjusted odds ratio associated with provider characteristics for pharmacotherapy initiation. RESULTS For the 639507 veterans who used tobacco, there were 30388 providers caring for them. Younger (p<0.001) and female (p<0.001) providers were more likely to initiate tobacco cessation pharmacotherapy. Compared to physicians, pharmacists were 74% more likely to initiate pharmacotherapy, while all groups of nurses were 5-8% and physicians' assistants were 12% less likely (p<0.001). Compared to those seen in primary care clinics, patients assessed in substance use treatment clinics were 16% more likely to have pharmacotherapy initiated (p<0.001), while those in psychiatry were 10% less likely (p<0.001), and those in outpatient surgery were 39% less likely to initiate pharmacotherapy (p<0.001). Compared to almost all other classes of VA facilities, patients seen in primary care community-based outpatient clinics (CBOCs) were 7-28% more likely to initiate pharmacotherapy (p<0.0001). CONCLUSIONS While the VA is at the leading edge of providing tobacco cessation pharmacotherapy, targeting quality improvement efforts towards providers, clinics, and facilities with low prescribing rates will be essential to continue the declining rates of tobacco use among VA patients.
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Affiliation(s)
- Amanda C. Blok
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, United States
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, United States
| | - Rosalinda V. Ignacio
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, United States
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, United States
| | - Mark C. Geraci
- Department of Veterans Affairs Pharmacy Benefits Management Services, United States Department of Veterans Affairs, Hines, United States
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, United States
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, United States
| | - Paul G. Barnett
- Health Economics Resource Center, United States Department of Veterans Affairs, Menlo Park, United States
| | - Sonia A. Duffy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, United States
- College of Nursing, The Ohio State University, Columbus, United States
- Department of Psychiatry, University of Michigan, Ann Arbor, United States
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Cattermole GN, Wells M. Comparison of adult weight estimation methods for use during emergency medical care. J Am Coll Emerg Physicians Open 2021; 2:e12515. [PMID: 34322682 PMCID: PMC8295032 DOI: 10.1002/emp2.12515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/07/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Many emergency drug and fluid doses are weight dependent in adults, but in resuscitation and low-resource settings it can be impractical or impossible to weigh a patient. It is especially important to obtain accurate weight estimation for dose calculations for emergency drugs with narrow therapeutic ranges. Several weight estimation methods have been proposed for use in adults, but none is widely established. The aim of this study was to compare the accuracy of adult weight estimation methods. METHODS Demographic and body measurement data were obtained from the US National Health and Nutrition Examination Survey (NHANES), and 7 previously published weight estimation methods were used to estimate the weight for each individual. The primary outcomes were the proportions of estimates within 10% and 20% of actual weight (P10, P20). An acceptable accuracy was predetermined to be P10 = 70% and P20 = 95%. RESULTS The data set included 5158 adults (51.2% women) with sufficient data to calculate all weight estimation methods. The Lorenz method performed best (P10 = 86.8%, P20 = 99.4%) and met the standard of acceptability across sex and body mass index subgroups. The Mercy and PAWPER XL-MAC methods performed acceptably in non-obese adults. CONCLUSION The ideal weight estimation method should be accurate, rapid, simple, and feasible. This study has demonstrated the accuracy of 7 methods. The Lorenz method performed best but is complex and likely to be difficult to apply in resuscitation settings. Other simpler and quicker methods are at least as accurate as the best methods widely used in children, and there is potential for further calibrating these for use in adults before validation in real-world studies.
