Analyzing family data: A GEE approach for substance use researchers

Effects of drug price reduction and prescribing restrictions on expenditures and utilisation of antihypertensive drugs in Korea

OBJECTIVES

To evaluate the quantitative effects of the drug price reduction on pharmaceutical expenditures and the new guidelines to restrict prescribing on drug utilisation for antihypertensive drugs.

DESIGN

We used an interrupted time series design with the National patient sample data of Health Insurance Review and Assessment Service in South Korea.

METHODS

54,295 participants who were with primary hypertension from the National patient sample data of Health Insurance Review and Assessment Service were included. The study period was from March 2011 to December 2013. The dependent variables were antihypertensive drug costs, antihypertensive drug cost per prescribing day, daily drug utilisation, average number of drugs per month, percentage of original drugs per prescription, drug overutilisation and prohibited combinations. Segmented regression analysis was used.

RESULTS

The drug price reduction reduced expenditure (US$-1.51, -10.2%), and the new guidelines reduced expenditures even more (US$-2.13; -16.2%). These policies saved US$4.22 (28%) of antihypertensive drug costs per patient in December 2013 compared to March 2012. Drug price reduction policy was introduced in April 2012. We established the policy effect by comparing it before (March 2012) with after(21 months later-December 2012). The effects of the guidelines decreased expenditures, daily drug utilisation and the average number of drugs per month more than did the drug price reduction.

CONCLUSIONS

Both policies saved money. The guidelines were more effective over time and had fewer side effects such as increasing daily drug utilisation and number of drugs than the effects of drug price reduction.

Intergenerational Hazardous Alcohol Use and Area Factors: The HUNT Study, Norway

BACKGROUND

Alcohol use among adolescents has been found to be associated with parental alcohol abuse, but it's relation to more prevalent forms of hazardous drinking patterns among parents has been less explored. Few studies have included area factors when investigating alcohol use across generations.

OBJECTIVES

The aims of this study were to investigate whether adolescent intoxication was associated with parental heavy episodic drinking (HED) and intoxication, area-level socioeconomic status (SES), and rates of area-level HED.

METHODS

General Estimation Equations (GEE) was applied to analyze data from the Nord-Trøndelag Health Study (2006-08) including 2,306 adolescents. Adolescent alcohol use was defined by self-reported frequency of intoxication. Parental alcohol use was defined by parental self-reports of drinking five glasses of alcohol at one occasion (HED), whether they had been strongly intoxicated, and adolescent reports of seeing parents intoxicated. Area-level SES and HED were based on data from HUNT3 and Statistics Norway.

RESULTS

Parental and offspring alcohol use were associated, although this varied to some extent with gender and exposures. The strongest associations were found between offspring intoxication and offspring reports of seeing their parent intoxicated (girls: OR 3.3, 95% CI 2.3-4.7; boys: OR 3.4, 95% CI 2.4-4.7). Intoxication was more common among girls, who lived in areas with a higher level of adult HED. Living in areas with higher SES was associated with less intoxication among adolescents.

CONCLUSION

Intoxication in adolescence was associated with factors at both family and area level, which emphasize the need of both population and high risk preventive approaches.

Psychological burden in inpatient relatives: the forgotten side of medical management

BACKGROUND

The burden of the hospital experience is a broad issue that has been evaluated in a particular context of intensive care unit (ICU). It is likely, however, that the load is heavy on families even in other hospital wards and not just in the ICU. The present study was designed to assess the prevalence of anxiety and depression in family members of patients admitted in a general medicine department, and to identify associated factors with those symptoms.

METHODS

Patients' and relatives' socio-demographic data and information pertaining to the patients' health characteristics were collected. Family members completed the Arabic version of Hospital Anxiety and Depression Scale (HADS). Associations between anxiety or depression and covariates of interest were investigated using generalized estimating equations, for univariate and multivariate logistic regression analysis.

RESULTS

The prevalence of anxiety (55.6%) and depression (41.1%) in family members remains high. The multivariate model identified three groups of factors associated with these symptoms: (i) Patient related: a short length of hospital stay is associated with depression (OR 1.04, 95% CI 1.01-1.08; P = 0.02); (ii) Family related: rural residence is associated with depression (OR 2.56, 95% CI 1.01-6.74; P = 0.04), and female gender is associated with anxiety and depression (OR 2.60, 95% CI 1.41-4.81; P = 0.002), (OR 3.04, 95% CI 1.62-5.70; P = 0.01), respectively; and (iii) Caregiver related: short length of visit (OR 1.08, 95% CI 1.03-1.13; P = 0.002) is associated with anxiety, admission to a share room (OR 2.56, 95% CI 1.25-5.23; P = 0.01) is associated with depression and a need for more information is associated with anxiety and depression (OR 1.78, 95% CI 1.02-3.10; P = 0.04),(OR 1.77, 95% CI 1.01-3.11; P = 0.04), respectively.

CONCLUSION

The prevalence of symptoms of anxiety and depression in family members remains high at the end of acute health care. It is hoped that improving the provision of information will decrease the risk of psychological distress.