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Zhao HJ, Ushcatz I, Tadrous M, Aoki V, Chang AY, Levell NJ, Von Schuckmann L, Drucker AM. International time trends and differences in topical actinic keratosis therapy utilization. JAAD Int 2024; 16:18-25. [PMID: 38764482 PMCID: PMC11099316 DOI: 10.1016/j.jdin.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 05/21/2024] Open
Abstract
Background Actinic Keratoses (AK) are precancerous lesions that can lead to Squamous Cell Carcinoma. International differences in the utilization of topical medications to treat AK are not well described. Objectives To describe international differences in topical AK medication utilization, including associations of countries' economic status with AK medication utilization. Methods We used IQVIA MIDAS pharmaceutical sales data for 65 countries (42 high-income, 24 middle-income) from April 2011 to December 2021. We calculated each country's quarterly utilization of medications in grams per 1000 population. We used univariable linear regression to assess the association between country economic status and AK medication utilization. Results High-income countries used 15.37 more grams per 1000 population of 5-fluorouracil (95% CI: 9.68, 21.05), 4.64 more grams per 1000 population of imiquimod (95% CI: 3.45, 5.83), and 0.32 more grams per 1000 population of ingenol mebutate (95% CI: 0.05, 0.60). Limitations Missing medication utilization data for some countries. Conclusion High-income countries use more topical AK therapies than middle-income countries.
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Affiliation(s)
- Heather J. Zhao
- Department of Medicine, Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Inna Ushcatz
- Department of Medicine, Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mina Tadrous
- Department of Medicine, Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Valeria Aoki
- Department of Dermatology, University of São Paulo School of Medicine, São Paulo, São Paulo Estado, Brazil
| | - Aileen Y. Chang
- Department of Dermatology, University of California, San Francisco, San Francisco, California
- Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Nick J. Levell
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Aaron M. Drucker
- Department of Medicine, Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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2
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Hung NP, Huong VTM, Kieu DTV, Quan LT, Minh NTT, Thuy NP. Drug utilization and medical expenses in psoriasis treatment at a dermatology hospital in Vietnam, 2019-2021. Ann Ig 2023; 35:670-682. [PMID: 37796471 DOI: 10.7416/ai.2023.2572] [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] [Indexed: 10/06/2023]
Abstract
Introduction Psoriasis is a persistent, chronic, inflammatory cutaneous disorder that recurs frequently and has negative impacts on the living quality of sufferers. Methods Data from the Inpatient and Outpatient Department medical records at Can Tho dermatology hospital were used to generate a descriptive statistics report on medicines and medical costs for psoriasis therapy in 2019-2021. Results The average number of prescription medications varied annually, averaging roughly 0.62±85.4% per prescription. Corticosteroids and calcipotriol were the most commonly recommended drugs for psoriasis. Antihistamines were the most often used medication, with over 12,000 instances among the 28,397 individuals studied. The peak in average per-treatment expenses occurred in 2021 when they fluctuated between US $120 and US $160. In contrast, examination expenses were the most costly, ranging from US $93-$107. Conclusion The bulk of psoriasis therapy treatments were topical agents, whose quantities rose progressively. Direct examination expenses accounted for the greatest proportion.
