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Karagiannis T, Bekiari E, Tsapas A. Socioeconomic aspects of incretin-based therapy. Diabetologia 2023; 66:1859-1868. [PMID: 37433896 PMCID: PMC10474181 DOI: 10.1007/s00125-023-05962-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/30/2023] [Indexed: 07/13/2023]
Abstract
Incretin-based therapies, particularly glucagon-like peptide-1 receptor agonists (GLP-1 RAs), have demonstrated cardiovascular benefits in people with type 2 diabetes. However, socioeconomic disparities in their uptake may constrain the collective advantages offered by these medications to the broader population. In this review we examine the socioeconomic disparities in the utilisation of incretin-based therapies and discuss strategies to address these inequalities. Based on real-world evidence, the uptake of GLP-1 RAs is reduced in people who live in socioeconomically disadvantaged areas, have low income and education level, or belong to racial/ethnic minorities, even though these individuals have a greater burden of type 2 diabetes and cardiovascular disease. Contributing factors include suboptimal health insurance coverage, limited accessibility to incretin-based therapies, financial constraints, low health literacy and physician-patient barriers such as provider bias. Advocating for a reduction in the price of GLP-1 RAs is a pivotal initial step to enhance their affordability among lower socioeconomic groups and improve their value-for-money from a societal perspective. By implementing cost-effective strategies, healthcare systems can amplify the societal benefits of incretin-based therapies, alongside measures that include maximising treatment benefits in specific subpopulations while minimising harms in vulnerable individuals, increasing accessibility, enhancing health literacy and overcoming physician-patient barriers. A collaborative approach between governments, pharmaceutical companies, healthcare providers and people with diabetes is necessary for the effective implementation of these strategies to enhance the overall societal benefits of incretin-based therapies.
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Affiliation(s)
- Thomas Karagiannis
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Bekiari
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- Harris Manchester College, University of Oxford, Oxford, UK.
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Dankers M, Verlegh P, Weber K, Nelissen-Vrancken M, van Dijk L, Mantel-Teeuwisse A. Marketing of medicines in primary care: An analysis of direct marketing mailings and advertisements. PLoS One 2023; 18:e0290603. [PMID: 37639431 PMCID: PMC10461816 DOI: 10.1371/journal.pone.0290603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Marketing materials from pharmaceutical companies attempt to create a positive image of marketed, often new, medicines. To gain more insight in strategies pharmaceutical companies use to influence primary care practitioners' attitudes towards marketed medicines, we investigated the use of persuasion strategies in direct marketing mailings and advertisements from pharmaceutical companies sent to general practitioners. METHODS General practitioners in the Netherlands were recruited to collect all direct marketing mailings, meaning all leaflets, letters and other information sent by pharmaceutical industries to the practice during one month (June 2022). Direct marketing mailings and advertisements in collected medical journals concerning medicines or diseases (together called marketing materials) were analysed according to presence of one of the seven common persuasion strategies, i.e. reciprocity, consistency/commitment, social proof, liking, authority, scarcity and unity; as well as marketed medicine and year of introduction. RESULTS Twenty general practices collected 68 unique marketing materials concerning 37 different medicines. Direct factor Xa inhibitors (n = 12), glucagon-like peptide-1 analogues (n = 5) and sodium-glucose co-transporter 2 inhibitors (n = 4) were the most frequently marketed medicines. The median year of introduction of all marketed medicines was 2012. All seven persuasion strategies were identified, with liking (64.7% of all materials) and authority (29.4%) as most prominent strategies, followed by social proof (17.6%), unity (14.7%), scarcity (13.2%), reciprocity (11.8%) and consistency/commitment (2.9%). In addition to those strategies, we identified emotional pressure (30.9%) as one commonly used new strategy. CONCLUSION Marketing materials sent to general practices use a wide range of persuasion strategies in an attempt to influence prescription behaviour. Primary care practitioners should be aware of these mechanisms through which pharmaceutical companies try to influence their attitudes towards new medicines.
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Affiliation(s)
- Marloes Dankers
- Dutch Institute for Rational Use of Medicine, Utrecht, the Netherlands
- Faculty of Science and Engineering, Department of PharmacoTherapy, Groningen Research Institute of Pharmacy, Epidemiology & Economics (PTEE), University of Groningen, Groningen, the Netherlands
| | - Peeter Verlegh
- Department of Marketing, School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Karla Weber
- Dutch Institute for Rational Use of Medicine, Utrecht, the Netherlands
| | | | - Liset van Dijk
- Faculty of Science and Engineering, Department of PharmacoTherapy, Groningen Research Institute of Pharmacy, Epidemiology & Economics (PTEE), University of Groningen, Groningen, the Netherlands
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Aukje Mantel-Teeuwisse
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
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Black JE, Harris SB, Ryan BL, Zou G, Ratzki-Leewing A. Real-World Effects of Second-Generation Versus Earlier Intermediate/Basal Insulin Analogues on Rates of Hypoglycemia in Adults with Type 1 and 2 Diabetes (iNPHORM, US). Diabetes Ther 2023:10.1007/s13300-023-01423-3. [PMID: 37270453 PMCID: PMC10299942 DOI: 10.1007/s13300-023-01423-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/12/2023] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Second-generation basal insulin analogues have been shown to reduce hypoglycemia in several trials and observational studies of select populations; however, it remains unclear whether these results persist in real-world settings. Using self-reported hypoglycemia events, we assessed whether second-generation basal insulin analogues reduce rates of hypoglycemia events (non-severe/severe; overall/daytime/nocturnal) compared to earlier intermediate/basal insulin analogues among people with insulin-treated type 1 or 2 diabetes. METHODS We used prospectively collected data from the Investigating Novel Predictions of Hypoglycemia Occurrence Using Real-World Models (iNPHORM) panel survey. This US-wide, 1-year internet-based survey assessed hypoglycemia experiences and related sociodemographic and clinical characteristics of people with diabetes (February 2020-March 2021). We estimated population-average rate ratios for hypoglycemia comparing second-generation to earlier intermediate/basal insulin analogues using negative binomial regression, adjusting for confounders. Within-person variability of repeated observations was addressed with generalized estimating equations. RESULTS Among iNPHORM participants with complete data, N = 413 used an intermediate/basal insulin analogue for ≥ 1 month during follow-up. After adjusting for baseline and time-updated confounders, average second-generation basal insulin analogue users experienced a 19% (95% CI 3-32%, p = 0.02) lower rate of overall non-severe hypoglycemia and 43% (95% CI 26-56%, p < 0.001) a lower rate of nocturnal non-severe hypoglycemia compared to earlier intermediate/basal insulin users. Overall severe hypoglycemia rates were similar among second-generation and earlier intermediate/basal insulin users (p = 0.35); however, the rate of severe nocturnal hypoglycemia was reduced by 44% (95% CI 10-65%, p = 0.02) among second-generation insulin users compared to earlier intermediate/basal insulin users. CONCLUSION Our real-world results suggest second-generation basal insulin analogues reduce rates of hypoglycemia, especially nocturnal non-severe and severe events. Whenever possible and feasible, clinicians should prioritize prescribing these agents over first-generation basal or intermediate insulin in people with type 1 and 2 diabetes.
