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Tsang CCS, Wang J, Shih YCT. Cost-effectiveness of medication therapy management among Medicare population and across racial/ethnic groups. Medicine (Baltimore) 2024; 103:e37935. [PMID: 38701304 DOI: 10.1097/md.0000000000037935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Inappropriate medication utilization among older adults is a pressing concern in the United States, owing to its high prevalence and the consequential detrimental impact it engenders. The adverse effects stemming from the inappropriate use of medication may be unequally borne by racial/ethnic minority populations, calling for greater efforts towards promoting equity in healthcare. The study objective was to assess the cost-effectiveness of Medication Therapy Management (MTM) services among Medicare beneficiaries and across racial/ethnic groups. METHODS Medicare administrative data from 2016 to 2017 linked to Area Health Resources Files were used to analyze Medicare fee-for-service patients aged 65 or above with continuous Parts A/B/D coverage. The intervention group included new MTM enrollees in 2017; the control group referred to patients who met the general MTM eligible criteria but did not enroll in 2016 or 2017. The 2 groups were matched using a propensity score method. Effectiveness was evaluated as the proportion of appropriate medication utilization based on performance measures developed by the Pharmacy Quality Alliance. Costs were computed as total healthcare costs from Medicare perspective. A multivariable net benefit regressions with a classic linear model and Bayesian analysis were utilized. Net benefit was calculated based on willingness-to-pay thresholds at various multiples of the gross domestic product in 2017. Three-way interaction terms among dummy variables for MTM enrollment, 2017, and racial/ethnic minority groups were incorporated in a difference-in-differences study design. RESULTS After adjusting for patient characteristics, the findings indicate that MTM receipt was associated with incremental net benefit among each race and ethnicity. For instance, the net benefit of MTM among the non-Hispanic White patients was $2498 (95% confidence interval = $1609, $3386) at a willingness-to-pay value of $59,908. The study found no significant difference in net benefits for MTM services between minority and White patients. CONCLUSION The study provides evidence that MTM is a cost-effective tool for managing medication utilization among the Medicare population. However, MTM may not be cost-effective in reducing racial/ethnic disparities in medication utilization in the short term. Further research is needed to understand the long-term cost-effectiveness of MTM on racial/ethnic disparities.
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Affiliation(s)
- Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN
| | - Ya-Chen Tina Shih
- University of California, Los Angeles, School of Medicine, Los Angeles, CA
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Tran K, Stedman M, Chang TI. Intensive Blood Pressure Control and Diabetes Mellitus-Related Limb Events in Patients With Type 2 Diabetes Mellitus: Reanalysis of ACCORD. J Am Heart Assoc 2021; 10:e021407. [PMID: 34320842 PMCID: PMC8475694 DOI: 10.1161/jaha.121.021407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kenneth Tran
- Division of Vascular SurgeryDepartment of SurgeryStanford University School of MedicineStanfordCA
| | - Margaret Stedman
- Division of NephrologyDepartment of MedicineStanford University School of MedicineStanfordCA
| | - Tara I. Chang
- Division of NephrologyDepartment of MedicineStanford University School of MedicineStanfordCA
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Winthrop KL, Loftus EV, Baumgart DC, Reinisch W, Nduaka CI, Lawendy N, Chan G, Mundayat R, Friedman GS, Salese L, Thorpe AJ, Su C. Tofacitinib for the Treatment of Ulcerative Colitis: Analysis of Infection Rates from the Ulcerative Colitis Clinical Programme. J Crohns Colitis 2021; 15:914-929. [PMID: 33245746 PMCID: PMC8218715 DOI: 10.1093/ecco-jcc/jjaa233] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of ulcerative colitis. We report integrated analyses of infections in the Phase [P]2 and P3 OCTAVE programmes. METHODS Three cohorts were analysed: Induction [P2/3 induction studies]; Maintenance [P3 maintenance study]; and Overall [all tofacitinib-treated patients in induction, maintenance, or ongoing, open-label, long-term extension studies; as of May 2019]. Proportions and incidence rates [IRs; unique patients with events/100 patient-years] of serious infections [SIs], herpes zoster [HZ] [non-serious and serious], and opportunistic infections [OIs] are reported [censored at time of event]. RESULTS In the Induction Cohort [N = 1220], no patients receiving placebo and eight [0.9%] receiving tofacitinib 10 mg twice daily [BID] developed SIs. Maintenance Cohort [N = 592] SI IRs (95% confidence interval [CI]) were 1.94 [0.23-7.00] for placebo and 1.35 [0.16-4.87] and 0.64 [0.02-3.54] for tofacitinib 5 and 10 mg BID, respectively; HZ IRs were 0.97 [0.02-5.42], 2.05 [0.42-6.00], and 6.64 [3.19-12.22], respectively. In the Overall Cohort [N = 1157; 82.9% predominantly received tofacitinib 10 mg BID], SI, HZ, and non-HZ OI IRs were 1.70 [1.24-2.27], 3.48 [2.79-4.30], and 0.15 [0.04-0.38], respectively. No SIs resulted in death. CONCLUSIONS During induction, SIs were more frequent with tofacitinib versus placebo. SIs were generally infrequent in the Maintenance and Overall Cohorts, with rates comparable between treatment groups. Maintenance Cohort HZ IR was numerically higher with tofacitinib 10 mg BID versus 5 mg BID. Overall Cohort HZ IRs remained stable over time. Non-HZ OIs and viral infections were rare.
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Affiliation(s)
- Kevin L Winthrop
- Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Walter Reinisch
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Chudy I Nduaka
- Inflammation and Immunology, Pfizer Inc, Collegeville, PA, USA
| | - Nervin Lawendy
- Inflammation and Immunology, Pfizer Inc, Collegeville, PA, USA
| | - Gary Chan
- Inflammation and Immunology, Pfizer Inc, Collegeville, PA, USA
| | - Rajiv Mundayat
- Inflammation and Immunology, Pfizer Inc, New York, NY, USA
| | - Gary S Friedman
- Inflammation and Immunology, Pfizer Inc, Collegeville, PA, USA
| | - Leonardo Salese
- Inflammation and Immunology, Pfizer Inc, Collegeville, PA, USA
| | - Andrew J Thorpe
- Inflammation and Immunology, Pfizer Inc, Collegeville, PA, USA
| | - Chinyu Su
- Inflammation and Immunology, Pfizer Inc, Collegeville, PA, USA
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Kaya M, Nakamura K, Nagamine M, Suyama Y, Nakajo M, Uchida R, Hagikura K, Kanda A, Sugiyama K, Sugiyama R, Nakagaki S, Kimura M. A retrospective study comparing interventions by oncology and non-oncology pharmacists in outpatient chemotherapy. Cancer Rep (Hoboken) 2021; 4:e1371. [PMID: 33739629 PMCID: PMC8388162 DOI: 10.1002/cnr2.1371] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The differences in the clinical pharmacy services (CPS) provided by oncology and non-oncology pharmacists have not been sufficiently explained. AIM This study aimed to demonstrate the differences in direct CPS provided by oncology and non-oncology pharmacists for patients and physicians, and to assess the potential impact of these services on medical costs. METHODS We retrospectively examined CPS provided by oncology and non-oncology pharmacists for outpatients who underwent chemotherapy between January and December 2016. RESULTS In total, 1177 and 1050 CPS provided by oncology and non-oncology pharmacists, respectively, were investigated. The rates of interventions performed by oncology and non-oncology pharmacists for physicians-determined treatment were 18.5% and 11.3%, respectively (p < .001). The rates of oncology and non-oncology pharmacist interventions accepted by physicians were 84.6 and 78.8%, respectively (p = .12). Level 4 and Level 5 interventions accounted for 64.6% of all oncology pharmacist interventions and 53.0% of all non-oncology pharmacist interventions (p = .03). The rates of improvement in symptoms from adverse drug reactions among patients resulting from interventions by oncology and non-oncology pharmacists were 89.4 and 72.1%, respectively (p = .02). Conservative assessments of medical cost impact showed that a single intervention by an oncology and by a non-oncology pharmacist saved ¥6355 and ¥3604, respectively. CONCLUSION The results of the present study suggested that CPS by oncology pharmacists enable safer and more effective therapy for patients with cancer and indirectly contribute to reducing health care fees.
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Affiliation(s)
- Michihiro Kaya
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Kazuyo Nakamura
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Makiko Nagamine
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Yukako Suyama
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Michiaki Nakajo
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Ryo Uchida
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Kakeru Hagikura
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Ai Kanda
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Kyohei Sugiyama
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Rina Sugiyama
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Shigeru Nakagaki
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
| | - Midori Kimura
- Department of PharmacyShizuoka General HospitalShizuoka CityJapan
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Abu-Ghanem Y, Kleinmann N, Erlich T, Winkler HZ, Zilberman DE. The Impact of Dietary Modifications and Medical Management on 24-Hour Urinary Metabolic Profiles and the Status of Renal Stone Disease in Recurrent Stone Formers. Isr Med Assoc J 2021; 23:12-16. [PMID: 33443336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Dietary modifications and patient-tailored medical management are significant in controlling renal stone disease. Nevertheless, the literature regarding effectiveness is sparse. OBJECTIVES To explore the impact of dietary modifications and medical management on 24-hour urinary metabolic profiles (UMP) and renal stone status in recurrent kidney stone formers. METHODS We reviewed our prospective registry database of patients treated for nephrolithiasis. Data included age, sex, 24-hour UMP, and stone burden before treatment. Under individual treatment, patients were followed at 6-8 month intervals with repeat 24-hour UMP and radiographic images. Nephrolithiasis-related events (e.g., surgery, renal colic) were also recorded. We included patients with established long-term follow-up prior to the initiation of designated treatment, comparing individual nephrolithiasis status before and after treatment initiation. RESULTS Inclusion criteria were met by 44 patients. Median age at treatment start was 60.5 (50.2-70.2) years. Male:Female ratio was 3.9:1. Median follow-up was 10 (6-25) years and 5 (3-6) years before and after initiation of medical and dietary treatment, respectively. Metabolic abnormalities detected included: hypocitraturia (95.5%), low urine volume (56.8%), hypercalciuria (45.5%), hyperoxaluria (40.9%), and hyperuricosuria (13.6%). Repeat 24-hour UMP under appropriate diet and medical treatment revealed a progressive increase in citrate levels compared to baseline and significantly decreased calcium levels (P = 0.001 and 0.03, respectively). A significant decrease was observed in stone burden (P = 0.001) and overall nephrolithiasis-related events. CONCLUSIONS Dietary modifications and medical management significantly aid in correcting urinary metabolic abnormalities. Consequently, reduced nehprolithiasis-related events and better stone burden control is expected.
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Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Kleinmann
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Erlich
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Harry Z Winkler
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mehta B, Jannat-Khah D, Mancuso CA, Bass AR, Moezinia CJ, Gibofsky A, Goodman SM, Ibrahim S. Geographical variations in COVID-19 perceptions and patient management: a national survey of rheumatologists. Semin Arthritis Rheum 2020; 50:1049-1054. [PMID: 32911282 PMCID: PMC7342007 DOI: 10.1016/j.semarthrit.2020.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/26/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the perceptions and behaviors of rheumatologists in the United States (US) regarding the risk of COVID-19 for their autoimmune patients and the subsequent management of immunosuppressive and anti-inflammatory medications. METHODS We administered an online survey to a convenience sample of rheumatologists in the US from 4/8/20-5/4/20 via social media and group emails. Survey respondents provided demographic information such as, age, gender, state of practice, and practice type. We asked questions about COVID-19 risk in rheumatic patients, as well as their medication management during the pandemic. We conducted descriptive analysis and Multivariable regression models. RESULTS 271 respondents completed the survey nationally. 48% of respondents either agreed or strongly agreed with the statement "Patients with rheumatic diseases are at a higher risk of COVID-19 irrespective of their immunosuppressive medications". 50% disagreed or strongly disagreed with the statement "The pandemic has led you to reduce the use/dosage/frequency of biologics", while 56% agreed or strongly agreed with the statement "The pandemic has led you to reduce the use/dosage/frequency of steroids". A third of respondents indicated that at least 10% of their patients had self-discontinued or reduced at least one immunosuppressive medication to mitigate their risk of COVID-19. Responses to these questions as well as to questions regarding NSAID prescription patterns were significantly different in the Northeast region of US compared to other regions. CONCLUSION In this national sample of rheumatologists, there are variations regarding perceptions of patients' risk of COVID-19, and how to manage medications such as NSAIDs, biologics and steroids during the pandemic. These variations are more pronounced in geographical areas where COVID-19 disease burden was high.
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Affiliation(s)
- Bella Mehta
- Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medicine, New York, NY, USA.
| | - Deanna Jannat-Khah
- Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medicine, New York, NY, USA
| | - Carol A Mancuso
- Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medicine, New York, NY, USA
| | - Anne R Bass
- Hospital for Special Surgery, New York, NY, USA
| | | | | | - Susan M Goodman
- Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medicine, New York, NY, USA
| | - Said Ibrahim
- Weill Cornell Medicine, New York, NY, USA; Weill Cornell Health Policy and Research, New York, NY, USA
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Axon DR, Chinthammit C, Tate J, Taylor AM, Leal S, Pickering M, Black H, Warholak T, Campbell PJ. Current Procedural Terminology Codes for Medication Therapy Management in Administrative Data. J Manag Care Spec Pharm 2020; 26:1297-1300. [PMID: 32996390 PMCID: PMC10391033 DOI: 10.18553/jmcp.2020.26.10.1297] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Three pharmacist-specific Current Procedural Terminology (CPT) codes exist to facilitate medication therapy management (MTM) reimbursement (codes 99605, 99606, and 99607). However, no studies have used CPT codes in administrative claims databases to identify subjects who have received MTM services. OBJECTIVE To assess the prevalence of MTM services provided, using CPT codes identified in an administrative dataset. METHODS A retrospective cohort study was conducted using a subset of Medicare Part D individuals from the IBM MarketScan Medicare Supplemental Research Databases (2009-2015). Researchers identified beneficiaries who received MTM services using CPT codes 99605, 99606, and 99607. RESULTS Of the 16,483,709 individuals in the dataset, only 3,291 had CPT codes indicating that they received MTM services, representing an overall prevalence of 0.020%. CONCLUSIONS The use of CPT codes as an indicator of MTM service provision resulted in far lower MTM utilization rates than in published literature. Reliance on CPT codes to identify MTM services in administrative claims is not recommended, given that it limited the researchers' ability to properly identify patient receipt of such services. More accurate methodologies are warranted for identifying MTM use and its effects on patient outcomes. DISCLOSURES This work was supported by Pharmacy Quality Alliance; Merck Sharp & Dohme, a subsidiary of Merck & Co. (Kenilworth, NJ); and SinfoniaRx. The funding sources had no role in study design, collection, analysis, and interpretation of data, writing the report, or decision to submit the article for publication. Tate, Chinthammit, and Campbell completed this work during their employment at the University of Arizona. Pickering was an employee of Pharmacy Quality Alliance at the time of this study. Black is employed by Merck. Axon reports grants from the Arizona Department of Health Services and the American Association of Colleges of Pharmacy; Campbell reports a grant from the Community Pharmacy Foundation; Chinthammit reports fees from Eli Lilly; Black has received a grant from Merck; Warholak reports grants from the Arizona Department of Health Services and Novartis, all unrelated to this study. Taylor reports grants from Tabula Rasa Op-Co, during the conduct of the study, and from the Arizona Department of Health Services, outside the conduct of this study. This research was accepted as a poster presentation at the International Society for Pharmacoeconomics and Outcomes Research Annual Meeting, May 16-20, 2020, in Orlando, FL, but was not presented due to the COVID-19 pandemic. An abstract was published in Value in Health, 2020;23(Suppl 1):S305.
