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Scherrer JF, Miller-Matero LR, Sullivan MD, Chrusciel T, Salas J, Davidson W, Zabel C, Wilson L, Lustman P, Ahmedani B. A Preliminary Study of Stress, Mental Health, and Pain Related to the COVID-19 Pandemic and Odds of Persistent Prescription Opioid Use. J Gen Intern Med 2023; 38:1016-1023. [PMID: 36385413 PMCID: PMC9668385 DOI: 10.1007/s11606-022-07940-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The COVID-19 pandemic has been associated with increased opioid prescribing. It is not known if perceived COVID-19 related stress is associated with increased odds of long-term opioid use. OBJECTIVE To determine if greater COVID-19-related stress and worsening pain attributed to the pandemic was associated with LTOT over a 6-month observation period. DESIGN Longitudinal cohort. PARTICIPANTS Patients (n=477) from two midwestern health care systems, with any acute or chronic non-cancer pain, starting a new period of 30-90-day prescription opioid use, were invited to participate in the Prescription Opioids and Depression Pathways Cohort Study, a longitudinal survey study of pain, opioid use, and mental health outcomes. MAIN MEASURES Baseline and 6-month follow-up assessments were used to measure the association between perceived COVID-19 stressors, the perception that pain was made worse by the pandemic and the odds of persistent opioid use, i.e., remaining a prescription opioid user at 6-month follow-up. Multivariate models controlled for demographics, opioid dose, and change in pain characteristics, mental health measures, and social support. KEY RESULTS Participants were, on average, 53.9 (±11.4) years of age, 67.1% White race, and 70.9% female. The most frequently endorsed COVID-19 stressor was "worry about health of self/others" (85.7% endorsed) and the least endorsed was "worsened pain due to pandemic" (26.2%). After adjusting for all covariates, "worsened pain due to pandemic" (OR=2.88; 95%CI: 1.33-6.22), change in pain interference (OR=1.20; 95%CI: 1.04-1.38), and change in vital exhaustion (OR=0.90; 95%CI: 0.82-0.99) remained significantly associated with persistent opioid use. CONCLUSIONS Patients who attribute worsening pain to the COVID-19 pandemic are more likely to be persistent opioid users. Further research is warranted to identify mechanisms underlying this association. Clinicians may consider discussing pain in the context of the pandemic to identify patients at high risk for persistent opioid use.
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Affiliation(s)
- Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, USA.
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, USA.
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, Detroit, MI, USA
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, USA
| | - Timothy Chrusciel
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, USA
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Whitney Davidson
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Celeste Zabel
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, Detroit, MI, USA
| | - Lauren Wilson
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Patrick Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian Ahmedani
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, Detroit, MI, USA
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Brüne M, Emmel C, Meilands G, Andrich S, Droste S, Claessen H, Jülich F, Icks A. Self-reported medication intake vs information from other data sources such as pharmacy records or medical records: Identification and description of existing publications, and comparison of agreement results for publications focusing on patients with cancer - a systematic review. Pharmacoepidemiol Drug Saf 2021; 30:531-560. [PMID: 33617072 DOI: 10.1002/pds.5210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/18/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE To identify and describe publications addressing the agreement between self-reported medication and other data sources among adults and, in a subgroup of studies dealing with cancer patients, seek to identify parameters which are associated with agreement. METHODS A systematic review including a systematic search within five biomedical databases up to February 28, 2019 was conducted as per the PRISMA Statement. Studies and agreement results were described. For a subgroup of studies dealing with cancer, we searched for associations between agreement and patients' characteristics, study design, comparison data source, and self-report modality. RESULTS The literature search retrieved 3392 publications. Included articles (n = 120) show heterogeneous agreement. Eighteen publications focused on cancer populations, with relatively good agreement identified in those which analyzed hormone therapy, estrogen, and chemotherapy (n = 11). Agreement was especially good for chemotherapy (proportion correct ≥93.6%, kappa ≥0.88). No distinct associations between agreement and age, education or marital status were identified in the results. There was little evaluation of associations between agreement and study design, self-report modality and comparison data source, thus not allowing for any conclusions to be drawn. CONCLUSION An overview of the evidence available from validation studies with a description of several characteristics is provided. Studies with experimental design which evaluate factors that might affect agreement between self-report and other data sources are lacking.
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Affiliation(s)
- Manuela Brüne
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Carina Emmel
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Gisela Meilands
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Silke Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Sigrid Droste
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Heiner Claessen
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Fabian Jülich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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Barthold D, Gibbons LE, Marcum ZA, Gray SL, Keene CD, Grabowski TJ, Postupna N, Larson EB, Crane PK. Alzheimer's Disease-Related Neuropathology Among Patients with Medication Treated Type 2 Diabetes in a Community-Based Autopsy Cohort. J Alzheimers Dis 2021; 83:1303-1312. [PMID: 34420950 PMCID: PMC8846930 DOI: 10.3233/jad-210059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Diabetes is a risk factor for Alzheimer's disease and related dementias (ADRD). Epidemiologic evidence shows an association between diabetes medications and ADRD risk; cell and mouse models show diabetes medication association with AD-related neuropathologic change (ADNC). OBJECTIVE This hypothesis-generating analysis aimed to describe autopsy-measured ADNC for individuals who used diabetes medications. METHODS Descriptive analysis of ADNC for Adult Changes in Thought (ACT) Study autopsy cohort who used diabetes medications, including sulfonylureas, insulin, and biguanides; total N = 118. ADNC included amyloid plaque distribution (Thal phasing), neurofibrillary tangle (NFT) distribution (Braak stage), and cortical neuritic plaque density (CERAD score). We also examined quantitative measures of ADNC using the means of standardized Histelide measures of cortical PHF-tau and Aβ1-42. Adjusted analyses control for age at death, sex, education, APOE genotype, and diabetes complication severity index. RESULTS Adjusted analyses showed no significant association between any drug class and traditional neuropathologic measures compared to nonusers of that class. In adjusted Histelide analyses, any insulin use was associated with lower mean levels of Aβ1-42 (-0.57 (CI: -1.12, -0.02)) compared to nonusers. Five years of sulfonylureas and of biguanides use was associated with lower levels of Aβ1-42 compared to nonusers (-0.15 (CI: -0.28, -0.02), -0.31 (CI: -0.54, -0.07), respectively). CONCLUSION Some evidence exists that diabetes medications are associated with lower levels of Aβ1-42, but not traditional measures of neuropathology. Future studies are needed in larger samples to build understanding of the mechanisms between diabetes, its medications, and ADRD, and to potentially repurpose existing medications for prevention or delay of ADRD.
