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Joseph RM, van Staa TP, Lunt M, Abrahamowicz M, Dixon WG. Exposure measurement error when assessing current glucocorticoid use using UK primary care electronic prescription data. Pharmacoepidemiol Drug Saf 2018; 28:179-186. [PMID: 30264875 PMCID: PMC6492099 DOI: 10.1002/pds.4649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/23/2018] [Accepted: 08/04/2018] [Indexed: 01/20/2023]
Abstract
Purpose To quantify misclassification in glucocorticoid (GC) exposure defined using UK primary care prescription data. Methods A cross‐sectional study including patients with rheumatoid arthritis prescribed oral GCs in the past 2 years. Glucocorticoid exposure based on electronic prescription records was compared with participant‐reported GC use captured using a paper diary. Prescription data (containing information about prescriptions issued but no dispensing information) was provided by the Clinical Practice Research Datalink. The following variables were defined: current use and dose of oral GCs and if (and when) participants had received a GC injection. For oral GCs, self‐reported use was taken to represent “true” exposure. A dataset representing a hypothetical population was generated to assess the impact of the misclassification found for current use. Results A total of 67 of 78 study participants (86%) were correctly classified as currently on/off oral GCs; 32/38 (84.2%) participants reporting current GC use and 35/40 (87.5%) participants not reporting current use were correctly classified. Estimated values of current dose were imprecise (correlation coefficient 0.46). Concordance between reported and prescribed GC injections was poor (kappa statistic 0.14). Misclassification bias was demonstrated in the hypothetical population: For “true” relative risks of 1.5, 4, and 9, the “observed” relative risks were 1.33, 2.48, and 3.58, respectively. Conclusions Misclassification of current use of oral GCs was low but sufficient to lead to significant bias. Researchers should take care to assess the likely impact of exposure misclassification on their analyses.
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Affiliation(s)
- Rebecca M Joseph
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Tjeerd P van Staa
- Health eResearch Centre, Centre for Health Informatics, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Faculty of Science, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Health eResearch Centre, Centre for Health Informatics, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Rheumatology Department, Salford Royal NHS Foundation Trust, Salford, UK
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52
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Sediq R, van der Schans J, Dotinga A, Alingh RA, Wilffert B, Bos JH, Schuiling-Veninga CC, Hak E. Concordance assessment of self-reported medication use in the Netherlands three-generation Lifelines Cohort study with the pharmacy database iaDB.nl: The PharmLines initiative. Clin Epidemiol 2018; 10:981-989. [PMID: 30147377 PMCID: PMC6101003 DOI: 10.2147/clep.s163037] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background While self-reported data are commonly used as a source of medication use for pharmaco-epidemiological studies, such information is prone to forms of bias. Several previous studies showed that various factors like age, type of drug and data collection method may influence accuracy. We aimed to assess the concordance of the self-reported medication use that was documented at entry to the Lifelines Cohort Study, a three-generation follow-up study in the Netherlands that started in 2006 and included over 167,000 participants. Materials and methods As part of the PharmLines Initiative, we collected medication data from the Lifelines participants encoded according to the Anatomical Therapeutic Chemical (ATC) coding scheme and linked the data via Statistics Netherlands to the widely used and representative pharmacy prescription database of the University of Groningen, IADB.nl. Analyses were conducted at second level of ATC coding for all recorded medications as well as a top list of most used medications at drug-specific fifth level. Cohen’s kappa statistics were used to measure the concordance for all participants according to sex and age. Results The level of concordance between the two data sources largely differed according to the therapeutic class. Medication used for the cardiovascular system and diabetes, thyroid therapy, bisphosphonates and anti-thrombotic drugs showed a very good agreement (κ>0.75). Medication as needed or prone to stigmatization bias showed a moderate agreement (κ=0.41–0.60), whereas medications used for short periods of time showed a fair agreement (κ=0.0–0.4). Concordance was similar for males and females, but younger adults tended to have lower concordance rates than older adults. Conclusion The self-reported method was valid for capturing prevalent chronic medication use at one moment in time, but invalid for medication used for short periods of time. There is no effect of sex on the agreement, and more studies are needed on the influence of age. Future pharmaco-epidemiological studies should preferably combine the two data sources to achieve the highest accuracy of drug exposure rates.
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Affiliation(s)
- Rahmat Sediq
- Department of Pharmaco-Therapy, Epidemiology & Economics, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, the Netherlands,
| | - Jurjen van der Schans
- Department of Pharmaco-Therapy, Epidemiology & Economics, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, the Netherlands,
| | - Aafje Dotinga
- Lifelines Cohort Study, Lifelines Databeheer B.V., Groningen, the Netherlands
| | - Rolinde A Alingh
- Lifelines Cohort Study, Lifelines Databeheer B.V., Groningen, the Netherlands
| | - Bob Wilffert
- Department of Pharmaco-Therapy, Epidemiology & Economics, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, the Netherlands, .,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
| | - Jens Hj Bos
- Department of Pharmaco-Therapy, Epidemiology & Economics, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, the Netherlands,
| | - Catharina Cm Schuiling-Veninga
- Department of Pharmaco-Therapy, Epidemiology & Economics, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, the Netherlands,
| | - Eelko Hak
- Department of Pharmaco-Therapy, Epidemiology & Economics, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, the Netherlands, .,Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands,
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Donoghue OA, McGarrigle CA, Foley M, Fagan A, Meaney J, Kenny RA. Cohort Profile Update: The Irish Longitudinal Study on Ageing (TILDA). Int J Epidemiol 2018; 47:1398-1398l. [DOI: 10.1093/ije/dyy163] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Orna A Donoghue
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | | | - Margaret Foley
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - Andrew Fagan
- Centre for Advanced Medical Imaging, St James’s Hospital, Dublin, Ireland
| | - James Meaney
- Centre for Advanced Medical Imaging, St James’s Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing (MISA), St James’s Hospital, Dublin, Ireland
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54
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Johnson KL, Franco J, Harris-Vieyra LE. A Survey of Dental Patient Attitudes on the Likelihood and Perceived Importance of Disclosing Daily Medications. J Dent Educ 2018; 82:839-847. [DOI: 10.21815/jde.018.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/31/2017] [Indexed: 12/31/2022]
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55
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Forsman J, Taipale H, Masterman T, Tiihonen J, Tanskanen A. Comparison of dispensed medications and forensic-toxicological findings to assess pharmacotherapy in the Swedish population 2006 to 2013. Pharmacoepidemiol Drug Saf 2018; 27:1112-1122. [DOI: 10.1002/pds.4426] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/02/2018] [Accepted: 02/19/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Jonas Forsman
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Heidi Taipale
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- School of Pharmacy; University of Eastern Finland; Kuopio Finland
| | - Thomas Masterman
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Jari Tiihonen
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Forensic Psychiatry; Niuvanniemi Hospital; Kuopio Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Forensic Psychiatry; Niuvanniemi Hospital; Kuopio Finland
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Byrne P, Cullinan J, Murphy C, Smith SM. Cross-sectional analysis of the prevalence and predictors of statin utilisation in Ireland with a focus on primary prevention of cardiovascular disease. BMJ Open 2018; 8:e018524. [PMID: 29439070 PMCID: PMC5829660 DOI: 10.1136/bmjopen-2017-018524] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To describe the prevalence of statin utilisation by people aged over 50 years in Ireland and the factors associated with the likelihood of using a statin, focusing particularly on those using statins for primary prevention of cardiovascular disease (CVD). METHODS This is a cross-sectional analysis of cardiovascular risk and sociodemographic factors associated with statin utilisation from wave 1 of The Irish Longitudinal Study on Ageing. A hierarchy of indications for statin utilisation, consisting of eight mutually exclusive levels of CVD-related diagnoses, was created. Participants were assigned one level of indication. The prevalence of statin utilisation was calculated. The likelihood that an individual was using a statin was estimated using a multivariable logistic regression model, controlling for cardiovascular risk and sociodemographic factors. RESULTS In this nationally representative sample (n=5618) of community-dwelling participants aged 50 years and over, 1715 (30.5%) were taking statins. Of these, 65.0% (57.3% of men and 72.7% of women) were doing so for the primary prevention of CVD. Thus, almost two-thirds of those taking statins did so for primary prevention and there was a notable difference between women and men in this regard. We also found that statin utilisation was highest among those with a prior history of CVD and was significantly associated with age (compared with the base category 50-64 years; 65-74 years OR 1.38 (95% CI 1.16 to 1.65); 75+ OR 1.33 (95% CI 1.04 to 1.69)), living with a spouse or partner (compared with the base category living alone; OR 1.35 (95% CI 1.10 to 1.65)), polypharmacy (OR 1.74 (95% CI 1.39 to 2.19)) and frequency of general practitioner visits (compared with the base category 0 visits per year; 1-2 visits OR 2.46 (95% CI 1.80 to 3.35); 3-4 visits OR 3.24 (95% CI 2.34 to 4.47); 5-6 visits OR 2.98 (95% CI 2.08 to 4.26); 7+ visits OR 2.51 (95% CI 1.73 to 3.63)), even after controlling for clinical need. There was no association between using statins and gender, education, income, social class, health insurance status, location or Systematic Coronary Risk Evaluation (SCORE) risk in the multivariable analysis. CONCLUSION Statin utilisation among those with no history of CVD accounted for almost two-thirds of all statin use, in part reflecting the high proportion of the population with no history of CVD, although utilisation rates were highest among those with a history of CVD.
