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Nagai K, Tanaka T, Kodaira N, Kimura S, Takahashi Y, Nakayama T. Data resource profile: JMDC claims database sourced from health insurance societies. J Gen Fam Med 2021; 22:118-127. [PMID: 33977008 PMCID: PMC8090843 DOI: 10.1002/jgf2.422] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/09/2023] Open
Abstract
JMDC, Inc. (JMDC) has created a database, using data collected from health insurance societies in Japan, consisting of ledgers of insureds, claims (for hospitalization, outpatient treatment, drug preparation, and dental treatment), and health checkup results. The earliest data are from the claims in January 2005, except dental claims from December 2009 and health checkup results from April 2008. Currently (the end of June 2020), the number of insureds included is approximately 9.8 million. This database is unique for Japan and has the following characteristics: (a) the basic population can be ascertained; (b) standardization is carried out using a dictionary; and (c) anonymized individual IDs can be followed on the basis of a time-series over various periods, with the earliest starting date being January 2005. However, it has certain limitations, in that the disease status and test results cannot be ascertained, and there is insufficient access to data for elderly people.
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Affiliation(s)
| | | | | | | | - Yoshimitsu Takahashi
- Department of Health InformaticsKyoto University School of Public HealthKyotoJapan
| | - Takeo Nakayama
- Department of Health InformaticsKyoto University School of Public HealthKyotoJapan
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Siddique YH, Rahul, Idrisi M, Shahid M. Effect of Cabergoline on Cognitive Impairments in Transgenic Drosophila Model of Parkinson’s Disease. LETT DRUG DES DISCOV 2020. [DOI: 10.2174/1570180817999200514100917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Parkinson’s disease is a common neurodegenerative disorder characterized
by selective loss of dopaminergic neurons in the substantia nigra pars compacta.
Introduction:
The effects of alpha synuclein, parkin mutation and pharmacological agents have
been studied in the Drosophila model.
Methods:
The effect of cabergoline was studied on the cognitive impairments exhibited by the
transgenic Drosophila expressing human alpha-synuclein in the neurons. The PD flies were allowed
to feed on the diet having 0.5, 1 and 1.5 μM of cabergoline.
Results and Discussion:
The exposure of cabergoline not only showed a dose-dependent significant
delay in the cognitive impairments but also prevented the loss of dopaminergic neurons. Molecular
docking studies showed the positive interaction between cabergoline and alpha-synuclein.
Conclusion:
The results suggest a protective effect of cabergoline against the cognitive impairments.
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Affiliation(s)
- Yasir Hasan Siddique
- Drosophila Transgenic Laboratory, Section of Genetics, Department of Zoology, Faculty of Life Sciences, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India
| | - Rahul
- Drosophila Transgenic Laboratory, Section of Genetics, Department of Zoology, Faculty of Life Sciences, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India
| | - Mantasha Idrisi
- Department of Chemistry, Aligarh Muslim University, Aligarh 202002, India
| | - Mohd. Shahid
- Department of Chemistry, Aligarh Muslim University, Aligarh 202002, India
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Seta T, Takahashi Y, Yamashita Y, Nakayama T. Status of use of protease inhibitors for the prevention and treatment of pancreatitis after endoscopic retrograde cholangiopancreatography: An epidemiologic analysis of the evidence-practice gap using a health insurance claims database. Drug Discov Ther 2020; 13:137-144. [PMID: 31327789 DOI: 10.5582/ddt.2019.01029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Existing evidence suggests that protease inhibitors (PIs) used to prevent or treat pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) are ineffective, and their use is not recommended by clinical practice guidelines. However, in Japan, PIs are administered with the aim to prevent or treat post-ERCP pancreatitis. This study aimed to clarify the gap between guideline recommendations and contents of practice. We used the health insurance claims database of Japan Medical Data Center. Among patients who had undergone ERCP, those with acute pancreatitis or post-ERCP pancreatitis recorded in claims as disease names were defined as post-ERCP pancreatitis patients. The study period was divided into three terms according to the date of publication of clinical practice guidelines for acute pancreatitis. Among 2,945 patients who had undergone ERCP, 2,847 were eligible for analysis. Of these, 1,375 (48.3%) patients had claims with pancreatitis recorded as the disease name; PIs were prescribed to 1,238 (90.0%). Rates of prescription of PIs were 72.3% in 2005-07, 70.9% in 2008-09, and 83.6% in 2010-15, showing a significant increase (p < 0.001). In conclusion, PIs are administered in clinical practice in Japan for the purpose of preventing or treating pancreatitis, with an increasing trend in prescription in recent years.
