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Dobscha SK, Luther SL, Kerns RD, Finch DK, Goulet JL, Brandt CA, Skanderson M, Bathulapalli H, Fodeh SJ, Hahm B, Bouayad L, Lee A, Han L. Mental Health Diagnoses are Not Associated With Indicators of Lower Quality Pain Care in Electronic Health Records of a National Sample of Veterans Treated in Veterans Health Administration Primary Care Settings. THE JOURNAL OF PAIN 2023; 24:273-281. [PMID: 36167230 PMCID: PMC9898089 DOI: 10.1016/j.jpain.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/08/2022] [Accepted: 08/25/2022] [Indexed: 02/06/2023]
Abstract
Prior research has demonstrated disparities in general medical care for patients with mental health conditions, but little is known about disparities in pain care. The objective of this retrospective cohort study was to determine whether mental health conditions are associated with indicators of pain care quality (PCQ) as documented by primary care clinicians in the Veterans Health Administration (VHA). We used natural language processing to analyze electronic health record data from a national sample of Veterans with moderate to severe musculoskeletal pain during primary care visits in the Fiscal Year 2017. Twelve PCQ indicators were annotated from clinician progress notes as present or absent; PCQ score was defined as the sum of these indicators. Generalized estimating equation Poisson models examined associations among mental health diagnosis categories and PCQ scores. The overall mean PCQ score across 135,408 person-visits was 8.4 (SD = 2.3). In the final adjusted model, post-traumatic stress disorder was associated with higher PCQ scores (RR = 1.006, 95%CI 1.002-1.010, P = .007). Depression, alcohol use disorder, other substance use disorder, schizophrenia, and bipolar disorder diagnoses were not associated with PCQ scores. Overall, results suggest that in this patient population, presence of a mental health condition is not associated with lower quality pain care. PERSPECTIVE: This study used a natural language processing approach to analyze medical records to determine whether mental health conditions are associated with indicators of pain care quality as documented by primary care clinicians. Findings suggest that presence of a diagnosed mental health condition is not associated with lower quality pain care.
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Affiliation(s)
- Steven K Dobscha
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon; VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, Oregon.
| | - Stephen L Luther
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida; College of Public Health, University of South Florida, Tampa, Florida
| | - Robert D Kerns
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut; Yale School of Medicine Department of Psychiatry and Neurology, New Haven, Connecticut
| | - Dezon K Finch
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida
| | - Joseph L Goulet
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut; Yale School of Medicine Department of Emergency Medicine, New Haven, Connecticut
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut; Yale School of Medicine Department of Emergency Medicine, New Haven, Connecticut
| | - Melissa Skanderson
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut
| | - Harini Bathulapalli
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut
| | - Samah J Fodeh
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut; Yale School of Medicine Department of Emergency Medicine, New Haven, Connecticut
| | - Bridget Hahm
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida
| | - Lina Bouayad
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida; Information Systems and Business Analytics, College of Business, Florida International University, Miami, Florida
| | - Allison Lee
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut; Yale School of Medicine Department of Psychiatry and Neurology, New Haven, Connecticut
| | - Ling Han
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut; Yale School of Medicine Department of Internal Medicine, New Haven, Connecticut
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Turkoz I, Daskiran M, Starr HL, Najarian D, Lopena O, Obando C, Keenan A, Benson C, Gopal S. Comparing Relapse Rates in Real-World Patients with Schizophrenia Who Were Adequately versus Not Adequately Treated with Paliperidone Palmitate Once-Monthly Injections Before Transitioning to Once-Every-3-Months Injections. Neuropsychiatr Dis Treat 2022; 18:1927-1937. [PMID: 36065384 PMCID: PMC9440679 DOI: 10.2147/ndt.s373725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This retrospective cohort study evaluated real-world data on relapses in adult patients with schizophrenia who transitioned to long-acting injectable paliperidone palmitate once-every-3-months (PP3M) following treatment with once-monthly paliperidone palmitate (PP1M). Patients and Methods Data derived from the IBM® MarketScan® Multi-State Medicaid Database were analyzed. Adults aged ≥18 years with ≥1 schizophrenia diagnosis claim and ≥12 months of continuous medical and prescription enrollment before and/or at index date of PP3M were eligible for inclusion. Patients were matched on propensity score to 2 PP3M cohorts: (1) adequately treated (AT), defined as patients treated with PP1M for ≥4 months, with the last 2 doses the same and a PP3M initiation dose meeting the corresponding PP1M-to-PP3M dose conversion, or (2) not adequately treated (NAT), defined as patients who received ≤2 or no PP1M doses. Relapse rates and time to relapse distributions based on the first occurrence of a qualifying event during the 2-year follow-up period were compared between PP3M cohorts using Kaplan-Meier survival curves and log rank test statistics. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Two sensitivity analyses using different matched populations were performed to assess the robustness of the primary findings. Results Propensity score matching yielded a sample of 1314 patients (657 per group). Most patients were male (68.9%) and aged 25-64 years (90.1%). The relapse rate was significantly lower in the AT (18.4%) versus NAT cohort (26.8%), P = 0.0002. Risk of relapse decreased by 35% for AT versus NAT (HR: 0.65 [95% CI: 0.51-0.81]). Relapse reductions favored the AT cohort in both sensitivity analyses (HR: 0.67 [95% CI: 0.54-0.83] and HR: 0.74 [95% CI: 0.56-0.97]). Conclusion In this analysis of Medicaid claims data, patients adequately treated with PP1M before transitioning to PP3M demonstrated significantly lower relapse rates and delayed time to relapse.
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Affiliation(s)
- Ibrahim Turkoz
- Statistics & Decision Sciences, Janssen Research and Development, LLC, Titusville, NJ, USA
| | - Mehmet Daskiran
- Statistics & Decision Sciences, Janssen Research and Development, LLC, Titusville, NJ, USA
| | - H Lynn Starr
- Neuroscience, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Dean Najarian
- Neuroscience, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Oliver Lopena
- Neuroscience, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Camilo Obando
- Neuroscience, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Alexander Keenan
- Real World Value & Evidence, Neuroscience, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Carmela Benson
- Real World Value & Evidence, Neuroscience, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Srihari Gopal
- Schizophrenia/Neuroscience Therapeutic Area, Janssen Research and Development, LLC, Titusville, NJ, USA
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Loosen SH, Roderburg C, Jahn JK, Joerdens M, Luedde T, Kostev K, Luedde M. Heart failure and depression: a comparative analysis with different types of cancer. Eur J Prev Cardiol 2021; 29:e112-e114. [PMID: 33984863 DOI: 10.1093/eurjpc/zwab048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/20/2021] [Accepted: 03/09/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Sven H Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Christoph Roderburg
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Julia K Jahn
- Internal Medicine I, Central Hospital Bremerhaven, Postbrookstraße103, Bremerhaven, Germany
| | - Markus Joerdens
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Tom Luedde
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Karel Kostev
- Epidemiology, IQVIA, Unterschweinstiege2-14, Frankfurt, Germany
| | - Mark Luedde
- KGP Bremerhaven, Postbrookstr. 105, 27574 Bremerhaven, Germany
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Cocoros NM, Haynes K, Her Q, Cosgrove A, Dee E, Lin ND, Tu CM, Ding Y, Nguyen M, Toh S. Identification of potential drug name confusion errors in the Sentinel System. Pharmacoepidemiol Drug Saf 2019; 28:1405-1410. [PMID: 31483085 DOI: 10.1002/pds.4891] [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: 04/15/2019] [Revised: 08/07/2019] [Accepted: 08/18/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE In July 2015, the US Food and Drug Administration (FDA) published a drug safety communication regarding errors in prescribing and dispensing of the antidepressant Brintellix (vortioxetine) and the antiplatelet Brilinta (ticagrelor) that arose due to proprietary drug name confusion. Brintellix is indicated for major depressive disorder; Brilinta is indicated to reduce cardiovascular death, myocardial infarction, and stroke in patients with acute coronary syndrome or history of myocardial infarction. Brintellix was renamed to Trintellix in May 2016. Using Brilinta and Brintellix as a proof-of-concept feasibility use case, we assessed whether drug name confusion errors between the pair could be identified in electronic health care data via the combination of a claims-based algorithm and limited manual claims data review. METHODS Using data from the Sentinel System, we defined potential errors as Brintellix users without an on- or off-label indication for Brintellix, without a dispensing for a drug with the same indications as Brintellix, and with an on- or off-label indication for Brilinta between -365 and +30 days after index Brintellix dispensing; the reverse was done for Brilinta. We manually reviewed claims profiles of potential cases. RESULTS We identified 27 (0.1%) potential errors among 21 208 Brintellix users; 16 appeared to be likely errors based on claims profile review. Fifty-one (0.3%) of the 16 779 Brilinta users were identified as potential errors, and four appeared to be likely errors. CONCLUSIONS A claims-based algorithm combined with manual review of claims profiles could identify potential drug name confusion errors, and narrow down likely errors that warrant further investigation.