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Affiliation(s)
- N P Hung
- Department of Pharmaceutical Management, Faculty of Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - V T M Huong
- Department of Medicinal Chemistry, Faculty of Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - D T V Kieu
- Faculty of Pharmacy, Can Tho City Dermatology Hospital, Can Tho Vietnam
| | - L T Quan
- RM Healthcare limited liability company, Ho Chi Minh, Vietnam
| | - N T T Minh
- Faculty of Basic Sciences, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - N P Thuy
- Faculty of Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
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Tsang CCS, Wang J. Addressing racial/ethnic disparities associated with Medicare Part D Star Ratings among population with Alzheimer's disease and related dementias. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1067-1075. [PMID: 37551695 PMCID: PMC10592311 DOI: 10.1080/14737167.2023.2245139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 08/01/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Previous studies noted that racial/ethnic minority groups were less likely than non-Hispanic White beneficiaries to be included in the assessment of medication utilization measures of Medicare Part D Star Ratings due to restrictive inclusion criteria for measure calculation. This study explored whether adding a measure with less stringent inclusion criteria to Star Ratings can reduce disparities in measure assessment among beneficiaries with Alzheimer's disease and related dementias (ADRD). METHODS This cross-sectional study utilized 2017 Medicare databases linked to Area Health Resources Files. Multivariable logistic regression was used to compare disparities before and after adding the new measure. RESULTS By adding the new measure, disparities in the odds for assessment inclusion between non-Hispanic White beneficiaries and Black, Hispanic, Asian, and Other beneficiaries were respectively reduced by 97% (odds ratio, or OR = 1.97, 95% Confidence Interval or CI = 1.89-2.05), 72% (OR = 1.72, 95% CI = 1.58-1.87), 115% (OR = 2.15, 95% CI = 1.87-2.46), and 44% (OR = 1.44, 95% CI = 1.28-1.62). CONCLUSIONS To improve the selection of medication utilization measures in Star Ratings among beneficiaries with ADRD, policymakers should investigate the optimal composition of measures to better align the interests of patients, providers, and health plans.
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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, United States
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, United States
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Dong X, Tsang CCS, Browning JA, Sim Y, Wan JY, Chisholm-Burns MA, Dagogo-Jack S, Cushman WC, Wang J. Solving racial/ethnic disparities associated with Medicare Part D Star Ratings. Curr Med Res Opin 2023; 39:963-971. [PMID: 37219396 PMCID: PMC10423313 DOI: 10.1080/03007995.2023.2217654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Medicare Part D Star Ratings are instrumental in shaping healthcare quality improvement efforts. However, the calculation metrics for medication performance measures for this program have been associated with racial/ethnic disparities. In this study, we aimed to explore whether an alternative program, named Star Plus by us that included all medication performance measures developed by Pharmacy Quality Alliance and applicable to our study population, would reduce such disparities among Medicare beneficiaries with diabetes, hypertension, and/or hyperlipidemia. METHOD We conducted an analysis of a 10% random sample of Medicare A/B/D claims linked to the Area Health Resources File. Multivariate logistic regressions with minority dummy variables were used to examine racial/ethnic disparities in measure calculations of Star Ratings and Star Plus, respectively. RESULTS Adjusted results indicated that relative to non-Hispanic Whites (Whites), racial/ethnic minorities had significantly lower odds of being included in the Star Ratings measure calculations: the odds ratios (ORs) for Blacks, Hispanics, Asians, and Others were 0.68 (95% confidence interval [CI] = 0.66-0.71), 0.73 (CI = 0.69-0.78), 0.88 (CI = 0.82-0.93), and 0.92 (CI = 0.88-0.97), respectively. In contrast, every beneficiary in the sample was included in Star Plus. Further, racial/ethnic minorities had significantly higher increase in the odds of being included in measure calculation in Star Plus than Star Ratings. The ORs for Blacks, Hispanics, Asians, and Others were 1.47 (CI = 1.41-1.52), 1.37 (CI = 1.29-1.45), 1.14 (CI = 1.07-1.22), and 1.09 (CI = 1.03-1.14), respectively. CONCLUSIONS Our study demonstrated that racial/ethnic disparities may be eliminated by including additional medication performance measures to Star Ratings.