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Affiliation(s)
- Jason E Black
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Stewart B Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Bridget L Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Robarts Research Institute, Western University, London, ON, Canada
| | - Alexandria Ratzki-Leewing
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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Newer long-acting insulin prescriptions to type 2 diabetes patients: prevalence and practice variation. Br J Gen Pract 2022; 72:e430-e436. [PMID: 35606162 PMCID: PMC9172218 DOI: 10.3399/bjgp.2021.0581] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/04/2022] [Indexed: 10/31/2022] Open
Abstract
Background Little is known about the prescription of expensive non-recommended newer long-acting insulins (glargine 300 U/ml and degludec) for type 2 diabetes mellitus (T2DM) patients. Aim To identify practice variation in and practice and patient-related characteristics associated with the prescription of newer long-acting insulins to T2DM patients in primary care. Design and Setting Retrospective cohort study in Dutch general practices (Nivel Primary Care Database). Method The first prescription for intermediate or long-acting insulins in 2018 was identified for patients aged ≥40 using other T2DM drugs. Per practice, the median percentage and interquartile range (IQR) of patients with newer insulin prescriptions were calculated. Multilevel logistic regression models were constructed to calculate intraclass correlation coefficients (ICC) and quantify the association of patient and practice characteristics with prescriptions for newer insulins (odds ratio’s (OR) and 95% confidence intervals (CI)). Results 7,757 patients with prescriptions for intermediate or long-acting insulins from 282 general practices were identified. A median percentage of 21.2% (IQR=12.5-36.4%) of all patients prescribed intermediate or long-acting insulins per practice received a prescription for newer insulins. After multilevel modelling, the ICC decreased from 20% to 19%. Female sex (OR=0.77;95%CI=0.69–0.87), age ≥86 years compared to 40-55 years (OR=0.22;95%CI=0.15-0.34), prescriptions for metformin (OR=0.66;95%CI=0.53-0.82), sulphonylurea (OR=0.58;95%CI=0.51-0.66) or other newer T2DM drugs (OR=3.10;95%CI=2.63-3.66) and dispensing practices (OR=1.78;95%CI=1.03-3.10) were associated with the prescription of newer insulins. Conclusion The interpractice variation in the prescription of newer insulins is large and could only be partially explained by patient and practice related differences. This indicates substantial opportunities for improvement.
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Metes ID, Xue L, Chang CCH, Huskamp HA, Gellad WF, Lo-Ciganic WH, Choudhry NK, Richards-Shubik S, Guclu H, Donohue JM. Association between physician adoption of a new oral anti-diabetic medication and Medicare and Medicaid drug spending. BMC Health Serv Res 2019; 19:703. [PMID: 31619229 PMCID: PMC6794771 DOI: 10.1186/s12913-019-4520-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/10/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In the United States, there is well-documented regional variation in prescription drug spending. However, the specific role of physician adoption of brand name drugs on the variation in patient-level prescription drug spending is still being investigated across a multitude of drug classes. Our study aims to add to the literature by determining the association between physician adoption of a first-in-class anti-diabetic (AD) drug, sitagliptin, and AD drug spending in the Medicare and Medicaid populations in Pennsylvania. METHODS We obtained physician-level data from QuintilesIMS Xponent™ database for Pennsylvania and constructed county-level measures of time to adoption and share of physicians adopting sitagliptin in its first year post-introduction. We additionally measured total AD drug spending for all Medicare fee-for-service and Part D enrollees (N = 125,264) and all Medicaid (N = 50,836) enrollees with type II diabetes in Pennsylvania for 2011. Finite mixture model regression, adjusting for patient socio-demographic/clinical characteristics, was used to examine the association between physician adoption of sitagliptin and AD drug spending. RESULTS Physician adoption of sitagliptin varied from 44 to 99% across the state's 67 counties. Average per capita AD spending was $1340 (SD $1764) in Medicare and $1291 (SD $1881) in Medicaid. A 10% increase in the share of physicians adopting sitagliptin in a county was associated with a 3.5% (95% CI: 2.0-4.9) and 5.3% (95% CI: 0.3-10.3) increase in drug spending for the Medicare and Medicaid populations, respectively. CONCLUSIONS In a medication market with many choices, county-level adoption of sitagliptin was positively associated with AD spending in Medicare and Medicaid, two programs with different approaches to formulary management.