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Affiliation(s)
- Douglas Barthold
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
- The Plein Center for Geriatric Pharmacy Research, Education, and Outreach, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Laura E. Gibbons
- General Internal Medicine, Data Management and Statistics Core, Alzheimer’s Disease Research Center, University of Washington, Seattle, WA, USA
- Department of Medicine, UW School of Medicine, University of Washington, Seattle, WA, USA
| | - Zachary A. Marcum
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
- The Plein Center for Geriatric Pharmacy Research, Education, and Outreach, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Shelly L. Gray
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
- The Plein Center for Geriatric Pharmacy Research, Education, and Outreach, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - C. Dirk Keene
- Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Thomas J. Grabowski
- Department of Radiology and Neurology, UW School of Medicine, Alzheimer’s Disease Research Center, University of Washington, Seattle, WA, USA
| | - Nadia Postupna
- Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Eric B. Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Medicine, UW School of Medicine, University of Washington, Seattle, WA, USA
| | - Paul K. Crane
- Department of Medicine, UW School of Medicine, University of Washington, Seattle, WA, USA
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Brüne M, Andrich S, Haastert B, Kaltheuner M, Icks A. New prescription of antihyperglycemic agents among patients with diabetes in Germany: Moderate concordance between health insurance data and self-reports. Pharmacoepidemiol Drug Saf 2020; 30:304-312. [PMID: 33098336 DOI: 10.1002/pds.5160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE To analyze the concordance of new prescription of antihyperglycemic agents between two data sources: patients' self-reports and statutory health insurance (SHI) data among patients with diabetes. METHODS Within a cross-sectional study, 494 patients with diabetes were interviewed if and which new prescriptions of diabetes medication they received within the last 3 or 6 months. SHI data for 12 months were linked to cover these periods. For the agreement measurement, SHI data was set as reference, and kappa, positive predictive value (PPV), and sensitivity were calculated for single Anatomical Therapeutic Chemical (ATC) codes and cumulated code groups. RESULTS The number of new prescriptions within 3 or 6 months was low, with 5.5% (n = 27) for Metformin/self-report being the highest. Contingency tables were unbalanced and showed large numbers in the no/no-cells. Regarding non-agreement, we found new prescriptions slightly more often in SHI data only than in self-reports only, with insulin and metformin representing an exception. Agreement results were moderate with large confidence intervals (CI). The values for cumulated "all drugs in diabetes" were: kappa = 0.58 (95% CI: 0.51-0.65), PPV = 62.0 (53.4-70.2), sensitivity = 55.6 (47.3-63.6). CONCLUSIONS Patients reported a low number of new prescriptions within the last 3 or 6 months. In general we found moderate agreement and in case of non-agreement that self-report no/SHI yes was slightly more frequent than vice versa. These results were based on small case numbers, but could nevertheless be considered when collecting self-reported information on the prescription of antihyperglycemic agents.
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Affiliation(s)
- Manuela Brüne
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Silke Andrich
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Burkhard Haastert
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,mediStatistica, Neuenrade, Germany
| | | | - Andrea Icks
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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Abstract
OBJECTIVES Many survivors of sepsis suffer long-term cognitive impairment, but the mechanisms of this association remain unknown. The objective of this study was to determine whether sepsis is associated with cerebral microinfarcts on brain autopsy. DESIGN Retrospective cohort study. SETTING AND SUBJECTS Five-hundred twenty-nine participants of the Adult Changes in Thought, a population-based prospective cohort study of older adults carried out in Kaiser Permanente Washington greater than or equal to 65 years old without dementia at study entry and who underwent brain autopsy. MEASUREMENTS AND MAIN RESULTS Late-life sepsis hospitalization was identified using administrative data. We identified 89 individuals with greater than or equal to 1 sepsis hospitalization during study participation, 80 of whom survived hospitalization and died a median of 169 days after discharge. Thirty percent of participants with one or more sepsis hospitalization had greater than two microinfarcts, compared with 19% participants without (χ p = 0.02); 20% of those with sepsis hospitalization had greater than two microinfarcts in the cerebral cortex, compared with 10% of those without (χ p = 0.01). The adjusted relative risk of greater than two microinfarcts was 1.61 (95% CI, 1.01-2.57; p = 0.04); the relative risk for having greater than two microinfarcts in the cerebral cortex was 2.12 (95% CI, 1.12-4.02; p = 0.02). There was no difference in Braak stage for neurofibrillary tangles or consortium to establish a registry for Alzheimer's disease score for neuritic plaques between, but Lewy bodies were less significantly common in those with sepsis. CONCLUSIONS Sepsis was specifically associated with moderate to severe vascular brain injury as assessed by microvascular infarcts. This association was stronger for microinfarcts within the cerebral cortex, with those who experienced severe sepsis hospitalization being more than twice as likely to have evidence of moderate to severe cerebral cortical injury in adjusted analyses. Further study to identify mechanisms for the association of sepsis and microinfarcts is needed.