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Affiliation(s)
- Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jamie A. Browning
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yongbo Sim
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jim Y. Wan
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marie A. Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Samuel Dagogo-Jack
- Department of Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - William C. Cushman
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
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Watanabe JH, Kwon J, Nan B, Abeles SR, Mehta SR. Examination of Medication Use Patterns by Age Group, Comorbidity, and Month in COVID-19 Positive Patients in a Large Statewide Health System During the Pandemic in 2020. J Pharm Technol 2022; 38:75-87. [PMID: 35571345 PMCID: PMC9096847 DOI: 10.1177/87551225211068675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background: Understanding medication use patterns for patients with COVID-19 will provide needed insight into the evolution of COVID-19 treatment over the course of the SARS-CoV-2 pandemic and aid clinical management considerations. Objectives: To systematically determine most frequently used medications among COVID-19 patients overall and by hospitalization status. Secondary objective was use measurement of medications considered potential therapeutic options. Methods: Retrospective cohort study was performed using data from the University of California COVID Research Data Set (UC CORDS) patients between March 10, 2020, and December 31, 2020. Main outcomes were percentages of patients prescribed medications, overall, by age group, and by comorbidity based on hospitalization status for COVID-19 patients. Use percentage by month of COVID-19 diagnosis was measured. Cumulative count of potential therapeutic options was measured over time. Results: Dataset included 22 896 unique patients with COVID-19 (mean [SD] age, 42.4 [20.4] years; 12 154 [53%] women). Most frequently used medications in patients overall were acetaminophen (21.2%), albuterol (14.9%), ondansetron (13.9%), and enoxaparin (10.8%). Dexamethasone use increased from fewer than 50 total hospitalized patients through April who had received the medication, to more than 500 patients by mid-August. Cumulative count of enoxaparin users was the largest throughout the study period. Conclusion and Relevance: In this retrospective cohort study, across age and comorbidity groups, predominant utilization was for supportive care therapy. Dexamethasone and remdesivir experienced large increases in use. Conversely, hydroxychloroquine and azithromycin use markedly dropped. Medication utilization rapidly shifted toward more evidence-concordant treatment of patients with COVID-19 as rigorous study findings emerged.
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Affiliation(s)
- Jonathan H. Watanabe
- Department of Clinical Pharmacy
Practice, UC Irvine School of Pharmacy & Pharmaceutical Sciences, Irvine, CA,
USA,Jonathan H. Watanabe, Associate Dean of
Assessment and Quality, Professor of Clinical Pharmacy, Department of Clinical
Pharmacy Practice, UC Irvine School of Pharmacy & Pharmaceutical Sciences,
101 Theory, Suite 100, Irvine, CA 92697, USA.
| | - Jimmy Kwon
- Department of Statistics, UC Irvine
Donald Bren School of Information & Computer Sciences, Irvine, CA, USA
| | - Bin Nan
- Department of Statistics, UC Irvine
Donald Bren School of Information & Computer Sciences, Irvine, CA, USA
| | - Shira R. Abeles
- Department of Medicine, UC San Diego
School of Medicine, La Jolla, CA, USA
| | - Sanjay R. Mehta
- Department of Medicine, UC San Diego
School of Medicine, La Jolla, CA, USA
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Ozaki AF, Krumholz HM, Mody FV, Jackevicius CA. National Trends in the Use of Sacubitril/Valsartan. J Card Fail 2021; 27:839-847. [PMID: 34364661 DOI: 10.1016/j.cardfail.2021.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Better understanding of recent sacubitril/valsartan prescription patterns may help identify factors that influence its use. The aim of the study was to characterize sacubitril/valsartan use and dosage patterns nationally. METHODS AND RESULTS We conducted a population-level cohort study using IQVIA Inc. National Prescription Audit™ data in the United States from August 2016 to July 2019. Over 3 years, there was a 5.6-fold increase in the number of sacubitril/valsartan prescriptions dispensed per month, totaling 3.3 million prescriptions. For the most recent year, this extrapolates to a best-case scenario of 13.8% of patients with heart failure with reduced ejection fraction using sacubitril/valsartan, representing at most one-half of those eligible for sacubitril/valsartan use. During the most recent year, 48.7% of dispensed prescriptions were for the lowest strength (24/26 mg) and only 20.6% for the target strength (97/103 mg). A greater proportion of the target strength was used in younger patients (< 65years: 24.6%; ≥ 85: 11.1%; P<0.0001). Cardiologists prescribed 59.0% of all dispensed prescriptions, and noncardiologists showed a greater increase (7.5-fold vs 4.9-fold; P<0.0001) over time. CONCLUSIONS Recent use of sacubitril/valsartan has increased greatly in the United States; however, a substantial proportion of eligible patients with heart failure with reduced ejection fraction did not receive treatment, and only 1 in 5 prescriptions dispensed were for the target strength. Further exploration of barriers to the use of sacubitril/valsartan and dosing uptitration and their clinical implications warrant further evaluation.