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Affiliation(s)
- Paula Byrne
- National University of Ireland Galway, Galway, Ireland
| | - John Cullinan
- National University of Ireland Galway, Galway, Ireland
| | - Catríona Murphy
- Dublin City University, Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Dublin, Ireland
| | - Susan M Smith
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Hafferty JD, Campbell AI, Navrady LB, Adams MJ, MacIntyre D, Lawrie SM, Nicodemus K, Porteous DJ, McIntosh AM. Self-reported medication use validated through record linkage to national prescribing data. J Clin Epidemiol 2018; 94:132-142. [PMID: 29097340 PMCID: PMC5808931 DOI: 10.1016/j.jclinepi.2017.10.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 10/10/2017] [Accepted: 10/23/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Researchers need to be confident about the reliability of epidemiologic studies that quantify medication use through self-report. Some evidence suggests that psychiatric medications are systemically under-reported. Modern record linkage enables validation of self-report with national prescribing data as gold standard. Here, we investigated the validity of medication self-report for multiple medication types. STUDY DESIGN AND SETTING Participants in the Generation Scotland population-based cohort (N = 10,244) recruited 2009-2011 self-reported regular usage of several commonly prescribed medication classes. This was matched against Scottish NHS prescriptions data using 3- and 6-month fixed time windows. Potential predictors of discordant self-report, including general intelligence and psychological distress, were studied via multivariable logistic regression. RESULTS Antidepressants self-report showed very good agreement (κ = 0.85, [95% confidence interval (CI) 0.84-0.87]), comparable to antihypertensives (κ = 0.90 [CI 0.89-0.91]). Self-report of mood stabilizers showed moderate-poor agreement (κ = 0.42 [CI 0.33-0.50]). Relevant past medical history was the strongest predictor of self-report sensitivity, whereas general intelligence was not predictive. CONCLUSION In this large population-based study, we found self-report validity varied among medication classes, with no simple relationship between psychiatric medication and under-reporting. History of indicated illness predicted more accurate self-report, for both psychiatric and nonpsychiatric medications. Although other patient-level factors influenced self-report for some medications, none predicted greater accuracy across all medications studied.
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Affiliation(s)
- Jonathan D Hafferty
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh EH10 5HF, UK.
| | - Archie I Campbell
- Generation Scotland, Centre for Genomics and Experimental Medicine, Institute for Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Lauren B Navrady
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh EH10 5HF, UK
| | - Mark J Adams
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh EH10 5HF, UK
| | - Donald MacIntyre
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh EH10 5HF, UK
| | - Stephen M Lawrie
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh EH10 5HF, UK
| | - Kristin Nicodemus
- Generation Scotland, Centre for Genomics and Experimental Medicine, Institute for Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK; Institute for Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh1, Edinburgh EH4 2XU, UK
| | - David J Porteous
- Generation Scotland, Centre for Genomics and Experimental Medicine, Institute for Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK; Institute for Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh1, Edinburgh EH4 2XU, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, 7 George Square, EH8 9JZ, UK
| | - Andrew M McIntosh
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh EH10 5HF, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, 7 George Square, EH8 9JZ, UK
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Moriarty F, Cahir C, Bennett K, Hughes CM, Kenny RA, Fahey T. Potentially inappropriate prescribing and its association with health outcomes in middle-aged people: a prospective cohort study in Ireland. BMJ Open 2017; 7:e016562. [PMID: 29042380 PMCID: PMC5652466 DOI: 10.1136/bmjopen-2017-016562] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To determine the prevalence of potentially inappropriate prescribing (PIP) in a cohort of community-dwelling middle-aged people and assess the relationship between PIP and emergency department (ED) visits, general practitioner (GP) visits and quality of life (QoL). DESIGN Prospective cohort study. SETTING The Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort study of ageing. PARTICIPANTS Individuals aged 45-64 years recruited to TILDA who were eligible for the means-tested General Medical Services scheme and followed up after 2 years. EXPOSURE PIP was determined in the 12 months preceding baseline and follow-up TILDA data collection by applying the PRescribing Optimally in Middle-aged People's Treatments (PROMPT) criteria to participants' medication dispensing data. OUTCOME MEASURES At follow-up, the reported rates of ED and GP visits over 12 months (primary outcome) and the CASP-R12 (Control Autonomy Self-realisation Pleasure) measure of QoL (secondary outcome). ANALYSIS Multivariate negative binomial (rates) and linear regression (CASP-R12) models controlling for potential confounders. RESULTS At 2-year follow-up (n=808), PIP was detected in 42.9% by the PROMPT criteria. An ED visit was reported by 18.7% and 94.4% visited a GP (median 4 visits, IQR 2-6). Exposure to ≥2 PROMPT criteria was associated with higher rates of healthcare utilisation and lower QoL in unadjusted regression. However, in multivariate analysis, the associations between PIP and rates of ED visits (adjusted incidence rate ratio (IRR) 0.92, 95% CI 0.53 to 1.58), and GP visits (IRR 1.06, 95% CI 0.87 to 1.28), and CASP-R12 score (adjusted β coefficient 0.35, 95% CI -0.93 to 1.64) were not statistically significant. Numbers of medicines and comorbidities were associated with higher healthcare utilisation. CONCLUSIONS Although PIP was prevalent in this study population, there was no evidence of a relationship with ED and GP visits and QoL. Further research should evaluate whether the PROMPT criteria are related to these and other adverse outcomes in the general middle-aged population.