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Anderson TS, Xu E, Whitaker E, Steinman MA. A systematic review of methods for determining cross-sectional active medications using pharmacy databases. Pharmacoepidemiol Drug Saf 2019; 28:403-421. [PMID: 30761662 PMCID: PMC7050409 DOI: 10.1002/pds.4706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/12/2018] [Accepted: 11/12/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE Pharmacy dispensing databases are often used to identify patients' medications at a particular time point, for example to measure prescribing quality or the impact of medication use on clinical outcomes. We performed a systematic review of studies that examined methods to assess medications in use at a specific point in time. METHODS Comprehensive literature search to identify studies that compared active medications identified using pharmacy databases to medications identified using nonautomated data sources. Two investigators independently reviewed abstracts and full-text material. RESULTS Of 496 studies screened, 29 studies evaluating 50 comparisons met inclusion criteria. Twenty-nine comparisons evaluated fixed look-back period approaches, defining active medications as those filled in a specified period prior to the index date (range 84-730 days). Fourteen comparisons evaluated medication-on-hand approaches, defining active medications as those for which the most recent fill provided sufficient supply to last through the study index date. Sensitivity ranged from 48% to 93% for fixed look-back period approaches and 35% to 97% for medication-on-hand approaches. Interpretation of comparative performance of methods was limited by use of different reference sources, target medication classes, and databases across studies. In four studies with head-to-head comparisons of these methods, sensitivity of the medication-on-hand approach was a median of 7% lower than the corresponding fixed look-back approach. CONCLUSIONS The reported accuracy of methods for identifying active medications using pharmacy databases differs greatly across studies. More direct comparisons of common approaches are needed to establish the accuracy of methods within and across populations, medication classes, and databases.
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Affiliation(s)
- Timothy S Anderson
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | - Edison Xu
- San Francisco VA Medical Center, San Francisco, CA, USA.,Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
| | - Evans Whitaker
- Medical Library, University of California San Francisco, San Francisco, CA, USA
| | - Michael A Steinman
- San Francisco VA Medical Center, San Francisco, CA, USA.,Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
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Pisa FE, Casetta A, Clagnan E, Michelesio E, Vecchi Brumatti L, Barbone F. Medication use during pregnancy, gestational age and date of delivery: agreement between maternal self-reports and health database information in a cohort. BMC Pregnancy Childbirth 2015; 15:310. [PMID: 26608022 PMCID: PMC4660837 DOI: 10.1186/s12884-015-0745-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Health databases are a promising resource for epidemiological studies on medications safety during pregnancy. The reliability of information on medications exposure and pregnancy timing is a key methodological issue. This study (a) compared maternal self-reports and database information on medication use, gestational age, date of delivery; (b) quantified the degree of agreement between sources; (c) assessed predictors of agreement. Methods Pregnant women recruited in a prenatal clinic in Friuli Venezia Giulia (FVG) region, Italy, from 2007 to 2009, completed a questionnaire inquiring on medication use during pregnancy, gestational age and date of delivery. Redeemed prescriptions and birth certificate records were extracted from regional databases through record linkage. Percent agreement, Kappa coefficient, prevalence and bias-adjusted Kappa (PABAK) were calculated. Odds Ratio (OR), with 95 % confidence interval (95 % CI), of ≥1 agreement was calculated through unconditional logistic regression. Results The cohort included 767 women, 39.8 % reported medication use, and 70.5 % were dispensed at least one medication. Kappa and PABAK indicated almost perfect to substantial agreement for antihypertensive medications (Kappa 0.86, PABAK 0.99), thyroid hormones (0.88, 0.98), antiepileptic medications (1.00, 1.00), antithrombotic agents (0.70, 0.96). PABAK value was greater than Kappa for medications such as insulin (Kappa 0.50, PABAK 0.99), antihistamines for systemic use (0.50, 0.99), progestogens (0.28, 0.79), and antibiotics (0.12, 0.63). Adjusted OR was 0.48 (95 % CI 0.26; 0.90) in ex- vs. never smokers, 0.64 (0.38; 1.08) in < high school vs. university, 1.55 (1.01; 2.37) in women with comorbidities, 2.25 (1.19; 4.26) in those aged 40+ vs. 30–34 years. Gestational age matched exactly in 85.2 % and date of delivery in 99.5 %. Conclusions For selected medications used for chronic conditions, the agreement between self-reports and dispensing data was high. For medications with low to very low prevalence of use, PABAK provides a more reliable measure of agreement. Maternal reports and dispensing data are complementary to each other to increase the reliability of information on the use of medications during pregnancy. Birth certificates provide reliable data on the timing of pregnancy. FVG health databases are a valuable source of data for pregnancy research. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0745-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Federica Edith Pisa
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Via Colugna 50, 33100, Udine, Italy. .,Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
| | - Anica Casetta
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
| | - Elena Clagnan
- Direzione Centrale Salute, Integrazione Socio Sanitaria e Politiche Sociali, Regione Friuli Venezia Giulia, Udine, Italy.
| | | | - Liza Vecchi Brumatti
- Scientific Direction, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
| | - Fabio Barbone
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Via Colugna 50, 33100, Udine, Italy. .,Department of Medical and Biological Sciences, University of Udine, Udine, Italy. .,Department of Medicine, University of Trieste, Trieste, Italy.