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Affiliation(s)
- David R. Axon
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson
| | - Chanadda Chinthammit
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson
| | - Jared Tate
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson
| | - Ann M. Taylor
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson
| | | | - Matthew Pickering
- Quality Measurement Research & Quality Strategies, Pharmacy Quality Alliance, Alexandria, Virginia
| | - Heather Black
- Outcomes Research, Merck & Co., Kenilworth, New Jersey
| | - Terri Warholak
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson
| | - Patrick J. Campbell
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson
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Chou J, Pellegrin K, Cooke CE, Zarowitz B, Hanlon A, Lozano A, Brandt NJ. Understanding the Socioeconomic and Geographical Characteristics of Beneficiaries Receiving a Comprehensive Medication Review. J Manag Care Spec Pharm 2020; 26:1276-1281. [PMID: 32996388 PMCID: PMC10391206 DOI: 10.18553/jmcp.2020.26.10.1276] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Medicare Part D sponsors are required to offer medication therapy management (MTM) programs to eligible beneficiaries. Recent studies have demonstrated that there have been racial/ethnic disparities in MTM eligibility criteria. For example, compared with non-Hispanic White beneficiaries, Hispanic and non-Hispanic Black beneficiaries are less likely to be eligible for MTM. However, there is limited evidence for socioeconomic and geographical characteristics of those who are eligible and receive MTM services. OBJECTIVE To describe the demographic, socioeconomic, and geographic characteristics of Medicare beneficiaries who received MTM services. METHODS As part of a previous study, a national survey evaluated a convenience sample of perspectives of Medicare beneficiaries on the MTM standardized format. The survey was distributed through Medicare Part D plans to beneficiaries receiving MTM services from 2017-2018. As part of the survey, respondents could provide their ZIP codes. Geographical variables, such as the National Center for Health Statistics (NCHS) urban-rural classification scheme and economic research service (ERS) county typology codes, were then applied to respondents' ZIP codes, allowing for the classification of counties or census tracts by urbanization and economic dependence measures. Descriptive statistics are reported for demographic, geographical, and socioeconomic information. RESULTS Of the 300 (of 434) respondents who provided their ZIP codes, 51.3% were aged 65-74 years; 50% were male; and 66.7% had at least a college education. There were 82.7% who self-identified as White, while only 8% self-identified as Hispanic or Black/African American. The majority of respondents (58.4%) lived in large metropolitan areas as defined by the NCHS urban-rural classification scheme. Respondents' counties were characterized by economic dependence with 14.0% of respondents living in federal/state government-dependent counties and 12.7% living in recreation-dependent counties. CONCLUSIONS The majority of respondents who provided their ZIP codes identified themselves as White and lived in large metropolitan areas. Respondents who identified themselves as Hispanic or Black/African American were not well represented. This study provides geographical and socioeconomic characteristics of Medicare beneficiaries who received MTM services and highlights racial/ethnic differences. Further work is needed to confirm geographical and socioeconomic disparities among beneficiaries who received MTM services. DISCLOSURES No outside funding supported this study. Pellegrin is a member of the AMCP MTM Advisory Group. The other authors have nothing to disclose.
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Affiliation(s)
- Joshua Chou
- University of Maryland School of Pharmacy, Baltimore
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Prasanna SMS, Cader TSB, Sabalingam S, Shanika LGT, Samaranayake NR. Are medications safely used by residents in elderly care homes? - A multi-centre observational study from Sri Lanka. PLoS One 2020; 15:e0233486. [PMID: 32497110 PMCID: PMC7272092 DOI: 10.1371/journal.pone.0233486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 05/06/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Most residents in elderly care homes in Sri Lanka do not receive formal, on-site, patient care services. OBJECTIVE To evaluate the appropriateness of prescribing, dispensing, administration, and storage practices of medication used by residents in selected elderly care homes in Colombo District, Sri Lanka. METHODOLOGY This was a prospective, cross-sectional, multi-center study of 100 residents with chronic, non-communicable diseases, who resided in nine selected elderly care homes in Sri Lanka. Medication histories were obtained from each resident/caregiver and the appropriateness of medications in their current prescription was reviewed using standard treatment guidelines. Prescriptions were cross-checked against respective dispensing labels to identify dispensing errors. Medication administration was directly observed on two separate occasions per resident for accuracy of administration, and matched against the relevant prescription instructions. Medication storage was also observed in terms of exposure to temperature and sunlight, the suitability of container, and adequacy of separation if using multiple medications. RESULTS The mean age of residents was 70±10.5 years and the majority were women (72%). A total of 168 errors out of 446 prescriptions were identified. The mean number of prescribing errors per resident was 1.68±1.23 [median, 2.00 (1.00-3.00)]. Inappropriate dosing frequencies were the highest (37.5%;63/168), followed by missing or inappropriate medications (31.5%;53/168). The mean number of dispensing errors per resident was 15.9±13.1 [median, 14.0 (6.00-22.75)] with 3.6 dispensing errors per every medication dispensed. Mean administration errors per resident was 0.95±1.5 [median, 0.00 (0.00-1.00)], with medication omissions being the predominant error (50.5%;48/95). Another lapse was incorrect storage of medications (143 storage errors), and included 83 medications not properly separated from each other (58.0%). CONCLUSION Multiple errors related to prescribing, dispensing, administration, and storage were identified amongst those using medication in elderly care homes. Services of a dedicated consultant pharmacist could improve the quality of medication use in elderly care homes in Sri Lanka.
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Affiliation(s)
- S. M. S. Prasanna
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - T. S. B. Cader
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - S. Sabalingam
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - L. G. T. Shanika
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - N. R. Samaranayake
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
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Nash EF, Middleton PG, Taylor-Cousar JL. Outcomes of pregnancy in women with cystic fibrosis (CF) taking CFTR modulators - an international survey. J Cyst Fibros 2020; 19:521-526. [PMID: 32151568 DOI: 10.1016/j.jcf.2020.02.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [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: 12/18/2019] [Revised: 02/13/2020] [Accepted: 02/25/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND As their long-term prognosis improves, women with CF are increasingly choosing to have children, but the safety of CFTR modulators in pregnancy and breastfeeding is currently unknown. METHODS A survey was sent to lead clinicians of adult CF centres in Europe, the United Kingdom (UK), United States of America (USA), Australia and Israel requesting anonymised data on pregnancy outcomes in women using CFTR modulators before and during pregnancy and lactation. RESULTS We identified 64 pregnancies in 61 women taking IVA (n = 31), LUM/IVA (n = 26) or TEZ/IVA (n = 7), resulting in 60 live births. In 44 pregnancies, CFTR modulators were either continued throughout pregnancy or temporarily stopped and then restarted. Two maternal complications were deemed related to CFTR modulator therapy; cessation of modulator therapy resulted in clinical decline in 9 women prompting resumption of therapy during pregnancy. No modulator-related complications were reported in infants exposed in utero and/or during breastfeeding. CONCLUSIONS CFTR modulators were reported to be generally well tolerated in pregnancy and breastfeeding, with only 2 maternal complications that were deemed related to CFTR modulator therapy. Women stopping CFTR modulators in pregnancy may experience a decline in clinical status and in the cases identified in this survey, restarting therapy led to a clinical improvement. Current experience remains limited and longer-term prospective follow-up is required to exclude delayed adverse effects.
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Affiliation(s)
- Edward F Nash
- West Midlands Adult Cystic Fibrosis Centre, University Hospitals Birmingham NHS Foundation Trust, Bordesley Green East, Birmingham, United Kingdom.
| | | | - Jennifer L Taylor-Cousar
- National Jewish Health, Internal Medicine and Pediatrics, Pulmonary, Denver, Colorado, United States
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Aditama L, Athiyah U, Utami W, Rahem A. Adherence behavior assessment of oral antidiabetic medication use: a study of patient decisions in long-term disease management in primary health care centers in Surabaya. J Basic Clin Physiol Pharmacol 2020; 30:/j/jbcpp.ahead-of-print/jbcpp-2019-0257/jbcpp-2019-0257.xml. [PMID: 31953995 DOI: 10.1515/jbcpp-2019-0257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/07/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
Background Adherence to medication has an important role in the long-term management of diabetes. The Indonesian Endocrinologist Association found that of the 50% of the entire population who have been diagnosed with diabetes, two-thirds are undergoing therapy and only one-third have been achieving the intended outcomes of the drug therapy. This study aimed to identify patients' adherence behavior and the root causes of non-adherence. Methods This study used a non-experimental mixed-methods approach. A total of 40 patients with type 2 diabetes mellitus (T2DM), who were part of the referral program of the National Health Care Security System (BPJS Kesehatan) were recruited by purposive sampling from 17 primary health care centers in Surabaya, Indonesia. Results The adherence behavior assessment revealed non-adherence among 80% of the patients. The highest instances of non-adherence based on the percentage scores involved the following: patients forgot to take the medications (38.23%), patients preferred not to take the medications (20.59%) and the drug products were not available for the patient (14.71%). The factors influencing non-adherence included the complex instructions for taking medication, the absence of a reminder, the unwanted side effects of the drug, the feeling of repetition, the feeling that drugs were ineffective and the concern for the drug's effects on the kidney. Conclusions The high rates of non-adherence identified in this study encourage pharmacists to implement better medication therapy management for chronic diseases. The patients' understanding of drug therapy indications and regimens is very important in increasing the expectations of achieving effective treatment, awareness and concern for medication safety and treatment compliance.
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Affiliation(s)
- Lisa Aditama
- Faculty of Pharmacy, University of Surabaya, Jl. Tenggilis Mejoyo, Kali Rungkut, Surabaya, 60293, Indonesia
| | - Umi Athiyah
- Faculty of Pharmacy, University of Airlangga, Surabaya, East Java, Indonesia
| | - Wahyu Utami
- Faculty of Pharmacy, University of Airlangga, Surabaya, East Java, Indonesia
| | - Abdul Rahem
- Faculty of Pharmacy, University of Airlangga, Surabaya, East Java, Indonesia
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Whitlock RH, Hougen I, Komenda P, Rigatto C, Clemens KK, Tangri N. A Safety Comparison of Metformin vs Sulfonylurea Initiation in Patients With Type 2 Diabetes and Chronic Kidney Disease: A Retrospective Cohort Study. Mayo Clin Proc 2020; 95:90-100. [PMID: 31902433 DOI: 10.1016/j.mayocp.2019.07.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/06/2019] [Accepted: 07/31/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the safety of metformin vs sulfonylureas in patients with type 2 diabetes by chronic kidney disease (CKD) stage. PATIENTS AND METHODS This retrospective cohort study included adults in Manitoba, Canada, with type 2 diabetes, an incident monotherapy prescription for metformin or a sulfonylurea, and a serum creatinine measurement from April 1, 2006, to March 31, 2017. Patients were stratified by estimated glomerular filtration rate (eGFR) into the following groups: eGFR of 90 or greater, 60 to 89, 45 to 59, 30 to 44, or less than 30 mL/min/1.73 m2. Outcomes included all-cause mortality, cardiovascular events, and major hypoglycemic episodes. Baseline characteristics were used to calculate propensity scores and perform inverse probability of treatment weights analysis, and eGFR group was examined as an effect modifier for each outcome. RESULTS The cohort consisted of 21,996 individuals (19,990 metformin users and 2006 sulfonylurea users). Metformin use was associated with lower risk for all-cause mortality (hazard ratio [HR], 0.48; 95% CI, 0.40-0.58; P<.001), cardiovascular events (HR, 0.67; 95% CI, 0.52-0.86; P=.002), and major hypoglycemic episodes (HR, 0.14; 95% CI, 0.09-0.20; P<.001) when compared with sulfonylureas. CKD was a significant effect modifier for all-cause mortality (P=.002), but not for cardiovascular events or major hypoglycemic episodes. CONCLUSION Sulfonylurea monotherapy is associated with higher risk for all-cause mortality, major hypoglycemic episodes, and cardiovascular events compared with metformin. Although the presence of CKD attenuated the mortality benefit, metformin may be a safer alternative to sulfonylureas in patients with CKD.
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Affiliation(s)
- Reid H Whitlock
- Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Ingrid Hougen
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Paul Komenda
- Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Claudio Rigatto
- Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kristin K Clemens
- Institute of Clinical Evaluative Sciences, London, ON, Canada; Division of Endocrinology, Department of Medicine, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; St. Joseph's Health Care London, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada
| | - Navdeep Tangri
- Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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Tovoli F, Ielasi L, Casadei-Gardini A, Granito A, Foschi FG, Rovesti G, Negrini G, Orsi G, Renzulli M, Piscaglia F. Management of adverse events with tailored sorafenib dosing prolongs survival of hepatocellular carcinoma patients. J Hepatol 2019; 71:1175-1183. [PMID: 31449860 DOI: 10.1016/j.jhep.2019.08.015] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [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: 04/24/2019] [Revised: 07/10/2019] [Accepted: 08/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Sorafenib is associated with multiple adverse events (AEs), potentially causing its permanent interruption. It is unknown how physicians' experience has impacted on the management of these AEs and consequently on clinical outcomes. We aimed to assess whether AE management changed over time and if these modifications impacted on treatment duration and overall survival (OS). METHODS We analysed the prospectively collected data of 338 consecutive patients who started sorafenib between January 2008 and December 2017 in 3 tertiary care centres in Italy. Patients were divided according to the starting date: Group A (2008-2012; n = 154), and Group B (2013-2017, n = 184). Baseline and follow-up data were compared. In the OS analysis, patients who received second-line treatments were censored when starting the new therapy. RESULTS Baseline characteristics, AEs, and radiological response were consistent across groups. Patients in Group B received a lower median daily dose (425 vs. 568 mg/day, p <0.001) due to more frequent dose modifications. However, treatment duration was longer (5.8 vs. 4.1 months, p = 0.021) with a trend toward a higher cumulative dose in Group B. Notably, the OS was also higher (12.0 vs. 11.0 months, p = 0.003) with a sharp increase in the 2-year survival rate (28.1 vs. 18.4%, p = 0.003) in Group B. Multivariate time-dependent Cox regression analysis confirmed later period of treatment (2013-2017) as an independent predictor of survival (HR 0.728; 95%CI 0.581-0.937; p = 0.013). Unconsidered confounders were unlikely to affect these results at the sensitivity analysis. CONCLUSIONS Experience in the management of sorafenib-related AEs prolongs treatment duration and survival. This factor should be considered in the design of future randomised clinical trials including a sorafenib treatment arm, as an underestimate of sample size may derive. LAY SUMMARY Sorafenib has been the standard frontline systemic treatment for hepatocellular carcinoma for over a decade. Its tolerability is limited by different adverse events, which might lead to its permanent discontinuation in a sizeable proportion of patients. After a careful analysis of potential confounders, we demonstrated that the physicians' experience in managing adverse events related to sorafenib has improved over time, with longer treatment periods and less permanent discontinuation for toxicities. More importantly, these improvements also translated into longer patient survival. Our results have relevant repercussions in clinical practice and in the design of future clinical trials.