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Affiliation(s)
- Ilinca D Metes
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A651, Pittsburgh, PA, 15261, USA
| | - Lingshu Xue
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A651, Pittsburgh, PA, 15261, USA
| | - Chung-Chou H Chang
- Department of Medicine, School of Medicine, University of Pittsburgh, 200 Meyran Avenue, Suite 200, Pittsburgh, PA, 15213, USA.,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Walid F Gellad
- Department of Medicine, School of Medicine, University of Pittsburgh, 200 Meyran Avenue, Suite 200, Pittsburgh, PA, 15213, USA.,Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15215, USA
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL, 32610, USA
| | - Niteesh K Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA
| | - Seth Richards-Shubik
- College of Business and Economics, Lehigh University, Rausch Business Center, Room 465, 621 Taylor St, Bethlehem, PA, 18015, USA
| | - Hasan Guclu
- Department of Statistics, School of Science, Istanbul Medeniyet University, Uskudar, 34700, Istanbul, Turkey
| | - Julie M Donohue
- Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA. .,Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A635, Pittsburgh, PA, 15261, USA.
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Meyers K, Wu Y, Brill A, Sandfort T, Golub SA. To switch or not to switch: Intentions to switch to injectable PrEP among gay and bisexual men with at least twelve months oral PrEP experience. PLoS One 2018; 13:e0200296. [PMID: 30024903 PMCID: PMC6053164 DOI: 10.1371/journal.pone.0200296] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/22/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Phase III trials of long-acting injectable (LAI) PrEP, currently underway, have great potential for expanding the menu of HIV prevention options. Imagining a future in which multiple PrEP modalities are available to potential users of biomedical HIV prevention, we investigated which factors might help direct a patient-physician shared-decision making process to optimize the choice of biomedical HIV prevention method. METHODS Participants (n = 105; ages 19-63; 46.7% men of color) were former participants in a PrEP demonstration project and had taken daily oral PrEP for ≥ 12 months. Participants were given information about LAI PrEP and asked whether they would be interested in switching from oral to LAI PrEP. Participants were also asked about specific pros/cons of LAI PrEP, PrEP attitudes and experiences, and personality factors. RESULTS Two-thirds (66.7%) of current oral PrEP users would switch to LAI PrEP. Intention to switch was associated with product-level and psychosocial factors. Attitudes towards logistical factors (i.e. getting to regular clinic visits for recurring shots) featured more prominently than factors related to the physical experience of PrEP modality (i.e., concerns about injection pain) as motivators for switching. In a multivariate regression model, psychosocial factors including the emotional burden of daily pill taking, deriving a sense of responsibility from PrEP use, and self-identifying as an early adopter, were the strongest predictors of switching. CONCLUSIONS These data underscore the importance of attending not only to product-level factors, but also to the logistical and psychological experience of prevention methods for users. Findings have significant implications for the development of patient education materials and patient-provider shared decision aids.
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Affiliation(s)
- Kathrine Meyers
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York, United States of America
| | - Yumeng Wu
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York, United States of America
| | - Atrina Brill
- Department of Psychology, Hunter College of the City University of New York, New York, New York, United States of America
| | - Theodorus Sandfort
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, United States of America
| | - Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, New York, United States of America
- Department of Psychology, the Graduate Center of the City University of New York, New York, New York, United States of America
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DEDEHAYIR OZGUR, ORTT ROLANDJ, RIVEROLA CARLA, MIRALLES FRANCESC. INNOVATORS AND EARLY ADOPTERS IN THE DIFFUSION OF INNOVATIONS: A LITERATURE REVIEW. INTERNATIONAL JOURNAL OF INNOVATION MANAGEMENT 2017. [DOI: 10.1142/s1363919617400102] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Despite accounting for a very small percentage of the population that adopts an innovation, the ‘innovators’ and ‘early adopters’ — representing the two earliest groups of individuals to acquire the new product or service — play a crucial role in the dissemination of the innovation to larger market segments. The objective of this paper is to understand the characteristics of these individuals that positively influence their decisions to adopt innovations. We argue that awareness of these traits will enable firms to attain speedier uptake of their offerings while aiding policymakers achieve quicker and wider proliferation of new technologies intended for societal benefit. We undertake a review of the literature studying the diffusion of innovations and show future directions that this framework should take to analyse the adoption lifecycle.