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Breast cancer recurrence in relation to antidepressant use. Cancer Causes Control 2015; 27:125-36. [PMID: 26518198 DOI: 10.1007/s10552-015-0689-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/23/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE Women with breast cancer frequently use antidepressants; however, questions about the effect of these medications on breast cancer recurrence remain. METHODS We identified 4,216 women ≥18 years with an incident stage I or II breast cancer diagnosed between 1990 and 2008 in a mixed-model healthcare delivery system linked to a cancer registry. Recurrences were ascertained from chart review. Medication exposures were extracted from electronic pharmacy records. We used multivariable Cox proportional hazards models to estimate hazard ratios (HR) and 95 % confidence intervals (CI) to assess the association between antidepressant use and breast cancer recurrence and mortality. We also conducted analyses restricted to tamoxifen users. RESULTS Antidepressants overall, tricyclic antidepressants, and selective serotonin reuptake inhibitors were not associated with risk of breast cancer recurrence or mortality. Women taking paroxetine only (adjusted HR: 1.66; 95 % CI 1.02, 2.71) and trazodone only (adjusted HR: 1.76; 95 % CI 1.06, 2.92), but not fluoxetine only (adjusted HR: 0.92; 95 % CI 0.55, 1.53), had higher recurrence risks than antidepressant nonusers. There was some suggestion of an increased recurrence risk with concurrent paroxetine and tamoxifen use compared with users of tamoxifen only (adjusted HR: 1.49; 95 % CI 0.79, 2.83). CONCLUSIONS In general, antidepressants did not appear increase risk of breast cancer recurrence, though there were some suggested increases in risk that warrant further investigation in other datasets. Our results combined systematically and quantitatively with results from other studies may be useful for patients and providers making decisions about antidepressant use after breast cancer diagnosis.
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Unmuessig V, Fishman PA, Vrijhoef HJM, Elissen AMJ, Grossman DC. Association of Controlled and Uncontrolled Hypertension With Workplace Productivity. J Clin Hypertens (Greenwich) 2015; 18:217-22. [PMID: 26279464 DOI: 10.1111/jch.12648] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/26/2015] [Accepted: 07/05/2015] [Indexed: 11/28/2022]
Abstract
The authors estimated the lost productive time (LPT) due to absenteeism and presenteeism among employees at the Group Health Cooperative with controlled and uncontrolled hypertension compared with normotensive patients. The patients responded to a survey inquiring about health behaviors with links to their medical record to identify diagnoses, blood pressure measurement, and prescription drug dispenses. Individuals with controlled hypertension were more likely to report any LPT relative to individuals with uncontrolled hypertension (40.6% vs 32.6%, P<.05). There were no significant differences in the average hours of LPT due to presenteeism among individuals regardless of their hypertension status but individuals with hypertension were more likely to report hours of LPT due to absenteeism compared with normotensive individuals (1.04 vs 0.59 hours; P=.001). Individuals with uncontrolled hypertension were more likely to report LPT due to absenteeism compared with individuals with controlled hypertension (1.35 vs 0.72 hours; P=.001). There were no significant differences between individuals with hypertension whose blood pressure was controlled and normotensive individuals with respect to the likelihood of reporting any LPT or in the amounts of absenteeism and presenteeism.
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Affiliation(s)
| | | | - Hubertus J M Vrijhoef
- Saw Swee Hock School of Public Health, National University Singapore, Singapore, Singapore.,Department of General Practice, Free University Brussels, Brussels, Belgium.,Department of Patient and Care, Maastricht University Hospital, Maastricht, the Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, School for Public Health and Primary Care Maastricht University, Maastricht, the Netherlands
| | - David C Grossman
- Group Health Research Institute, Seattle, WA.,Population and Purchaser Strategy, Group Health Physicians, Seattle, WA
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Lundin JI, Ton TG, LaCroix AZ, Longstreth W, Franklin GM, Swanson PD, Smith-Weller T, Racette BA, Checkoway H. Formulations of hormone therapy and risk of Parkinson's disease. Mov Disord 2014; 29:1631-6. [PMID: 25255692 PMCID: PMC4216612 DOI: 10.1002/mds.26037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 07/28/2014] [Accepted: 08/03/2014] [Indexed: 11/10/2022] Open
Abstract
Hormone therapy (HT) is a class of medications widely prescribed to women in the Western world. Evidence from animal models and in vitro studies suggests that estrogen may protect against nigrostriatal system injury and increase dopamine synthesis, metabolism, and transport. Existing epidemiologic research indicates a possible reduced risk of Parkinson's disease (PD) associated with HT use. The objective of this study was to evaluate PD risk associated with specific HT formulations. Neurologist-confirmed cases and age-matched controls were identified from Group Health Cooperative (GHC) of Washington State. Final analysis included 137 female cases and 227 controls. Hormone therapy use was ascertained from the GHC pharmacy database, further classified as conjugated estrogens, esterified estrogens, and progestin. Ever use of HT formulation demonstrated a suggested elevated risk with esterified estrogen use (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.0-9.8), and no risk associated with conjugated estrogen use (OR, 0.6; 95% CI, 0.6-1.3). Restricting this analysis to prescriptions that included progestin further elevated the risk associated with esterified estrogen use (OR, 6.9; 95% CI, 2.1-22.9); again, no risk was associated with conjugated estrogen use (OR, 1.7; 95% CI, 0.6-5.0). The findings from this study suggest an increase in PD risk associated with esterified estrogen use combined with progestin, and no risk associated with conjugated estrogen with progestin. These findings could have important implications for choice of HT in clinical practice.