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Affiliation(s)
- Takeshi Seta
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center
| | | | - Yukitaka Yamashita
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health
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Horii T, Momo K, Yasu T, Kabeya Y, Atsuda K. Determination of factors affecting medication adherence in type 2 diabetes mellitus patients using a nationwide claim-based database in Japan. PLoS One 2019; 14:e0223431. [PMID: 31593574 PMCID: PMC6782087 DOI: 10.1371/journal.pone.0223431] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 09/20/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The extent of medication adherence in patients with type 2 diabetes mellitus (T2DM) several years after starting treatment with hypoglycemic agents remains unknown. Most previous work on medication adherence targeting this group of patients has been undertaken across a single year or is questionnaire based. This study aimed to determine medication adherence status and factors affecting adherence 3 years after initiation of hypoglycemic agents, using a nationwide medical claim-based database in Japan. METHODS This retrospective study was conducted on data from 884 subjects with T2DM to better understand medication adherence, the effects of polypharmacy, and other factors. We also investigated the effects of medication nonadherence on hemoglobin A1c levels. Proportion of days covered was defined as the number of days for which a hypoglycemic agent was prescribed and in the patient's possession to the number of days in the observation period. A proportion of days covered ≥0.8 were considered adherent, and those with a value <0.8 as nonadherence. Polypharmacy was defined as taking ≥5 medications. RESULTS Of the 884 patients investigated, 440 were considered adherent during the study period. Significant factors related to adherence included number of medications (3 or 4, or ≥5), male sex, age 50-<60 years, and total number of visits ≥17. Medication adherence was also a factor related to patients with hemoglobin A1c values < 7.0% at the end of the observation period. CONCLUSIONS We surveyed medication adherence for 3 years with post medication initiation, and found that subjects aged 50-<60 years, those with ≥3 concomitant medications, and those with a total number of visits ≥17 were more likely to be adherent and persistent, and more likely to continue their hypoglycemic agents. A high degree of medication adherence was found to have a positive influence on hemoglobin A1c levels.
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Affiliation(s)
- Takeshi Horii
- Research and Education Center for Clinical Pharmacy, Division of Clinical Pharmacy, Laboratory of Pharmacy Practice and Science 1, Kitasato University School of Pharmacy, Kanagawa, Japan
| | - Kenji Momo
- Department of Pharmacy, The Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Department of Hospital Pharmaceutics, School of pharmacy, Showa University, Tokyo, Japan
| | - Takeo Yasu
- Department of Medicinal Therapy Research, Pharmaceutical Education and Research Center, Meiji Pharmaceutical University, Tokyo, Japan
| | - Yusuke Kabeya
- Department of Home Care Medicine, Sowa Hospital, Kanagawa, Japan
| | - Koichiro Atsuda
- Research and Education Center for Clinical Pharmacy, Division of Clinical Pharmacy, Laboratory of Pharmacy Practice and Science 1, Kitasato University School of Pharmacy, Kanagawa, Japan
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Horii T, Iwasawa M, Kabeya Y, Atuda K. Polypharmacy and oral antidiabetic treatment for type 2 diabetes characterised by drug class and patient characteristics: A Japanese database analysis. Sci Rep 2019; 9:12992. [PMID: 31506542 PMCID: PMC6736933 DOI: 10.1038/s41598-019-49424-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/23/2019] [Indexed: 11/09/2022] Open
Abstract
Polypharmacy (PP) occurs in patients with type 2 diabetes (T2DM) owing to multimorbidity. We evaluated concomitant PP and medication adherence in T2DM 3 years after initiation of administration of a hypoglycaemic agent using a nationwide claim-based database in Japan. Factors associated with medication PP and imperfect adherence were identified using multivariable logistic regression. PP was defined as using ≥6 medications. Patients with proportion of days covered (PDC) of <80% were defined as having poor medication adherence. A total of 884 patients were analysed. Multivariate analysis revealed that age, total number of consultations and body mass index (BMI) are factors that influence PP. Factors associated with PDC < 80% were 2–3, 4–5 and ≥ 6 medications compared with 1 medication, male sex, <17 consultations and age 50–59 and ≥ 60 years compared with <40 years. In conclusion, older age, high total number of consultations and BMI ≥ 25 kg/m2 are risk factors for PP. PP influenced good medication adherence at the end of the observation period.