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Affiliation(s)
- OZGUR DEDEHAYIR
- Queensland University of Technology, 2 George Street, 4000 Brisbane, Australia
| | - ROLAND J. ORTT
- Delft University of Technology, Jaffalaan 5, 2628 BX Delft, The Netherlands
| | - CARLA RIVEROLA
- La Salle — Universitat Ramon Llull, Sant Joan la Salle 42, Barcelona 08022, Spain
| | - FRANCESC MIRALLES
- La Salle — Universitat Ramon Llull, Sant Joan la Salle 42, Barcelona 08022, Spain
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Lo-Ciganic WH, Gellad WF, Huskamp HA, Choudhry NK, Chang CCH, Zhang R, Jones BL, Guclu H, Richards-Shubik S, Donohue JM. Who Were the Early Adopters of Dabigatran?: An Application of Group-based Trajectory Models. Med Care 2016; 54:725-32. [PMID: 27116109 PMCID: PMC4907845 DOI: 10.1097/mlr.0000000000000549] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Variation in physician adoption of new medications is poorly understood. Traditional approaches (eg, measuring time to first prescription) may mask substantial heterogeneity in technology adoption. OBJECTIVE Apply group-based trajectory models to examine the physician adoption of dabigratran, a novel anticoagulant. METHODS A retrospective cohort study using prescribing data from IMS Xponent™ on all Pennsylvania physicians regularly prescribing anticoagulants (n=3911) and data on their characteristics from the American Medical Association Masterfile. We examined time to first dabigatran prescription and group-based trajectory models to identify adoption trajectories in the first 15 months. Factors associated with rapid adoption were examined using multivariate logistic regressions. OUTCOMES Trajectories of monthly share of oral anticoagulant prescriptions for dabigatran. RESULTS We identified 5 distinct adoption trajectories: 3.7% rapidly and extensively adopted dabigatran (adopting in ≤3 mo with 45% of prescriptions) and 13.4% were rapid and moderate adopters (≤3 mo with 20% share). Two groups accounting for 21.6% and 16.1% of physicians, respectively, were slower to adopt (6-10 mo post-introduction) and dabigatran accounted for <10% share. Nearly half (45.2%) of anticoagulant prescribers did not adopt dabigatran. Cardiologists were much more likely than primary care physicians to rapidly adopt [odds ratio (OR)=12.2; 95% confidence interval (CI), 9.27-16.1] as were younger prescribers (age 36-45 y: OR=1.49, 95% CI, 1.13-1.95; age 46-55: OR=1.34, 95% CI, 1.07-1.69 vs. >55 y). CONCLUSIONS Trajectories of physician adoption of dabigatran were highly variable with significant differences across specialties. Heterogeneity in physician adoption has potential implications for the cost and effectiveness of treatment.
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Affiliation(s)
- Wei-Hsuan Lo-Ciganic
- Department of Pharmacy, Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ 85719, USA
- Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Walid F. Gellad
- Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA
| | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
| | - Niteesh K. Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Chung-Chou H. Chang
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Ruoxin Zhang
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Bobby L. Jones
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Hasan Guclu
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Statistics Department, Istanbul Medeniyet University, Istanbul, Turkey 34700
| | - Seth Richards-Shubik
- Department of Economics, College of Business and Economics, Lehigh University, Bethlehem, PA 18015
| | - Julie M. Donohue
- Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Lublóy Á. Factors affecting the uptake of new medicines: a systematic literature review. BMC Health Serv Res 2014; 14:469. [PMID: 25331607 PMCID: PMC4283087 DOI: 10.1186/1472-6963-14-469] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 09/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The successful diffusion of new drugs is crucial for both pharmaceutical companies and patients-and of wider stakeholder concern, including for the funding of healthcare provision. Micro-level characteristics (the socio-demographic and professional characteristics of medical professionals), meso-level characteristics (the prescribing characteristics of doctors, the marketing efforts of pharmaceutical companies, interpersonal communication among doctors, drug attributes, and the characteristics of patients), and macro-level characteristics (government policies) all influence the diffusion of new drugs. This systematic literature review examines the micro- and meso-level characteristics of early prescribers of newly introduced drugs. Understanding the characteristics of early adopters may help to speed up the diffusion process, promote cost-efficient prescribing habits, forecast utilisation, and develop targeted intervention strategies. METHODS The PubMed and Scopus electronic databases were chosen for their extensive coverage of the pertinent literature and used to identify 205 potentially relevant studies by means of a four-layered search string. The 35 studies deemed eligible were then synthetized carefully and critically, to extract variables relevant to this review. RESULTS Early adoption of new drugs is not a personal trait, independent of drug type, but early adopters share both micro- and meso-level characteristics. At prescriber level, doctors' interest in particular therapeutic areas, participation in clinical trials, and volume of prescribing-either in total or within the therapeutic class of the new drug-increase the likelihood of early adoption. The marketing efforts of pharmaceutical companies and doctors' professional and social interactions leading to prescribing contagion are very powerful predictors of new drug uptake. At patient level, doctors with younger patients, patients with higher socioeconomic statuses and/or patients with poorer health statuses are more inclined to prescribe new drugs early. In contrast, the socio-demographic characteristics of prescribers and many practice-related factors play little role in the adoption process. CONCLUSIONS The most powerful predictors of new drug uptake include the doctors' strong scientific commitment, high prescribing volume in total or in within the therapeutic class of the new drug, high exposure to marketing, and intense communication with colleagues.
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Affiliation(s)
- Ágnes Lublóy
- Department of Finance, Institute of Finance and Accounting, Corvinus University of Budapest, Fővám tér 8, Budapest 1093, Hungary.