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Affiliation(s)
- Jessica I. Lundin
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Thanh G.N. Ton
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Andrea Z. LaCroix
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
| | - W.T. Longstreth
- Department of Neurology, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Gary M. Franklin
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Phillip D. Swanson
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Terri Smith-Weller
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Brad A. Racette
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Harvey Checkoway
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
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A comparison of self-reported oral contraceptive use and automated pharmacy data in perimenopausal and early postmenopausal women. Ann Epidemiol 2014; 25:55-9. [PMID: 25453353 DOI: 10.1016/j.annepidem.2014.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/03/2014] [Accepted: 10/10/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE Oral contraceptive (OC) use can occur throughout a woman's reproductive life span with the potential for long-term impacts on health. To assess potential measurement error in prior OC use, this study compared level of agreement between self-reported prior OC use and pharmacy dispensing data in perimenopausal and/or early postmenopausal women. METHODS The study's 1399 women (ages, 45-59 years) were participants in a population-based case-control study of the association between OC use and fracture risk. Episodes of lifetime self-reported OC use (in months) were collected, by telephone interview, for January 1, 2008 through November 25, 2012. Pharmacy fills, back to 1980, were collected from automated data. Agreement was measured using the prevalence-adjusted and bias-adjusted kappa index. RESULTS The number of women with OC pharmacy fills was 11% to 45% higher than those who reported OC use during each time period. Between-measures agreement was better for more recent use. Prevalence-adjusted and bias-adjusted kappa index values ranged from 0.88 (95% confidence interval, 0.85-0.90) within 5 years from the reference date to 0.65 (95% confidence interval, 0.59-0.71) within 15 to 20 years. CONCLUSIONS For studies designed to assess the long-term effects of OC use, the current results are reassuring in noting moderate agreement between self-reported OC use and pharmacy data for up to 15 to 20 years before the interview.
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Naumann RB, Dellinger AM, Anderson ML, Bonomi AE, Rivara FP. Healthcare utilization and costs among older adult female drivers and former drivers. JOURNAL OF SAFETY RESEARCH 2012; 43:141-144. [PMID: 22710001 DOI: 10.1016/j.jsr.2012.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 01/23/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE This study compared the healthcare utilization and costs for specific types of medical services among older adult women who currently drive and those who no longer drive. METHODS This study included 347 women aged 65 or older who were either former (had stopped driving) or current drivers, randomly sampled from a large U.S. health plan to participate in a telephone survey, and who had automated health records with healthcare utilization and cost data. Bivariate analyses and generalized linear modeling were used to examine associations between driving status and healthcare utilization and costs. RESULTS Adjusting for age, income, and marital status, former drivers were more likely than current drivers to use mental health care services (RR=3.37; 95% CI: 1.03, 10.98). Former drivers also tended to use more inpatient (RR=1.85; 95% CI: 0.88, 3.87) and emergency services (RR=1.89; 95% CI: 0.96, 3.70), but results did not reach statistical significance. Total annual healthcare costs in 2005 were almost twice as high for former drivers compared with current drivers ($13,046 vs. $7,054; mean difference=$5,992; 95% CI: -$360, $12,344), although this relationship was not statistically significant (CR=1.61; 95% CI: 0.88, 2.96). IMPACT ON INDUSTRY Former drivers were more than three times as likely as current drivers to use mental health services, and tended to use more emergency and inpatient services. Further research on factors that potentially mediate the relationship between driving status and health service use is warranted.
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Affiliation(s)
- Rebecca B Naumann
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Liss DT, Chubak J, Anderson ML, Saunders KW, Tuzzio L, Reid RJ. Patient-reported care coordination: associations with primary care continuity and specialty care use. Ann Fam Med 2011; 9:323-9. [PMID: 21747103 PMCID: PMC3133579 DOI: 10.1370/afm.1278] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/14/2011] [Accepted: 04/11/2011] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Care coordination is increasingly recognized as a necessary element of high-quality, patient-centered care. This study investigated (1) the association between care coordination and continuity of primary care, and (2) differences in this association by level of specialty care use. METHODS We conducted a cross-sectional study of Medicare enrollees with select chronic conditions in an integrated health care delivery system in Washington State. We collected survey information on patient experiences and automated health care utilization data for 1 year preceding survey completion. Coordination was defined by the coordination measure from the short form of the Ambulatory Care Experiences Survey (ACES). Continuity was measured by primary care visit concentration. Patients who had 10 or more specialty care visits were classified as high users. Linear regression was used to estimate the association between coordination and continuity, controlling for potential confounders and clustering within clinicians. We used a continuity-by-specialty interaction term to determine whether the continuity-coordination association was modified by high specialty care use. RESULTS Among low specialty care users, an increase of 1 standard deviation (SD) in continuity was associated with an increase of 2.71 in the ACES coordination scale (P <.001). In high specialty care users, we observed no association between continuity and reported coordination (P= .77). CONCLUSIONS High use of specialty care may strain the ability of primary care clinicians to coordinate care effectively. Future studies should investigate care coordination interventions that allow for appropriate specialty care referrals without diminishing the ability of primary care physicians to manage overall patient care.
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Affiliation(s)
- David T Liss
- Department of Health Services, University of Washington, Seattle, Washington, USA.
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Gray SL, Walker R, Dublin S, Haneuse S, Crane PK, Breitner JCS, Bowen J, McCormick W, Larson EB. Histamine-2 receptor antagonist use and incident dementia in an older cohort. J Am Geriatr Soc 2011; 59:251-7. [PMID: 21314645 DOI: 10.1111/j.1532-5415.2010.03275.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine whether histamine-2 receptor antagonist medications (H2RAs) are associated with a lower incidence of all-cause dementia or Alzheimer's disease (AD), as some studies have suggested. DESIGN Prospective population-based cohort SETTING Group Health, an integrated health maintenance organization, Seattle, Washington. PARTICIPANTS Two thousand nine hundred twenty-three participants aged 65 and older without dementia at baseline, with initial recruitment between 1994 and 1996. MEASUREMENTS Follow-up occurred every 2 years to identify incident dementia and AD using standard criteria. Exposure to H2RAs was determined based on automated pharmacy data. Three aspects of exposure (time-varying) were examined based on standard daily dose (SDD): cumulative use, intensity of use (highest SDD in any prior 2-year window), and cumulative use stratified according to recency (1-3 years vs >3 years before). RESULTS Over a mean follow-up of 6.7 years, 585 subjects developed dementia (453 developed AD). Total cumulative exposure was not associated with dementia (P=.35; omnibus test) or AD (P=.23). The adjusted hazard ratios for the highest exposure category (>1,080 SDDs) compared with light or no use were 1.28 (95% confidence interval (CI)=0.95-1.72) for dementia and 1.41 (95% CI=1.00-1.97) for AD. Intensity of use was not associated with dementia (P=.39) or AD (P=.63). Examining exposure according to recent and distant cumulative use also showed no association with dementia (P=.11) or AD (P=.30). CONCLUSION No association was found between H2RA use and risk of all-cause dementia or AD using more-detailed and -extensive information about past H2RA use than any prior study.
