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Li X, Zeng Z, Fan X, Wang W, Luo X, Yang J, Chang Y. Trends and Patterns of Systemic Glucocorticoid Prescription in Primary Care Institutions in Southwest China, from 2018 to 2021. Risk Manag Healthc Policy 2023; 16:2849-2868. [PMID: 38146314 PMCID: PMC10749547 DOI: 10.2147/rmhp.s436747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/02/2023] [Indexed: 12/27/2023] Open
Abstract
Purpose The purpose of this study was to investigate the prescribing patterns and usage trends of systemic glucocorticoids in primary care institutions located in Southwest China from 2018 to 2021. Materials and Methods A retrospective cross-sectional analysis of systemic glucocorticoids prescriptions was conducted in 32 primary care institutions located in Southwest China between 2018 and 2021. Prescriptions of systemic glucocorticoids were classified as appropriate or inappropriate use. Inappropriate use was further classified into (1) inappropriate indications and (2) inappropriate selection of glucocorticoids. Generalized estimation equations were employed to investigate the factors associated with inappropriate utilization of systemic glucocorticoids. The seasonal autoregressive integrated moving average (SARIMA) model was employed to predict the rate of inappropriate glucocorticoids prescriptions. Results A total of 203,846 (92.89%) prescriptions were included, both the number of systemic glucocorticoids prescriptions and inappropriate prescriptions increased in winter. Diseases of the respiratory system (68.90%) were the most frequent targets of systemic glucocorticoids use. Of all prescriptions, 73.18% exhibited inappropriate indications, while 0.05% demonstrated inappropriate selection. The utilization of systemic glucocorticoids was deemed inappropriate for diseases of the respiratory system (94.19%), followed by diseases of the digestive system (87.75%). Physicians, who were female or younger than 33 years old, possess lower levels of education and professional titles and exhibit a higher likelihood of inappropriately prescribing systemic glucocorticoids. The phenomenon of inappropriate glucocorticoids use was commoner among male patients aged 65 years and older. After conducting model verification, it was determined that the SARIMA model could be used to predict the monthly rate of inappropriate systemic glucocorticoids prescriptions in primary care institutions in southwest China. Conclusion The inappropriate use of systemic glucocorticoids remains a significant concern in primary care institutions. In this regard, continuing education and professional knowledge training of physicians should be strengthened in the future.
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Affiliation(s)
- Xiaoyi Li
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Zhen Zeng
- Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou Province, People’s Republic of China
| | - Xingying Fan
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Wenju Wang
- School of Public Health, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Xiaobo Luo
- School of Public Health, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Junli Yang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Yue Chang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
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Rickey L, Auger K, Britto MT, Rodgers I, Field S, Odom A, Lehr M, Cronin A, Walsh KE. Measurement of Ambulatory Medication Errors in Children: A Scoping Review. Pediatrics 2023; 152:e2023061281. [PMID: 37986581 DOI: 10.1542/peds.2023-061281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children use most medications in the ambulatory setting where errors are infrequently intercepted. There is currently no established measure set for ambulatory pediatric medication errors. We have sought to identify the range of existing measures of ambulatory pediatric medication errors, describe the data sources for error measurement, and describe their reliability. METHODS We performed a scoping review of the literature published since 1986 using PubMed, CINAHL, PsycINFO, Web of Science, Embase, and Cochrane and of grey literature. Studies were included if they measured ambulatory, including home, medication errors in children 0 to 26 years. Measures were grouped by phase of the medication use pathway and thematically by measure type. RESULTS We included 138 published studies and 4 studies from the grey literature and identified 21 measures of medication errors along the medication use pathway. Most measures addressed errors in medication prescribing (n = 6), and administration at home (n = 4), often using prescription-level data and observation, respectively. Measures assessing errors at multiple phases of the medication use pathway (n = 3) frequently used error reporting databases and prospective measurement through direct in-home observation. We identified few measures of dispensing and monitoring errors. Only 31 studies used measurement methods that included an assessment of reliability. CONCLUSIONS Although most available, reliable measures are too resource and time-intensive to assess errors at the health system or population level, we were able to identify some measures that may be adopted for continuous measurement and quality improvement.