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Ferrajolo C, Arcoraci V, Sullo MG, Rafaniello C, Sportiello L, Ferrara R, Cannata A, Pagliaro C, Tari MG, Caputi AP, Rossi F, Trifirò G, Capuano A. Pattern of statin use in southern italian primary care: can prescription databases be used for monitoring long-term adherence to the treatment? PLoS One 2014; 9:e102146. [PMID: 25072244 PMCID: PMC4114740 DOI: 10.1371/journal.pone.0102146] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/16/2014] [Indexed: 12/14/2022] Open
Abstract
Objectives We sought to evaluate the prescribing pattern of statins according to national and regional health policy interventions and to assess specifically the adherence to the therapy in outpatient setting in Southern Italy. Methods A population-based study was performed on persons ≥15 years old, living in the catchment area of Caserta (Southern Italy), and registered in Arianna database between 2004 and 2010. Prevalence and incidence of new treatments with statins were calculated for each year and stratified by drug. Adherence to therapy was measured by Medication Possession Ratio. Sub-analyses by individual compound and type of cardiovascular prevention were performed. Results From 2004 to 2010, the one-year prevalence of statin use increased from 44.9/1,000 inhabitants to 79.8/1,000, respectively, consistently with the incidence of new use from 16.2/1,000 to 19.5/1,000, except a slight decrease after criteria reimbursement revision on 2005 (13.3/1,000). The incidence of new treatments decreased for atorvastatin, and increased for simvastatin over the study years. Overall, 43% of new users were still highly adherent to the treatment (MPR≥80%) after six months, while 26% after 4-years of follow-up. As compared with highly adherent patients, the probability to be non-adherent (MPR≤25%) at 4-years of follow-up was 26% higher for women than for men (full adj. odds ratio: 1.26; 95% CI: 1.10–1.45), and 64% higher in patients who started on primary rather than on secondary prevention (1.64; 1.29–2.07). Conclusions Prevalence and incidence of statin use increased consistently with health policy interventions. Only one-fourth of patients who newly initiated a statin were adherent to the treatment after 4-year of follow-up. Since the benefits of statins in terms of cardiovascular outcome and costs are associated with their chronic use, the identification of patient-related predictors of non-adherence such as gender, primary prevention could be suitable for physicians to improve the patients' compliance.
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Affiliation(s)
- Carmen Ferrajolo
- Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Experimental Medicine Department, Pharmacology Section, Second University of Naples, Naples, Italy
- Medical Informatics Department, Erasmus University Medical Centre, Rotterdam, Netherlands
- * E-mail:
| | - Vincenzo Arcoraci
- Clinical and Experimental Medicine Department, University of Messina, Messina, Italy
| | - Maria Giuseppa Sullo
- Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Experimental Medicine Department, Pharmacology Section, Second University of Naples, Naples, Italy
| | - Concetta Rafaniello
- Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Experimental Medicine Department, Pharmacology Section, Second University of Naples, Naples, Italy
| | - Liberata Sportiello
- Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Experimental Medicine Department, Pharmacology Section, Second University of Naples, Naples, Italy
| | - Rosarita Ferrara
- Clinical and Experimental Medicine Department, University of Messina, Messina, Italy
| | - Angelo Cannata
- Clinical and Experimental Medicine Department, University of Messina, Messina, Italy
| | | | | | | | - Francesco Rossi
- Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Experimental Medicine Department, Pharmacology Section, Second University of Naples, Naples, Italy
| | - Gianluca Trifirò
- Medical Informatics Department, Erasmus University Medical Centre, Rotterdam, Netherlands
- Clinical and Experimental Medicine Department, University of Messina, Messina, Italy
| | - Annalisa Capuano
- Campania Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Experimental Medicine Department, Pharmacology Section, Second University of Naples, Naples, Italy
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11
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Bourke J, Roper S. In with the new: the determinants of prescribing innovation by general practitioners in Ireland. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2012; 13:393-407. [PMID: 21503785 DOI: 10.1007/s10198-011-0311-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 03/25/2011] [Indexed: 05/30/2023]
Abstract
An important element of the process by which new drugs achieve widespread use is their adoption by GPs. In this paper, we explore the factors that shape the timing of the first prescription of six new drugs by General Practitioners in Ireland. Our analysis is based on a dataset that matches prescription data with data on GP characteristics. We then use duration analysis to explore both equilibrium and non-equilibrium determinants of prescribing innovation. Our study highlights a range of commonalities across all of the drugs considered and suggests the importance of GP and practice characteristics in shaping prescribing decisions. We also find strongly significant, and consistently signed, stock and order effects across these drugs: GPs who have a track record of early adoption tend also to be early adopters of other new drugs; and, the larger the proportion of GPs which have already adopted a new drug the slower is subsequent adoption. Epidemic and learning effects are also evident with slower adoption by rural practices and among those GPs with narrower prescribing portfolios.
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Affiliation(s)
- Jane Bourke
- Department of Economics, University College Cork, Cork, Ireland.
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Garjón FJ, Azparren A, Vergara I, Azaola B, Loayssa JR. Adoption of new drugs by physicians: a survival analysis. BMC Health Serv Res 2012; 12:56. [PMID: 22401169 PMCID: PMC3353238 DOI: 10.1186/1472-6963-12-56] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 03/08/2012] [Indexed: 11/10/2022] Open
Abstract
Background New drugs often substitute others cheaper and with a risk-benefit balance better established. Our aim was to analyse the diffusion of new drugs during the first months of use, examining the differences between family physicians and specialists. Methods Prescription data were obtained of cefditoren, duloxetine, etoricoxib, ezetimibe, levocetirizine, olmesartan, pregabalin and tiotropium 36 months after their launching. We obtained the monthly number of prescriptions per doctor and the number prescribers of each drug by specialty. After discarding those with less than 10 prescriptions during this period, physicians were defined as adopters if the number of prescriptions was over the 25th percentile for each drug and level (primary or secondary care). The diffusion of each drug was studied by determining the number of adopter family physicians throughout the study period. Among the group of adopters, we compared the month of the first prescription by family physicians to that of other specialists using the Kaplan-Meier method. Results The adoption of the drugs in primary care follows an exponential diffusion curve that reaches a plateau at month 6 to 23. Tiotropium was the most rapidly and widely adopted drug. Cefditoren spread at a slower rate and was the least adopted. The diffusion of etoricoxib was initially slowed down due to administrative requirements for its prescription. The median time of adoption in the case of family physicians was 4-6 months. For each of the drugs, physicians of a specialty other than family physicians adopted it first. Conclusions The number of adopters of a new drug increases quickly in the first months and reaches a plateau. The number of adopter family physicians varies considerably for different drugs. The adoption of new drugs is faster in specialists. The time of adoption should be considered to promote rational prescribing by providing timely information about new drugs and independent medical education.