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Affiliation(s)
- Shelly L Gray
- School of Pharmacy, University of Washington, Seattle, Washington, USA.
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Dublin S, Walker RL, Jackson ML, Nelson JC, Weiss NS, Jackson LA. Use of proton pump inhibitors and H2 blockers and risk of pneumonia in older adults: a population-based case-control study. Pharmacoepidemiol Drug Saf 2011; 19:792-802. [PMID: 20623507 DOI: 10.1002/pds.1978] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To examine whether use of proton pump inhibitors (PPIs) and H2 blockers is associated with increased pneumonia risk. METHODS We conducted a population-based, nested case-control study within Group Health, an integrated healthcare delivery system. Among community-dwelling, immunocompetent adults aged 65-94, we identified presumptive cases of ambulatory and hospitalized community-acquired pneumonia in 2000-2003 from ICD-9 codes and validated them by medical record review (N = 1125). Controls were selected, matched to cases on age, sex, and calendar year (N = 2235). Current PPI or H2 blocker use was ascertained from computerized pharmacy records. Comorbid illnesses and other characteristics were ascertained by medical record review. Multivariable conditional logistic regression was used to examine the association between medication use and pneumonia risk. We conducted sensitivity analyses using only administrative and pharmacy data to assess how these results differed from our primary results. RESULTS The prevalence of PPI or H2 blocker use was 21% (241/1125) for pneumonia cases and 16% (350/2235) for controls (adjusted odds ratio [OR] 1.03, 95% CI 0.86-1.24, compared to nonuse). No increased risk was seen for recent initiation. The prevalence of PPI use was 12% (132/1125) for cases and 7% (160/2235) for controls (adjusted OR 1.13, 95% CI 0.88-1.44). Analyses using only administrative and pharmacy data yielded risk estimates farther from the null (adjusted OR 1.32, 95% CI 1.17-1.49, for current PPI use versus nonuse). CONCLUSIONS Use of PPIs and H2 blockers is not associated with increased pneumonia risk in older adults. The increased risk observed in some prior studies may reflect confounding.
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Affiliation(s)
- Sascha Dublin
- Group Health Research Institute, Seattle, Washington 98101-1448, USA.
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Abstract
OBJECTIVE We sought to estimate the direct cost, from the perspective of the health insurer or purchaser, of breast-care services in the year following a false positive screening mammogram compared with a true negative examination. DESIGN We identified 21,125 women aged 40 to 80 years enrolled in an integrated healthcare delivery system in Washington State, who participated in screening mammography between January 1, 1998 and July 30, 2002. Pathology and cancer registry data were used to identify breast cancer diagnoses in the year following the screening mammogram. A positive examination was defined as a Breast Imaging Reporting and Data System assessment of 0, 4, or 5. Women with a positive screening mammogram but no breast cancer diagnosed within 1 year were classified as false positives. We used diagnostic and procedure codes in automated health plan data to identify services received in the year following the screening mammogram. Medicare reimbursement rates were applied to all services. We used ordinary least-squares linear regression to estimate the difference in costs following a false positive versus true negative screening mammogram. RESULTS False positive results occurred in 9.9% of women; most false positives (87.3%) were followed by breast imaging only. The mean cost of breast-care following a false positive mammogram was $527. This was $503 (95% confidence interval, $490-$515) more than the cost of breast-care services for true negative women. CONCLUSIONS The direct costs for breast-related procedures following false positive screening mammograms may contribute substantially to US healthcare spending.
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Horsburgh S, Norris P, Becket G, Crampton P, Arroll B, Cumming J, Herbison P, Sides G. The Equity in Prescription Medicines Use Study: using community pharmacy databases to study medicines utilisation. J Biomed Inform 2010; 43:982-7. [PMID: 20709187 DOI: 10.1016/j.jbi.2010.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 07/05/2010] [Accepted: 08/07/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE Pharmacy dispensing databases provide a comprehensive source of data on medicines use free from many of the biases inherent in administrative databases. There are challenges associated with using pharmacy databases however. This paper describes the methods we used, and their performance, so that other researchers considering using pharmacy databases may benefit from our experiences. METHODS Data were collected from all nine pharmacy dispensing databases in an isolated New Zealand town for the period October 2005-September 2006. Probabilistic record matching was used to link individuals across pharmacies. Patient addresses from the pharmacy data were geo-located to small areas so an area measure of socioeconomic deprivation could be assigned. Medicines were coded according to the ATC-DDD drug classification system. RESULTS Data on 619,264 dispensings were collected. Record matching reduced an initial pool of individuals from 54,484 to 38,027. Socioeconomic deprivation ranks were assigned for 30,972 (93%) of the 33,375 unique addresses identified, or 36,048 (95%) of individuals. ATC codes were assigned to 613,490 (99%) of the dispensings, with DDDs assigned to 561,223 (91%). Overall, 93% of dispensing records had complete demographic and drug information. CONCLUSIONS The methods described in this paper generated a rich dataset for medicines use research. These methods, while initially resource-intensive, can to a great extent be automated and applied to other locations, and will hopefully prove useful to other researchers facing similar challenges with using pharmacy databases. However, it is difficult to envisage these methods being viable on a long-term or national scale.