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Affiliation(s)
- Aya F Ozaki
- Department of Pharmacy Practice and Administration, Western University of Health Sciences, Pomona, California; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Harlan M Krumholz
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Freny V Mody
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Division of Cardiology, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Cynthia A Jackevicius
- Department of Pharmacy Practice and Administration, Western University of Health Sciences, Pomona, California; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; ICES, Toronto, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
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Ewig CLY, Cheng YM, Li HS, Wong JCL, Cho AHY, Poon FMH, Li CK, Cheung YT. Use of Chronic Prescription Medications and Prevalence of Polypharmacy in Survivors of Childhood Cancer. Front Oncol 2021; 11:642544. [PMID: 33869032 PMCID: PMC8047635 DOI: 10.3389/fonc.2021.642544] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/04/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND As survivors of childhood cancer age, development of cancer treatment-related chronic health conditions often occur. This study aimed to describe the pattern of chronic prescription medication use and identify factors associated with polypharmacy among survivors of childhood cancer. METHODS This was a retrospective study conducted at the pediatric oncology long-term follow-up clinic in Hong Kong. Eligible subjects included survivors who were (1) diagnosed with cancer before 18 years old, (2) were at least 3 years post-cancer diagnosis and had completed treatment for at least 30 days, and (3) receiving long-term follow-up care at the study site between 2015 and 2018. Dispensing records of eligible survivors were reviewed to identify medications taken daily for ≥30 days or used on an "as needed" basis for ≥6 months cumulatively within the past 12-month period. Polypharmacy was defined as the concurrent use of ≥5 chronic medications. Multivariable log-binomial modeling was conducted to identify treatment and clinical factors associated with medication use pattern and polypharmacy. RESULTS This study included 625 survivors (mean current age = 17.9 years, standard deviation [SD] = 7.2 years) who were 9.2 [5.2] years post-treatment. Approximately one-third (n = 219, 35.0%) of survivors were prescribed at least one chronic medication. Frequently prescribed medication classes include systemic antihistamines (26.5%), sex hormones (19.2%), and thyroid replacement therapy (16.0%). Overall prevalence of polypharmacy was 5.3% (n = 33). A higher rate of polypharmacy was found in survivors of CNS tumors (13.6%) than in survivors of hematological malignancies (4.3%) and other solid tumors (5.3%) (P = .0051). Higher medication burden was also observed in survivors who had undergone cranial radiation (RR = 6.31; 95% CI = 2.75-14.49) or hematopoietic stem-cell transplantation (HSCT) (RR = 3.53; 95% CI = 1.59-7.83). CONCLUSION Although polypharmacy was observed in a minority of included survivors of childhood cancer, chronic medication use was common. Special attention should be paid to survivors of CNS tumors and survivors who have undergone HSCT or cranial radiation. These individuals should be monitored closely for drug-drug interactions and adverse health outcomes that may result from multiple chronic medications, particularly during hospitalization in an acute care setting.
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Affiliation(s)
- Celeste L. Y. Ewig
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yi Man Cheng
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Hoi Shan Li
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Alex Hong Yu Cho
- Department of Pharmacy, Hong Kong Children’s Hospital, Hong Kong, China
| | | | - Chi Kong Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
- Department of Oncology and Hematology, The Hong Kong Children’s Hospital, Hong Kong, China
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Kertes J, Stein Reisner O, Grunhaus L, Neumark Y. The Impact of Smoking Cessation on Hospitalization and Psychiatric Medication Utilization among People with Serious Mental Illness. Subst Use Misuse 2021; 56:1543-1550. [PMID: 34193007 DOI: 10.1080/10826084.2021.1942057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Despite the high prevalence of smoking amongst people with serious mental illness (SMI), referral rates to smoking cessation programs (SCPs) are low. Mental health workers reticence to refer to SCPs has been attributed, in part, to their belief that quitting will have a deleterious effect on their patients' mental health status. Objectives: This study's objective was to determine if participating in a smoking cessation program had an adverse effect on mental health status among people with SMI, measured here by a change in hospitalization occurrence or psychiatric medication utilization. People with SMI who had participated in at least one SCP session in a large health maintenance organization (n = 403) were compared to an age-gender-diagnosis matched sample of SMI smokers (1,209) who had never participated. Results: No change in psychiatric hospitalization occurrence pre- versus post-SCP participation was found among participants (Pre:7.2% vs. Post:5.2, p = 0.2) or nonparticipants (Pre:7.0% vs. Post:6.0%, p = 0.2). Mean defined daily dose (DDD) for anti-psychotic, mood stabilizer, anti-depressant and anxiolytic medications also did not change over time for participants and nonparticipants. However, participants who did not complete the SCP and didn't quit had a 0.35 higher mean DDD for anti-psychotic medications compared with participants who had completed the SCP or quit, and with nonparticipants (p = 0.006), and were the only group to exhibit an increase in mean antipsychotic DDD over time (Pre:1.42, Post:1.63). SCP participation was not associated with hospitalization occurrence or psychiatric medication utilization. Conclusions/Importance: Smoking cessation should be encouraged, with close monitoring during the quit process.