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Affiliation(s)
- Francesco Tovoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Luca Ielasi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Andrea Casadei-Gardini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per Lo Studio e Cura Dei Tumori, Meldola, Italy; Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
| | - Alessandro Granito
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Giulia Rovesti
- Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
| | - Giulia Negrini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giulia Orsi
- Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
| | - Matteo Renzulli
- Unit of Radiology, Department of Diagnostic Medicine and Prevention, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Wahler RG, Piccione C, Maerten-Rivera J. Pharmacy Students' Ability to Identify Fall Risk-Increasing Drugs Using an Innovative Assessment Tool. Am J Pharm Educ 2019; 83:7461. [PMID: 32001880 PMCID: PMC6983879 DOI: 10.5688/ajpe7461] [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: 12/06/2018] [Accepted: 04/02/2019] [Indexed: 06/10/2023]
Abstract
Objective. To evaluate change in the ability of third-year pharmacy students to identify drugs that increase fall risk after training in and experience using the Medication Falls Risk Assessment Tool (MFRAT). Methods. An assessment was administered to students prior to MFRAT use and after MFRAT use. The assessment consisted of 10 medication regimens for various chronic conditions (50 distinct drug choices with 30 correct answers and 20 distractors), and students were to identify fall risk increasing drugs (FRIDs). Using a flipped-classroom approach, students viewed an online presentation on FRIDs and then participated in instructor guided, in-class application of the MFRAT using student-collected data from an actual patient case. Students completed medication therapy management (MTM) documentation. The assessment data for students who had previously used the MFRAT (experienced) were analyzed separately from first time users (inexperienced). Results. Three assessment scores were evaluated: number correct (maximum 30; higher score is better), number of distractors (maximum 20; lower score better), and a combined total score (maximum 50; higher score better). In inexperienced users (n=104), pre- and post-assessment means improved significantly for correct score (24.9 vs 29.5) and total score (39.4 vs 44.3). Among experienced users (n=10), pre- and post-assessment means improved significantly for correct responses (27.3 vs 29.7), distractors (7.0 vs 3.5), and total score (40.3 vs 46.2). Conclusion. The ability of both pharmacy students who had used the MFRAT previously and those who had not to correctly identify FRIDs increased on the post-assessment.
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Affiliation(s)
- Robert G Wahler
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York
| | - Christine Piccione
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York
| | - Jaime Maerten-Rivera
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York
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Abstract
BACKGROUND Administrative claims data are increasingly used to identify nonadherent patients. This necessitates a comprehensive review and assessment of their accuracy in identifying nonadherent patients. OBJECTIVES To (a) compare administrative claims-based measures of adherence with nonadherence verified by patient interview; (b) determine if and to what extent patients classified as nonadherent based on prescription claims differ from patients classified as nonadherent based on interventions designed to gather multiple types of medication lists to compare against the prescription fill history; and (c) assess the various patient-reported reasons for nonadherence. METHODS A cross-sectional study was used to identify patients from the Southern Piedmont Community Care Network of North Carolina who were enrolled with Medicaid between January 1, 2012, and May 31, 2013, and were using prescription medications for 1 or more chronic conditions. Patients with more than a 30-day gap in refill history were identified using prescription claims and were interviewed by pharmacists to assess the reasons for nonadherence. Based on the patient-reported reasons for a gap in refill, patients were classified as interview-verified nonadherent patients or interview-verified adherent patients. The positive predictive value of prescription claims in identifying nonadherent patients was calculated, and descriptive statistics were reported. Characteristics of interview-verified nonadherent patients were compared with adherent patients using t-tests and chi-square statistics. RESULTS 1,425 patients representing 2,936 patient-class of medication combinations were included in the final analysis. 824 (28.07%) of the 2,936 records that were flagged as nonadherent using claims analysis were confirmed as adherent during patient interviews. The positive predictive value of claims records in identifying nonadherent patients was 0.72. The 2 most common reasons for patients to be misclassified as nonadherent in claims data following self-report were discontinuation of medication on prescribers' directions (21.93%) and having an alternate channel for receiving the medication (6.13%). Among interview-verified nonadherent patients, side effects, patient beliefs, education, and socioeconomic barriers were the most common patient-reported reasons for gaps in refill. CONCLUSIONS Prescription claims may underestimate adherence in patients. When interviewed directly by a pharmacist, most patients reported discontinuation of medication as per prescribers' directions. To determine the overall validity of prescription claims data, further analysis is required to assess its accuracy in identifying truly nonadherent patients among those who are identified as nonadherent by claims data. DISCLOSURES No outside funding supported this study. Glassberg and Wei were employees at Community Care of North Carolina when this research was conducted. Trygstad is an employee of Community Care of North Carolina; Robinson is an employee of Community Care of Southern Piedmont, a subsidiary of Community Care of North Carolina. The geographies, health care professionals, and subjects involved in the study were related to the care coordination work that Community Care of North Carolina was charged with implementing through its informatics and subject matter expertise assistance provided to these local entities to augment primary care activities. Farley has received funding from the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, American College of Clinical Pharmacy, the National Institutes of Health, and Community Care of North Carolina and has also received consulting funds from UCB. The other authors have nothing additional to report.
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Affiliation(s)
| | | | - David Wei
- Real-World Data Analytics and Research Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, New Jersey
| | - Tamika Robinson
- Community Care of Southern Piedmont, Concord, North Carolina
| | - Joel F. Farley
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis
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Tetuan C, Axon DR, Bingham J, Boesen K, Lipsy R, Scovis N, Taylor AM, Warholak T, Lott BE, Leal S. Assessing the Effect of a Telepharmacist's Recommendations During an Integrated, Interprofessional Telehealth Appointment and Their Alignment with Quality Measures. J Manag Care Spec Pharm 2019; 25:1334-1339. [PMID: 31778622 PMCID: PMC10397946 DOI: 10.18553/jmcp.2019.25.12.1334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A growing provider shortage contributes to the widening gap in significant disparities that rural communities face. To expand access to care for rural-dwelling patients with epilepsy, a national nonprofit organization initiated an integrated, interprofessional telehealth program. OBJECTIVE To identify gaps in care based on a telepharmacist's recommendations and determine whether these recommendations aligned with Health Effectiveness Data Information Set (HEDIS) performance measures. METHODS A retrospective chart review was conducted for patients who had an appointment with an integrated interprofessional care team composed of an epileptologist, a social worker, registered nurses, and a pharmacist. This novel approach integrated provision of care by team members at geographically distinct remote locations. The pharmacist conducted comprehensive medical reviews via video conferencing and made recommendations to the epileptologist, primary care provider, and/or patient, as appropriate. The consultation was documented in the electronic health record (EHR). The pharmacist's recommendations were categorized as 1 of the 24 preselected HEDIS performance measures or as a non-HEDIS measure. The analysis used descriptive statistics to report patient demographics and pharmacist recommendations. RESULTS This study included 86 participants. 86 initial and 36 follow-up appointments were conducted between April 2016 and October 2017. The majority of patients were female (52%), with a mean age of 26.2 years (SD = 14.6, range 4-76) and were taking an average of 6.1 medications (SD = 3.6). 159 comorbidities or conditions were identified in the EHR along with 306 recommendations, for an average of 3.6 recommendations per patient (SD = 3.2). 41 (13.4%) recommendations aligned with preselected HEDIS measures, including medication management for depression (31.7%), hypertension (24.4%), asthma (9.8%), and comprehensive adult diabetes care (14.6%). The remaining 265 recommendations lacked sufficient documentation for categorization or failed to align with any targeted measure. CONCLUSIONS This retrospective analysis showed that only 13% of pharmacist recommendations aligned with HEDIS quality measures. While it demonstrates the added value of clinical pharmacists in novel telehealth approaches, future work is needed to develop strategies to increase the number of recommendations aligning with HEDIS measures that adhere to national consensus treatment guidelines via telepharmacist training and improved documentation. DISCLOSURES SinfoníaRx provided funding for this project through a grant to Warholak, Taylor, Axon, and Lott. Bingham, Boesen, Scovis, and Leal are employed by SinfoníaRx. Data from this study were presented at the American Society of Health-System Pharmacists Ambulatory Care Conference 2018; June 4, 2018; Denver, CO, and the Southwestern States Residency Conference 2018; June 15, 2018; Chandler, AZ.
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Affiliation(s)
- Christa Tetuan
- Medication Management Center, University of Arizona College of Pharmacy, Tucson
| | | | | | | | - Robert Lipsy
- Medication Management Center, University of Arizona College of Pharmacy, Tucson
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McMahill-Walraven CN, Kent DJ, Panozzo CA, Pawloski PA, Haynes K, Marshall J, Brown J, Eichelberger B, Lockhart CM. Harnessing the Biologics and Biosimilars Collective Intelligence Consortium to Evaluate Patterns of Care. J Manag Care Spec Pharm 2019; 25:1156-1161. [PMID: 31397619 PMCID: PMC10398299 DOI: 10.18553/jmcp.2019.19041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION As clinical trials test efficacy rather than effectiveness of medications, real-world effectiveness data often vary from clinical trial data. Given the recent market entry of multiple biologics and biosimilars, a dedicated assessment of these diverse agents is needed to build the evidence base regarding efficacy and safety of innovator biologics and biosimilars. PROGRAM DESCRIPTION The Academy of Managed Care Pharmacy's Biologics and Biosimilars Collective Intelligence Consortium (BBCIC) was convened to address the lack of real-world, postmarket outcome evidence generation for innovator biologics and corresponding biosimilars. The BBCIC is a multistakeholder scientific research consortium whose participants prioritize topics and collaboratively conduct research studies. The BBCIC conducts a wide range of analyses, including population characterization, epidemiologic studies, and active observational studies, and develops best practices for conducting large-scale studies to provide real-world evidence. OBSERVATIONS Over the past 3 years, we undertook multiple descriptive analyses with the goal of characterizing data availability and demonstrating the feasibility and efficacy of using the BBCIC distributed research network (DRN), which includes commercial claims data from 2008-2018 covering approximately 100 million lives, with approximately 20 million active members in 2017 from 2 major U.S. health plans and 3 regional integrated delivery networks. We analyzed 4 medication classes of particular interest to biologics and biosimilars development: insulins, granulocyte colony-stimulating factors, erythropoietic-stimulating agents, and anti-inflammatories. We were able to identify exposures and user characteristics in all 4 categories. Herein we describe the successes and challenges of conducting some of our analyses, specifically among insulin users with type 1 diabetes mellitus. IMPLICATIONS Our results demonstrate the BBCIC DRN's ability to identify and characterize exposures, cohorts, and outcomes that can contribute to more sophisticated comparative surveillance of biosimilars and innovator biologics in the future. Additional linkages to laboratory data and a wider range of insurance carriers will further strengthen the BBCIC DRN. DISCLOSURES This study was coordinated and funded by the Biologics and Biosimilars Collective Intelligence Consortium (BBCIC) and represents the independent findings of the BBCIC Insulins Principal Investigator and the BBCIC Insulins Research Team. Lockhart is employed by the BBCIC; Eichelberger was employed by the BBCIC at the time of this study. McMahill-Walraven is employed by Aetna, a CVS Health business. Panozzo, Marshall, and Brown are employed by Harvard Pilgrim Healthcare Institute. Aetna receives external funding through research grants and subcontracts with Harvard Pilgrim Healthcare Institute, which are funded by the FDA, NIH, PCORI, BBCIC, Pfizer, and GSK; the Reagan-Udall Foundation for IMEDS; and PCORI for the ADAPTABLE Study. Aetna was reimbursed for data and analytic support from Harvard Pilgrim Healthcare Institute and the Reagan Udall Foundation for the U.S. Food and Drug Administration. This work was presented as a poster at AMCP Nexus 2018; October 22-25, 2018; in Orlando, FL.
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Affiliation(s)
| | | | | | | | | | - James Marshall
- Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | - Jeffrey Brown
- Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
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Paolella D, Cherry E, Jolly JA, DeClercq J, Choi L, Zuckerman A. Closing the Gap: Identifying Rates and Reasons for Nonadherence in a Specialty Population. J Manag Care Spec Pharm 2019; 25:1282-1288. [PMID: 31663457 PMCID: PMC10398139 DOI: 10.18553/jmcp.2019.25.11.1282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adherence to specialty and nonspecialty medications is often calculated using pharmacy claims data. However, specialty medication regimens are complex and may require periods of intentional gaps in therapy. Common adherence calculations are insufficient in identifying reasons for gaps in therapy. Because adherence reporting is a growing measure of quality care for specialty pharmacy accreditation and payer and manufacturer contracts, a better understanding of the rates and reasons for nonadherence within a specialty population is needed. OBJECTIVE To identify rates and reasons for misidentified and true nonadherence in patients who are prescribed specialty medications. METHODS A single center, retrospective cohort study was conducted using pharmacy claims data between March 2017 and February 2018. Medication adherence was calculated using proportion of days covered (PDC). Electronic medical records of a random 10% sample of nonadherent patients (PDC < 80%) were manually reviewed to identify reasons for nonadherence. Patients were then classified as either (a) misidentified as nonadherent (i.e., a provider-directed discontinuation or disruption of treatment that varies from the prescribed administration schedule or transfer of the prescription to an external pharmacy) or (b) truly nonadherent (discontinuation or disruption of treatment that varies from the prescribed administration instruction that is not directed or recommended by the provider or health care team). RESULTS Of the 7,488 included prescription records from 18 specialty areas, 1,059 met criteria for nonadherence. 105 prescription records (representing 105 unique patients) were manually reviewed; most of these patients (58%) were truly nonadherent, driven by inability to contact patients for refills (59%). However, 40% were misidentified as nonadherent, most due to provider-directed medication holding (69%). Two percent of patients were nonadherent for unknown reasons. CONCLUSIONS Many patients classified as nonadherent based on pharmacy claims experienced gaps in therapy due to medically appropriate reasons. Methods to better measure and identify true nonadherence are needed to efficiently and adequately affect specialty medication adherence behavior. DISCLOSURES This study received funding support from CTSA Award No. UL1 TR002243 from the National Center for Advancing Translational Sciences. Study findings and conclusions are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health. Zuckerman reports research support from Sanofi and Gilead Sciences, unrelated to this study. The other authors have nothing to disclose. A poster based on the data from this study was presented at AMCP Nexus 2018 on October 24, 2018, in Orlando, FL.
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Affiliation(s)
| | - Elizabeth Cherry
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jacob A. Jolly
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joshua DeClercq
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Leena Choi
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Autumn Zuckerman
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
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Gebremariam TH, Sherman CB, Schluger NW. Perception of asthma control among asthmatics seen inChest Clinic at Tertiary Hospital, Addis Ababa, Ethiopia. BMC Pulm Med 2019; 19:187. [PMID: 31660922 PMCID: PMC6819349 DOI: 10.1186/s12890-019-0959-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 07/25/2018] [Accepted: 10/15/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patient awareness of asthma severity is important for optimal asthma management. However, there is often a discrepancy between physician assessment of asthma control based on guidelines and patient discernment of control. We compared physician and patient perception of asthma control in a clinic population seen at a tertiary hospital in Addis Ababa, Ethiopia. METHODS In this cross-sectional study, 182 consecutive patients with a physician diagnosis of asthma seen in Chest Clinic at Tikur Anbessa Specialized Hospital (TASH) between July and December 2015 were studied. Demographics, asthma symptoms, medication use in the past month, and self-perception of asthma control in the past 7 days were obtained from the clinic records. Physician assessed asthma control was based on the GINA asthma symptom control assessment tool. Lung function was measured using a Diagnostic EasyOne Plus model 2001 SN spirometer. The institutional review board approved the study protocol. RESULTS Of the 182 subjects, 68.1% were female. The mean age was 52 ± 12 years, and the mean (SD) duration of asthma was 19.4 ± 12.7 years. Forty-four (24.2%) patients had physician determined well-controlled asthma and 138 (75.8%) patients had physician determined partly controlled/uncontrolled asthma. One hundred and fifty-one (83%) patients thought their asthma control was good. However, the degree of concordance between physician evaluation and patient perception of asthma control was low (kappa index = 0.09). On multivariate analysis, self-perceived poor asthma control was associated with any activity limitation due to asthma and inconsistent inhaled corticosteroid use. CONCLUSION In our study, the first of its kind in Ethiopia, a high percent of patients with physician determined well-controlled asthma has appropriate perception of their disease state. However, those patients with partly controlled/uncontrolled asthma had poor self-perception of their disease, emphasizing the need for further patient education. These conclusions may be especially useful in the care of asthmatics from other low-income countries.