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Affiliation(s)
- Frank Moriarty
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carmel M Hughes
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Clinical and Practice Research Group, School of Pharmacy, Queen’s University Belfast, Belfast, Northern Ireland
| | - Rose Anne Kenny
- The Irish Longitundinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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59
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Rohde D, Hickey A, Williams D, Bennett K. Cognitive impairment and cardiovascular medication use: Results from wave 1 of The Irish Longitudinal Study on Ageing. Cardiovasc Ther 2017; 35. [PMID: 28836733 DOI: 10.1111/1755-5922.12300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 07/24/2017] [Accepted: 08/20/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Daniela Rohde
- Division of Population Health Sciences; Royal College of Surgeons in Ireland; Dublin Ireland
| | - Anne Hickey
- Division of Population Health Sciences; Royal College of Surgeons in Ireland; Dublin Ireland
| | - David Williams
- Geriatric and Stroke Medicine; Royal College of Surgeons in Ireland and Beaumont Hospital; Dublin Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences; Royal College of Surgeons in Ireland; Dublin Ireland
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60
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Sinnott SJ, Bennett K, Cahir C. Pharmacoepidemiology resources in Ireland-an introduction to pharmacy claims data. Eur J Clin Pharmacol 2017; 73:1449-1455. [PMID: 28819675 PMCID: PMC5662670 DOI: 10.1007/s00228-017-2310-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/21/2017] [Indexed: 02/07/2023]
Abstract
Introduction Administrative health data, such as pharmacy claims data, present a valuable resource for conducting pharmacoepidemiological and health services research. Often, data are available for whole populations allowing population level analyses. Moreover, their routine collection ensures that the data reflect health care utilisation in the real-world setting compared to data collected in clinical trials. Setting and methods The Irish Health Service Executive-Primary Care Reimbursement Service (HSE-PCRS) community pharmacy claims database is described. The availability of demographic variables and drug-related information is discussed. The strengths and limitations associated using this database for conducting research are presented, in particular, internal and external validity. Examples of recently conducted research using the HSE-PCRS pharmacy claims database are used to illustrate the breadth of its use. Results and conclusions The HSE-PCRS national pharmacy claims database is a large, high-quality, valid and accurate data source for measuring drug exposure in specific populations in Ireland. The main limitation is the lack of generalisability for those aged <70 years and the lack of information on indication or outcome.
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Affiliation(s)
- Sarah-Jo Sinnott
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons Ireland, Dublin, Ireland
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Cheung K, El Marroun H, Elfrink ME, Jaddoe VWV, Visser LE, Stricker BHC. The concordance between self-reported medication use and pharmacy records in pregnant women. Pharmacoepidemiol Drug Saf 2017; 26:1119-1125. [PMID: 28744981 DOI: 10.1002/pds.4264] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/25/2017] [Accepted: 06/15/2017] [Indexed: 11/05/2022]
Abstract
PURPOSE Several studies have been conducted to assess determinants affecting the performance or accuracy of self-reports. These studies are often not focused on pregnant women, or medical records were used as a data source where it is unclear if medications have been dispensed. Therefore, our objective was to evaluate the concordance between self-reported medication data and pharmacy records among pregnant women and its determinants. METHODS We conducted a population-based cohort study within the Generation R study, in 2637 pregnant women. The concordance between self-reported medication data and pharmacy records was calculated for different therapeutic classes using Yule's Y. We evaluated a number of variables as determinant of discordance between both sources through univariate and multivariate logistic regression analysis. RESULTS The concordance between self-reports and pharmacy records was moderate to good for medications used for chronic conditions, such as selective serotonin reuptake inhibitors or anti-asthmatic medications (0.88 and 0.68, respectively). Medications that are used occasionally, such as antibiotics, had a lower concordance (0.51). Women with a Turkish or other non-Western background were more likely to demonstrate discordance between pharmacy records and self-reported data compared with women with a Dutch background (Turkish: odds ratio, 1.63; 95% confidence interval, 1.16-2.29; other non-Western: odds ratio, 1.33; 95% confidence interval, 1.03-1.71). CONCLUSIONS Further research is needed to assess how the cultural or ethnic differences may affect the concordance or discordance between both medication sources. The results of this study showed that the use of multiple sources is needed to have a good estimation of the medication use during pregnancy.
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Affiliation(s)
- K Cheung
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Inspectorate of Health Care, Utrecht, The Netherlands
| | - H El Marroun
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M E Elfrink
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC University Medical Center Rotterdam, The Netherlands
| | - V W V Jaddoe
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L E Visser
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Apotheek Haagse Ziekenhuizen, HAGA, The Hague, The Netherlands
| | - B H Ch Stricker
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Inspectorate of Health Care, Utrecht, The Netherlands
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62
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Rowan CG, Flory J, Gerhard T, Cuddeback JK, Stempniewicz N, Lewis JD, Hennessy S. Agreement and validity of electronic health record prescribing data relative to pharmacy claims data: A validation study from a US electronic health record database. Pharmacoepidemiol Drug Saf 2017; 26:963-972. [PMID: 28608510 DOI: 10.1002/pds.4234] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 04/01/2017] [Accepted: 04/17/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Granular clinical and laboratory data available in electronic health record (EHR) databases provide researchers the opportunity to conduct investigations that would not be possible in insurance claims databases; however, for pharmacoepidemiology studies, accurate classification of medication exposure is critical. OBJECTIVE The aim of this study was to evaluate the validity of classifying medication exposure using EHR prescribing (EHR-Rx) data. METHODS We conducted a retrospective cohort study among patients with linked claims and EHR data in OptumLabs™ Data Warehouse. The agreement between EHR-Rx data and pharmacy claims (PC-Rx) data (for 40 medications) was determined using the positive predictive value (PPV) and medication possession ratio (MPR)-calculated in 1- and 12-month medication exposure periods (MEPs). Secondary analyses were restricted to incident vs prevalent EHR-Rxs, age ≥65 vs <65, white vs black race, males vs females, and number of EHR-Rxs. RESULTS The validity metrics varied substantially among the 40 medications assessed. Across all medications, the period PPV and MPR were 62% and 63% in the 1-month MEP. They were 78% and 43% in the 12-month MEP. Overall, PPV and MPR were higher for patients with a prevalent EHR-Rx and age <65. CONCLUSIONS Despite substantial variability among different medications, there was very good agreement between EHR-Rx data and PC-Rx data. To maximize the validity of classifying medication exposure with EHR prescribing data, researchers may consider using longer MEPs (eg, 12 months) and potentially require multiple EHR-Rxs to classify baseline medication exposure.
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Affiliation(s)
- Christopher G Rowan
- Collaborative Healthcare Research and Data Analytics (COHRDATA), Santa Monica, CA, USA
| | - James Flory
- Department of Health Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Tobias Gerhard
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
| | | | | | - James D Lewis
- Division of Gastroenterology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Stickley A, Santini ZI, Koyanagi A. Urinary incontinence, mental health and loneliness among community-dwelling older adults in Ireland. BMC Urol 2017; 17:29. [PMID: 28388898 PMCID: PMC5385037 DOI: 10.1186/s12894-017-0214-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/20/2017] [Indexed: 11/16/2022] Open
Abstract
Background Urinary incontinence (UI) is associated with worse health among older adults. Little is known however, about its relation with loneliness or the role of mental health in this association. This study examined these factors among older adults in Ireland. Methods Data were analyzed from 6903 community-dwelling adults aged ≥ 50 collected in the first wave of The Irish Longitudinal Study on Ageing (TILDA) in 2009–11. Information was obtained on the self-reported occurrence (yes/no) and severity (frequency/activity limitations) of UI in the past 12 months. Loneliness was measured using the UCLA Loneliness Scale short form. Information was also obtained on depression (CES-D), anxiety (HADS-A) and other sociodemographic variables. Logistic regression analysis was used to examine the association between variables. Results In a model adjusted for all potential confounders except mental disorders, compared to no UI, any UI was associated with significantly higher odds for loneliness (odds ratio: 1.51). When depression was included in the analysis, the association was attenuated and became non-significant while the inclusion of anxiety had a much smaller effect. Similarly, although frequency of UI and activity limitations due to UI were both significantly associated with loneliness prior to adjustment for mental disorders, neither association remained significant after adjustment for both depression and anxiety. Conclusion UI is associated with higher odds for loneliness among older community-dwelling adults but this association is largely explained by comorbid mental health problems, in particular, depression.