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Affiliation(s)
- Jennifer Kertes
- Department of Health Evaluation & Research, Maccabi HealthCare, Jerusalem, Israel
| | | | - Leon Grunhaus
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yehuda Neumark
- Braun Hebrew University-Hadassah School of Public Health & Community Medicine, Jerusalem, Israel
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Abstract
Prostate cancer is one of the most common cancer in males. Both the incidence and the mortality rates of prostate cancer show an increasing trend. Androgen deprivation therapy (ADT) is the standard treatment for metastatic prostate cancer. The aim of our study was to show the epidemiology of prostate cancer and the proportion of patients utilizing ADT.This study used Taiwan's National Health Insurance Research Database (NHIRD) and identified the patients who had been diagnosed with prostate cancer (International Classification of Disease (ICD)-10: C61) and followed up between Jan 1, 2008 and Dec 31, 2015. The ADT drugs used by prostate cancer patients were recorded: Gonadotropin-releasing hormone (GnRH) agonists; GnRH antagonist; estrogen analogs and androgen receptor antagonist.A total of 25,233 patients with newly diagnosed prostate cancer in 2008-2014 were enrolled. The utilization of ADT increased from more than 7,000 person-time in 2008 to more than 50,000 person-time in 2014. Cyproterone acetate was the most commonly used drug in 2008-2015, but its proportion of utilization, which was the highest in stage 2 cancer, dropped from 43% in 2008 to 15% in 2015. Bicalutamide was the second most used drug from 2008 to 2015, but its utilization was not different for different stages.The incidence rate of prostate cancer increased in the study period and medical expenditure also increased in ADT treatment. Health insurance benefits for various ADT drugs should be further evaluated.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan
| | - Ya-Ling Wang
- Department of Pharmacy, Kaohsiung Medical University Hospital
| | - Chung-Yu Chen
- Department of Pharmacy, Kaohsiung Medical University Hospital
- Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Okeowo D, Patterson A, Boyd C, Reeve E, Gnjidic D, Todd A. Clinical practice guidelines for older people with multimorbidity and life-limiting illness: what are the implications for deprescribing? Ther Adv Drug Saf 2018; 9:619-630. [PMID: 30479737 PMCID: PMC6243426 DOI: 10.1177/2042098618795770] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/07/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim of this study was (1) to apply the current United Kingdom (UK) National Institute for Health and Care Excellence (NICE) clinical practice guidelines to a hypothetical older patient with multimorbidity and life-limiting illness; (2) consider how treatment choices could be influenced by NICE guidance specifically related to multimorbidity; and, (3) ascertain if such clinical practice guidelines describe how and when medication should be reviewed, reduced and stopped. METHODS Based upon common long-term conditions in older people, a hypothetical older patient was constructed. Relevant NICE guidelines were applied to the hypothetical patient to determine what medication should be initiated in three treatment models: a new patient model, a treatment-resistant model, and a last-line model. Medication complexity for each model was assessed according to the medication regimen complexity index (MRCI). RESULTS The majority of the guidelines recommended the initiation of medication in the hypothetical patient; if the initial treatment approach was unsuccessful, each guideline advocated the use of more medication, with the regimen becoming increasingly complex. In the new patient model, 4 separate medications (9 dosage units) would be initiated per day; for the treatment-resistant model, 6 separate medications (15 dosage units); and, for the last-line model, 11 separate medications (20 dosage units). None of the guidelines used for the hypothetical patient discussed approaches to stopping medication. CONCLUSIONS In a UK context, disease-specific clinical practice guidelines routinely advocate the initiation of medication to manage long-term conditions, with medication regimens becoming increasingly complex through the different steps of care. There is often a lack of information regarding specific treatment recommendations for older people with life-limiting illness and multimorbidity. While guidelines frequently explain how and when a medication should be initiated, there is often no information concerning when and how the medications should be reduced or stopped.