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Affiliation(s)
- Tewodros H. Gebremariam
- Addis Ababa University, College of Heath Sciences, Lideta Sub-city Gambia St., P O Box 22787 code, 1000 Addis Ababa, Ethiopia
| | | | - Neil W. Schluger
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia, USA
- University College of Physicians and Surgeons, New York, NY USA
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Wood J, Jenkins S, Putrino D, Mulrennan S, Morey S, Cecins N, Bear N, Hill K. A smartphone application for reporting symptoms in adults with cystic fibrosis improves the detection of exacerbations: Results of a randomised controlled trial. J Cyst Fibros 2019; 19:271-276. [PMID: 31522924 DOI: 10.1016/j.jcf.2019.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 07/03/2019] [Revised: 09/02/2019] [Accepted: 09/02/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Respiratory exacerbations impair lung function and health-related quality of life in people with CF, with delayed identification of exacerbations often resulting in worse outcomes. We developed a smartphone application (app) for adults with CF to report symptoms to the CF team, and investigated its impact on antibiotic use and other outcomes. METHODS Participants were randomised to intervention (use of the app weekly or sooner if symptoms had worsened) or control (usual care). The app comprised questions relating to symptoms suggestive of an exacerbation. If worsening symptoms were reported, the participant was contacted by the nurse practitioner. The primary outcome measure was the number of courses and days of intravenous (IV) antibiotics. RESULTS Sixty participants (29 female, aged [mean ± SD] 31 ± 9 years, FEV1 60 ± 18% predicted) were recruited, with 29 (48%) allocated to the intervention group. Over the 12-month follow-up, there was no clear effect of the app on the number of courses of IV antibiotics (incidence rate ratio [IRR] 1; 95% confidence interval [CI] 0.6 to 1.7), however number of courses of oral antibiotics increased (IRR 1.5; 95% CI 1.0 to 2.2). The median [IQR] time to detection of exacerbation requiring oral or IV antibiotics was shorter in the intervention group compared with the control group (70 [123] vs. 141 [140] days; p = .02). No between-group differences were observed in other outcomes. CONCLUSION The use of an app reduced time to detect respiratory exacerbations that required antibiotics, however did not demonstrate a clear effect on the number of courses of IV antibiotics.
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Affiliation(s)
- Jamie Wood
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia; Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Sue Jenkins
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia; Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - David Putrino
- Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Siobhain Mulrennan
- Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Sue Morey
- Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Nola Cecins
- Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Clinical Research and Education, Child and Adolescent Health Services, Perth, Western Australia, Australia
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia; Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
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Ferries E, Dye JT, Hall B, Ndehi L, Schwab P, Vaccaro J. Comparison of Medication Therapy Management Services and Their Effects on Health Care Utilization and Medication Adherence. J Manag Care Spec Pharm 2019; 25:688-695. [PMID: 31134865 PMCID: PMC10397886 DOI: 10.18553/jmcp.2019.25.6.688] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Medication therapy management (MTM) programs are designed to improve clinical outcomes and enhance appropriate medication use. Comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) are 2 broad interventions defined within MTM services. While MTM services have been extensively researched, there are few comparisons of CMR versus non-CMR interventions. Given the variability in MTM interventions and lack of a consistent TMR definition in the literature, this study sought to compare CMRs and TMRs that were clearly defined based on Centers for Medicare & Medicaid Services (CMS) criteria. OBJECTIVES To (a) compare acute inpatient admissions and emergency department (ED) visits between patients participating in MTM services (CMR, TMR, or both) and eligible nonparticipating patients and (b) examine the effect of receiving TMR services on medication adherence. METHODS This was a retrospective cohort study of patients with Medicare Part D coverage who received MTM services and a 1:1 propensity score-matched control group. Participants had to be eligible for MTM services in 2014 or 2015 based on CMS requirements. CMRs were offered to all MTM-eligible patients, while TMRs were completed based on clinical rules that helped identify medication-related problems (MRPs). The date of MTM intervention, or eligibility for the control group, was considered the index date. Participants had to be continuously enrolled in a Medicare Advantage plan that included prescription drug coverage during the study period and have at least 6 months of data before and after the index date. Medical and pharmacy claims were assessed to examine trend-adjusted inpatient admissions and ED visits from pre-index to post-index date for participants and matched controls. RESULTS In 2014 and 2015, receipt of TMR interventions was associated with statistically significant reductions in acute inpatient admissions. In 2014, there were 55.2 fewer admits per 1,000 individuals (95% CI = 29-81) and 30.8 fewer admits per 1,000 individuals in 2015 (95% CI = 20-42). Receipt of CMR-only interventions was associated with fewer acute inpatient admissions only when coupled with preidentification of MRPs (36.8 [95% CI = 25-49] fewer admits per 1,000 individuals). In 2015, there were significant reductions in ED visits for participants receiving TMR-only interventions or TMR/CMR interventions (26.1 [95% CI = 11-41] and 12.0 [95% CI = 1-23] fewer ED visits per 1,000 individuals, respectively). In both years, a larger percentage (0.4% for oral diabetes medications; 7.7% for antihypertensives; 3.0% for statins) of MTM participants had greater improvements in medication adherence in the post-index period compared with controls. CONCLUSIONS Receiving MTM services targeted at resolution of MRPs (TMR or CMR/TMR) resulted in positive reductions in health care utilization and increases in medication adherence. Given the importance of optimal medication utilization, this study highlights the need for additional focus on resolution of MRPs through TMRs and CMRs that can support improved clinical outcomes. DISCLOSURES No outside funding supported this study. Researchers completed the work as part of their employment with Humana. All authors are or were employees of Humana at the time of the study. There are no other conflicts of interest to disclose. This study was previously presented at AMCP Nexus 2017 on October 16, 2017, in Dallas, TX.
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Affiliation(s)
| | | | | | | | - Phil Schwab
- Humana Healthcare Research, Louisville, Kentucky
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22
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Luo M, Tan CS, Lim WY, Chia KS, Tang WE, Tai ES, Venkataraman K. Association of diabetes treatment with long-term glycemic patterns in patients with type 2 diabetes mellitus: A prospective cohort study. Diabetes Metab Res Rev 2019; 35:e3122. [PMID: 30600922 PMCID: PMC6590368 DOI: 10.1002/dmrr.3122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/14/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 01/06/2023]
Abstract
AIM This study aimed to analyze diabetes treatment and treatment changes in association with long-term glycemic patterns in an Asian population with diabetes. MATERIALS AND METHODS This was a prospective cohort study of 6218 patients with type 2 diabetes managed in public primary care clinics in Singapore. Clinical data from 2011 to 2016 were extracted from electronic medical records, including serial HbA1c measurements and dispensed antidiabetic medication records. Patterns of longitudinal HbA1c trajectories were identified using latent class growth analysis, and patients' annual treatment plans were compared between subgroups with different HbA1c patterns. RESULTS We identified four distinct HbA1c patterns. Eighty-one percent of patients were classified in the low-stable group, where monotherapy and dual therapy with oral agents were the most common treatments. We also identified three groups with poorer control, with moderate-stable (14%), moderate-increase (3%), and high-decrease (2%) HbA1c patterns. Insulin treatment was most prevalent in these groups, with 61% to 72% of subjects receiving insulin treatment in 2016. More than 60% of subjects in poorer control groups had experienced treatment intensification during follow-up. Addition of multiple insulin injections was the most common intensification in moderate-increase and high-decrease groups. CONCLUSIONS Treatment reflected and was appropriate to the extent of dysglycemia in this population. A small group of patients had deteriorating glycemic control, in spite of being treated with multiple insulin injections, suggesting non-response or non-adherence to treatment. Further investigation is needed to identify reasons for the deteriorating control observed and design effective interventions for these patients.
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Affiliation(s)
- Miyang Luo
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
| | | | - Kee Seng Chia
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | | | - E. Shyong Tai
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
- Division of EndocrinologyNational University HospitalSingapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
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Tamargo C, Sando K, Prados Y, Cowart K. Change in Proportion of Days Covered for Statins Following Implementation of a Pharmacy Student Adherence Outreach Program. J Manag Care Spec Pharm 2019; 25:588-592. [PMID: 31039060 PMCID: PMC10397650 DOI: 10.18553/jmcp.2019.25.5.588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Nearly half of statin users discontinue therapy within the first year of treatment. Nonadherence to statin therapy may lead to an increased risk of atherosclerotic cardiovascular disease and, thus, higher costs due to hospitalizations. Value-based care models, such as accountable care organizations (ACO), are measured on adherence rates to statins through proportion of days covered (PDC). However, there is little research describing pharmacy student-based interventions within value-based care models. OBJECTIVES To (a) identify mean change in PDC for statins following implementation of a pharmacy student adherence outreach program and (b) identify the proportion of patients converted to PDC ≥ 0.80 following the implementation of the outreach program. METHODS This single-center retrospective quasi-experimental study included patients actively enrolled in a Humana Medicare Advantage Prescription Drug (MA-PD) plan who completed at least 1 adherence outreach telephone call performed by a pharmacy student between January 1, 2017, and December 31, 2017. RESULTS 99 patients met inclusion criteria. Atorvastatin was the most commonly prescribed statin (43%), followed by simvastatin (38%). Sixty-four percent of patients had a baseline PDC of < 0.80. Mean (SD) PDC was 0.66 (±0.24) before the pharmacy student adherence outreach intervention, and 0.79 (± 0.23)-a 0.13 increase-after the pharmacy student adherence outreach intervention (P < 0.001). Among patients who had PDC < 0.80 at baseline, 35% of patients (n = 35) were converted to PDC ≥ 0.80 (P < 0.001), and 5% of patients with a baseline PDC ≥ 0.80 had a decrease in PDC to < 0.80 following the intervention. CONCLUSIONS Among patients enrolled in a Humana MA-PD plan within an ACO, mean PDC for statins increased following exposure to a pharmacy student adherence outreach program. One third of patients converted their PDCs to ≥ 0.80 following the intervention. Value-based care programs may consider incorporating pharmacy student services to improve adherence to statins. DISCLOSURES No outside funding supported this research. The authors have no financial conflicts of interest to disclose. At the time of conducting this research, all authors were employed at Nova Southeastern University. Preliminary results were presented as a poster at the AMCP Managed Care & Specialty Pharmacy Annual Meeting; April 23-26, 2018; Boston, MA.
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Affiliation(s)
- Chloe Tamargo
- Nova Southeastern University College of Pharmacy, Davie, Florida
| | - Karen Sando
- Nova Southeastern University College of Pharmacy, Davie, Florida
| | - Yesi Prados
- Nova Southeastern University College of Pharmacy, Davie, Florida
| | - Kevin Cowart
- Nova Southeastern University College of Pharmacy, Davie, Florida
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Duncan P, Cabral C, McCahon D, Guthrie B, Ridd MJ. Efficiency versus thoroughness in medication review: a qualitative interview study in UK primary care. Br J Gen Pract 2019; 69:e190-e198. [PMID: 30745357 PMCID: PMC6400610 DOI: 10.3399/bjgp19x701321] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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] [Received: 06/13/2018] [Accepted: 09/20/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Medication reviews may improve the safety of prescribing and the National Institute for Health and Care Excellence (NICE) highlights the importance of involving patients in this process. AIM To explore GP and pharmacist perspectives on how medication reviews were conducted in general practice in the UK. DESIGN AND SETTING Analysis of semi-structured interviews with GPs and pharmacists working in the South West of England, Northern England, and Scotland, sampled for heterogeneity. Interviews took place between January and October 2017. METHOD Interviews focused on experience of medication review. Data saturation was achieved when no new insights arose from later interviews. Interviews were analysed thematically. RESULTS In total, 13 GPs and 10 pharmacists were interviewed. GPs and pharmacists perceived medication review as an opportunity to improve prescribing safety. Although interviewees thought patients should be involved in decisions about their medicines, high workload pressures meant that most medication reviews were conducted with limited or no patient input. For some GPs, a medication review was done 'in the quickest way possible to say that it was done'. Pharmacists were perceived by both professions as being more thorough but less time efficient than GPs, and few pharmacists were routinely involved in medication reviews even in practices employing a pharmacist. Interviewees argued that it was easier to continue medicines than it was to stop them, particularly because stopping medicines required involving the patient and this generated extra work. CONCLUSION Practices tended to prioritise being efficient (getting the work done) rather than being thorough (doing it well), so that most medication reviews were carried out with little or no patient involvement, and medicines were rarely stopped or reduced. Time and resource constraints are an important barrier to implementing NICE guidance.
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Affiliation(s)
- Polly Duncan
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol
| | - Christie Cabral
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol
| | - Deborah McCahon
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol
| | | | - Matthew J Ridd
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol
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Naqvi AA, Hassali MA, Aftab MT, Nadir MN. A qualitative study investigating perceived barriers to medication adherence in chronic illness patients of Karachi, Pakistan. J PAK MED ASSOC 2019; 69:216-223. [PMID: 30804587] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The study aimed to perceived barriers to medication adherence in patients with chronic illnesses.. METHODS A qualitative study was conducted in a tertiary care hospital in Karachi in September 2017, using grounded theory and inductive approach. Interviews were conducted using a checklist in Urdu language from patients of chronic illnesses determined based on medicines dispensed from the out-patient pharmacy in hospital. Interviews were recorded, transcribed verbatim, translated in English and validated. The translated quotations were analysed using a qualitative analysis software, and thematic analysis was conducted. Codes were generated and analysed by semantic linkages and network analysis using ATLAS.ti qualitative research software. RESULTS Of the 16 patients interviewed, 8(50%) were males and 8(50%) were females. Barriers to medication adherence identified were patient behaviour (intentional and un-intentional non-adherence), comorbidity and pill burden, cost-related non-adherence, and low patient knowledge. The last barrier was associated with the rest. CONCLUSIONS Counselling has the potential to increase patient knowledge regarding medication use, and active pharmacist-physician collaboration can improve medication adherence..