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Affiliation(s)
- Andrew Stickley
- The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, 141 89, Sweden.
| | - Ziggi Ivan Santini
- The Danish National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, 1353, Copenhagen, Denmark
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu/CIBERSAM, Barcelona, Spain
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Rohde D, Williams D, Gaynor E, Bennett K, Dolan E, Callaly E, Large M, Hickey A. Secondary prevention and cognitive function after stroke: a study protocol for a 5-year follow-up of the ASPIRE-S cohort. BMJ Open 2017; 7:e014819. [PMID: 28348196 PMCID: PMC5372058 DOI: 10.1136/bmjopen-2016-014819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/22/2016] [Accepted: 01/06/2017] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Cognitive impairment is common following stroke and can increase disability and levels of dependency of patients, potentially leading to greater burden on carers and the healthcare system. Effective cardiovascular risk factor control through secondary preventive medications may reduce the risk of cognitive decline. However, adherence to medications is often poor and can be adversely affected by cognitive deficits. Suboptimal medication adherence negatively impacts secondary prevention targets, increasing the risk of recurrent stroke and further cognitive decline. The aim of this study is to profile cognitive function and secondary prevention, including adherence to secondary preventive medications and healthcare usage, 5 years post-stroke. The prospective associations between cognition, cardiovascular risk factors, adherence to secondary preventive medications, and rates of recurrent stroke or other cardiovascular events will also be explored. METHODS AND ANALYSIS This is a 5-year follow-up of a prospective study of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) cohort of patients with stroke. This cohort will have a detailed assessment of cognitive function, adherence to secondary preventive medications and cardiovascular risk factor control. ETHICS AND DISSEMINATION Ethical approval for this study was granted by the Research Ethics Committees at Beaumont Hospital, Dublin and Connolly Hospital, Dublin, Mater Misericordiae University Hospital, Dublin, and the Royal College of Surgeons in Ireland. Findings will be disseminated through presentations and peer-reviewed publications.
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Affiliation(s)
- Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | - Eva Gaynor
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eamon Dolan
- Department of Geriatric Medicine, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Elizabeth Callaly
- Department of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Margaret Large
- Clinical Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Murphy C, Shelley E, O'Halloran AM, Fahey T, Kenny RA. Failure to control hypercholesterolaemia in the Irish adult population: cross-sectional analysis of the baseline wave of The Irish Longitudinal Study on Ageing (TILDA). Ir J Med Sci 2017; 186:1009-1017. [PMID: 28283862 PMCID: PMC5660837 DOI: 10.1007/s11845-017-1590-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/22/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hypercholesterolaemia is an important modifiable risk factor for cardiovascular disease (CVD) which requires monitoring and management at a population level. AIMS This study aims to describe the distribution of serum cholesterol in a community living population of older adults in Ireland and to examine the awareness, treatment and control of hypercholesterolaemia according to CVD risk status. METHOD This is a cross-sectional study in a nationally representative sample of adults aged 50-79 years (n = 5287). Hypercholesterolaemia was defined as low-density lipoprotein cholesterol (LDL-C) in excess of the recommended CVD risk category target and/or on lipid-lowering medication. RESULTS This study reports a mean total cholesterol (TC) of 5.1 mmol/L (95% CI 5.0-5.1 mmol/L) and a mean LDL-C of 2.9 mmol/L (95% CI 2.8-2.9 mmol/L) in those aged 50-79 years. In a subgroup aged 50-64 years, 73% (95% CI 71.5-74.5%) were hypercholesterolaemic. LDL-C was controlled to the guideline target in 57% of those with CVD and 49% of those with diabetes. Lack of awareness of hypercholesterolaemia was high across the remainder of the population. CONCLUSION Despite a substantial reduction in population mean TC from a high of 6.0 mmol/L in the 1980s to 5.1 mmol/L, this study reports a failure to control hypercholesterolaemia to recommended risk-stratified targets in the Irish adult population. Recommendations for policy include continued monitoring of those at highest risk and CVD risk assessment in those perceived to be at low risk in order to inform shared decision making in relation to lifestyle modification and medication management.
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Affiliation(s)
- C Murphy
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland. .,The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College, Dublin, Ireland.
| | - E Shelley
- Department of Public Health, Health Service Executive, Dublin, Ireland
| | - A M O'Halloran
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - T Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College, Dublin, Ireland
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Taipale H, Tanskanen A, Koponen M, Tolppanen AM, Tiihonen J, Hartikainen S. Agreement between PRE2DUP register data modeling method and comprehensive drug use interview among older persons. Clin Epidemiol 2016; 8:363-371. [PMID: 27785101 PMCID: PMC5066699 DOI: 10.2147/clep.s116160] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background PRE2DUP is a modeling method that generates drug use periods (ie, when drug use started and ended) from drug purchases recorded in dispensing-based register data. It is based on the evaluation of personal drug purchasing patterns and considers hospital stays, possible stockpiling of drugs, and package information. Objective The objective of this study was to investigate person-level agreement between self-reported drug use in the interview and drug use modeled from dispensing data with PRE2DUP method for various drug classes used by older persons. Methods Self-reported drug use was assessed from the GeMS Study including a random sample of persons aged ≥75 years from the city of Kuopio, Finland, in 2006. Drug purchases recorded in the Prescription register data of these persons were modeled to determine drug use periods with PRE2DUP modeling method. Agreement between self-reported drug use on the interview date and drug use calculated from register-based data was compared in order to find the frequently used drugs and drug classes, which was evaluated by Cohen’s kappa. Kappa values 0.61–0.80 were considered to represent good and 0.81–1.00 as very good agreement. Results Among 569 participants with mean age of 82 years, the agreement between interview and register data was very good for 75% and very good or good for 93% of the studied drugs or drug classes. Good or very good agreement was observed for drugs that are typically used on regular bases, whereas “as needed” drugs represented poorer results. Conclusion PRE2DUP modeling method validly describes regular drug use among older persons. For most of drug classes investigated, PRE2DUP-modeled register data described drug use as well as interview-based data which are more time-consuming to collect. Further studies should be conducted by comparing it with other methods and in different drug user populations.
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Affiliation(s)
- Heidi Taipale
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio; National Institute for Health and Welfare, Helsinki
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
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Palamar JJ, Shearston JA, Cleland CM. Discordant reporting of nonmedical opioid use in a nationally representative sample of US high school seniors. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:530-538. [PMID: 27315427 PMCID: PMC5055456 DOI: 10.1080/00952990.2016.1178269] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nonmedical opioid use has become a major public health concern due to increases in treatment admissions, overdoses, and deaths. Use has also been linked to heroin initiation. Reliable data on nonmedical opioid use are needed to continue to inform prevention. OBJECTIVE To determine the prevalence and correlates of discordant self-report of nonmedical use of opioids in a national sample. METHODS Utilizing a nationally representative sample of 31,149 American high school seniors in the Monitoring the Future study (2009-2013), discordant responses between self-reported 12-month nonmedical opioid use and self-reported 12-month nonmedical Vicodin and OxyContin use (reporting Vicodin/OxyContin use, but not reporting "opioid" use) were assessed. We also used multivariable logistic regression to determine the characteristics of students who were most likely to provide a discordant response. RESULTS 37.1% of those reporting nonmedical Vicodin use and 28.2% of those reporting nonmedical OxyContin use did not report overall nonmedical opioid use. Prevalence of nonmedical opioid use (8.3%) would increase when factoring in Vicodin, OxyContin, or both, by 2.8%, 1.3%, and 3.3%, respectively. Females were more likely to provide a discordant response to Vicodin and highly religious students were more likely to provide a discordant response regarding OxyContin use. Those who reported cocaine or nonmedical tranquilizer use were at consistently low odds for discordant responses. Nonmedical amphetamine users were at low odds for providing a discordant Vicodin response. CONCLUSION Prevalence of nonmedical opioid use may be underreported on some surveys, particularly among specific subpopulations. Further research on the effect of question order and skip-patterns (e.g., "gate" questions) is needed. Reliable data on nonmedical opioid use are needed to continue to accurately inform prevention.