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Affiliation(s)
- Francisco Javier Garjón
- Servicio Navarro de Salud, Servicio de Prestaciones Farmacéuticas, Plaza de la Paz s/n, E-31002 Pamplona, Spain.
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13
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Schmier JK, Covert DW, Robin AL. First-year treatment costs among new initiators of topical prostaglandin analog identified from November 2007 through April 2008. Curr Med Res Opin 2010; 26:2769-77. [PMID: 21043550 DOI: 10.1185/03007995.2010.531254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Ocular surface disease (OSD) is a common side effect of ophthalmic medications containing the preservative benzalkonium chloride (BAK). Little is known whether and how glaucoma treatment patterns and annual costs vary based on the presence of BAK. The objective of this analysis was to estimate first-year treatment costs among new initiators of topical prostaglandin analogs in a managed care population. RESEARCH DESIGN AND METHODS A model was developed to estimate first-year direct medical costs associated with glaucoma prescriptions and outpatient ophthalmic care. Patients were identified from a pharmacy claims database, covering more than 75 million individuals, if they initiated therapy with one of three prostaglandin analog products between November 1, 2007 and April 30, 2008. Patients needed to have at least 6 months of prior claims data in which there were no glaucoma therapy claims and at least 12 months of follow-up data available after the initial claim. Patients were excluded if they were not continuously eligible for pharmacy benefits throughout this 18-month period. Published studies were used to estimate outpatient visit-related health care resource use, and costs for prescription medications and health care resource use were derived from standard, published benchmarks. RESULTS The database analysis identified 9398 patients meeting study criteria, 45% (n = 4230) of whom remained on their initial prostaglandin therapy for 12 months after initiation. Adjunctive intraocular pressure lowering therapy was needed in 23.6%, 18.5%, and 13.3% of bimatoprost, latanoprost, and BAK-free travoprost patients, respectively. Median numbers of days to the first prescription filled for adjunctive therapy (if required) were 72.5, 74.0, and 125.0 for patients initiating on bimatoprost, latanoprost, and BAK-free travoprost. Total estimated first-year costs were $1973, $1807, and $1739 for patients initiating therapy with bimatoprost, latanoprost, and BAK-free travoprost. Findings were consistent through sensitivity analysis. CONCLUSIONS A BAK-free prostaglandin analog may permit longer duration of monotherapy and be associated with lower first-year direct treatment costs. Use of a claims database and the selection of new initiators of prostaglandin analogs limit projecting findings to all glaucoma patients.
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Murphy AL, Martin-Misener R, Cooke C, Sketris I. Administrative claims data analysis of nurse practitioner prescribing for older adults. J Adv Nurs 2010; 65:2077-87. [PMID: 19674174 DOI: 10.1111/j.1365-2648.2009.05069.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM This paper is a report of a study to identify the patterns of prescribing by primary health care nurse practitioners for a cohort of older adults. BACKGROUND The older adult population is known to receive complex pharmacotherapy. Monitoring prescribing to older adults can inform quality improvement initiatives. In comparison to other countries, research examining nurse practitioner prescribing in Canada is limited. Nurse practitioner prescribing for older adults is relatively unexplored in the international literature. Although commonly used to study physician prescribing, few studies have used claims data from drug insurance programmes to investigate nurse practitioner prescribing. METHOD Drug claims for prescriptions written by nurse practitioners from fiscal years 2004/05 to 2006/07 for beneficiaries of the Nova Scotia Seniors' Pharmacare programme were analysed. Data were retrieved and analysed in May 2008. Prescribing was described for each drug using the World Health Organization Anatomical Therapeutic Chemical code classification system by usage and costs for each fiscal year. RESULTS Antimicrobials and non-steroidal anti-inflammatory drugs consistently represented the top ranked groups for prescription volume and cost. Over the three fiscal years, antimicrobial prescription rates declined relative to rates of other groups of medications. Prescription volume per nurse doubled and cost per prescription increased by approximately 20%. CONCLUSION Prescription claims data can be used to characterize the prescribing trends of nurse practitioners. Research linking patient characteristics, including diagnoses, to prescriptions is needed to assess prescribing quality. Some potential areas of improvement were identified with antimicrobial and non-steroidal antiinflammatory selection.
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Affiliation(s)
- Andrea L Murphy
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
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15
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Carlzon D, Gustafsson L, Eriksson AL, Rignér K, Sundström A, Wallerstedt SM. Characteristics of primary health care units with focus on drug information from the pharmaceutical industry and adherence to prescribing objectives: a cross-sectional study. BMC CLINICAL PHARMACOLOGY 2010; 10:4. [PMID: 20156362 PMCID: PMC2831842 DOI: 10.1186/1472-6904-10-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 02/15/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adherence to prescribing guidelines varies between primary health care units. The aim of the present study was to investigate correlations between characteristics of primary health care units and adherence to prescribing objectives for rational drug use with focus on drug information from the pharmaceutical industry. METHODS A cross-sectional study was performed in all 25 primary health care units in Göteborg, Sweden. A questionnaire on characteristics of practice settings [(i) size of unit, (ii) profession of head, (iii) use of temporary physicians, (iv) drug information from the pharmaceutical industry, (v) producer-independent drug information, and (vi) education on prescribing for newly employed physicians] was sent to the heads of the units. A national sales register for prescribed drugs (Xplain) was used for evaluation of adherence to the six regional prescribing objectives concerning proton pump inhibitors (PPIs), angiotensin converting enzyme inhibitors (ACEIs), statins and antidepressants. RESULTS Twenty-two out of 25 primary health care units responded to the questionnaire (response rate 88%). A physician as head and presence of producer-independent drug information was positively correlated with adherence to the prescribing objectives (median number of prescribing objectives adhered to (25th - 75th percentile): 2.5 (1-3.25) vs 1 (0-2), P = 0.013; 2 (1-3) vs 0, P = 0.043, respectively. Presence of drug information from the pharmaceutical industry and education on prescribing for newly employed physicians was negatively associated with adherence to the prescribing objectives: 1 (0-2) vs 3.5 (2.25-4.75), P = 0.005; 1 (0-2) vs 3 (1.5-4), P = 0.034, respectively. CONCLUSION Several characteristics of the primary health care units correlated with adherence to prescribing objectives for rational drug use. Further research on this topic is needed and would constitute valuable information for health care decision makers.