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Affiliation(s)
- Simon Horsburgh
- School of Pharmacy, University of Otago, Dunedin, New Zealand.
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Newcomb PA, Trentham-Dietz A, Hampton JM. Bisphosphonates for osteoporosis treatment are associated with reduced breast cancer risk. Br J Cancer 2010; 102:799-802. [PMID: 20160722 PMCID: PMC2833248 DOI: 10.1038/sj.bjc.6605555] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Bisphosphanates are used primarily for the prevention and treatment of osteoporosis, and are also indicated for osseous complications of malignancy. In addition to their bone resorption properties, the most commonly used nitrogen-containing bisphosphonate compounds also inhibit protein prenylation, and thus may exert anti-tumour properties. METHODS To evaluate whether the use of these drugs may be associated with cancer, specifically breast cancer, we conducted a population-based case-control study in Wisconsin from 2003 to 2006. Participants included 2936 incident invasive breast cancer cases and 2975 population controls aged < 70 years. Bisphosphonate use and potential confounders were assessed by interview. RESULTS Using multivariable logistic regression, the odds ratio for breast cancer in current bisphosphonate users compared with non-users was 0.67 (95% confidence interval 0.51-0.89). Increasing duration of use was associated with a greater reduction in risk (P-trend=0.01). Risk reduction was observed in women who were not obese (P-interaction=0.005). CONCLUSION These results are suggestive of an additional benefit of the common use of bisphosphonates, in this instance, the reduction in breast cancer risk.
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Affiliation(s)
- P A Newcomb
- Paul P Carbone Comprehensive Cancer Center, University of Wisconsin, 610 Walnut Street, Madison, WI 53726, USA.
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Bonomi AE, Anderson ML, Rivara FP, Thompson RS. Health care utilization and costs associated with physical and nonphysical-only intimate partner violence. Health Serv Res 2009; 44:1052-67. [PMID: 19674432 PMCID: PMC2699921 DOI: 10.1111/j.1475-6773.2009.00955.x] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To estimate health care utilization and costs associated with the type of intimate partner violence (IPV) women experience by the timing of their abuse. METHODS A total of 3,333 women (ages 18-64) were randomly sampled from the membership files of a large health plan located in a metropolitan area and participated in a telephone survey to assess IPV history, including the type of IPV (physical IPV or nonphysical abuse only) and the timing of the abuse (ongoing; recent, not ongoing but occurring in the past 5 years; remote, ending at least 5 years prior). Automated annual health care utilization and costs were assembled over 7.4 years for women with physical IPV and nonphysical abuse only by the time period during which their abuse occurred (ongoing, recent, remote), and compared with those of never-abused women (reference group). RESULTS Mental health utilization was significantly higher for women with physical or nonphysical abuse only compared with never-abused women-with the highest use among women with ongoing abuse (relative risk for those with ongoing abuse: physical, 2.61; nonphysical, 2.18). Physically abused women also used more emergency department, hospital outpatient, primary care, pharmacy, and specialty services; for emergency department, pharmacy, and specialty care, utilization was the highest for women with ongoing abuse. Total annual health care costs were higher for physically abused women, with the highest costs for ongoing abuse (42 percent higher compared with nonabused women), followed by recent (24 percent higher) and remote abuse (19 percent higher). Women with recent nonphysical abuse only had annual costs that were 33 percent higher than nonabused women. CONCLUSION Physical and nonphysical abuse contributed to higher health care utilization, particularly mental health services utilization.
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Affiliation(s)
- Amy E Bonomi
- Human Development and Family Science, The Ohio State University, Columbus, OH 43210, USA.
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Bonomi AE, Anderson ML, Rivara FP, Cannon EA, Fishman PA, Carrell D, Reid RJ, Thompson RS. Health care utilization and costs associated with childhood abuse. J Gen Intern Med 2008; 23:294-9. [PMID: 18204885 PMCID: PMC2359481 DOI: 10.1007/s11606-008-0516-1] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 10/09/2007] [Accepted: 01/09/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physical and sexual childhood abuse is associated with poor health across the lifespan. However, the association between these types of abuse and actual health care use and costs over the long run has not been documented. OBJECTIVE To examine long-term health care utilization and costs associated with physical, sexual, or both physical and sexual childhood abuse. DESIGN Retrospective cohort. PARTICIPANTS Three thousand three hundred thirty-three women (mean age, 47 years) randomly selected from the membership files of a large integrated health care delivery system. MEASUREMENTS Automated annual health care utilization and costs were assembled over an average of 7.4 years for women with physical only, sexual only, or both physical and sexual childhood abuse (as reported in a telephone survey), and for women without these abuse histories (reference group). RESULTS Significantly higher annual health care use and costs were observed for women with a child abuse history compared to women without comparable abuse histories. The most pronounced use and costs were observed for women with a history of both physical and sexual child abuse. Women with both abuse types had higher annual mental health (relative risk [RR] = 2.07; 95% confidence interval [95%CI] = 1.67-2.57); emergency department (RR = 1.86; 95%CI = 1.47-2.35); hospital outpatient (RR = 1.35 = 95%CI = 1.10-1.65); pharmacy (incident rate ratio [IRR] = 1.57; 95%CI = 1.33-1.86); primary care (IRR = 1.41; 95%CI = 1.28-1.56); and specialty care use (IRR = 1.32; 95%CI = 1.13-1.54). Total adjusted annual health care costs were 36% higher for women with both abuse types, 22% higher for women with physical abuse only, and 16% higher for women with sexual abuse only. CONCLUSIONS Child abuse is associated with long-term elevated health care use and costs, particularly for women who suffer both physical and sexual abuse.
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Affiliation(s)
- Amy E Bonomi
- Human Development and Family Science, The Ohio State University, Columbus, OH 43210, USA.