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Affiliation(s)
- Noelle M Cocoros
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Kevin Haynes
- HealthCore, Government and Academic Research, Wilmington, DE, USA
| | - Qoua Her
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Austin Cosgrove
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Elizabeth Dee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Nancy D Lin
- OptumInsight Life Sciences Inc., Boston, MA, USA
| | - Chi-Ming Tu
- U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Yulan Ding
- U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Michael Nguyen
- U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Tamblyn R, Bates DW, Buckeridge DL, Dixon W, Forster AJ, Girard N, Haas J, Habib B, Kurteva S, Li J, Sheppard T. Multinational comparison of new antidepressant use in older adults: a cohort study. BMJ Open 2019; 9:e027663. [PMID: 31092665 PMCID: PMC6530307 DOI: 10.1136/bmjopen-2018-027663] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES We used an international pharmacosurveillance network to estimate the rate and characteristics of antidepressant use in older adults in countries with more conservative (UK) and liberal depression guidelines (Canada, USA). SETTING Electronic health records and population-based administrative data from six jurisdictions in four countries (UK, Taiwan, USA and Canada). PARTICIPANTS A historical cohort of older adults (≥65 years) who had a new episode of antidepressant use between 2009 and 2014. OUTCOME MEASURES The age and sex-standardised cumulative incidence of new episodes of antidepressant use in older adults was measured. Descriptive statistics were used to compare the proportion of new users by the antidepressant prescribed, therapeutic class, potential treatment indication and country, as well as the characteristics of the first treatment episode (standardised daily doses, duration and changes). RESULTS The incidence of antidepressant use between 2009 and 2014 varied from 4.7% (Montreal and Quebec City) to 18.6% (Taiwan). Tricyclic antidepressants (TCAs) were the most commonly used class in the UK (48.8%) and Taiwan (52.4%) compared with selective serotonin reuptake inhibitors (SSRIs) in North American jurisdictions (42.3%-53.3%). Chronic pain was the most common potential treatment indication (41.2%-68.2%). Among users with chronic pain, TCAs were used most frequently in the UK and Taiwan (55.2%-60.4%), whereas SSRIs were used most frequently in North America (33.5%-46.4%). Treatment was longer (252-525 vs 169-437 days), standardised doses were higher (0.7-1.3 vs 0.5-1.0) and treatment was more likely to be changed (31%-46% vs 21%-34%) among patients with depression (9.1%-43%) than those with chronic pain. CONCLUSION Antidepressant use in older adults varied 24-fold by country, with the UK, which has the most conservative treatment guidelines, being among the lowest. Chronic pain was the most common potential treatment indication. Evaluation of real-world risks of TCAs is a priority for future research, given high rates of use and the potential for increased toxicity in older adults because of potent anticholinergic effects.