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Affiliation(s)
- Daniel Carlzon
- Department of Clinical Pharmacology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
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16
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Groves KEM, Schellinck T, Sketris I, MacKinnon NJ. Identifying early prescribers of cycloxygenase-2 inhibitors (COX-2s) in Nova Scotia, Canada: Considerations for targeted academic detailing. Res Social Adm Pharm 2009; 6:257-67. [PMID: 20813338 DOI: 10.1016/j.sapharm.2009.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Expenditures on prescribed drugs in Canada are now well past those for all services provided by outpatient physicians ($26.9 billion vs. $21.5 billion in 2007). Government has the opportunity to dedicate resources to continuing medical education of physicians, and effective profiling would assist in the allocation of these educational resources. OBJECTIVE The purpose of this study was to evaluate physician prescribing patterns and establish criteria by which various prescribing profiles may be segmented and identified, so as to better target detailing and continuing medical education resources. METHODS A sample of 925 physicians practicing in Nova Scotia (NS) was characterized by age, sex, rural/urban nature of their practice and specialty. They were subsequently evaluated relative to all prescriptions filled by their patients who were beneficiaries of the NS Department of Health's senior's Pharmacare drug insurance program. The adoption of COX-2 inhibitors (eg, Vioxx) and Celebrex) and their substitution for NS-NSAIDs (non-specific non-steroidal anti-inflammatory drugs, eg, Motrin) from 1999 to 2003 were examined. RESULTS This analysis established the profiles of 2 key groups of physicians. The first consisted of those most likely to comprise the early, high volume COX-2-prescribing universe (profiles based on the absolute number of prescriptions written over a given period). These individuals were likely to be older, more experienced, male general practitioners operating in a rural practice. The second group consisted of those most likely to comprise the early, high-relative, COX-2-prescribing universe (prescribing of COX-2s relative to non-selective, non-steroidal anti-inflammatory drugs (NS-NSAIDs)). These individuals were likely to be younger, less experienced female general practitioners, operating in an urban practice. CONCLUSION This research moves us closer to identifying unique physician segments that account for either the largest volume of prescriptions for new drugs, or the largest relative volume of prescriptions. Use of these physician groups can help continuing medical education providers target specific prescribers with information to assist them in examining and improving their prescribing.
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Affiliation(s)
- Kent E M Groves
- College of Pharmacy, Dalhousie University, 5968 College St., Halifax NS B3H 3J5 Canada.
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Trifirò G, Alacqua M, Corrao S, Moretti S, Tari DU, Galdo M, Caputi AP, Arcoraci V. Lipid-lowering drug use in Italian primary care: effects of reimbursement criteria revision. Eur J Clin Pharmacol 2008; 64:619-25. [PMID: 18213473 DOI: 10.1007/s00228-007-0459-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Accepted: 12/27/2007] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess whether the prescribing pattern of lipid-lowering drugs (LLD) changed after reimbursement criteria revision in a general practice in southern Italy. METHODS From the Caserta-1 Local Health Service database, 93 general practitioners (GPs) who had consistently sent data about their patients during the years 2003-2005 were recruited. Prevalence of use and incidence of new treatments were calculated for each year, stratified by three drug cohorts: statins, omega-3 fatty acids, and fibrates. Subanalyses by gender, age, and indication of use were performed. RESULTS Overall, 1-year prevalence of LLD use increased from 2003 to 2004. After reimbursement criteria revision (November 2004), a slight decrease was observed for statins, from 41.1 (95% CI: 39.9-42.2) per 1,000 inhabitants in 2004 to 40.3 (39.2-41.5) in 2005, while omega-3 utilization fell markedly: 14.6 (13.9-15.3) vs. 5.4 (5.0-5.8). The use of both statins and omega-3 fatty acids was reduced particularly for primary prevention. On the other hand, utilization of statins increased in diabetic patients and as secondary prevention from 2004 to 2005. Concerning individual molecules, 1-year prevalence of use of any statin declined from 2004 to 2005, except for rosuvastatin. CONCLUSIONS Revision of reimbursement criteria led to significant changes in the trend in LLD use in general practice in southern Italy: (1) statin utilization was slightly reduced in 2005, although it increased in certain categories, such as diabetic patients, and (2) omega-3 fatty acid use was strongly reduced even though a higher use in postinfarction cases was reported.
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Affiliation(s)
- G Trifirò
- Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Via Consolare Valeria-Gazzi, 98125 Messina, Italy.