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Affiliation(s)
- Daniel Okeowo
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Alastair Patterson
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Cynthia Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily Reeve
- NHMRC-Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia Geriatric Medicine Research, Faculty of Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada College of Pharmacy, Faculty of Health, Dalhousie University, NS, Canada
| | - Danijela Gnjidic
- Faculty of Pharmacy and Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Adam Todd
- Faculty of Medical Sciences, School of Pharmacy, Newcastle University, Rm G.66, King George VI Building, Queen Victoria Road, Newcastle upon Tyne, NE1 7RU, UK
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Durvasula R, Kelly J, Schleyer A, Anawalt BD, Somani S, Dellit TH. Standardized Review and Approval Process for High-Cost Medication Use Promotes Value-Based Care in a Large Academic Medical System. Am Health Drug Benefits 2018; 11:65-73. [PMID: 29915640 PMCID: PMC5973244] [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] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/14/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND As healthcare costs rise and reimbursements decrease, healthcare organization leadership and clinical providers must collaborate to provide high-value healthcare. Medications are a key driver of the increasing cost of healthcare, largely as a result of the proliferation of expensive specialty drugs, including biologic agents. Such medications contribute significantly to the inpatient diagnosis-related group payment system, often with minimal or unproved benefit over less-expensive therapies. OBJECTIVE To describe a systematic review process to reduce non-evidence-based inpatient use of high-cost medications across a large multihospital academic health system. METHODS We created a Pharmacy & Therapeutics subcommittee consisting of clinicians, pharmacists, and an ethics representative. This committee developed a standardized process for a timely review (<48 hours) and approval of high-cost medications based on their clinical effectiveness, safety, and appropriateness. The engagement of clinical experts in the development of the consensus-based guidelines for the use of specific medications facilitated the clinicians' acceptance of the review process. RESULTS Over a 2-year period, a total of 85 patient-specific requests underwent formal review. All reviews were conducted within 48 hours. This review process has reduced the non-evidence-based use of specialty medications and has resulted in a pharmacy savings of $491,000 in fiscal year 2016, with almost 80% of the savings occurring in the last 2 quarters, because our process has matured. CONCLUSION The creation of a collaborative review process to ensure consistent, evidence-based utilization of high-cost medications provides value-based care, while minimizing unnecessary practice variation and reducing the cost of inpatient care.
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Affiliation(s)
- Raghu Durvasula
- Associate Professor of Medicine, Division of Nephrology, University of Washington Medical Center, Seattle
| | - Janet Kelly
- Assistant Director of Pharmacy Services, University of Washington Medical Center
| | - Anneliese Schleyer
- Associate Professor of Medicine, Harborview Medical Center, University of Washington
| | - Bradley D Anawalt
- Professor of Medicine, Division of General Internal Medicine, Department of Medicine, University of Washington
| | - Shabir Somani
- Chief Pharmacy Officer and Assistant Dean, University of Washington School of Pharmacy
| | - Timothy H Dellit
- Professor of Medicine, Harborview Medical Center, University of Washington School of Medicine
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12
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Abstract
BACKGROUND Deprescribing is a recommended intervention to reduce morbidity and mortality caused by polypharmacy in older residents. However, a lack of definite deprescription guidelines and evidence of clinically meaningful outcomes complicates or precludes the practicality of such an approach. OBJECTIVE The objective of the present pilot study is to establish and implement a stepwise taper protocol that can potentially minimize overuse of proton pump inhibitors in a safe, effective, and feasible manner in the nursing home. METHODS Proton pump inhibitor dosage was reduced by half every 3 weeks until the lowest dose was reached; thereafter, the frequency was changed to every other day for 3 weeks, if tolerated. Subsequently, histamine receptor antagonists replaced proton pump inhibitors and followed the same deprescription regimen until discontinuation. Patient-specific interventions also included reassessment of therapeutic agents and dosage forms for more tolerable alternatives to facilitate deprescription efforts and minimize gastric ulceration or discomfort. RESULTS The pilot study enrolled 10 patients (average age 65.6 years, medication burden 16.8 units, and antisecretory duration 37.5 months). Physicians accepted >95% of interventions, and 90% of patients achieved cessation at 12 weeks. Post cessation, none of the patients needed antacid, prokinetic, or antisecretory agents at 4 weeks. Difficulties in order interpretation and transcription among nurses as well as order entry and calculations among pharmacists were noted. CONCLUSIONS The present pilot study added to the growing body of evidence that gradual deprescription of antisecretory medications is feasible. Nonetheless, the pilot design precludes any conclusions about safety and efficacy of the intervention.