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Affiliation(s)
- Takeshi Horii
- Division of Clinical Pharmacy (Laboratory of Pharmacy Practice and Science I) and Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Sagamihara, Kanagawa, Japan.
| | - Makiko Iwasawa
- Division of Clinical Pharmacy (Laboratory of Drug Information) and Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Sagamihara, Kanagawa, Japan
| | - Yusuke Kabeya
- Sowa Hospital, Department of Home Care Medicine, Sagamihara, Kanagawa, Japan
| | - Koichiro Atuda
- Division of Clinical Pharmacy (Laboratory of Pharmacy Practice and Science I) and Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Sagamihara, Kanagawa, Japan
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Nakayama T, Imanaka Y, Okuno Y, Kato G, Kuroda T, Goto R, Tanaka S, Tamura H, Fukuhara S, Fukuma S, Muto M, Yanagita M, Yamamoto Y. Analysis of the evidence-practice gap to facilitate proper medical care for the elderly: investigation, using databases, of utilization measures for National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). Environ Health Prev Med 2017; 22:51. [PMID: 29165139 PMCID: PMC5664421 DOI: 10.1186/s12199-017-0644-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 02/01/2017] [Indexed: 11/19/2022] Open
Abstract
As Japan becomes a super-aging society, presentation of the best ways to provide medical care for the elderly, and the direction of that care, are important national issues. Elderly people have multi-morbidity with numerous medical conditions and use many medical resources for complex treatment patterns. This increases the likelihood of inappropriate medical practices and an evidence-practice gap. The present study aimed to: derive findings that are applicable to policy from an elucidation of the actual state of medical care for the elderly; establish a foundation for the utilization of National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), and present measures for the utilization of existing databases in parallel with NDB validation. Cross-sectional and retrospective cohort studies were conducted using the NDB built by the Ministry of Health, Labor and Welfare of Japan, private health insurance claims databases, and the Kyoto University Hospital database (including related hospitals). Medical practices (drug prescription, interventional procedures, testing) related to four issues—potential inappropriate medication, cancer therapy, chronic kidney disease treatment, and end-of-life care—will be described. The relationships between these issues and clinical outcomes (death, initiation of dialysis and other adverse events) will be evaluated, if possible.
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Affiliation(s)
- Takeo Nakayama
- Department of Health Informatics, Kyoto University, School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yasushi Okuno
- Department of Biomedical Data Intelligence, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Genta Kato
- Solutions Center for Health Insurance Claims, Kyoto University Hospital, Kyoto, Japan
| | - Tomohiro Kuroda
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Rei Goto
- Graduate School of Business Administration, Keio University, Yokohama, Japan.,Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shiro Tanaka
- Faculty of Economics, Kyoto University, Kyoto, Japan
| | - Hiroshi Tamura
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Shunichi Fukuhara
- Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shingo Fukuma
- Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Manabu Muto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motoko Yanagita
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Yamamoto
- Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Dong J, Cui Y, Li S, Le W. Current Pharmaceutical Treatments and Alternative Therapies of Parkinson's Disease. Curr Neuropharmacol 2016; 14:339-55. [PMID: 26585523 PMCID: PMC4876590 DOI: 10.2174/1570159x14666151120123025] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/16/2015] [Accepted: 10/09/2015] [Indexed: 01/01/2023] Open
Abstract
Over the decades, pharmaceutical treatments, particularly dopaminergic (DAergic) drugs have been considered as the main therapy against motor symptoms of Parkinson's disease (PD). It is proposed that DAergic drugs in combination with other medications, such as monoamine oxidase type B inhibitors, catechol-O-methyl transferase inhibitors, anticholinergics and other newly developed non-DAergic drugs can make a better control of motor symptoms or alleviate levodopa-induced motor complications. Moreover, non-motor symptoms of PD, such as cognitive, neuropsychiatric, sleep, autonomic and sensory disturbances caused by intrinsic PD pathology or drug-induced side effects, are gaining increasing attention and urgently need to be taken care of due to their impact on quality of life. Currently, neuroprotective therapies have been investigated extensively in pre-clinical studies, and some of them have been subjected to clinical trials. Furthermore, non-pharmaceutical treatments, including deep brain stimulation (DBS), gene therapy, cell replacement therapy and some complementary managements, such as Tai chi, Yoga, traditional herbs and molecular targeted therapies have also been considered as effective alternative therapies to classical pharmaceutics. This review will provide us updated information regarding the current drugs and non-drugs therapies for PD.