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Affiliation(s)
- Joseph J. Palamar
- New York University Langone Medical Center, Department of Population Health, New York, NY, USA
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, USA
| | - Jenni A. Shearston
- New York University Langone Medical Center, Department of Population Health, New York, NY, USA
- College of Global Public Health, New York University, New York, NY, USA
| | - Charles M. Cleland
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, USA
- College of Nursing, New York University, New York, NY, USA
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Moriarty F, Bennett K, Cahir C, Kenny RA, Fahey T. Potentially inappropriate prescribing according to STOPP and START and adverse outcomes in community-dwelling older people: a prospective cohort study. Br J Clin Pharmacol 2016; 82:849-57. [PMID: 27136457 DOI: 10.1111/bcp.12995] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/21/2016] [Accepted: 04/28/2016] [Indexed: 02/03/2023] Open
Abstract
AIMS This study aims to determine if potentially inappropriate prescribing (PIP) is associated with increased healthcare utilization, functional decline and reduced quality of life (QoL) in a community-dwelling older cohort. METHOD This prospective cohort study included participants aged ≥65 years from The Irish Longitudinal Study on Ageing (TILDA) with linked administrative pharmacy claims data who were followed up after 2 years. PIP was defined by the Screening Tool for Older Persons Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START). The association with number of emergency department (ED) visits and GP visits reported over 12 months was analyzed using multivariate negative binomial regression adjusting for confounders. Marginal structural models investigated the presence of time-dependent confounding. RESULTS Of participants followed up (n = 1753), PIP was detected in 57% by STOPP and 41.8% by START, 21.7% reported an ED visit and 96.1% visited a GP (median 4, IQR 2.5-6). Those with any STOPP criterion had higher rates of ED visits (adjusted incident rate ratio (IRR) 1.30, 95% confidence interval (CI) 1.02, 1.66) and GP visits (IRR 1.15, 95%CI 1.06, 1.24). Patients with two or more START criteria had significantly more ED visits (IRR 1.45, 95%CI 1.03, 2.04) and GP visits (IRR 1.13, 95%CI 1.01, 1.27) than people with no criteria. Adjusting for time-dependent confounding did not affect the findings. CONCLUSIONS Both STOPP and START were independently associated with increased healthcare utilization and START was also related to functional decline and QoL. Optimizing prescribing to reduce PIP may provide an improvement in patient outcomes.
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Affiliation(s)
- Frank Moriarty
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin
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Colantonio LD, Kent ST, Kilgore ML, Delzell E, Curtis JR, Howard G, Safford MM, Muntner P. Agreement between Medicare pharmacy claims, self-report, and medication inventory for assessing lipid-lowering medication use. Pharmacoepidemiol Drug Saf 2016; 25:827-35. [PMID: 26823152 DOI: 10.1002/pds.3970] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/18/2015] [Accepted: 12/29/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Medicare claims have been used to study lipid-lowering medication (LLM) use among US adults. METHODS We analyzed the agreement between Medicare claims for LLM and LLM use indicated by self-report during a telephone interview and, separately, by a medication inventory performed during an in-home study visit upon enrollment into the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. We included REGARDS participants ≥65 years enrolled in 2006-2007 with Medicare pharmacy benefits (Part D) from 120 days before their telephone interview through their medication inventory (n = 899). RESULTS Overall, 39.2% and 39.5% of participants had a Medicare claim for an LLM within 120 days prior to their interview and medication inventory, respectively. Also, 42.7% of participants self-reported using LLMs, and 41.8% had an LLM in their medication inventory. The Kappa statistic (95% confidence interval [CI]) for agreement of Medicare claims with self-report and medication inventory was 0.68 (0.63-0.73) and 0.72 (0.68-0.77), respectively. No Medicare claims for LLMs were present for 22.1% (95%CI: 18.1-26.6%) of participants who self-reported taking LLMs and 18.9% (15.1-23.3%) with LLMs in their medication inventory. Agreement between Medicare claims and self-report was lower among Black male individuals (Kappa = 0.34 [95%CI: 0.14-0.54]) compared with Black female individuals (0.70 [0.61-0.79]), White male individuals (0.65 [0.56-0.75]), and White female individuals (0.79 [0.72-0.86]). Agreement between Medicare claims and the medication inventory was also low among Black male individuals (Kappa = 0.48 [95%CI: 0.29-0.66]). CONCLUSIONS Although substantial agreement exists, many Medicare beneficiaries who self-report LLM use or have LLMs in a medication inventory have no claims for these medications. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lisandro D Colantonio
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shia T Kent
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meredith L Kilgore
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Delzell
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey R Curtis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monika M Safford
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Single Agent Antihypertensive Therapy and Orthostatic Blood Pressure Behaviour in Older Adults Using Beat-to-Beat Measurements: The Irish Longitudinal Study on Ageing. PLoS One 2016; 11:e0146156. [PMID: 26730962 PMCID: PMC4701419 DOI: 10.1371/journal.pone.0146156] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/13/2015] [Indexed: 12/05/2022] Open
Abstract
Background Impaired blood pressure (BP) stabilisation after standing, defined using beat-to-beat measurements, has been shown to predict important health outcomes. We aimed to define the relationship between individual classes of antihypertensive agent and BP stabilisation among hypertensive older adults. Methods Cross-sectional analysis from The Irish Longitudinal Study on Ageing, a cohort study of Irish adults aged 50 years and over. Beat-to-beat BP was recorded in participants undergoing an active stand test. We defined grade 1 hypertension according to European Society of Cardiology criteria (systolic BP [SBP] 140-159mmHg ± diastolic BP [DBP] 90-99mmHg). Outcomes were: (i) initial orthostatic hypotension (IOH) (SBP drop ≥40mmHg ± DBP drop ≥20mmHg within 15 seconds [s] of standing accompanied by symptoms); (ii) sustained OH (SBP drop ≥20mmHg ± DBP drop ≥10mmHg from 60 to 110s inclusive); (iii) impaired BP stabilisation (SBP drop ≥20mmHg ± DBP drop ≥10mmHg at any 10s interval during the test). Outcomes were assessed using multivariable-adjusted logistic regression. Results A total of 536 hypertensive participants were receiving monotherapy with a renin-angiotensin-aldosterone-system inhibitor (n = 317, 59.1%), beta-blocker (n = 89, 16.6%), calcium channel blocker (n = 89, 16.6%) or diuretic (n = 41, 7.6%). A further 783 untreated participants met criteria for grade 1 hypertension. Beta-blockers were associated with increased odds of initial OH (OR 2.05, 95% CI 1.31–3.21) and sustained OH (OR 3.36, 95% CI 1.87–6.03) versus untreated grade 1 hypertension. Multivariable adjustment did not attenuate the results. Impaired BP stabilisation was evident at 20s (OR 2.59, 95% CI 1.58–4.25) and persisted at 110s (OR 2.90, 95% CI 1.64–5.11). No association was found between the other agents and any study outcome. Conclusion Beta-blocker monotherapy was associated with a >2-fold increased odds of initial OH and a >3-fold increased odds of sustained OH and impaired BP stabilisation, compared to untreated grade 1 hypertension. These findings support existing literature questioning the role of beta-blockers as first line agents for essential hypertension.