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Affiliation(s)
- Atta Abbas Naqvi
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia (USM), Penang, Malaysia
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia (USM), Penang, Malaysia
| | - Muhammad Tariq Aftab
- Department of Pharmacology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muhammad Nehal Nadir
- Faculty of Pharmacy, Ziauddin University, Karachi, Pakistan. Correspondence: Atta Abbas Naqvi
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Schneider MJ, Ammendolia C, Murphy DR, Glick RM, Hile E, Tudorascu DL, Morton SC, Smith C, Patterson CG, Piva SR. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e186828. [PMID: 30646197 PMCID: PMC6324321 DOI: 10.1001/jamanetworkopen.2018.6828] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Lumbar spinal stenosis (LSS) is the most common reason for spine surgery in older US adults. There is an evidence gap about nonsurgical LSS treatment options. OBJECTIVE To explore the comparative clinical effectiveness of 3 nonsurgical interventions for patients with LSS. DESIGN, SETTING, AND PARTICIPANTS Three-arm randomized clinical trial of 3 years' duration (November 2013 to June 2016). Analysis began in August 2016. All interventions were delivered during 6 weeks with follow-up at 2 months and 6 months at an outpatient research clinic. Patients older than 60 years with LSS were recruited from the general public. Eligibility required anatomical evidence of central canal and/or lateral recess stenosis (magnetic resonance imaging/computed tomography) and clinical symptoms associated with LSS (neurogenic claudication; less symptoms with flexion). Analysis was intention to treat. INTERVENTIONS Medical care, group exercise, and manual therapy/individualized exercise. Medical care consisted of medications and/or epidural injections provided by a physiatrist. Group exercise classes were supervised by fitness instructors in senior community centers. Manual therapy/individualized exercise consisted of spinal mobilization, stretches, and strength training provided by chiropractors and physical therapists. MAIN OUTCOMES AND MEASURES Primary outcomes were between-group differences at 2 months in self-reported symptoms and physical function measured by the Swiss Spinal Stenosis questionnaire (score range, 12-55) and a measure of walking capacity using the self-paced walking test (meters walked for 0 to 30 minutes). RESULTS A total of 259 participants (mean [SD] age, 72.4 [7.8] years; 137 women [52.9%]) were allocated to medical care (88 [34.0%]), group exercise (84 [32.4%]), or manual therapy/individualized exercise (87 [33.6%]). Adjusted between-group analyses at 2 months showed manual therapy/individualized exercise had greater improvement of symptoms and physical function compared with medical care (-2.0; 95% CI, -3.6 to -0.4) or group exercise (-2.4; 95% CI, -4.1 to -0.8). Manual therapy/individualized exercise had a greater proportion of responders (≥30% improvement) in symptoms and physical function (20%) and walking capacity (65.3%) at 2 months compared with medical care (7.6% and 48.7%, respectively) or group exercise (3.0% and 46.2%, respectively). At 6 months, there were no between-group differences in mean outcome scores or responder rates. CONCLUSIONS AND RELEVANCE A combination of manual therapy/individualized exercise provides greater short-term improvement in symptoms and physical function and walking capacity than medical care or group exercises, although all 3 interventions were associated with improvements in long-term walking capacity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01943435.
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Affiliation(s)
- Michael J. Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Donald R. Murphy
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ronald M. Glick
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Physical Medicine Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Hile
- College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Dana L. Tudorascu
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sally C. Morton
- Department of Statistics, College of Science, Virginia Polytechnic Institute and State University, Blacksburg
| | - Clair Smith
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Charity G. Patterson
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sara R. Piva
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
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Martinez C, Katholing A, Folkerts K, Rietbrock S. Thirteen-year trend in the persistence with vitamin K antagonists for venous thromboembolism in the UK: a cohort study. Curr Med Res Opin 2018; 34:1985-1990. [PMID: 29798688 DOI: 10.1080/03007995.2018.1481375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 10/16/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) comprises deep vein thrombosis (DVT) and pulmonary embolism (PE) and is associated with significant recurrence and mortality risk. Standard VTE treatment includes at least 3 months anticoagulation. The objective was to describe time trends in the duration of oral anticoagulation in patients initially treated with vitamin K antagonists (VKAs). METHODS A retrospective cohort study was conducted on patients with first VTE and VKA treatment initiation within 30 days, identified from the UK Clinical Practice Research Datalink from 2001 to 2014. VKA users were followed for the duration of oral anticoagulation which included switching to non-VKA oral anticoagulants. The probability of remaining on anticoagulation treatment (persistence) was estimated using Kaplan-Meier survival functions. RESULTS A total of 16,018 patients with VTE initiated VKA; 48.2% males, mean age 62.1 years, median VKA treatment duration 6.5 months. The 90-day persistence increased from 75.6% in 2001 to 91.2% in 2013 (p < .0001) and the 180-day persistence from 39.3% in 2001 to 61.1% in 2013 (p < .0001). This time trend was also shown for patients with DVT, PE, provoked VTE, unprovoked VTE, provoked DVT, unprovoked DVT, provoked PE and unprovoked PE. There were no major differences in persistence between patients with provoked and unprovoked VTE, but persistence was lower following DVT than PE (p < .0001). CONCLUSIONS The increase in persistence was independent of the presentation of the first VTE (provoked or unprovoked), but higher for first PE. Whether the increasing persistence resulted in decreasing risk of recurrent VTE needs to be confirmed.
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Affiliation(s)
- Carlos Martinez
- a Institute for Epidemiology , Statistics and Informatics GmbH , 60388 Frankfurt , Germany
| | - Anja Katholing
- a Institute for Epidemiology , Statistics and Informatics GmbH , 60388 Frankfurt , Germany
| | - Kerstin Folkerts
- b Bayer AG, Strategic Marketing, Pharmaceuticals HEOR CV ., 42096 Wuppertal , Germany
| | - Stephan Rietbrock
- a Institute for Epidemiology , Statistics and Informatics GmbH , 60388 Frankfurt , Germany
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Niriayo YL, Kumela K, Kassa TD, Angamo MT. Drug therapy problems and contributing factors in the management of heart failure patients in Jimma University Specialized Hospital, Southwest Ethiopia. PLoS One 2018; 13:e0206120. [PMID: 30352096 PMCID: PMC6198973 DOI: 10.1371/journal.pone.0206120] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 10/08/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Drug therapy problem (DTP) is any unwanted incident related to medication therapy that actually or potentially affects the desired goals of treatment. Heart failure (HF) patients are more likely to experience DTP owing to multiple prescriptions and comorbidities. Despite the serious negative impact of DTP on treatment outcomes, there is a dearth of study on DTP among HF patients in Ethiopia. OBJECTIVE The main aim of this study was to assess the prevalence and contributing factors of DTP among ambulatory HF patients in Jimma University Specialized Hospital, Ethiopia. METHODS A hospital based prospective observational study was conducted. Written informed consent was obtained from each patient after full explanation of the study. Data were collected through patient interview and expert review of medical, medication and laboratory records of one-year follow-up from May 2015 to April 2016. DTPs were identified using Cipolle's method followed by consensus review with experts. Binary logistic regression was performed to identify factors contributing to DTP. A p<0.05 was considered statistically significant in all analyses. RESULT Of 340 study participants; male to female ratio was equivalent, the mean (± SD = standard deviation) age was 50.5±15.6 years. Eight hundred eighty DTPs were identified equating 2.6 ±1.8 DTPs per patient. The frequently identified DTPs were dosage too low (27.8%), ineffective drug therapy (27.6%) and need additional drug therapy (27.4%). Most commonly implicated drugs were beta-blockers (34.4%), angiotensin converting enzyme inhibitors (24.8%), statins (16.5%) and antithrombotics (13.1%). Factors contributing to DTP were age >50 years (AOR [adjusted odd ratio] = 5.43, 95%CI [95% confidence interval] = 2.03-14.50); negative medication belief (AOR = 3.50, 95%CI = 1.22-10.05); poor involvement of patients in the therapeutic decision makings (AOR = 4.11, 95%CI = 1.91-8.88); number of co-morbidity≥2(AOR = 5.26, 95%CI = 2.38-11.65) and number of medications ≥5 (AOR = 3.68, 95%CI = 1.28-10.51). CONCLUSION DTPs are common among ambulatory care HF patients. Patients with older age, negative medication belief, polypharmacy, co-morbidities and those who were poorly involved in the therapeutic decision were more likely to experience DTP. Despite traditional prescription refilling, an integrated multidisciplinary approach involving patients and clinically trained pharmacists should be implemented in the patient care process at ambulatory care clinics in order to improve overall outcomes and reduce DTPs and associated burdens in HF patients.
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Affiliation(s)
- Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy,College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kabaye Kumela
- Department of Clinical Pharmacy, School of Pharmacy, Faculty of Health Sciences, Jimma University, Jimma, Oromyia, Ethiopia
| | - Tesfaye Dessale Kassa
- Department of Clinical Pharmacy, School of Pharmacy,College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mulugeta Tarekegn Angamo
- Department of Clinical Pharmacy, School of Pharmacy, Faculty of Health Sciences, Jimma University, Jimma, Oromyia, Ethiopia
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobar, Australia
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de Barra M, Scott CL, Scott NW, Johnston M, de Bruin M, Nkansah N, Bond CM, Matheson CI, Rackow P, Williams AJ, Watson MC. Pharmacist services for non-hospitalised patients. Cochrane Database Syst Rev 2018; 9:CD013102. [PMID: 30178872 PMCID: PMC6513292 DOI: 10.1002/14651858.cd013102] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND This review focuses on non-dispensing services from pharmacists, i.e. pharmacists in community, primary or ambulatory-care settings, to non-hospitalised patients, and is an update of a previously-published Cochrane Review. OBJECTIVES To examine the effect of pharmacists' non-dispensing services on non-hospitalised patient outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, two other databases and two trial registers in March 2015, together with reference checking and contact with study authors to identify additional studies. We included non-English language publications. We ran top-up searches in January 2018 and have added potentially eligible studies to 'Studies awaiting classification'. SELECTION CRITERIA Randomised trials of pharmacist services compared with the delivery of usual care or equivalent/similar services with the same objective delivered by other health professionals. DATA COLLECTION AND ANALYSIS We used standard methodological procedures of Cochrane and the Effective Practice and Organisation of Care Group. Two review authors independently checked studies for inclusion, extracted data and assessed risks of bias. We evaluated the overall certainty of evidence using GRADE. MAIN RESULTS We included 116 trials comprising 111 trials (39,729 participants) comparing pharmacist interventions with usual care and five trials (2122 participants) comparing pharmacist services with services from other healthcare professionals. Of the 116 trials, 76 were included in meta-analyses. The 40 remaining trials were not included in the meta-analyses because they each reported unique outcome measures which could not be combined. Most trials targeted chronic conditions and were conducted in a range of settings, mostly community pharmacies and hospital outpatient clinics, and were mainly but not exclusively conducted in high-income countries. Most trials had a low risk of reporting bias and about 25%-30% were at high risk of bias for performance, detection, and attrition. Selection bias was unclear for about half of the included studies.Compared with usual care, we are uncertain whether pharmacist services reduce the percentage of patients outside the glycated haemoglobin target range (5 trials, N = 558, odds ratio (OR) 0.29, 95% confidence interval (CI) 0.04 to 2.22; very low-certainty evidence). Pharmacist services may reduce the percentage of patients whose blood pressure is outside the target range (18 trials, N = 4107, OR 0.40, 95% CI 0.29 to 0.55; low-certainty evidence) and probably lead to little or no difference in hospital attendance or admissions (14 trials, N = 3631, OR 0.85, 95% CI 0.65 to 1.11; moderate-certainty evidence). Pharmacist services may make little or no difference to adverse drug effects (3 trials, N = 590, OR 1.65, 95% CI 0.84 to 3.24) and may slightly improve physical functioning (7 trials, N = 1329, mean difference (MD) 5.84, 95% CI 1.21 to 10.48; low-certainty evidence). Pharmacist services may make little or no difference to mortality (9 trials, N = 1980, OR 0.79, 95% CI 0.56 to 1.12, low-certaintly evidence).Of the five studies that compared services delivered by pharmacists with other health professionals, no studies evaluated the impact of the intervention on the percentage of patients outside blood pressure or glycated haemoglobin target range, hospital attendance and admission, adverse drug effects, or physical functioning. AUTHORS' CONCLUSIONS The results demonstrate that pharmacist services have varying effects on patient outcomes compared with usual care. We found no studies comparing services delivered by pharmacists with other healthcare professionals that evaluated the impact of the intervention on the six main outcome measures. The results need to be interpreted cautiously because there was major heterogeneity in study populations, types of interventions delivered and reported outcomes.There was considerable heterogeneity within many of the meta-analyses, as well as considerable variation in the risks of bias.
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Affiliation(s)
- Mícheál de Barra
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - Claire L Scott
- NHS Education for ScotlandScottish Dental Clinical Effectiveness ProgrammeDundee Dental Education CentreSmall's WyndDundeeUKDD1 4HN
| | - Neil W Scott
- University of AberdeenMedical Statistics TeamPolwarth BuildingForesterhillAberdeenScotlandUKAB 25 2 ZD
| | - Marie Johnston
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - Marijn de Bruin
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - Nancy Nkansah
- University of CaliforniaClinical Pharmacy155 North Fresno Street, Suite 224San FranciscoCaliforniaUSA93701
| | - Christine M Bond
- University of AberdeenDivision of Applied Health SciencesPolwarth BuildingForesterhillAberdeenUKAB25 2ZD
| | | | - Pamela Rackow
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - A. Jess Williams
- Nottingham Trent UniversitySchool of PsychologyNottinghamEnglandUK
| | - Margaret C Watson
- University of BathDepartment of Pharmacy and Pharmacology5w 3.33Claverton DownBathUKBA2 7AY
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Krysiak R, Szkróbka W, Okopień B. Sexual function and depressive symptoms in young women with hypothyroidism receiving levothyroxine/liothyronine combination therapy: a pilot study. Curr Med Res Opin 2018; 34:1579-1586. [PMID: 29508635 DOI: 10.1080/03007995.2018.1448771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Indexed: 10/17/2022]
Abstract
Objective Even mild hypothyroidism in pre-menopausal women is accompanied by impaired sexual functioning. The study was aimed at comparing the effect of levothyroxine, administered alone or in combination with liothyronine, on sexual function and depressive symptoms in pre-menopausal women treated because of hypothyroidism. Methods This quasi-randomized, single-blind study included 39 young women receiving levothyroxine treatment who, despite thyrotropin and thyroid hormone levels within normal limits, still experienced clinical symptoms of hypothyroidism. These patients were divided into two groups: group A (n = 20) continued levothyroxine treatment, while group B (n = 19) received levothyroxine/liothyronine combination therapy. At the beginning of the study, and 6 months later, all participants of the study filled in questionnaires evaluating female sexual functioning (Female Sexual Function Index; FSFI) and the presence and severity of depressive symptoms (Beck Depression Inventory-Second Edition; BDI-II). Results The study was completed by 37 women. Baseline sexual functioning and depressive symptoms did not differ between the study groups. Neither the total FSFI score nor the domain scores changed throughout the study in women who continued levothyroxine treatment. Compared to levothyroxine administered alone, levothyroxine/liothyronine combination therapy increased scores for two domains: sexual desire and arousal, tended to increase the total FSFI score, as well as tended to decrease the overall BDI-II score. The effect of the combination therapy on sexual function correlated with a treatment-induced increase in serum levels of free triiodothyronine and testosterone. Conclusions The obtained results suggest that levothyroxine administered together with liothyronine is superior to levothyroxine administered alone in affecting female sexual functioning.