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13
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Ackermann RT, Wallia A, O'Brien MJ, Kang R, Cooper A, Moran MR, Liss DT. Correlates of second-line type 2 diabetes medication selection in the USA. BMJ Open Diabetes Res Care 2017; 5:e000421. [PMID: 29225892 PMCID: PMC5706487 DOI: 10.1136/bmjdrc-2017-000421] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/03/2017] [Accepted: 08/10/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Past research provides insufficient evidence to inform second-line diabetes medication prescribing when metformin is no longer sufficient. We evaluated patient, prescriber, and health plan characteristics associated with selection of second-line diabetes medications in the USA. RESEARCH DESIGN AND METHODS We used a multiple case-comparison study design to identify characteristics associated with the probability of starting each of six second-line diabetes medication alternatives within 77 744 adults enrolled in commercial or Medicare Advantage health plans from 2011 to 2015. National administrative data were provided by a large commercial health payer. Multinomial logistic regression models were used to identify characteristics independently associated with selecting each diabetes drug class. RESULTS From 2011 to 2015, sulfonylureas still represented 47% of all second-line drug starts, with proportionately higher use in patients ≥75 years of age (63% of drug starts). Basal insulin was more likely to be selected when a past A1c test result was >10% (13.0% vs 4.5% for those with A1c <8%; p<0.001). Initiation of a glucagon-like peptide-1 receptor agonist was associated with being female (10.1% vs 6.0% for male; p<0.001) and having a diagnosis code for obesity (10.8% vs 6.9% for no diagnosis; p<0.001). For all drug classes, the recent prescribing behavior of the provider was a strong correlate of subsequent second-line drug selection. CONCLUSIONS Sulfonylureas continue to represent almost half of second-line diabetes medication starts in the USA. This could reflect overuse for some groups such as older adults, for whom some alternatives may be safer, although more costly and potentially less effective. Future research should compare outcomes of medication choices and conditions under which particular classes are most effective.