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Affiliation(s)
| | | | | | - Weidong Le
- Neurology and Director of Center for Translational Research of Neurological Diseases, 1st Affiliated Hospital, Dalian Medical University, Dalian 116021, Liaoning Province, China.
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Goto A, Goto M, Terauchi Y, Yamaguchi N, Noda M. Association Between Severe Hypoglycemia and Cardiovascular Disease Risk in Japanese Patients With Type 2 Diabetes. J Am Heart Assoc 2016; 5:e002875. [PMID: 26961698 PMCID: PMC4943262 DOI: 10.1161/jaha.115.002875] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background It remains unclear whether severe hypoglycemia is associated with cardiovascular disease (CVD) in Asian populations with type 2 diabetes (T2D). Furthermore, no study in Japan, where the prescription patterns differ from those in other countries, has examined this association. Methods and Results We retrospectively included 58 223 patients (18–74 years old) with T2D. First, we examined the potential predictors of severe hypoglycemia. Then, we investigated the association between severe hypoglycemia and CVD risk. Finally, we performed an updated systematic review and meta‐analysis to incorporate our findings and recently published studies into the previous systematic review and meta‐analysis. During 134 597 person‐years from cumulative observation periods, 128 persons experienced severe hypoglycemia and 550 developed CVD events. In a multivariate Cox proportional hazard model, severe hypoglycemia was strongly and positively associated with the risk of CVD (multivariate‐adjusted adjusted hazard ratio, 3.39; 95% CI, 1.25–9.18). In a propensity score–matched cohort that had similar baseline characteristics for patients with severe hypoglycemia and those without, severe hypoglycemia was more strongly associated with the risk of CVD. An updated systematic review and meta‐analysis that included 10 studies found that severe hypoglycemia was associated with an ≈2‐fold increased risk of CVD (pooled relative risk, 1.91; 95% CI, 1.69–2.15). Conclusions Our results suggest that severe hypoglycemia is strongly associated with an increased risk of CVD in Japanese patients with T2D, further supporting the notion that avoiding severe hypoglycemia may be important in preventing CVD in this patient population.
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Affiliation(s)
- Atsushi Goto
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Maki Goto
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Naohito Yamaguchi
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Mitsuhiko Noda
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan
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Ohisa M, Kimura Y, Matsuo J, Akita T, Sato T, Matsuoka T, Sakamune K, Katayama K, Huy Do S, Miyakawa Y, Tanaka J. Estimated numbers of patients with liver disease related to hepatitis B or C virus infection based on the database reconstructed from medical claims from 2008 to 2010 in Japan. Hepatol Res 2015; 45:1228-40. [PMID: 25627814 DOI: 10.1111/hepr.12497] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 01/01/2015] [Accepted: 01/20/2015] [Indexed: 12/20/2022]
Abstract
AIM To estimate the number of patients with liver-related diseases classified by hepatitis viruses (HBV, HCV) based on the information from re-coded medical claims including several diagnosed diseases. METHODS We analyzed reimbursement data provided by health insurance societies for 2.1 million individuals during 2008-2010. Database information of employees and their families aged under 65 years employees with hepatitis-related disease was extracted, the 1-year period prevalence was calculated, and then number of patients with liver disease related to HBV and HCV by sex and age groups, respectively, was estimated. RESULTS The estimated number of patients were almost equivalent during 2008-2010. As for HBV and HCV, the estimated numbers of patients with chronic hepatitis (CH) in a year ranged 192 641-226 601 and 282 438-306 877, respectively. CONCLUSION In the 2008 Patient Survey in Japan, the number of patients was estimated by the main disease in one patient, even though the patient was diagnosed with several diseases. Based on the database with hepatitis-related diseases after evaluating several diagnosed diseases from medical claims, the estimation method and protocol may minimize the disadvantage of medical claim analysis, and is useful for patients, especially asymptomatic carriers and those with CH which had been underestimated in the 2008 Patient Survey.