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Affiliation(s)
- Robert Krysiak
- a Department of Internal Medicine and Clinical Pharmacology , Medical University of Silesia , Katowice , Poland
| | - Witold Szkróbka
- a Department of Internal Medicine and Clinical Pharmacology , Medical University of Silesia , Katowice , Poland
| | - Bogusław Okopień
- a Department of Internal Medicine and Clinical Pharmacology , Medical University of Silesia , Katowice , Poland
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Colvin NN, Mospan CM, Buxton JA, Waggett JD, Gillette C. Using Indian Health Service (IHS) counseling techniques in an independent community pharmacy to improve adherence rates among patients with diabetes, hypertension, or hyperlipidemia. J Am Pharm Assoc (2003) 2018; 58:S59-S63.e2. [PMID: 29895481 DOI: 10.1016/j.japh.2018.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/31/2018] [Accepted: 04/11/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To 1) identify barriers to medication adherence and 2) examine the relationship between the Indian Health Service (IHS) 3 prime questions and medication adherence in patients with diabetes, hypertension, or hyperlipidemia before and 6 months after intervention. METHODS This quasi-experimental study evaluated the effectiveness of an adherence program at an independent community pharmacy. Patients who met inclusion criteria were telephoned monthly to answer questions related to their medications. Patients served as their own controls to show comparison between pre- and postintervention adherence rates calculated according to proportion of days covered over the previous 6 months. Mean medication adherences before and after intervention were assessed via paired t test. Linear regression was used to analyze predictors of average medication adherence. The Charlson Comorbidity Index was used to measure the impact of comorbid conditions on medication adherence. RESULTS Fifty-six of 354 patients met inclusion criteria, consented, and completed the study. The percentage of patients achieving an adherence rate of 80% or more increased from 9% initially to 59% at study completion. Each medication class showed improvement in adherence rates: diabetes from 66.24% to 80.06% (P = 0.0153), hypertension from 72.33% to 81.34% (P = 0.0192), and hyperlipidemia from 64.45% to 74.66% (P = 0.0103). Overall, average medication adherence increased by 11% (P < 0.0001). The top patient-reported barrier to adherence was convenience/forgetfulness (46.43%). CONCLUSION Pharmacist-led counseling sessions with the use of the 3 prime questions showed short-term improvement in adherence rates among patients participating in a medication adherence program. Future studies should assess if improved adherence is sustained long-term following active intervention.
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Liang SHY, Yang YH, Kuo TY, Liao YT, Lin TC, Lee Y, McIntyre RS, Kelsen BA, Wang TN, Chen VCH. Suicide risk reduction in youths with attention-deficit/hyperactivity disorder prescribed methylphenidate: A Taiwan nationwide population-based cohort study. Res Dev Disabil 2018; 72:96-105. [PMID: 29121517 DOI: 10.1016/j.ridd.2017.10.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 06/01/2017] [Revised: 10/09/2017] [Accepted: 10/25/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) youths have increased suicide risk. Nevertheless, the beneficial effects of methylphenidate (MPH) on suicide attempt have received relatively little attention. AIMS To investigate the MPH usage and the risk of suicide attempt among ADHD youths. METHODS We identified 84,898 youths less than 18 years old with ADHD diagnosis between 1997 and 2013 from National Health Insurance, and examined whether MPH use affected suicide attempt risk using Cox proportional-hazards models. OUTCOME AND RESULTS Among ADHD youths, reduction of suicide risk was found in patients prescribed 90-180days of MPH after adjusting for confounding factors (hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.19-0.90) and a greater reduction in those prescribed more than 180days of MPH (HR: 0.28, 95% CI: 0.17-0.48). CONCLUSIONS AND IMPLICATIONS We observed a 59% suicide attempt risk reduction among ADHD youths prescribed between 90 and 180days and a 72% risk reduction in those prescribed more than 180days of MPH. The protective benefit observed by the group prescribed MPH for longer duration underscores the importance of psychoeducation and compliance enhancement as part of ADHD management. Indication bias is identified as a limitation of this study, and future self-case control study to investigate the association between suicide attempt and ADHD medication is suggested. WHAT THIS PAPER ADDS This nationwide population-based cohort study showed that among ADHD youths, reduction of suicide risk was observed in patients prescribed MPH for duration 90days and longer, underscoring the importance of appropriate ADHD pharmacotherapy and enhancing drug compliance.
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Affiliation(s)
- Sophie Hsin-Yi Liang
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC; Department of Child Psychiatry, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan, ROC
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC; Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Ting-Yu Kuo
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
| | - Yin-To Liao
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC; Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Tzu-Chin Lin
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC; Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Department of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada
| | - Brent A Kelsen
- Language Center, National Taipei University, New Taipei City, Taiwan, ROC
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Vincent Chin-Hung Chen
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC; Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC.
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Chang AC, Lincoln J, Lantaff WM, Gernant SA, Jaynes HA, Doucette W, Snyder ME. Characterization of actions taken during the delivery of medication therapy management: A time-and-motion approach. J Am Pharm Assoc (2003) 2018; 58:61-66.e7. [PMID: 29129668 PMCID: PMC5748350 DOI: 10.1016/j.japh.2017.09.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/10/2017] [Accepted: 09/23/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To characterize actions performed by pharmacists and support staff during provision of medication therapy management (MTM) and to compare actions performed according to practice characteristics. METHODS A purposeful sample of 7 MTM practices (2 call centers and 5 community practices) was identified and visited by investigators. Pharmacists and support staff were observed during their routine provision of MTM. Investigators characterized "major" (e.g., preparation for a comprehensive medication review) and "minor" (i.e., specific steps in overarching major action) actions with the use of a time-and-motion approach. RESULTS A total of 32 major and 469 minor actions were observed. Practices were characterized as Later Maturity Level or Early Maturity Level on the basis of their self-reported MTM appointment volume, self-assessment of the extent of integration of chronic care model principles, and payer mix. Later Maturity Level practices were more likely to deliver follow-up medication therapy reviews and comprehensive medication reviews (CMRs) as opposed to targeted medication reviews (TMRs) and to receive physician referrals for MTM. Later Maturity Level practices were also more likely to use paid interns than pharmacy rotation students. CMR activities observed at Later Maturity Level practices lasted a median of 30.8 minutes versus 20.3 minutes for CMR activities at Early Maturity Level practices. Similarly, TMR activities observed at Later Maturity Level practices were longer: a median of 31.0 minutes versus 12.3 minutes. At Later Maturity Level practices, pharmacists spent a greater proportion of time providing patient education, while support staff spent a greater proportion of time on tasks such as capturing demographics and introducing or explaining MTM. CONCLUSION MTM activities were longer at Later Maturity Level practices, and these practices were more likely to use paid pharmacy interns and to receive physician referrals for MTM. This work provides a foundation for future research.
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Brown LM, Rashrash ME, Schommer JC. The certainty in consumers' willingness to accept pharmacist-provided medication therapy management services. J Am Pharm Assoc (2003) 2017; 57:211-216. [PMID: 28285775 DOI: 10.1016/j.japh.2017.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/30/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To describe consumers' willingness to accept medication therapy management (MTM) services provided by a pharmacist. DESIGN Cross-sectional Internet survey included questions about willingness to use 11 components of MTM services. PARTICIPANTS The data of 8352 United States' adults who were on 3 or more medications were obtained from the 2015 National Consumer Survey on the Medication Experience and Pharmacists' Roles, which included 26,173 respondents. MAIN OUTCOME MEASURES Respondents used a scale that ranged from "definitely would not accept" to "definitely would accept" to specify their willingness to use each of the MTM components. RESULTS The mean age was 53.1 years, with an average of 1.9 health problems and 5.4 prescription medications. About 50% of respondents definitely would accept 6 or more MTM components. The services with the highest rates of "definitely would accept" were "Recommend the use of a generic drug to help save money" and "Provide advice in administering medications as prescribed" (65.4% and 64.2%, respectively). The next highest were "Performing a review of all medications to make sure they are effective, safe, and affordable" and "Recommendation of nonprescription medications to take care of mild ailments or discomforts" (57.0% and 56.4%, respectively). Those who definitely would accept MTM services, compared with those who would not, differed in terms of gender, education level, income, medication insurance coverage, ever having been a pharmacist, and number of health problems. CONCLUSION The majority of United States' adults expressed a certain willingness to accept most of the components of MTM services. More research needs to be done to understand why certain groups were less willing to accept MTM services.
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McNaughton CD, Brown NJ, Rothman RL, Liu D, Kabagambe EK, Levy PD, Self WH, Storrow AB, Collins SP, Roumie CL. Systolic Blood Pressure and Biochemical Assessment of Adherence: A Cross-Sectional Analysis in the Emergency Department. Hypertension 2017; 70:307-314. [PMID: 28652467 PMCID: PMC5531074 DOI: 10.1161/hypertensionaha.117.09659] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 05/04/2017] [Revised: 04/16/2017] [Accepted: 05/20/2017] [Indexed: 12/23/2022]
Abstract
Elevated blood pressure (BP) is common in the emergency department (ED), but the relationship between antihypertensive medication adherence and BP in the ED is unclear. This cross-sectional study tested the hypothesis that higher antihypertensive adherence is associated with lower systolic BP (SBP) in the ED among adults with hypertension who sought ED care at an academic hospital from July 2012 to April 2013. Biochemical assessment of antihypertensive adherence was performed using a mass spectrometry blood assay, and the primary outcome was average ED SBP. Analyses were stratified by number of prescribed antihypertensives (<3, ≥3) and adjusted for age, sex, race, insurance, literacy, numeracy, education, body mass index, and comorbidities. Among 85 patients prescribed ≥3 antihypertensives, mean SBP for adherent patients was 134.4 mm Hg (±26.1 mm Hg), and in adjusted analysis was -20.8 mm Hg (95% confidence interval, -34.2 to -7.4 mm Hg; P=0.003) different from nonadherent patients. Among 176 patients prescribed <3 antihypertensives, mean SBP was 135.5 mm Hg (±20.6 mm Hg) for adherent patients, with no difference by adherence in adjusted analysis (+2.9 mm Hg; 95% confidence interval, -4.7 to 10.5 mm Hg; P=0.45). Antihypertensive nonadherence identified by biochemical assessment was common and associated with higher SBP in the ED among patients who had a primary care provider and health insurance and who were prescribed ≥3 antihypertensives. Biochemical assessment of antihypertensives could help distinguish medication nonadherence from other contributors to elevated BP and identify target populations for intervention.
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Affiliation(s)
- Candace D McNaughton
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.).
| | - Nancy J Brown
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Russell L Rothman
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Dandan Liu
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Edmond K Kabagambe
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Phillip D Levy
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Wesley H Self
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Alan B Storrow
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Sean P Collins
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Christianne L Roumie
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
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Melgarejo JD, Maestre GE, Thijs L, Asayama K, Boggia J, Casiglia E, Hansen TW, Imai Y, Jacobs L, Jeppesen J, Kawecka-Jaszcz K, Kuznetsova T, Li Y, Malyutina S, Nikitin Y, Ohkubo T, Stolarz-Skrzypek K, Wang JG, Staessen JA. Prevalence, Treatment, and Control Rates of Conventional and Ambulatory Hypertension Across 10 Populations in 3 Continents. Hypertension 2017; 70:50-58. [PMID: 28483916 PMCID: PMC11003768 DOI: 10.1161/hypertensionaha.117.09188] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 02/01/2017] [Revised: 02/14/2017] [Accepted: 04/07/2017] [Indexed: 01/19/2023]
Abstract
Hypertension is a major global health problem, but prevalence rates vary widely among regions. To determine prevalence, treatment, and control rates of hypertension, we measured conventional blood pressure (BP) and 24-hour ambulatory BP in 6546 subjects, aged 40 to 79 years, recruited from 10 community-dwelling cohorts on 3 continents. We determined how between-cohort differences in risk factors and socioeconomic factors influence hypertension rates. The overall prevalence was 49.3% (range between cohorts, 40.0%-86.8%) for conventional hypertension (conventional BP ≥140/90 mm Hg) and 48.7% (35.2%-66.5%) for ambulatory hypertension (ambulatory BP ≥130/80 mm Hg). Treatment and control rates for conventional hypertension were 48.0% (33.5%-74.1%) and 38.6% (10.1%-55.3%) respectively. The corresponding rates for ambulatory hypertension were 48.6% (30.5%-71.9%) and 45.6% (18.6%-64.2%). Among 1677 untreated subjects with conventional hypertension, 35.7% had white coat hypertension (23.5%-56.2%). Masked hypertension (conventional BP <140/90 mm Hg and ambulatory BP ≥130/80 mm Hg) occurred in 16.9% (8.8%-30.5%) of 3320 untreated subjects who were normotensive on conventional measurement. Exclusion of participants with diabetes mellitus, obesity, hypercholesterolemia, or history of cardiovascular complications resulted in a <9% reduction in the conventional and 24-hour ambulatory hypertension rates. Higher social and economic development, measured by the Human Development Index, was associated with lower rates of conventional and ambulatory hypertension. In conclusion, high rates of hypertension in all cohorts examined demonstrate the need for improvements in prevention, treatment, and control. Strategies for the management of hypertension should continue to not only focus on preventable and modifiable risk factors but also consider societal issues.
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Affiliation(s)
- Jesus D Melgarejo
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Gladys E Maestre
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Lutgarde Thijs
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Kei Asayama
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - José Boggia
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Edoardo Casiglia
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Tine W Hansen
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Yutaka Imai
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Lotte Jacobs
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Jørgen Jeppesen
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Kalina Kawecka-Jaszcz
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Tatiana Kuznetsova
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Yan Li
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Sofia Malyutina
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Yuri Nikitin
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Takayoshi Ohkubo
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Katarzyna Stolarz-Skrzypek
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Ji-Guang Wang
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Jan A Staessen
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS).
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Nygård LH, Talala K, Taari K, Tammela TLJ, Auvinen A, Murtola TJ. The effect of non-steroidal anti-inflammatory drugs on risk of benign prostatic hyperplasia. Prostate 2017; 77:1029-1035. [PMID: 28480542 DOI: 10.1002/pros.23359] [Citation(s) in RCA: 7] [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: 01/24/2017] [Accepted: 03/24/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Inflammation may play a role in pathogenesis of benign prostatic hyperplasia (BPH). However, the role of non-steroidal anti-inflammatory drugs (NSAIDs) as BPH risk factor is unclear. The objective of this study was to examine risk of BPH by NSAID use in a population-based cohort. METHODS A total of 74 754 Finnish men without previous BPH at baseline in 1996-1999 were linked to national medication reimbursement database for information on physician-prescribed NSAID purchases during 1995-2009. Information on BPH procedures and diagnoses was obtained from national Care Register for Health Care. Cox regression with adjustment for age and use of cholesterol-lowering, antidiabetic and antihypertensive medication, with NSAID use as time-dependent variable was used to analyse the risk of BPH surgery, medication use, and recorded diagnosis. RESULTS Of the subjects 57 707 men (77.2%) used prescription NSAIDs. The risk of BPH was elevated among NSAID users compared to non-users: HR 2.04, 95% CI 1.97-2.10 for BPH medication use, HR 1.59, 95% CI 1.47-1.71 for recorded diagnosis and HR 1.61, 95% CI 1.49-1.74 for surgery. The risk increase correlated with duration of NSAID usage, less with annual dosage. Nevertheless, the risk increase was observed already at short-term and low-dosage use. CONCLUSIONS NSAID use is associated with an increased risk of BPH. The association is affected by systematic differences by NSAID use as the risk increase was observed already at short-term use. Nevertheless, the association correlated with duration of use, suggesting that NSAID usage or the conditions indicating it may increase BPH risk.