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Affiliation(s)
- Giles N. Cattermole
- Department of Emergency MedicineKing's College Hospital National Health Service TrustLondonUK
| | - Mike Wells
- Department of Emergency MedicineUniversity of the WitwatersrandJohannesburgSouth Africa
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Bebitoglu BT, Oguz E, Acet NG, Akdeniz E, Sarikaya Ö. The short- and long-term effects of a course on rational drug use: A comparative study between prefinal- and final-year undergraduate medical students who attended the course in different clinical years. J Educ Health Promot 2021; 10:213. [PMID: 34395650 PMCID: PMC8318193 DOI: 10.4103/jehp.jehp_1152_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/06/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Rational pharmacology use and appropriate prescribing are among the key learning outcomes in medical education. Some medical faculties include rational pharmacotherapy course in their education programs at different years of education in Turkey. The aims of this study were to investigate the differences in effect of rational pharmacotherapy course on short- and long-terms by comparing two cohorts who attended the course in different clinical years of medical education by identifying which parameters of prescription items are different among groups. MATERIALS AND METHODS This quasi-experimental study was conducted in School of Medicine. Participants consisted of 157 students who attended the course in Grade 4 (n = 110, Group A) and Grade 5 (n = 47, Group B). Students were asked to complete a prescribing task both upon completion of the course and 1 year after. The performance in prescribing was determined by prescription scoring form. Repeated measures ANOVA was employed to test the intervention effect between two periods. McNemar test was employed to measure the change in each item on the prescription. Point-biserial correlations between each item on the prescription and their scores on the test as a whole were calculated. RESULTS The mean score of Group A dropped to 59.41 (standard deviation [SD] = 14.06) from 90.43 (SD = 8.90), and the mean score of Group B dropped to 73.37 (SD = 12.56) from 83.91 (SD = 10.03). All the prescription components in the scripts of the Group A students worsened significantly, except the "name of drug," whereas Group B students maintained most of them after 1 year. CONCLUSIONS This study shows that the long-term retention effect of rational pharmacotherapy course conducted in later years of education is better than the course conducted in earlier years of education, which may be related to the fact that students in later years are more likely to take on responsibility for patient therapy process in clinical education.
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Affiliation(s)
- Berna Terzioglu Bebitoglu
- Department of Medical Pharmacology, School of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Elif Oguz
- Department of Medical Pharmacology, School of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Nazife Gökçe Acet
- Department of Medical Pharmacology, School of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Esra Akdeniz
- Department of Medical Education, School of Medicine, Marmara University, İstanbul, Turkey
| | - Özlem Sarikaya
- Department of Medical Education, School of Medicine, Marmara University, İstanbul, Turkey
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Singhal S, Kloosterman C, Billian J, Bailey T, Soares N. Most Second-Generation Antipsychotic Prescriptions in Community Practice Are Neither FDA-Approved nor Within Prescribing Guideline Recommendations. J Pediatr Pharmacol Ther 2021; 26:460-466. [PMID: 34239397 DOI: 10.5863/1551-6776-26.5.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/12/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Second-generation antipsychotic (SGA) prescription use has become increasingly prevalent in the pediatric population, despite metabolic adverse effects. A significant number of SGA medications are prescribed for indications that are not approved by the FDA. This study aimed to quantify clinician adherence to the FDA and professional society indication, age, and dosing guidelines when prescribing SGA medications for pediatric patients. METHODS We used electronic health record data from 3 health care systems. We analyzed outpatient encounters where a pediatric patient was prescribed an SGA during an 18-month time frame. Clinician prescribing patterns were compared to a therapeutic regimen table created using professional society guidelines and FDA medication labels. RESULTS Most of the encounters listed an indication that was not documented as a recommended use (84.3%). Most prescriptions aligned with the generalized dose guidelines (93.8%) and age guidelines (94.9%). Clinicians were more likely to follow indication guidelines when prescribing risperidone, the highest adherence medication, compared with quetiapine, the lowest adherence medication (odds ratio [OR], 2.5; 95% CI, 1.1-6.0). Compared with prescriptions for younger children, clinicians were more likely to follow indication guidelines for children aged 13 to 15 years (OR, 2.8; 95% CI, 1.1-7.2) and 16 to 18 years (OR, 3.1; 95% CI, 1.2-8.1). CONCLUSION Community clinicians overall demonstrated a low level of adherence to indication guidelines when prescribing SGA medications to pediatric populations, while maintaining higher adherence to age and dosing guidelines. Older children were more likely to receive an SGA prescription for recommended indications compared with younger children.