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Green BB, Ralston JD, Fishman PA, Catz SL, Cook A, Carlson J, Tyll L, Carrell D, Thompson RS. Electronic communications and home blood pressure monitoring (e-BP) study: design, delivery, and evaluation framework. Contemp Clin Trials 2007; 29:376-95. [PMID: 17974502 DOI: 10.1016/j.cct.2007.09.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 08/30/2007] [Accepted: 09/10/2007] [Indexed: 01/20/2023]
Abstract
BACKGROUND Randomized controlled trials have provided unequivocal evidence that treatment of hypertension decreases mortality and major disability from cardiovascular disease; however, blood pressure remains inadequately treated in most affected individuals. This large gap continues despite the facts that more than 90% of adults with hypertension have health insurance, and hypertension is the leading cause of visits to the doctor. New approaches are needed to improve hypertension care. OBJECTIVES The Electronic Communications and Home Blood Pressure Monitoring (e-BP) study is a three-arm randomized controlled trial designed to determine whether care based on the Chronic Care Model and delivered over the Internet improves hypertension care. The primary study outcomes are systolic, diastolic, and blood pressure control; secondary outcomes are medication adherence, patient self-efficacy, satisfaction and quality of life, and healthcare utilization and costs. METHODS Hypertensive patients receiving care at Group Health medical centers are eligible if they have uncontrolled blood pressure on two screening visits and access to the Web and an e-mail address. Study participants are randomly assigned to three intervention groups: (a) usual care; (b) home blood pressure monitoring receipt and proficiency training on its use and the Group Health secure patient website (with secure e-mail access to their healthcare provider, access to a shared medical record, prescription refill and other services); or (c) this plus pharmacist care management (collaborative care management between the patient, the pharmacist, and the patient's physician via a secure patient website and the electronic medical record). CONCLUSION We will determine whether a new model of patient-centered care that leverages Web communications, self-monitoring, and collaborative care management improves hypertension control. If this model proves successful and cost-effective, similar interventions could be used to improve the care of large numbers of patients with uncontrolled hypertension.
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Bryson CL, Au DH, Young B, McDonell MB, Fihn SD. A Refill Adherence Algorithm for Multiple Short Intervals to Estimate Refill Compliance (ReComp). Med Care 2007; 45:497-504. [PMID: 17515776 DOI: 10.1097/mlr.0b013e3180329368] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND There are many measures of refill adherence available, but few have been designed or validated for use with repeated measures designs and short observation periods. OBJECTIVE To design a refill-based adherence algorithm suitable for short observation periods, and compare it to 2 reference measures. METHODS A single composite algorithm incorporating information on both medication gaps and oversupply was created. Electronic Veterans Affairs pharmacy data, clinical data, and laboratory data from routine clinical care were used to compare the new measure, ReComp, with standard reference measures of medication gaps (MEDOUT) and adherence or oversupply (MEDSUM) in 3 different repeated measures medication adherence-response analyses. These analyses examined the change in low density lipoprotein (LDL) with simvastatin use, blood pressure with antihypertensive use, and heart rate with beta-blocker use for 30- and 90-day intervals. Measures were compared by regression based correlations (R2 values) and graphical comparisons of average medication adherence-response curves. RESULTS In each analysis, ReComp yielded a significantly higher R2 value and more expected adherence-response curve regardless of the length of the observation interval. For the 30-day intervals, the highest correlations were observed in the LDL-simvastatin analysis (ReComp R2 = 0.231; [95% CI, 0.222-0.239]; MEDSUM R2 = 0.054; [95% CI, 0.049-0.059]; MEDOUT R2 = 0.053; [95% CI, 0.048-0.058]). CONCLUSIONS ReComp is better suited to shorter observation intervals with repeated measures than previously used measures.
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Affiliation(s)
- Chris L Bryson
- Health Services Research and Development Northwest Center of Excellence, Seattle, Washington 98101, USA.
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Zerzan J, Edlund T, Krois L, Smith J. The demise of Oregon's Medically Needy program: effects of losing prescription drug coverage. J Gen Intern Med 2007; 22:847-51. [PMID: 17380369 PMCID: PMC2219861 DOI: 10.1007/s11606-007-0178-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 10/23/2006] [Accepted: 02/27/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND In January 2003, people covered by Oregon's Medically Needy program lost benefits owing to state budget shortfalls. The Medically Needy program is a federally matched optional Medicaid program. In Oregon, this program mainly provided prescription drug benefits. OBJECTIVE To describe the Medically Needy population and determine how benefit loss affected this population's health and prescription use. DESIGN A 49-question telephone survey instrument created by the research team and administered by a research contractor. PARTICIPANTS A random sample of 1,269 eligible enrollees in Oregon's Medically Needy Program. Response rate was 35% with 439 individuals, ages 21-91 and 64% women, completing the survey. MEASUREMENTS Demographics, health information, and medication use at the time of the survey obtained from the interview. Medication use during the program obtained from administrative data. RESULTS In the 6 months after the Medically Needy program ended, 75% had skipped or stopped medications. Sixty percent of the respondents had cut back on their food budget, 47% had borrowed money, and 49% had skipped paying other bills to pay for medications. By self-report, there was no significant difference in emergency department visits, but a significant decrease in hospitalizations comparing 6 months before and after losing the program. Two-thirds of respondents rated their current health as poor or fair. CONCLUSIONS The Medically Needy program provided coverage for a low-income, chronically ill population. Since its termination, enrollees have decreased prescription drug use and increased financial burden. As states make program changes and Medicare Part D evolves, effects on vulnerable populations must be considered.
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Affiliation(s)
- Judy Zerzan
- Seattle VA Health Services Research and Development, 1100 Olive Way, #1400, Seattle, WA 98101, USA.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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