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Affiliation(s)
- Lotta H Nygård
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | | | - Kimmo Taari
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teuvo L J Tammela
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Teemu J Murtola
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Urology, Tampere University Hospital, Tampere, Finland
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Moga DC, Abner EL, Rigsby DN, Eckmann L, Huffmyer M, Murphy RR, Coy BB, Jicha GA. Optimizing medication appropriateness in older adults: a randomized clinical interventional trial to decrease anticholinergic burden. Alzheimers Res Ther 2017; 9:36. [PMID: 28535785 PMCID: PMC5442667 DOI: 10.1186/s13195-017-0263-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 05/04/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The complexity of medication therapy in older adults with multiple comorbidities often leads to inappropriate prescribing. Drugs with anticholinergic properties are of particular interest because many are not recognized for this property; their use may lead to increased anticholinergic burden resulting in significant health risks, as well as negatively impacting cognition. Medication therapy management (MTM) interventions showed promise in addressing inappropriate medication use, but the effectiveness of targeted multidisciplinary team interventions addressing anticholinergic medications in older populations is yet to be determined. METHODS We conducted an 8-week, parallel-arm, randomized trial to evaluate whether a targeted patient-centered pharmacist-physician team MTM intervention ("targeted MTM intervention") reduced the use of inappropriate anticholinergic medications in older patients enrolled in a longitudinal cohort at University of Kentucky's Alzheimer's Disease Center. Study outcomes included changes in the medication appropriateness index (MAI) targeting anticholinergic medications and in the anticholinergic drug scale (ADS) score from baseline to the end of study. RESULTS Between October 1, 2014 and September 30, 2015 we enrolled and randomized 50 participants taking at least one medication with anticholinergic properties. Of these, 35 (70%) were women, 45 (90%) were white, and 33 (66%) were cognitively intact (clinical dementia rating [CDR] = 0); mean age was 77.7 ± 6.6 years. At baseline, the mean MAI was 12.6 ± 6.3; 25 (50%) of the participants used two or more anticholinergics, and the mean ADS score was 2.8 ± 1.6. After randomization, although no statistically significant difference was noted between groups, we identified a potentially meaningful imbalance as the intervention group had more participants with intact cognition, and thus included CDR in all of the analyses. The targeted MTM intervention resulted in statistically significant CDR adjusted differences between groups with regard to improved MAI (change score of 3.6 (1.1) for the MTM group as compared with 1.0 (0.9) for the control group, p = 0.04) and ADS (change score of 1.0 (0.3) for the MTM group as compared with 0.2 (0.3) for the control group, p = 0.03). CONCLUSIONS Our targeted MTM intervention resulted in improvement in anticholinergic medication appropriateness and reduced the use of inappropriate anticholinergic medications in older patients. Our results show promise in an area of great importance to ensure optimum outcomes for medications used in older adults. TRIAL REGISTRATION ClinicalTrials.gov NCT02172612 . Registered 20 June 2014.
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Affiliation(s)
- Daniela C. Moga
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, 789 S Limestone Street, Room 241, Lexington, KY 40536 USA
- Department of Epidemiology, College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40536 USA
- Sanders-Brown Center on Aging, 800 South Limestone Street, Lexington, KY 40536 USA
| | - Erin L. Abner
- Department of Epidemiology, College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40536 USA
- Sanders-Brown Center on Aging, 800 South Limestone Street, Lexington, KY 40536 USA
| | - Dorinda N. Rigsby
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, 789 S Limestone Street, Room 241, Lexington, KY 40536 USA
| | - Lynne Eckmann
- PRO2RX LLC Pharmacy Consulting Services, 336 Romany Rd, Lexington, KY 40502 USA
| | - Mark Huffmyer
- PRO2RX LLC Pharmacy Consulting Services, 336 Romany Rd, Lexington, KY 40502 USA
| | - Richard R. Murphy
- Sanders-Brown Center on Aging, 800 South Limestone Street, Lexington, KY 40536 USA
- Department of Neurology, College of Medicine, University of Kentucky, 740 South Limestone Street, Lexington, KY 40536 USA
| | - Beth B. Coy
- Sanders-Brown Center on Aging, 800 South Limestone Street, Lexington, KY 40536 USA
| | - Gregory A. Jicha
- Sanders-Brown Center on Aging, 800 South Limestone Street, Lexington, KY 40536 USA
- Department of Neurology, College of Medicine, University of Kentucky, 740 South Limestone Street, Lexington, KY 40536 USA
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Howell CK, Reveles KR, Knodel LC, Pattyn NR, Frei CR. Know your medicine: A novel student-led community service learning program. Curr Pharm Teach Learn 2017; 9:353-359. [PMID: 29233271 DOI: 10.1016/j.cptl.2017.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 09/15/2015] [Revised: 09/21/2016] [Accepted: 01/28/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The objective of this article is to describe the efforts of the student pharmacist organization called Know Your Medicine (KYM) as they conduct medication therapy management (MTM) for older adults and underserved communities. METHODS Patients brought medications, immunization records, and health concerns to KYM events during academic years 2012-2013 and 2013-2014. Student pharmacists performed health screenings, created personalized medication records (PMR), made recommendations, created personal action plans (PAP), and conducted follow-up phone calls. RESULTS Student pharmacists provided MTM services for a total of 107 patients. The mean duration of a KYM appointment was 62±21min, and student pharmacists provided a mean of 3.5±2.1 recommendations per patient. Patients had a mean age of 78±11 years, 4.5±3.2 disease states, 6.9±4.6 prescriptions, 1.9±1.9 OTC medications, and 2.8±2.6 vitamins or herbals. At the time of the follow-up phone call, a mean of 2.6±1.9 recommendations per patient had been followed. DISCUSSION AND CONCLUSIONS Student pharmacists successfully implemented a new MTM program for older adults and underserved communities. This program can serve as an example of how other pharmacy colleges and schools might implement MTM training and real-world MTM experience for their student pharmacists.
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Affiliation(s)
- Crystal K Howell
- College of Pharmacy, The University of Texas at Austin, Austin, TX; Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - Kelly R Reveles
- College of Pharmacy, The University of Texas at Austin, Austin, TX; Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - Leroy C Knodel
- College of Pharmacy, The University of Texas at Austin, Austin, TX; Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - Nancy R Pattyn
- College of Pharmacy, The University of Texas at Austin, Austin, TX.
| | - Christopher R Frei
- College of Pharmacy, The University of Texas at Austin, Austin, TX; Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX.
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Abstract
OBJECTIVE We conducted a retrospective cohort study to investigate the HbA1c change associated with treatment intensification in a real-world population of patients with type 2 diabetes (T2D). METHODS Using a large US insurance claims database, patients aged ≥18 years with a T2D diagnosis and HbA1c ≥8.0% (64 mmol/mol) after ≥3 months of oral pharmacotherapy with metformin (± other oral antidiabetes agents) were identified (index date). Continuous enrollment was required for ≥12 months before (baseline) and after the index date with no baseline use of injectable antidiabetes drugs. We defined treatment intensification as prescriptions for injectable or additional oral antidiabetes drugs. Time to intensification was classified as timely (within 6 months) or not (≥6 months or not intensified). Linear regression models with propensity score 1:1 matching were performed to assess the effect of timely intensification on HbA1c. RESULTS Of the 11,525 patients meeting the inclusion criteria, only 37% had treatment intensified within 6 months. Mean age at index date was 57 years, 40% of the sample was female. The mean baseline A1C was 9.4% and 9.0%, while post-index A1C was 7.9% and 8.2% for timely intensified patients versus not, respectively. Patients with timely intensification had significantly greater HbA1c reduction compared with others (-0.33%, 95% CI: -0.41% to -0.25%) within 1 year of follow up. CONCLUSIONS In this analysis of patients with T2D and treatment failure in a real-world setting, earlier treatment intensification was associated with better glycemic control as indicated by lower HbA1c values.
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Affiliation(s)
- Alex Z Fu
- a Georgetown University Medical Center , Washington , DC , USA
| | - John J Sheehan
- b AstraZeneca Pharmaceuticals LP , Fort Washington , PA , USA at the time the research was conducted
- c Janssen Scientific Affairs LLC , Titusville , NJ , USA
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Punekar RS, Fox KM, Paoli CJ, Richhariya A, Cziraky MJ, Gandra SR, Toth PP. Lipid-lowering treatment modifications among patients with hyperlipidemia and a prior cardiovascular event: a US retrospective cohort study. Curr Med Res Opin 2017; 33:869-876. [PMID: 28276256 DOI: 10.1080/03007995.2017.1292898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND Numerous studies demonstrate that, even with use of statins, many patients are unable to meet their LDL-C goals. This study examined modifications to statin and/or ezetimibe therapy among patients with hyperlipidemia and prior history of cardiovascular (CV) events in a US commercially insured population. METHODS Adults (age ≥18 years) initiating statins and/or ezetimibe between 1 January 2007 and 31 December 2008 were identified from HealthCore Integrated Research Database. The index date was the initiation date of statins and/or ezetimibe. All patients had ≥1 medical claims related to myocardial infarction, unstable angina, ischemic stroke, transient ischemic attack, coronary artery bypass graft, or percutaneous coronary intervention within 12 months prior to the index date. Treatment modifications to statins and/or ezetimibe initiated on the index date (index therapy) included permanent discontinuation of any lipid lowering therapy (LLT), rechallenge, switching, subtraction, augmentation, and dose changes. RESULTS Among 17,902 patients, around 90% initiated with statin monotherapy, followed by statin and ezetimibe combination (3.0%: 18-64 years; 3.8%: ≥65 years). Ten percent or less initiated on high intensity statins. Most common treatment modifications were rechallenging index therapy (25.2%: 18-64 years, 27.0%: ≥65 years), switching (27.5%: 18-64 years, 24.6%: ≥65 years), and permanent discontinuation of any LLT (18.6%: 18-64 years, 21.0%: ≥65 years). Only 10% of patients in both groups underwent dose escalation. CONCLUSIONS Real-world evidence indicates that few high-risk patients initiate therapy with high-intensity statins. More than 50% of patients underwent a rechallenge or switching. Despite high CVD risk profile, approximately 20% of patients permanently discontinued any LLT. Key limitations: Pharmacy claims do not provide information on whether patients who had a pharmacy fill actually took the medication as prescribed. It is unknown whether rechallenge was a simple delay in filling a prescription or an actual rechallenge of their index therapy. Reasons for treatment discontinuations or modifications were unavailable in claims data.
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Affiliation(s)
| | | | | | | | | | | | - Peter P Toth
- d CGH Medical Center , Sterling , IL , USA
- e Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Blanchard AC, Horton E, Stanojevic S, Taylor L, Waters V, Ratjen F. Effectiveness of a stepwise Pseudomonas aeruginosa eradication protocol in children with cystic fibrosis. J Cyst Fibros 2017; 16:395-400. [PMID: 28189634 DOI: 10.1016/j.jcf.2017.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 10/21/2016] [Revised: 12/27/2016] [Accepted: 01/19/2017] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Antibiotic eradication therapy (AET) for initial Pseudomonas aeruginosa (Pa) infection is standard of care in children with cystic fibrosis (CF), but information is limited on treatment for patients who fail initial AET. The aim of this study was to evaluate the effectiveness of a multi-step protocol for AET for new-onset Pa infections in children with CF. METHODS A three-step AET protocol which includes: (step 1) 28days of tobramycin inhalation solution (TIS) for new-onset Pa infection; (step 2) a second course of TIS for patients with positive respiratory tract culture after step 1; (step 3) 14days of intravenous antibiotics followed by 28days of TIS for patients with a subsequent positive culture. We conducted a retrospective review of all pediatric CF patients who underwent the eradication protocol between January 2010 and December 2015. The success rate of each step and of the overall protocol was recorded. RESULTS During the study period, 128 patients had a total of 213 new-onset Pa infections. Of 195 asymptomatic episodes, 150 (76.9%, 95% CI 70.4; 82.6) cleared after step 1 and 12 cleared after step 2 (33.3% (95% CI 18.6; 50.9) stepwise success rate and 87.1% (95% CI 77.1; 88.1) cumulative success rate). Intravenous antibiotics followed by 28days of TIS were administered in 24 episodes; this was successful in 10 episodes (41.7%; 95% CI 22.1; 63.4). The regimen in asymptomatic patients failed in fourteen episodes (7.5%; 95% CI 4.2; 12.3) then considered chronically infected with Pa. Overall, the cumulative success rate of the asymptomatic arm was 88.2% (95% CI 82.8; 92.4). CONCLUSION The first step of the AET protocol led to the greatest eradication success. Subsequent eradication attempts have a success rate below 50%. Prospective studies of eradication protocols for this population are needed to determine the most effective treatment strategy.
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Affiliation(s)
- Ana C Blanchard
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto M5G 1X8, Canada.
| | - Eric Horton
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto M5G 1X8, Canada.
| | - Sanja Stanojevic
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto M5G 1X8, Canada.
| | - Louise Taylor
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto M5G 1X8, Canada.
| | - Valerie Waters
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto M5G 1X8, Canada.
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto M5G 1X8, Canada.
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Deal HJ, Cooke CA, Ingram EML, Sketris IS. Adoption of the Nova Scotia (Canada) Community Pharmacy Medication Management Program, 1-Year Post-Initiation. J Popul Ther Clin Pharmacol 2017; 24:e46-e55. [PMID: 28186715 DOI: 10.22374/17106222.24.1.6] [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] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Pharmacists conduct medication reviews to optimize drug therapy. Each jurisdiction implements and funds these programs differently. OBJECTIVE To describe the uptake of the first year of a community pharmacy medication review program reimbursed by the publically insured seniors' drug benefit program in Nova Scotia, Canada. METHODS This retrospective analysis included 294 pharmacies and 105,000 beneficiaries enrolled in the Nova Scotia Seniors' Pharmacare Program. Prescription and service claims data from this program were analyzed to determine type and number of beneficiaries receiving a medication review, number and predictors of pharmacies completing reviews, and number of prescribed medications 6-months before and 6-months after the review. RESULTS 428 medication reviews were conducted and billed by 33% of Nova Scotia pharmacies (1-50 reviews per pharmacy per year). The mean number and range of medications before the review were 10.8 (4-28) and following the review 10.4 (0-24), with an average decrease of 0.4 medications (95% CI 0.1-0.6), p=.0043). Patients receiving a review had a mean age of 75.2 years; 64.9% were female. Most pharmacies conducted reviews when patients reached their annual copayment (93%). CONCLUSIONS Approximately 33% of pharmacies billed at least one medication review in the first year of the program. In spite of a $150 reimbursement per community pharmacy medication review, only 428 reviews were conducted over a 13-month period for a population of over 100,000 seniors. Results suggest financial reimbursement alone is not sufficient to implement a medication management program; health systems need to determine patient, pharmacist, pharmacy and health system level strategies to implement medication reviews more broadly.