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Affiliation(s)
- Masayuki Ohisa
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuki Kimura
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Junko Matsuo
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoki Sato
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshihiko Matsuoka
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuaki Sakamune
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keiko Katayama
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Son Huy Do
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Effectiveness of risk minimization measures for cabergoline-induced cardiac valve fibrosis in clinical practice in Italy. J Neural Transm (Vienna) 2014; 122:799-808. [DOI: 10.1007/s00702-014-1314-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
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Prescribing pattern of anti-Parkinson drugs in Japan: a trend analysis from 2005 to 2010. PLoS One 2014; 9:e99021. [PMID: 24906013 PMCID: PMC4048287 DOI: 10.1371/journal.pone.0099021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/09/2014] [Indexed: 11/29/2022] Open
Abstract
Objective Therapeutic options for Parkinson's disease mainly consist of L-dopa and dopamine agonists. However, in Japan, the product labeling of the ergot dopamine agonists, cabergoline and pergolide, was revised in April 2007 due to the risk of developing cardiac valvulopathy. Here, we describe the prescribing trends of anti-Parkinson drugs from 2005 through 2010 in Japan, and examined whether these trends changed after the drug safety measures in 2007. Methods and Patients We used medical claim data from January 2005 to December 2010 for Parkinson's disease patients older than 30 years who were prescribed anti-Parkinson drugs. We calculated the proportion of patients prescribed each drug for each year, and compared the proportions of first-line drugs prescribed before and after April 2007. We also examined the prescription variations of cabergoline/pergolide users one year before or after April 2007. Results L-dopa was the most frequently prescribed drug for Parkinson's disease (2005, 58%; 2010, 51%). The proportion of patients prescribed ergot dopamine agonists markedly decreased and non-ergot dopamine agonists increased after 2007. Among first-line drugs, the proportion of non-ergot agents increased after April 2007. Among 54 cabergoline/pergolide users, 24 (44%) discontinued these drugs, nine of whom switched to non-ergot agents. Conclusion L-dopa was the mainstay of Parkinson's disease treatment between 2005 and 2010 in Japan. There was a decrease in ergot agents and an increase in non-ergot agents prescribed after the regulatory actions in 2007.
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Nakayama T. [Expects for academic detailing from the standpoints of evidence-based medicine (EBM)]. YAKUGAKU ZASSHI 2014; 134:367-70. [PMID: 24584016 DOI: 10.1248/yakushi.13-00235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Academic detailing, interactive information services by pharmacists for clinicians, has been getting interests in the US and European countries. A systematic review of randomized controlled trials supported the effectiveness of academic detailing. Knowledge of evidence-based medicine and clinical practice guidelines is one of the essential bases for pharmacists to promote these activities. In addition, pharmacists need to understand attitudes and ways of thinking of clinicians toward medicines. Through communications and information sharing between clinicians and pharmacists, collaborations to modify and improve the use of medicines should be facilitated. On these grounds, academic detailing will be able to play an important role in real healthcare circumstances.
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Affiliation(s)
- Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health
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13
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Wada M, Nakayama T, Ishizaki T, Satoh T, Ikeda S. Practice patterns for lower respiratory tract infections in hospital patients with particular focus on bacteriological examinations and injection antibiotics use. Int J Gen Med 2013; 6:597-604. [PMID: 23898230 PMCID: PMC3718841 DOI: 10.2147/ijgm.s44190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Various types of medical institutions perform treatments for lower respiratory tract infections. However, few studies have assessed and compared practice patterns across different medical institutions in Japan. To assess practice patterns for community-acquired lower respiratory tract infections among patients who needed hospitalization, we examined the use of injection antibiotics and the implementation of bacteriological examinations, and compared these across medical institutions. We then evaluated whether bacteriological examinations were being adequately implemented. METHODS A cross-sectional study was conducted using a database of health insurance claims. Subjects were patients (≥16 years old) who received injection antibiotics to treat lower respiratory tract infections, and who were listed among 2004-2007 insurance claims data. For each type of antibiotic, we obtained the dose prescribed, the number of patients treated, and the frequency of bacteriological examinations. RESULTS A total of 1649 patients were evaluated. The implementation rate of Gram stain and sputum culture was 14% at clinics (<20 beds), approximately 30% at small hospitals (20-99 beds), and 40%-45% at medium-sized (100-499 beds) and large hospitals (≥500 beds). As a whole, beta-lactams were most frequently used, accounting for 80% of all antibiotics used. Among beta-lactams, penicillins comprised 25% of the total amount of drugs used at hospitals with ≥300 beds, but approximately 13% at clinics and small hospitals. CONCLUSION Practice patterns varied depending on the size of the medical institution. The implementation rate of bacteriological examinations was not high enough, especially at clinics and small hospitals.