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Ohlsson H, Chaix B, Merlo J. Therapeutic traditions, patient socioeconomic characteristics and physicians' early new drug prescribing--a multilevel analysis of rosuvastatin prescription in south Sweden. Eur J Clin Pharmacol 2008; 65:141-50. [PMID: 18836707 DOI: 10.1007/s00228-008-0569-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the role that both patient and outpatient factors related to health care practice (HCP) play in physicians' early adoption of rosuvastatin. MATERIALS AND METHODS Generalized estimation equations (GEEs) and alternating logistic regression (ALR) with pair-wise odds ratios (PWORs) were used to measure similarities in rosuvastatin prescription within HCPs for all individuals with statin prescriptions in Skåne region, Sweden. RESULTS After 12 months, 53% of the HCPs had adopted the new statin. Rosuvastatin prescriptions co-occurred within certain HCPs 3.56 times more often than one would have expected based on a random distribution. Private HCPs had four times higher probability of prescribing rosuvastatin than public HCPs. CONCLUSION Contextual characteristics of the HCP seem to be relevant for understanding physicians' motivation to adopt rosuvastatin. Moreover, our study reveals inequity in health care as the socioeconomic status of the patients appears to influence the prescribing behavior of the physicians irrespective of medical reasons.
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Affiliation(s)
- Henrik Ohlsson
- Social Epidemiology, Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University, Malmö, Sweden.
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Layton D, Souverein PC, Heerdink ER, Shakir SAW, Egberts AGC. Prescriber adoption of newly approved selective COX-2 inhibitors. Pharmacoepidemiol Drug Saf 2008; 17:1168-74. [PMID: 18821717 DOI: 10.1002/pds.1667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION There is no consistent definition of prescribers who adopt new drug treatments early. This study examines if COX-2 inhibitors (coxibs) were prescribed by subsets of practitioners and describes GP adoption patterns of coxibs and existing NSAIDs over time. METHODS A population-based drug utilisation study using a Dutch medication claims database. Prescribers of patients (18+yrs) prescribed an NSAID January 1999-December 2003 were identified. Four NSAID categories were chosen reflecting selectivity (coxibs, preferential COX-2 inhibitors and non-selective (ns) NSAIDs (sub-categorised as first or second line treatment)). The characteristics of prescribers issuing>10 prescriptions examined were: Type (GP, Specialist, Other); GP NSAID prescribing preference ratio (nsNSAIDs/coxib first prescription); coxib (ratio<3); prescriber proportion responsible for 100%, 80% and 50% of initiations. Odds Ratios (95%CI) were calculated (first-line nsNSAIDs as reference). Plots of prescribing proportions by quarter year were examined. RESULTS NSAID cohorts comprised: first-line ns (N=38783); second-line ns (N=1459); COX-2 preferential (N=3107); coxib (N=4202) patients. For all four cohorts, GPs were the most common prescriber type (>67%); the most frequent prescribing preference was for first-line nsNSAIDs; 50% percentile prescribing proportions were low (<9%). GPs were equally as likely to prescribe coxibs as first-line nsNSAIDs [OR 1.0 (0.9, 1.1)]. Plots of 100% prescriber proportion for first-line nsNSAIDs and coxibs showed convergence; 50th percentile prescriber proportions plots were constant. CONCLUSIONS Small subsets of prescribers accounted for the majority of initiations regardless of NSAID type. Further studies are needed on such prescribers to inform healthcare policies and encourage participation in post-marketing safety studies.
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Affiliation(s)
- Deborah Layton
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, UK.
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Patient educational level and use of newly marketed drugs: a register-based study of over 600,000 older people. Eur J Clin Pharmacol 2008; 64:1215-22. [DOI: 10.1007/s00228-008-0549-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 07/21/2008] [Indexed: 12/24/2022]
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Alacqua M, Trifirò G, Cavagna L, Caporali R, Montecucco CM, Moretti S, Tari DU, Galdo M, Caputi AP, Arcoraci V. Prescribing pattern of drugs in the treatment of osteoarthritis in Italian general practice: the effect of rofecoxib withdrawal. ACTA ACUST UNITED AC 2008; 59:568-74. [PMID: 18383398 DOI: 10.1002/art.23526] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In October 2004, rofecoxib was removed from the world market because of an increased risk of myocardial infarction. The aim of the present study was to compare the trend of nonsteroidal antiinflammatory drug (NSAID) use and other analgesics in osteoarthritis (OA) treatment before and after rofecoxib withdrawal in Italian general practice. METHODS From the Caserta-1 Local Health Service database, 97 general practitioners were recruited. Prevalence and incidence of use of any study drug were calculated within 1 year before and after rofecoxib withdrawal. RESULTS One-year prevalence of nonselective and preferential NSAID use did not change after rofecoxib withdrawal, whereas coxib use fell from 4.4% (95% confidence interval [95% CI] 4.2-4.5%) in the period before rofecoxib withdrawal (period I) to 1.6% (95% CI 1.5-1.7%) in the period after withdrawal (period II). Weak opioids were used in no more than 0.4% (95% CI 0.3-0.5%) in period II, after their introduction to reimbursement in December 2004. Also, 1-year incidence of coxib decreased from 31.3 per 1,000 (95% CI 30.2-32.4%) in period I to 8.7 per 1,000 (95% CI 8.1-9.2%) in period II. The disappearance of rofecoxib was associated with replacement drugs such as newly marketed dexibuprofen and aceclofenac, whereas nimesulide use coincidentally decreased. CONCLUSION Rofecoxib withdrawal has markedly changed the prescribing pattern of drugs that are used in OA-related pain treatment, with a striking decrease of coxib use in Italian general practice. Education strategies addressed to health professionals should be planned to improve the management of pain treatment, particularly in degenerative joint diseases.
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