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Affiliation(s)
| | - Charmaine A Cooke
- Investment and Decision Support, Nova Scotia Department of Health and Wellness
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Maiese BA, Pham AT, Shah MV, Eaddy MT, Lunacsek OE, Wan GJ. Hospitalization Costs for Patients Undergoing Orthopedic Surgery Treated With Intravenous Acetaminophen (IV-APAP) Plus Other IV Analgesics or IV Opioid Monotherapy for Postoperative Pain. Adv Ther 2017; 34:421-435. [PMID: 27943118 PMCID: PMC5331089 DOI: 10.1007/s12325-016-0449-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION To assess the impact on hospitalization costs of multimodal analgesia (MMA), including intravenous acetaminophen (IV-APAP), versus IV opioid monotherapy for postoperative pain management in patients undergoing orthopedic surgery. METHODS Utilizing the Truven Health MarketScan® Hospital Drug Database (HDD), patients undergoing total knee arthroplasty (TKA), total hip arthroplasty (THA), or surgical repair of hip fracture between 1/1/2011 and 8/31/2014 were separated into postoperative pain management groups: MMA with IV-APAP plus other IV analgesics (IV-APAP group) or an IV opioid monotherapy group. All patients could have received oral analgesics. Baseline characteristics and total hospitalization costs were compared. Additionally, an inverse probability treatment weighting [IPTW] with propensity scores analysis further assessed hospitalization cost differences. RESULTS The IV-APAP group (n = 33,954) and IV opioid monotherapy group (n = 110,300) differed significantly (P < 0.0001) across baseline characteristics, though the differences may not have been clinically meaningful. Total hospitalization costs (mean ± standard deviation) were significantly lower for the IV-APAP group than the IV opioid monotherapy group (US$12,540 ± $9564 vs. $13,242 ± $35,825; P < 0.0001). Medical costs accounted for $701 of the $702 between-group difference. Pharmacy costs were similar between groups. Results of the IPTW-adjusted analysis further supported the statistically significant cost difference. CONCLUSIONS Patients undergoing orthopedic surgery who received MMA for postoperative pain management, including IV-APAP, had significantly lower total costs than patients who received IV opioid monotherapy. This difference was driven by medical costs; importantly, there was no difference in pharmacy costs. Generalizability of the results may be limited to patients admitted to hospitals similar to those included in HDD. Dosing could not be determined, so it was not possible to quantify utilization of IV-APAP or ascertain differences in opioid consumption between the 2 groups. This study did not account for healthcare utilization post-discharge.
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Affiliation(s)
| | - An T Pham
- Health Economics and Outcomes Research Department, Mallinckrodt Pharmaceuticals, Hampton, NJ, USA.
| | - Manasee V Shah
- Xcenda LLC, Palm Harbor, FL, USA
- Mapi Group, Ann Arbor, MI, USA
| | | | | | - George J Wan
- Health Economics and Outcomes Research Department, Mallinckrodt Pharmaceuticals, Hampton, NJ, USA
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Huiskes VJB, Burger DM, van den Ende CHM, van den Bemt BJF. Effectiveness of medication review: a systematic review and meta-analysis of randomized controlled trials. BMC Fam Pract 2017; 18:5. [PMID: 28095780 PMCID: PMC5240219 DOI: 10.1186/s12875-016-0577-x] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 12/26/2016] [Indexed: 12/02/2022]
Abstract
BACKGROUND Medication review is often recommended to optimize medication use. In clinical practice it is mostly operationalized as an intervention without co-interventions during a short term intervention period. However, most systematic reviews also included co-interventions and prolonged medication optimization interventions. Furthermore, most systematic reviews focused on specific patient groups (e.g. polypharmacy, elderly, hospitalized) and/or on specific outcome measures (e.g. hospital admissions and mortality). Therefore, the objective of this study is to assess the effectiveness of medication review as an isolated short-term intervention, irrespective of the patient population and the outcome measures used. METHODS A literature search was performed in MEDLINE, EMBASE and Web of Science from their inception through September 2015. Randomized controlled trials (RCTs) with medication review as isolated short term intervention (<3 months) were included. There were no restrictions with regard to patient characteristics and outcome measures. One reviewer extracted and a second checked data. The risk of bias of studies was evaluated independently by two reviewers. A best evidence synthesis was conducted for every outcome measure used in more than one trial. In case of binary variables a meta-analysis was performed in addition to the best evidence synthesis, to quantify the effect. RESULTS Thirty-one RCTs were included in this systematic review (55% low risk of bias). A best evidence synthesis was conducted for 22 outcome measures. No effect of medication review was found on clinical outcomes (mortality, hospital admissions/healthcare use, the number of patients falling, physical and cognitive functioning), except a decrease in the number of falls per patient. However, in a sensitivity analysis using a more stringent threshold for risk of bias, the conclusion for the effect on the number of falls changed to inconclusive. Furthermore no effect was found on quality of life and evidence was inconclusive about the effect on economical outcome measures. However, an effect was found on most drug-related problems: medication review resulted in a decrease in the number of drug-related problems, more changes in medication, more drugs with dosage decrease and a greater decrease or smaller increase of the number of drugs. CONCLUSIONS An isolated medication review during a short term intervention period has an effect on most drug-related outcomes, minimal effect on clinical outcomes and no effect on quality of life. No conclusion can be drawn about the effect on economical outcome measures. Therefore, it should be considered to stop performing cross-sectional medication reviews as standard care.
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Affiliation(s)
| | - David Marinus Burger
- Department of Pharmacy, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
| | | | - Bartholomeus Johannes Fredericus van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Hengstdal 3, 6574 NA Ubbergen, The Netherlands
- Department of Pharmacy, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, Maastricht, Peter Debyelaan 15, 6229 HX Maastricht, The Netherlands
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Nafar M, Samavat S, Khoshdel A, Alipour-Abedi B. Anemia Evaluation and Erythropoietin Dose Requirement Among Hemodialysis Patients: a Multicenter Study. Iran J Kidney Dis 2017; 11:56-65. [PMID: 28174354 DOI: pmid/28174354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/26/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Both anemia and high doses of erythropoietin have been associated with increased mortality among dialysis patients. This study was conducted to evaluate the effective dose of erythropoiesis-stimulating agents. MATERIALS AND METHODS This multicenter nationwide cross-sectional study assessed adult patients on hemodialysis for at least 3 months from 80 hemodialysis centers in Iran. Demographic data, erythropoietin dose, and laboratory data were collected. RESULTS A total of 7009 prevalent hemodialysis patients were enrolled. Fifty-five percent of the patients had their hemoglobin levels within the target values. In those with a hemoglobin level of 8 g/dL to 10 g/dL, an erythropoietin dose of 10000 IU/wk to 12000 IU/wk led to a significant increase in hemoglobin level. A mean erythropoietin dose of 7700 IU/wk was effective in maintaining the target hemoglobin of 10 g/dL to 12 g/dL during a 3-month follow-up period. Improvement in hemoglobin level was associated with male sex, diabetes mellitus, and hemodialysis adequacy, and its deterioration with lower parathyroid hormone, calcium-phosphorus product, and creatinine levels; malnutrition; transfusion; and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (R2 = 29.1%, P < .001). A dosage of 66.5 IU/kg/wk led to 1 g/dL increase in hemoglobin in anemic patients. CONCLUSIONS Data suggested that an estimated erythropoietin dose of 66.5 IU/kg/wk for each 1 g/dL hemoglobin level below the target could be used as a guide for prescription. A dosage of about 8000 IU/wk could help maintaining hemoglobin within the target. A longitudinal study is needed to estimate the required erythropoietin dose.
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Affiliation(s)
| | - Shiva Samavat
- Department of Nephrology, Shahid Labbafinejad Medical Center; Kidney Disease Research Center; Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Gavini M, Faber ES, Birnbaum A, Sadovsky R. Who really manages our patients' medications? A study of inner city adults over 40 years of age. J Am Pharm Assoc (2003) 2016; 57:188-192.e1. [PMID: 27964925 DOI: 10.1016/j.japh.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Primarily to determine how many of our adult patients receive significant assistance from another individual with medication management. Secondarily, to determine if the number of prescribed medications can be predictors of whether the patient receives significant assistance with medication management. DESIGN Cross-sectional survey study. SETTING A level 3 patient-centered medical home family practice clinic in an inner city university hospital in Brooklyn, New York. PARTICIPANTS Patients 40 years of age and older coming for a regular clinic visit to see the primary care physician. INTERVENTION Administering the survey to the patients was the intervention. MAIN OUTCOME MEASURES: The number of patients who receive significant assistance with any phase of medication management was the main outcome measure. RESULTS Out of 143 patients surveyed, 61 patients (42.7%) received assistance with 1 or more phases of medication management; 38.5% (n = 55) of patients received help with phase 1 (ensuring that patients have medications at home). Of those 55 patients, 28 (50.9%) received help from family members, 22 (40%) received help from pharmacies, and 5 (9.1%) received help from home health aides or visiting nurses. Thirteen patients (9%) received help with phase 2 (arranging medications to help take them properly); 11 (84.6%) of them received help from family members. Twenty-three patients (16.1%) received help with phase 3 (reminding patients to take medications or handing them to the patient); 17 (73.9%) out of 23 received help from family members. There was a statistically significant trend (Mann-Whitney 2-sided test: P <0.001) showing a direct relationship between the number of medications and the need for assistance with 1 or more phases of medication management. CONCLUSION Many adult patients receive help with 1 or more phases of medication management. Family members are the major source of assistance with medication management. Pharmacies also play an important role in making certain that patients have medications at home. Patients with a higher number of medications are more likely to receive assistance from others.
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Lin X, Xu R, Fang L, Chen W, Hu D, Zhao S, Wang Y, Li J, Yan X. Factors influencing low-density lipoprotein cholesterol target achievement in primary care - Results from DYSIS China. Int J Cardiol 2016; 222:51-56. [PMID: 27454615 DOI: 10.1016/j.ijcard.2016.07.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 05/15/2016] [Accepted: 07/04/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Primary care facilities are the base for hypercholesterolemia treatment. However, data regarding the effectiveness of lipid management in primary care are lacking. METHODS AND RESULTS To evaluate lipid management in the primary care setting in China, we compared patients' characteristics and lipid management outcomes between 6100 outpatients treated at primary care versus 19,217 patients in non-primary settings using data from the DYSlipidemia International Study-China (DYSIS-CHINA). Compared to patients treated at non-primary hospitals, patients who received treatment at primary settings were younger, thinner, and were more likely to be female and to have a family history of premature CVD. Overall, 26.8% of very high-risk and 40.8% of high-risk patients achieved the LDL-C target with primary care treatment, whereas these target rates were 41.2% (p<0.001) and 58.6% (p<0.001), respectively, among patients treated at non-primary hospitals. High-dose statin therapy was underused in primary care patients compared to non-primary hospital patients (p<0.001). Logistic regression analysis showed that female gender, diabetes, and obesity were negative factors, whereas life-style modification and use of high-dose statin (40mg/d simvastatin equivalent) were favorable factors in predicting LDL-C target attainment in the primary care setting. CONCLUSION Sedentary life style, alcohol drinking, and use of suboptimal statin dosage are key factors that unfavorably affect the LDL-C target rate among patients treated at primary care facilities in China. Sufficient training for primary care physicians regarding proper statin use and support for the combined use of a statin with ezetimibe could promote LDL-C target attainment in primary care.
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Affiliation(s)
- Xue Lin
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - RuiYi Xu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ligang Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Chen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dayi Hu
- Department of Cardiology, Peking University People's Hospital, No.11, Xi Zhi Men Nan Da Jie, Xicheng District, Beijing 100044, China
| | - Shuiping Zhao
- Department of Cardiology, Second Xiangya Hospital, Central South University, No.139, People Street (M.), Changsha 410011, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xi Li, Dongcheng District, Beijing 100050, China
| | - Jihu Li
- MSD China Holding Co., Ltd., No. 1601, Nanjing Rd.(W), JingAn District, Shanghai 20004, China
| | - Xiaowei Yan
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Vinogradova Y, Coupland C, Brindle P, Hippisley-Cox J. Discontinuation and restarting in patients on statin treatment: prospective open cohort study using a primary care database. BMJ 2016; 353:i3305. [PMID: 27353261 PMCID: PMC4925919 DOI: 10.1136/bmj.i3305] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To estimate rates of discontinuation and restarting of statins, and to identify patient characteristics associated with either discontinuation or restarting. DESIGN Prospective open cohort study. SETTING 664 general practices contributing to the Clinical Practice Research Datalink in the United Kingdom. Data extracted in October 2014. PARTICIPANTS Incident statin users aged 25-84 years identified between January 2002 and September 2013. Patients with statin prescriptions divided into two groups: primary prevention and secondary prevention (those already diagnosed with cardiovascular disease). Patients with statin prescriptions in the 12 months before study entry were excluded. MAIN OUTCOME MEASURES Discontinuation of statin treatment (first 90 day gap after the estimated end date of a statin prescription), and restarting statin treatment for those who discontinued (defined as any subsequent prescription between discontinuation and study end). RESULTS Of 431 023 patients prescribed statins as primary prevention with a median follow-up time of 137 weeks, 47% (n=204 622) discontinued treatment and 72% (n=147 305) of those who discontinued restarted. Of 139 314 patients prescribed statins as secondary prevention with median follow-up time of 182 weeks, 41% (n=57 791) discontinued treatment and 75% (43 211) of those who discontinued restarted. Younger patients (aged ≤50 years), older patients (≥75 years), women, and patients with chronic liver disease were more likely to discontinue statins and less likely to restart. However, patients in ethnic minority groups, current smokers, and patients with type 1 diabetes were more likely to discontinue treatment but then were more likely to restart, whereas patients with hypertension and type 2 diabetes were less likely to discontinue treatment and more likely to restart if they did discontinue. These results were mainly consistent in the primary prevention and secondary prevention groups. CONCLUSIONS Although a large proportion of statin users discontinue, many of them restart. For many patient groups previously considered as "stoppers," the problem of statin treatment "stopping" could be part of the wider issue of poor adherence. Identification of patient groups associated with completely stopping or stop-starting behaviour has positive implications for patients and doctors as well as suggesting areas for future research.
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Affiliation(s)
- Yana Vinogradova
- Division of Primary Care, University of Nottingham, University Park, Nottingham, NG2 7RD, UK
| | - Carol Coupland
- Division of Primary Care, University of Nottingham, University Park, Nottingham, NG2 7RD, UK
| | - Peter Brindle
- Avon Primary Care Research Collaborative, Bristol Clinical Commissioning Group, Bristol, UK University of Bristol, Bristol, UK
| | - Julia Hippisley-Cox
- Division of Primary Care, University of Nottingham, University Park, Nottingham, NG2 7RD, UK
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Caverly LJ, Caverly TJ, Kalikin LM, Foster BK, Simon RH, LiPuma JJ. Episodic oral antibiotic use in CF: Discordance between the electronic medical record and self-report. J Cyst Fibros 2016; 15:630-3. [PMID: 27156045 DOI: 10.1016/j.jcf.2016.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 02/23/2016] [Accepted: 04/19/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Accurate accounting of antibiotic use is necessary for studies comparing the CF airway microbiota across clinically relevant disease states. While poor adherence to chronic therapies is well described for individuals with CF, use patterns of episodic oral antibiotics are less clear. METHODS Eleven individuals with CF completed daily questionnaires regarding antibiotic use for a mean of 458days. Self-report of episodic oral antibiotic use was compared to antibiotic prescription data in the electronic medical record (EMR). RESULTS Self-reported use of episodic oral antibiotics differed from EMR data an average of 8.3% of days per subject. The majority of these discrepancies were due to self-reported use of oral antibiotics outside of the EMR-documented dates of antibiotic prescription. CONCLUSIONS Discrepancies exist between self-reported use of episodic oral antibiotics and EMR data that have implications for studies of the CF airway microbiota.
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Affiliation(s)
- Lindsay J Caverly
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109, United States.
| | - Tanner J Caverly
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, United States; Center for Clinical Management Research, Veterans Affairs, Ann Arbor, MI 48105, United States
| | - Linda M Kalikin
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Bridget K Foster
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Richard H Simon
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - John J LiPuma
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109, United States
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