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Affiliation(s)
- Ronald T Ackermann
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amisha Wallia
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J O'Brien
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Raymond Kang
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Cooper
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Margaret R Moran
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David T Liss
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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14
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Haag JD, Davis AZ, Hoel RW, Armon JJ, Odell LJ, Dierkhising RA, Takahashi PY. Impact of Pharmacist-Provided Medication Therapy Management on Healthcare Quality and Utilization in Recently Discharged Elderly Patients. Am Health Drug Benefits 2016; 9:259-268. [PMID: 27625743 PMCID: PMC5007055] [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] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 05/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The optimization of medication use during care transitions represents an opportunity to improve overall health-related outcomes. The utilization of clinical pharmacists during care transitions has demonstrated benefit, although the optimal method of integration during the care transition process remains unclear. OBJECTIVE To evaluate the impact of pharmacist-provided telephonic medication therapy management (MTM) on care quality in a care transitions program (CTP) for high-risk older adults. METHODS This prospective, randomized, controlled study was conducted from December 8, 2011, through October 25, 2012, in a primary care work group at a tertiary care academic medical center in the midwestern United States. High-risk elderly (aged ≥60 years) patients were randomized to a pharmacist-provided MTM program via telephone or to usual care within an existing outpatient CTP. The primary outcome was the quality of medication prescribing and utilization based on the Screening Tool to Alert Doctors to the Right Treatment (START) and the Screening Tool of Older Persons' Prescriptions (STOPP) scores. The secondary outcomes were medication utilization using a modified version of the Medication Appropriateness Index, hospital resource utilization within 30 days of discharge, and drug therapy problems. RESULTS Of 222 eligible high-risk patients, 25 were included in the study and were randomized to the pharmacist MTM intervention (N = 13) or to usual care (N = 12). No significant differences were found between the 2 groups in medications meeting the STOPP or START criteria. At 30-day follow-up, no significant differences were found between the 2 cohorts in medication utilization quality indicators or in hospital utilization. At 30-day follow-up, 3 (13.6%) patients had an emergency department visit or a hospital readmission since discharge. In all, 22 patients completed the study. Medication underuse was common, with 20 START criteria absent medications evident for all 25 patients at baseline, representing 15 (60%) patients with ≥1 missing medications. Overall, 55 drug therapy problems were identified at baseline, 24 (43.6%) of which remained unresolved at 30-day follow-up. CONCLUSION The use of a pharmacist-provided MTM program did not achieve a significant difference compared with usual care in an existing CTP; however, the findings demonstrated frequent utilization of inappropriate medications as well as medication underuse, and many drug therapy problems remained unresolved. The small size of the study may have limited the ability to detect a difference between the intervention and usual care groups.
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Affiliation(s)
- Jordan D Haag
- Clinical Pharmacist, Department of Pharmacy, Mayo Clinic in Rochester, MN
| | - Amanda Z Davis
- Clinical Pharmacist, Department of Pharmacy, Mayo Clinic in Rochester, MN
| | - Robert W Hoel
- Clinical Pharmacist, Department of Pharmacy, Mayo Clinic in Rochester, MN
| | - Jeffrey J Armon
- Clinical Pharmacist, Department of Pharmacy, Mayo Clinic in Rochester, MN
| | - Laura J Odell
- Clinical Pharmacist, Department of Pharmacy, Mayo Clinic in Rochester, MN
| | - Ross A Dierkhising
- Statistician, Division of Biomedical Statistics and Informatics, Mayo Clinic in Rochester, MN
| | - Paul Y Takahashi
- Consultant, Division of Primary Care Internal Medicine, Mayo Clinic in Rochester, MN
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15
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Abstract
BACKGROUND The purpose of this study was to assess select medication utilization prior to duloxetine initiation among patients with major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, fibromyalgia, and musculoskeletal pain associated with osteoarthritis or low back pain. METHODS Commercially insured duloxetine initiators between January 1, 2007 and March 31, 2010 were identified from a large US administrative claims database. Disease subgroups were constructed based on diagnosis from medical claims during the 12 months prior to duloxetine initiation. Prior use of antidepressants, anticonvulsants, opioids, nonsteroidal anti-inflammatory drugs, and muscle relaxants was assessed during the 12-month preinitiation period. RESULTS This study identified 56,845 (2007), 44,838 (2008), and 65,840 (January 2009 to March 2010) duloxetine initiators. Among the 2009 initiators, utilization patterns were similar for patients with major depressive disorder and generalized anxiety disorder, with antidepressants being the most used (84% and 80%, respectively), followed by opioids (58% and 55%, respectively). Patients across pain-related conditions also had similar utilization patterns, with opioid use being the highest (76%-82%), followed by antidepressants (65%-72%). Use of other medication classes was common (29%-63%) but less frequent, and over 50% of the patients used any antidepressants, 70% used any antidepressants or anticonvulsants, and 90% used any antidepressants, anticonvulsants, or opioids. Trends in the use of these select medications were similar between 2007 and 2009. CONCLUSION Patients used several types of medications over the 12 months prior to initiating duloxetine across disease states, with antidepressants and opioids being the most frequently used medications. Trends of select medication use were similar over time.
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Affiliation(s)
| | - Ning Wu
- United BioSource Corporation, Lexington, MA, USA
| | | | | | | | - Yang Zhao
- Eli Lilly and Company, Indianapolis, IN
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