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Affiliation(s)
- Mikio Wada
- General Internal Medicine, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | | | - Toshihiko Satoh
- School of Social Informatics, Aoyama Gakuin University, Sagamihara, Kanagawa, Japan
| | - Shunya Ikeda
- Department of Pharmaceutical Sciences, School of Pharmacy, International University of Health and Welfare, Ohtawara, Tochigi, Japan
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Estimates of the prevalence of and current treatment practices for rheumatoid arthritis in Japan using reimbursement data from health insurance societies and the IORRA cohort (I). Mod Rheumatol 2013. [DOI: 10.1007/s10165-013-0863-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nakayama T. [Approaching the "evidence-practice gap" in pharmaceutical risk management: analysis of healthcare claim data]. YAKUGAKU ZASSHI 2013; 132:549-54. [PMID: 22687689 DOI: 10.1248/yakushi.132.549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The concept of evidence-based medicine (EBM) has promulgated among healthcare professionals in recent years, on the other hand, the problem of underuse of useful clinical evidence is coming to be important. This is called as evidence-practice gap. The major concern about evidence-practice gap is insufficient implementation of evidence-based effective treatment, however, the perspective can be extended to measures to improve drug safety and prevention of drug related adverse events. First, this article reviews the characteristics of the database of receipt (healthcare claims) and the usefulness for research purpose of pharmacoepidemiology. Second, as the real example of the study on evidence-practice gap by using the receipt database, the case of ergot-derived anti-Parkinson drugs, of which risk of valvulopathy has been identified, is introduced. The receipt analysis showed that more than 70% of Parkinson's disease patients prescribed with cabergoline or pergolide did not undergo echocardiography despite the revision of the product label recommendation. Afterwards, the issues of pharmaceutical risk management and risk communication will be discussed.
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Affiliation(s)
- Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Japan.
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Quantitative Evaluation of Compliance with Recommendation for Sulfonylurea Dose Co-Administered with DPP-4 Inhibitors in Japan. Pharmaceutics 2012; 4:479-93. [PMID: 24300302 PMCID: PMC3834918 DOI: 10.3390/pharmaceutics4030479] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/08/2012] [Accepted: 08/30/2012] [Indexed: 01/29/2023] Open
Abstract
After the launch of dipeptidyl peptidase-4 (DPP-4), a new oral hypoglycemic drug (OHD), in December 2009, severe hypoglycemia cases were reported in Japan. Although the definite cause was unknown, co-administration with sulfonylureas (SU) was suspected as one of the potential risk factors. The Japan Association for Diabetes Education and Care (JADEC) released a recommendation in April 2010 to lower the dose of three major SUs (glimepiride, glibenclamide, and gliclazide) when adding a DPP-4 inhibitor. To evaluate the effectiveness of this risk minimization action along with labeling changes, dispensing records for 114,263 patients prescribed OHDs between December 2008 and December 2010 were identified in the Nihon-Chouzai pharmacy claims database. The adherence to the recommended dosing of SU co-prescribed with DPP-4 inhibitors increased from 46.3% before to 63.8% after the JADEC recommendation (p < 0.01 by time-series analysis), while no change was found in those for SU monotherapy and SU with other OHD co-prescriptions. The adherence was significantly worse for those receiving a glibenclamide prescription. The JADEC recommendation, along with labeling changes, appeared to have a favorable effect on the risk minimization action in Japan. In these instances, a pharmacy claims database can be a useful tool to evaluate risk minimization actions.
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