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Stroever SJ, Ostapenko D, Scatena R, Pusztai D, Coritt L, Frimpong AA, Nee P. Medication Use Among Patients With COVID-19 in a Large, National Dataset: Cerner Real-World Data™. Clin Ther 2021; 43:e173-e196. [PMID: 33958234 PMCID: PMC8049452 DOI: 10.1016/j.clinthera.2021.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE The outbreak of coronavirus disease 2019 (COVID-19) required clinicians to use knowledge of therapeutic mechanisms of established drugs to piece together treatment regimens. The purpose of this study is to examine the trends in medication use among patients with COVID-19 across the United States using a national dataset. METHODS We conducted a cross-sectional study of the COVID-19 cohort in the Cerner Real-World Data warehouse, which includes deidentified patient information for encounters associated with COVID-19 from December 1, 2019, through June 30, 2020. The primary variables of interest were medications given to patients during their inpatient COVID-19 treatment. We also identified demographic characteristics, calculated the proportion of patients with each medication, and stratified data by demographic variables. FINDINGS Our sample included 51,169 inpatients from every region of the United States. Males and females were equally represented, and most patients were white and non-Hispanic. The largest proportion of patients were older than 45 years. Corticosteroids were used the most among all patients (56.5%), followed by hydroxychloroquine (17.4%), tocilizumab (3.1%), and lopinavir/ritonavir (1.1%). We found substantial variation in medication use by region, race, ethnicity, sex, age, and insurance status. IMPLICATIONS Variations in medication use are likely attributable to multiple factors, including the timing of the pandemic by region in the United States and processes by which medications are introduced and disseminated. This study is the first of its kind to assess trends in medication use in a national dataset and is the first large, descriptive study of pharmacotherapy in hospitalized patients with COVID-19. It provides an important glimpse into prescribing patterns during a pandemic.
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Affiliation(s)
| | - Daniel Ostapenko
- Department of Innovation and Research, Nuvance Health, Danbury, Connecticut
| | - Robyn Scatena
- Department of Critical Care, Nuvance Health, Norwalk, Connecticut
| | - Daniel Pusztai
- Department of Pharmacy, Norwalk Hospital, Norwalk, Connecticut
| | - Lauren Coritt
- University of Vermont, Larner College of Medicine, Burlington, Vermond
| | - Akua A Frimpong
- University of Vermont, Larner College of Medicine, Burlington, Vermond
| | - Paul Nee
- Department of Infectious Diseases, Nuvance Health, Danbury, Connecticut
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Miglio G, Basso L, Armando LG, Traina S, Benetti E, Diarassouba A, Baroetto Parisi R, Esiliato M, Rolando C, Remani E, Cena C. A Network Approach for the Study of Drug Prescriptions: Analysis of Administrative Records from a Local Health Unit (ASL TO4, Regione Piemonte, Italy). Int J Environ Res Public Health 2021; 18:4859. [PMID: 34063257 DOI: 10.3390/ijerph18094859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022]
Abstract
In a Drug Prescription Network (DPN), each drug is represented as a node and two drugs co-prescribed to the same patient are represented as an edge linking the nodes. The use of DPNs is a novel approach that has been proposed as a means to study the complexity of drug prescription. The aim of this study is to demonstrate the analytical power of the DPN-based approach when it is applied to the analysis of administrative data. Drug prescription data that were collected at a local health unit (ASL TO4, Regione Piemonte, Italy), over a 12-month period (July 2018–June 2019), were used to create several DPNs that correspond to the five levels of the Anatomical Therapeutic Chemical classification system. A total of 5,431,335 drugs prescribed to 361,574 patients (age 0–100 years; 54.7% females) were analysed. As indicated by our results, the DPNs were dense networks, with giant components that contain all nodes. The disassortative mixing of node degrees was observed, which implies that non-random connectivity exists in the networks. Network-based methods have proven to be a flexible and efficient approach to the analysis of administrative data on drug prescription.
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Lewis J, Barry AR, Bellefeuille K, Pammett RT. Perceptions of Independent Pharmacist Prescribing among Health Authority- and Community-Based Pharmacists in Northern British Columbia. Pharmacy (Basel) 2021; 9:92. [PMID: 33922521 DOI: 10.3390/pharmacy9020092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022] Open
Abstract
Pharmacists across Canada have varying degrees of ability to prescribe medications depending on their jurisdiction of licensure. The purpose of this study was to the evaluate attitudes, beliefs, and perceptions of independent pharmacist prescribing among health authority- and community-based pharmacists. This prospective, cross-sectional online survey assessed the perceptions of independent pharmacist prescribing of health authority and community pharmacists practising in northern British Columbia (BC), which was defined as within the geographical boundaries of Northern Health. Responses were analysed using descriptive statistics and a regression analysis. There were 45 respondents to the survey: 22 community pharmacists and 23 health authority pharmacists. Both community and health authority pharmacists held positive perceptions of independent pharmacist prescribing and did not identify any barriers to incorporating independent pharmacist prescribing into their practice. Respondents were highly likely to apply for independent pharmacist prescribing authority, if available. Pharmacists in BC are currently not able to independently prescribe schedule I medications. The provincial regulatory body has proposed a framework for a Certified Pharmacist Prescriber designation, which if approved would allow pharmacists to prescribe in collaborative practice settings. This study provides some insight into the perception of pharmacists in northern BC in pursuing this designation, which may be valuable for planning purposes in case of adoption of the framework. These results are also likely applicable to other non-urban practice settings in Canada. Pharmacists in northern BC perceived independent pharmacist prescribing positively and a high proportion were likely to apply for this authority if it were permitted via legislation.