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Henriksen JP, Noerregaard S, Buck TC, Aagaard L. Medication histories by pharmacy technicians and physicians in an emergency department. Int J Clin Pharm 2015; 37:1121-7. [PMID: 26243529 DOI: 10.1007/s11096-015-0172-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 07/23/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medication histories (MHs) obtained at the time of patients' admission to hospital are often incomplete, and lack of information about patients' actual medicine use can potentially lead to prescribing failures and serious adverse events. Uses of clinical pharmacists in obtaining MHs are beneficial, but due to limited economic resources clinical pharmacists cannot be present in every hospital ward, and therefore pharmacy technicians (PTs) could probably be trained in obtaining MHs. OBJECTIVE To compare discrepancies in MHs obtained by physicians and PTs in an emergency department. Second to evaluate, whether PTs could assist and/or replace physicians in obtaining MHs. METHODS The study was conducted in the emergency department at Svendborg Hospital, Denmark and patients treated with a minimum of three prescribed medicines were included. On patients' admission to hospital, physicians recorded the primary MHs, and within 48 h the secondary MHs were made by PTs. All MHs were conducted using standard guidelines. A clinical pharmacist reviewed the MHs, and based on these reviews, a final medication list was defined, and the MHs were compared to this. The discrepancies were registered with respect to type and therapeutic group (medicines). RESULTS A total of 113 patients were included in this study, and data for 106 patients were analysed. On average, three discrepancies were detected for each patient in the primary MHs, and less than one discrepancy per patient in the secondary MHs. A total of 1075 prescriptions were registered, and for the physicians, 287 discrepancies (27 % of total prescriptions) were found, and for PTs the number was 28 (2 % of total prescriptions). The commonly detected discrepancy was "drug missing in the electronic patient record". The largest number of discrepancies was found for nervous system medications (ATC group N), medicines from ATC group A (alimentary tract and metabolism) and respiratory medicine (ATC group R). CONCLUSION Fewer discrepancies in the MHs obtained by PTs than physicians were detected compared to standard medicine lists made by an experienced clinical pharmacist.
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Affiliation(s)
- Jolene Pilegaaard Henriksen
- Department of Clinical Pharmacy, Odense University Hospital Pharmacy, Odense, Denmark
- Svendborg Hospital, Svendborg, Denmark
| | - Susanne Noerregaard
- Department of Clinical Pharmacy, Odense University Hospital Pharmacy, Odense, Denmark
- Svendborg Hospital, Svendborg, Denmark
| | - Thomas Croft Buck
- Department of Clinical Pharmacy, Odense University Hospital Pharmacy, Odense, Denmark
- Svendborg Hospital, Svendborg, Denmark
| | - Lise Aagaard
- Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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Richardson K, Bennett K, Maidment ID, Fox C, Smithard D, Kenny RA. Use of Medications with Anticholinergic Activity and Self-Reported Injurious Falls in Older Community-Dwelling Adults. J Am Geriatr Soc 2015. [DOI: 10.1111/jgs.13543] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kathryn Richardson
- Department of Medical Gerontology; Trinity College Dublin; Dublin Ireland
- School of Health Sciences; Faculty of Medicine and Health Sciences; University of East Anglia; Norwich UK
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics; Trinity Centre for Health Sciences; St. James' Hospital; Dublin Ireland
| | - Ian D. Maidment
- School of Life and Health Sciences; University of Aston; Birmingham UK
- Aston Research Centre for Healthy Ageing; University of Aston; Birmingham UK
| | - Chris Fox
- Norwich Medical School; Faculty of Medicine and Health Sciences; University of East Anglia; Norwich UK
| | - David Smithard
- Princess Royal University Hospital; King's College National Health Service Foundation Trust; London UK
- Department of Digital Arts and Electronics; University of Kent; Canterbury UK
| | - Rose Anne Kenny
- Department of Medical Gerontology; Trinity College Dublin; Dublin Ireland
- Trinity College Institute of Neuroscience; St. James' Hospital; Dublin Ireland
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Murphy C, Bennett K, Fahey T, Shelley E, Graham I, Kenny RA. Statin use in adults at high risk of cardiovascular disease mortality: cross-sectional analysis of baseline data from The Irish Longitudinal Study on Ageing (TILDA). BMJ Open 2015; 5:e008017. [PMID: 26169806 PMCID: PMC4513517 DOI: 10.1136/bmjopen-2015-008017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aims to examine the extent to which statins are used by adults at high risk of cardiovascular disease (CVD) compared to European clinical guidelines. The high-risk groups examined are those with (1) known CVD, (2) known diabetes and (3) a high or very high risk (≥5%) of CVD mortality based on Systematic COronary Risk Evaluation (SCORE). DESIGN This study is cross-sectional in design using data from the first wave (2009-2011) of The Irish Longitudinal Study on Ageing (TILDA). SETTING AND PARTICIPANTS The sample (n=3372) is representative of community living adults aged 50-64 years in Ireland. RESULTS Statins were used by 68.6% (95% CI 61.5% to 75.8%) of those with known CVD, 57.4% (95% CI 49.1% to 65.7%) of those with known diabetes and by 19.7% (95% CI 13.0% to 26.3%) of adults with a SCORE risk ≥5%. Over a third (38.5%, 95% CI 31.0% to 46.0%) of those with known CVD, 46.8% (95% CI 38.4% to 55.1%) of those with known diabetes and 85.2% (95% CI 79.3% to 91.1%) of those with a SCORE risk ≥5% were at or above the low-density lipoprotein cholesterol (LDL-C) target of 2.5 mmol/L specified in the 2007 European guidelines. CONCLUSIONS Despite strong evidence and clinical guidelines recommending the use of statins for secondary prevention, a gap exists between guidelines and practice in this cohort. It is also of concern that a low proportion of adults with a SCORE risk ≥5% were taking statins. A policy response that strengthens secondary prevention, and improves risk assessment and shared decision-making in the primary prevention of CVD is required.