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Affiliation(s)
- Robyn Tamblyn
- Department of Medicine and Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | | | - David L Buckeridge
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Direction de santé publique, Agence de la Santé et des services Sociaux de Montréal, Montreal, Quebec, Canada
| | - Will Dixon
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Alan J Forster
- Internal Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nadyne Girard
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - Jennifer Haas
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Bettina Habib
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - Siyana Kurteva
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jack Li
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
| | - Therese Sheppard
- Department of Medicine, University of Manchester, Manchester, UK
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Bushnell G, Stürmer T, Mack C, Pate V, Miller M. Who diagnosed and prescribed what? Using provider details to inform observational research. Pharmacoepidemiol Drug Saf 2018; 27:1422-1426. [PMID: 30379369 PMCID: PMC6407693 DOI: 10.1002/pds.4685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/03/2018] [Accepted: 10/02/2018] [Indexed: 11/06/2022]
Abstract
PURPOSE To describe how often patients with depression initiating antidepressants receive their depression diagnosis and prescriptions from the same provider and, when simultaneously initiating benzodiazepines, how often both prescriptions come from the same provider. METHODS Using a US healthcare claims database, we created a cohort of adults (18-64 years) with a depression diagnosis who initiated antidepressants. We examined concordance by provider specialty and provider identifier between (a) the first antidepressant prescription fill and most proximal depression diagnosis, and (b) the initial antidepressant and benzodiazepine prescription fills among simultaneous benzodiazepine and antidepressant initiators. RESULTS Among 245 166 antidepressant initiators with a recent depression diagnosis (female = 67%; median age = 39), the specialty of the provider assigning the depression diagnosis matched the antidepressant prescriber's specialty in 94% of cases with known provider details (provider identifier concordance = 93%). Concordance was higher for adults diagnosed by a general practitioner (98%) or psychiatrist (92%) than for those diagnosed by a psychologist (74%). In simultaneous new users of antidepressants and benzodiazepines (n = 19 371), both prescriptions were issued by the same provider specialty and provider identifier 94% and 93% of the time, respectively. CONCLUSIONS The vast majority of patients who received antidepressant prescriptions and depression diagnoses appear to have received both diagnosis and antidepressants from the same provider, suggesting that when antidepressants are issued around the time a patient is diagnosed with depression, the antidepressant was likely prescribed for depression. In addition, the great majority of patients who simultaneously initiate benzodiazepines appear to do so under the direction of one provider.
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Affiliation(s)
- Greta Bushnell
- Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina at Chapel Hill
| | | | - Virginia Pate
- Department of Epidemiology, University of North Carolina at Chapel Hill
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Wong J, Abrahamowicz M, Buckeridge DL, Tamblyn R. Assessing the accuracy of using diagnostic codes from administrative data to infer antidepressant treatment indications: a validation study. Pharmacoepidemiol Drug Saf 2018; 27:1101-1111. [PMID: 29687504 PMCID: PMC6220980 DOI: 10.1002/pds.4436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/24/2018] [Accepted: 03/12/2018] [Indexed: 11/07/2022]
Abstract
PURPOSE To assess the accuracy of using diagnostic codes from administrative data to infer treatment indications for antidepressants prescribed in primary care. METHODS Validation study of administrative diagnostic codes for 13 plausible indications for antidepressants compared with physician-documented treatment indications from an indication-based electronic prescribing system in Quebec, Canada. The analysis included all antidepressant prescriptions written by primary care physicians between January 1, 2003 and December 31, 2012 using the electronic prescribing system. Patient prescribed antidepressants were linked to physician claims and hospitalization data to obtain all diagnoses recorded in the past year. RESULTS Diagnostic codes had poor sensitivity for all treatment indications, ranging from a high of only 31.2% (95% CI, 26.8%-35.9%) for anxiety/stress disorders to as low as 1.3% (95% CI, 0.0%-5.2%) for sexual dysfunction. Sensitivity was notably worse among older patients and patients with more chronic comorbidities. Physician claims data were a better source of diagnostic codes for antidepressant treatment indications than hospitalization data. CONCLUSIONS Administrative diagnostic codes are poor proxies for antidepressant treatment indications. Future work should determine whether the use of other variables in administrative data besides diagnostic codes can improve the ability to predict antidepressant treatment indications.
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Affiliation(s)
- Jenna Wong
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealCanada
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealCanada
| | - David L. Buckeridge
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealCanada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealCanada
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