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de Oliveira Costa J, Bruno C, Schaffer AL, Raichand S, Karanges EA, Pearson SA. The changing face of Australian data reforms: impact on pharmacoepidemiology research. Int J Popul Data Sci 2021; 6:1418. [PMID: 34007904 PMCID: PMC8107783 DOI: 10.23889/ijpds.v6i1.1418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE A wealth of data is generated through Australia's universal health care arrangements. However, use of these data has been hampered by different federal and state legislation, privacy concerns and challenges in linking data across jurisdictions. A series of data reforms have been touted to increase population health research capacity in Australia, including pharmacoepidemiology research. Here we catalogued research leveraging Australia's Pharmaceutical Benefits Scheme (PBS) data (2014-2018) and discussed these outputs in the context of previously implemented and new data reforms. METHODS We conducted a systematic review of population-based studies using PBS dispensing claims. Independent reviewers screened abstracts of 4,996 articles and 310 full-text manuscripts. We characterised publications according to study population, analytical approach, data sources used, aims and medicines focus. RESULTS We identified 180 studies; 133 used individual-level data, 70 linked PBS dispensing claims with other health data (66 across jurisdictions). Studies using individual-level data focussed on Australians receiving government benefits (87 studies) rather than all PBS-eligible persons. 63 studies examined clinician or patient practices and 33 examined exposure-outcome relationships (27 evaluated medicines safety, 6 evaluated effectiveness). Medicines acting on the nervous and cardiovascular system account for the greatest volume of PBS medicines dispensed and were the most commonly studied (67 and 40 studies, respectively). Antineoplastic and immunomodulating agents account for approximately one third of PBS expenditure but represented only 10% of studies in this review. CONCLUSIONS The studies in this review represent more than a third of all population-based pharmacoepidemiology research published in the last three decades in Australia. Recent data reforms have contributed to this escalating output. However, studies are concentrated among specific subpopulations and medicines classes, and there remains a limited understanding of population benefits and harms derived from medicines use. The current draft Data Availability and Transparency legislation should further bolster efforts in population health research.
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Affiliation(s)
| | - Claudia Bruno
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Andrea L Schaffer
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Smriti Raichand
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Emily A Karanges
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
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Abstract
INTRODUCTION The historical separation between medicine and dentistry has resulted in the creation of separate health records, which have the potential to negatively impact patient care and safety. Of particular importance, errors or omissions in medication lists in separate electronic health records (EHRs) may lead to medical errors and serious adverse outcomes. OBJECTIVE This study aimed to compare medication lists reported in the EHRs of active patients treated by both the University of Michigan School of Dentistry and Michigan Medicine to determine if differences exist. METHODS In this cohort study, EHRs of a population of 159,733 patients that the University of Michigan medical and dental clinics share in common were investigated for agreement in the reporting of 16 medications. After exclusion of minors and patients not seen in the last 5 y, records of 27,277 patients were examined. RESULTS The maximum percentage of agreement in medications reported in both records was 52% for levothyroxine, and the minimum was 7% for sildenafil. The medical record had a significantly higher number of unique medications than the dental record, suggesting higher underreporting in the dental setting. CONCLUSION The lack of agreement in the report of medications with serious dental and medical implications argues in favor of unification of records and use of available technology to increase accurate medication reporting. KNOWLEDGE TRANSFER STATEMENT The results demonstrate a lack of agreement between medications reported in medical and dental records, which can have serious implications to patients' health. A unified health record, employing available technology to increase accurate medication reporting, would mitigate this problem.
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Affiliation(s)
- L M A Tenuta
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - C Canady
- Office of Dental Informatics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - R M Eber
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - L Johnson
- Office of Dental Informatics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.,Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
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