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Affiliation(s)
- Catriona Murphy
- Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, Trinity College, Dublin, Ireland
| | - Tom Fahey
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
| | - Emer Shelley
- Department of Public Health, Health Service Executive, Dublin, Ireland
| | - Ian Graham
- Department of Cardiology, Tallaght Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- Department of Medical Gerontology, Trinity College, Dublin, Ireland
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Moriarty F, Bennett K, Fahey T, Kenny RA, Cahir C. Longitudinal prevalence of potentially inappropriate medicines and potential prescribing omissions in a cohort of community-dwelling older people. Eur J Clin Pharmacol 2015; 71:473-82. [PMID: 25666030 PMCID: PMC4356885 DOI: 10.1007/s00228-015-1815-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 01/28/2015] [Indexed: 11/27/2022]
Abstract
Purpose This study aims to compare the prevalence of potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) using several screening tools in an Irish community-dwelling older cohort, to assess if the prevalence changes over time and to determine factors associated with any change. Methods This is a prospective cohort study of participants aged ≥65 years in The Irish Longitudinal Study on Ageing (TILDA) with linked pharmacy claims data (n = 2051). PIM and PPO prevalence was measured in the year preceding participants’ TILDA baseline interviews and in the year preceding their follow-up interviews using the Screening Tool for Older Persons’ Prescriptions (STOPP), Beers criteria (2012), Assessing Care of Vulnerable Elders (ACOVE) indicators and the Screening Tool to Alert doctors to Right Treatment (START). Generalised estimating equations were used to determine factors associated with change in prevalence over time. Results Depending on the screening tool used, between 19.8 % (ACOVE indicators) and 52.7 % (STOPP) of participants received a PIM at baseline, and PPO prevalence ranged from 38.2 % (START) to 44.8 % (ACOVE indicators), while 36.7 % of participants had both a PIM and PPO. Common criteria were aspirin for primary prevention (19.6 %) and omission of calcium/vitamin D in osteoporosis (14.7 %). Prevalence of PIMs and PPOs increased at follow-up (PIMs range 22–56.1 %, PPOs range 40.5–49.3 %), and this was associated with patient age, female sex, and numbers of medicines and chronic conditions. Conclusions Sub-optimal prescribing is common in older patients. Ongoing prescribing review to optimise care is important, particularly as patients get older, receive more medicines or develop more illnesses. Electronic supplementary material The online version of this article (doi:10.1007/s00228-015-1815-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frank Moriarty
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland,
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75
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Peklar J, Henman MC, Kos M, Richardson K, Kenny RA. Concurrent use of drugs and supplements in a community-dwelling population aged 50 years or more: potential benefits and risks. Drugs Aging 2015; 31:527-40. [PMID: 24890574 DOI: 10.1007/s40266-014-0180-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of vitamin and mineral (VMs) and non-vitamin/non-mineral supplements (non-VMs) in the general population and the older population in developed countries has increased. When combined with drugs, their use can be associated with benefit and potential risks. OBJECTIVE The aims of this study were to determine the extent and associated factors of the combined use of drugs and VM/non-VM supplements, and to examine the potential major drug-supplement interactions METHODS Cross-sectional analysis of first-wave data of TILDA, The Irish Longitudinal Study on Ageing, nationally representative a cohort including 8,081 community-dwelling persons aged ≥50 years. Prevalences including 95 % confidence intervals (CI) were weighted to the population. Group differences in drug and supplement use were assessed using Pearson's Chi-square test, and associations between concurrent drug-supplement use and covariates were assessed using logistic regression. Potential interactions between drugs and supplements were assessed using relevant sources. RESULTS Every seventh respondent (14.0 %; 95 % CI 13.1-15.0) reported regular concurrent use of drugs and supplements; 7.9 % (95 % CI 7.3-8.6) took only VMs, 3.9 % (95 % CI 3.4-4.4) took only non-VMs, and 2.2 % (95 % CI 1.8-2.6) took at least one of each concurrently with drugs. Concurrent use was more prevalent in women and in the oldest (≥75 years) group. Chronic disease, female sex, third-level education and private medical insurance were associated with an increased likelihood of use of both supplement types, whereas those classed as employed were much less likely to use any supplements. Supplements were combined with drugs in all of the commonly prescribed therapeutic groups, ranging from just under 60 % with drugs for bone diseases to 15.7 % with drugs for diabetes. Potential major drug-supplement interactions were detected in 4.5 % (95 % CI 3.4-5.8) of concurrent drug-supplement users, and were more prevalent in older respondents. CONCLUSIONS Concurrent use of drugs and supplements among those aged over 50 years in the Irish population is substantial and increases with age. There is considerable variation in usage, and the outcome of this approach is evidence of unmet need and therefore unrealised benefits among some subgroups, and of exposure to avoidable and potential serious drug interactions among others.
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Affiliation(s)
- Jure Peklar
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia,
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76
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Richardson K, Bennett K, Kenny RA. Polypharmacy including falls risk-increasing medications and subsequent falls in community-dwelling middle-aged and older adults. Age Ageing 2015; 44:90-6. [PMID: 25313240 DOI: 10.1093/ageing/afu141] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND polypharmacy is an important risk factor for falls, but recent studies suggest only when including medications associated with increasing the risk of falls. DESIGN a prospective, population-based cohort study. SUBJECTS 6,666 adults aged ≥50 years from The Irish Longitudinal study on Ageing. METHODS participants reported regular medication use at baseline. Any subsequent falls, any injurious falls and the number of falls were reported 2 years later. The association between polypharmacy (>4 medications) or fall risk-increasing medications and subsequent falls or injurious falls was assessed using modified Poisson regression. The association with the number of falls was assessed using negative binomial regression. RESULTS during follow-up, 231 falls per 1,000 person-years were reported. Polypharmacy including antidepressants was associated with a greater risk of any fall (adjusted relative risk (aRR) 1.28, 95% CI 1.06-1.54), of injurious falls (aRR 1.51, 95% CI 1.10-2.07) and a greater number of falls (adjusted incident rate ratio (aIRR) 1.60, 95% CI 1.19-2.15), but antidepressant use without polypharmacy and polypharmacy without antidepressants were not. The use of benzodiazepines was associated with injurious falls when coupled with polypharmacy (aRR 1.40, 95% CI 1.04-1.87), but was associated with a greater number of falls (aIRR 1.32, 95% CI 1.05-1.65), independent of polypharmacy. Other medications assessed, including antihypertensives, diuretics and antipsychotics, were not associated with outcomes. CONCLUSION in middle-aged and older adults, polypharmacy, including antidepressant or benzodiazepine use, was associated with injurious falls and a greater number of falls.
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Affiliation(s)
- Kathryn Richardson
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland The Irish Longitudinal Study on Ageing, Chemistry Extension Building, Trinity College Dublin, Dublin, Ireland
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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Li Q, Chitnis A, Hammer M, Langer J. Real-world clinical and economic outcomes of liraglutide versus sitagliptin in patients with type 2 diabetes mellitus in the United States. Diabetes Ther 2014; 5:579-90. [PMID: 25256818 PMCID: PMC4269653 DOI: 10.1007/s13300-014-0084-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The objective of this study was to compare the clinical effectiveness of liraglutide with sitagliptin and assess the associated economic outcomes in patients with type 2 diabetes mellitus (T2DM) treated in real-world practice in the United States (US). METHODS This retrospective cohort study used a large US claims database to identify patients with T2DM who initiated liraglutide or sitagliptin between January 2010 and December 2012. Adults (≥18 years old) with persistent use of therapy for ≥3 months were included. Changes in glycated hemoglobin A1c (A1C) and the proportion of patients achieving A1C targets (≤6.5% and <7%) were examined at 6-month follow-up. Diabetes-related total, medical, and pharmacy costs over the follow-up period were assessed. Multivariable regression models were used to estimate the outcomes associated with liraglutide relative to sitagliptin, adjusting for differences in patient demographics and clinical characteristics. RESULTS The study included 1,465 patients with T2DM who initiated liraglutide (N = 376) or sitagliptin (N = 1,089) (mean age [standard deviation (SD)]: 54 [8.9] vs. 58 [10.8] years; 43.9% vs. 61.8% males; both P < 0.01). After controlling for confounding factors, liraglutide patients experienced 0.31% points greater reduction in A1C (0.95% vs. 0.63% points; P < 0.01) at 6-month follow-up than sitagliptin patients and were more likely to reach A1C targets of ≤6.5% (odds ratio [OR]: 2.00; P < 0.01) and <7% (OR: 1.55; P < 0.01). Liraglutide patients had $994 lower mean diabetes-related medical costs ($1,241 vs. $2,235; P < 0.01), but $544 higher diabetes-related pharmacy costs ($2,100 vs. $1,556; P < 0.01) during the follow-up. No difference was found in the total mean diabetes-related costs between the two cohorts. CONCLUSION Liraglutide showed greater improvement in glycemic outcomes than sitagliptin among adult patients with T2DM in real-world clinical practice. Although diabetes-related pharmacy costs for patients using liraglutide were higher compared with sitagliptin, these were offset by significantly lower diabetes-related medical costs, resulting in similar total diabetes-related costs between the two treatment groups.
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Affiliation(s)
- Qian Li
- Evidera, Lexington, MA, USA,
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Ferrer P, Ballarín E, Sabaté M, Laporte JR, Schoonen M, Rottenkolber M, Fortuny J, Hasford J, Tatt I, Ibáñez L. Sources of European drug consumption data at a country level. Int J Public Health 2014; 59:877-87. [PMID: 24875352 DOI: 10.1007/s00038-014-0564-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 04/30/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES This study aimed at outlining the characteristics of nationwide administrative databases monitoring drug consumption in Europe. METHODS Internet and bibliographic databases (April 2010) were searched and experts in drug utilization (DU) research interviewed to find nationwide administrative medicines consumption databases in Europe, with data for the out- and inpatient healthcare sector. A questionnaire was developed to gather additional information. We collected data providers, websites, accessibility, data sources, healthcare settings, population coverage, medicines-related data, patient and prescriber data, periods covered, and linkage to other databases. RESULTS Thirty-one administrative nationwide medicine consumption databases in 25 countries were identified. Questionnaires were responded for 20 databases. Eleven provided wholesalers' sales data, 11 on reimbursed, 5 on prescribed, and 4 on dispensing medicines. Fifteen databases provided inpatient drug consumption data, mainly wholesalers' sales. CONCLUSIONS Nationwide administrative databases are of value to all stakeholders involved in the conduct and interpretation of post-marketing safety studies, and in the conduct of DU research. The endorsement of the anatomical therapeutic chemical/defined daily dose methodology by these databases contributes to data harmonization. However, there is still a lack of information on inpatient medicines consumption at a patient-level.
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Affiliation(s)
- Pili Ferrer
- Fundació Institut Català de Farmacologia, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
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Tan LD, Chan AL, Albertson TE. New combination treatments in the management of asthma: focus on fluticasone/vilanterol. J Asthma Allergy 2014; 7:77-83. [PMID: 24833910 PMCID: PMC4014386 DOI: 10.2147/jaa.s39625] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Despite the 2007 National Asthma Education and Prevention Program Expert Panel 3 guidelines for the treatment of uncontrolled asthma, many patients with poorly controlled asthma still continue to tax the health care system. Controlling asthma symptoms and preventing acute exacerbations have been the foundation of care. Using long-term controller treatments such as inhaled corticosteroids (ICS) and inhaled long-acting beta2-agonists (LABAs) is a common approach. While patient responses to recommended pharmacotherapy may vary, poor adherence to therapy also contributes to poor asthma control. A once-daily combination inhaler, such as fluticasone furoate, an ICS, in combination with vilanterol, a LABA, offers increased convenience and potential improved adherence, which should result in enhanced clinical outcomes and reduced exacerbations. The ICS/LABA combination inhaler of fluticasone furoate and vilanterol is currently approved in the United States for use in the maintenance of chronic obstructive pulmonary disease and to reduce exacerbations. This paper reviews the expanding literature on the efficacy of fluticasone furoate and vilanterol in treating asthma.
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Affiliation(s)
- Laren D Tan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA ; Department of Medicine, Veterans Administration Northern California Health Care System, Mather, CA
| | - Andrew L Chan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA ; Department of Medicine, Veterans Administration Northern California Health Care System, Mather, CA
| | - Timothy E Albertson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA ; Department of Medicine, Veterans Administration Northern California Health Care System, Mather, CA ; Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento, CA, USA
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Richardson K, Kenny RA, Bennett K. The effect of free health care on polypharmacy: a comparison of propensity score methods and multivariable regression to account for confounding. Pharmacoepidemiol Drug Saf 2014; 23:656-65. [PMID: 24677639 DOI: 10.1002/pds.3590] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 01/14/2014] [Accepted: 01/16/2014] [Indexed: 11/08/2022]
Abstract
PURPOSE Differing healthcare access has implications for public health. In Ireland, eligibility for free public health care is means tested. Here, we examine the association between healthcare access and polypharmacy while accounting for underlying socio-economic and health status differences. METHODS Self-reported regular medication use, history of diagnosed health conditions, disability, socio-demographics, and objective measures of depression and anxiety for adults aged 50-69 years (n = 5796) were ascertained from the population-representative Irish Longitudinal Study on Ageing. Objective measures of frailty, cognition, hypertension, and body mass index were also assessed for 4241 participants. The associations between free healthcare access and polypharmacy and use of 15 medication classes were estimated using multivariable modified Poisson regression, adjustment for the propensity score, and inverse probability of treatment weighting by the propensity score. RESULTS Polypharmacy was reported by 22% and 7% of the 1932 and 3864 participants with and without public healthcare coverage. Public patients had a 21-38% greater risk of polypharmacy depending on the method used to account for confounding. Results were less robust using propensity score weighting. There was evidence that classes of cardiovascular drugs, drugs for acid-related disorders, and analgesics were used more commonly in public patients. Associations were mostly unaffected after also accounting for objective health measures but were significantly attenuated after accounting for frequency of healthcare visits. CONCLUSIONS Publically funded health care in Ireland leads to greater medication use in people aged 50-69 years. This may reflect over-prescribing to public patients or restricted use among those who pay out of pocket.
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Affiliation(s)
- Kathryn Richardson
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland; Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
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DeKoven M, Lee WC, Bouchard J, Massoudi M, Langer J. Real-world cost-effectiveness: lower cost of treating patients to glycemic goal with liraglutide versus exenatide. Adv Ther 2014; 31:202-16. [PMID: 24477354 PMCID: PMC3930836 DOI: 10.1007/s12325-014-0098-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Indexed: 12/24/2022]
Abstract
Introduction While the liraglutide effect and action in diabetes (LEAD-6) clinical trial compared the efficacy and safety of liraglutide once daily (LIRA) to exenatide twice daily (EXEN) in adult patients with type 2 diabetes, few studies have explored the associated per-patient costs of glycemic goal achievement of their use in a real-world clinical setting. Methods This retrospective cohort study used integrated medical and pharmacy claims linked with glycated hemoglobin A1C (A1C) results from the IMS Patient-Centric Integrated Data Warehouse. Patients’ ≥18 years and naïve to incretin therapies during a 6-month pre-index period, with ≥1 prescription for LIRA or EXEN between January 2010 and December 2010, were included. Patients with evidence of insulin use (pre- or post-index) were excluded. Only patients who were persistent on their index treatment during a 180-day post-index period were included. Follow-up A1C assessments were based on available laboratory data within 45 days before or after the 6-month post-index point in time. Diabetes-related pharmacy costs over the 6-month post-index period were captured and included costs for both the index drugs and concomitant diabetes medications. Results 234 LIRA and 182 EXEN patients were identified for the analysis. The adjusted predicted diabetes-related pharmacy costs per patient over the 6-month post-index period were higher for LIRA compared to EXEN ($2,002 [95% confidence interval (CI): $1,981, $2,023] vs. $1,799 [95% CI: $1,778, $1,820]; P < 0.001). However, a higher adjusted predicted percentage of patients on LIRA reached A1C < 7% goal (64.4% [95% CI: 63.5, 65.3] vs. 53.6% [95% CI: 52.6, 54.6]; P < 0.05), translating into lower average diabetes-related pharmacy costs per successfully treated patient for LIRA as compared to EXEN ($3,108 vs. $3,354; P < 0.0001). Conclusions Although predicted diabetes-related pharmacy costs were greater with LIRA vs. EXEN, a higher proportion of patients on LIRA achieved A1C < 7%, resulting in a lower per-patient cost of A1C goal achievement with LIRA compared to EXEN. Electronic supplementary material The online version of this article (doi:10.1007/s12325-014-0098-8) contains supplementary material, which is available to authorized users.
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