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Affiliation(s)
- Lisa Rickey
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Katherine Auger
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maria T Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Isabelle Rodgers
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Shayna Field
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Alayna Odom
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Madison Lehr
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Kathleen E Walsh
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Luo X, Yu S, Zeng Z, Zhou X, Liu Y, Wang L, Hu J, Chang Y. Systemic glucocorticoid prescriptions pattern and factors of inappropriate use in primary care institutions of Southwest China. Front Public Health 2022; 10:952098. [PMID: 36172212 PMCID: PMC9510701 DOI: 10.3389/fpubh.2022.952098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/24/2022] [Indexed: 01/24/2023] Open
Abstract
Background Inappropriate use of glucocorticoids in primary care institutions is serious. It not only causes economic burden, but leads to many adverse reactions. The purpose of this study is to explore systemic glucocorticoid prescription pattern and factors of inappropriate use in primary care institutions. Methods This is a retrospective study. Systemic glucocorticoids prescribed in 58 primary care institutions in Guizhou province of Southwest China in 2020 were selected from the Health Information System. All prescriptions were classified as appropriate or inappropriate use. Inappropriate use was classified into the following two categories: (a) Inappropriate indications; (b) Inappropriate selection of glucocorticoids. Multivariate analysis was used to explore the factors associated with inappropriate use of systemic glucocorticoids. Results A total of 63,315 glucocorticoid prescriptions were included in the analysis. Diseases of the respiratory system (60.8%) and diseases of the skin and subcutaneous tissue (23.1%) were the most common indications for use. Injections (89.8%) predominated and dexamethasone (86.5%) was the most prescribed glucocorticoid. 68.2% of all prescriptions were inappropriate. Compared to physicians with a college degree, physicians with a junior college (OR: 1.12, 95% CI: 1.08-1.17) and technical secondary education (OR: 1.12, 95% CI:1.05-1.19) were more likely to prescribe glucocorticoids inappropriately as were attending physicians (OR: 1.12, 95% CI: 1.01-1.25) and resident physicians (OR: 1.31, 95% CI: 1.15-1.48) compared to associate chief physicians. The risk of inappropriate glucocorticoid use was highest in patients 65 years of age and older (OR: 6.00, 95% CI: 5.62-6.40). In contrast, prescriptions given by injection were more likely to be used inappropriately than those given orally (OR: 0.44, 95% CI: 0.41-0.46). Conclusion Inappropriate use of systemic glucocorticoids without appropriate indications was extremely prominent in primary care institutions of Guizhou Province, especially in diseases of the respiratory system and among the elderly. The risk of inappropriate glucocorticoid use was highest in patients 65 years of age and older. It is important to note that physicians younger than 33, with more than 40 years of service, and attending or residents were more likely to inappropriately prescribe glucocorticoids.
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Affiliation(s)
- Xiaobo Luo
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Shitao Yu
- Guiyang Public Health Clinical Center, Guiyang, China
| | - Zhen Zeng
- Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Xunrong Zhou
- Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China,Xunrong Zhou
| | - Yuxi Liu
- School of Humanities and Management, Institute for Health Law and Policy, Guangdong Medical University, Dongguan, China,Yuxi Liu
| | - Lei Wang
- Primary Health Department of Guizhou Provincial Health Commission, Guiyang, China
| | - Jiaqi Hu
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
| | - Yue Chang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China,*Correspondence: Yue Chang
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Yang Q, Yuan F, Li L, Jin J, He J. Effects of monthly evaluations on the rates of irrational antimicrobial prescription in the outpatient and emergency departments at Ningbo No. 6 Hospital, Ningbo, China. Eur J Med Res 2022; 27:98. [PMID: 35733215 PMCID: PMC9214680 DOI: 10.1186/s40001-022-00728-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a major global public health problem. The primary cause of antibiotic resistance is inappropriate antibiotic use. In this study, we aimed to verify whether the monthly evaluation of antibiotic prescription improves clinical antibiotic use in outpatient and emergency departments. METHODS A minimum of 25% of the prescriptions for antibacterial drugs were randomly selected at the outpatient and emergency departments to enter the monthly evaluation system from July 2016 to June 2019. We analysed the rate of irrational prescription of antibiotics, proportion of the use of antibiotics, and consistency between the evaluation and expert groups after implementing the monthly assessment to validate the role of monthly evaluations. RESULTS After 3 years of monthly evaluations of antibiotic prescriptions, the utilisation rate of single antibiotics in the outpatient and emergency departments was found to increase each year. Each year, a decreasing trend was observed for the irrational use of antibiotics, whereas the proportion of antibiotics to the total drugs prescribed gradually decreased in the same period. In addition, the consistency of prescription evaluation results between the evaluation and expert groups increased continuously. CONCLUSIONS Monthly evaluation of antibiotic prescriptions is an effective management tool for the rational use of antibiotics in clinical practice. This practice could help reduce the combinative use of antibiotics, rate of irrational antibiotic prescription, and antibiotic use ratio, and play an important role in safe clinical drug use.
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Affiliation(s)
- Qiong Yang
- Department of Pharmacy, Ningbo No. 6 Hospital, Ningbo, China
| | - Fangfang Yuan
- Department of Rheumatism and Immunology, Ningbo No. 6 Hospital, Ningbo, China
| | - Li Li
- Department of Pharmacy, Ningbo No. 6 Hospital, Ningbo, China
| | - Jianfeng Jin
- Department of Pharmacy, Ningbo No. 6 Hospital, Ningbo, China
| | - Junhong He
- Department of Pharmacy, Ningbo No. 6 Hospital, Ningbo, China.
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Han JY, Yang EA, Rhim JW, Han SB. Effects of Antiviral Therapy and Glucocorticoid Therapy on Fever Duration in Pediatric Patients with Influenza. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121385. [PMID: 34946330 PMCID: PMC8707365 DOI: 10.3390/medicina57121385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 01/20/2023]
Abstract
Background and Objectives: Considering developing resistance against neuraminidase inhibitors (NAIs) and their adverse reactions, restricted use of NAIs and use of alternative drugs should be considered for treating influenza. Although glucocorticoids (GCs) have been used for severe influenza, their effects on non-severe influenza have rarely been evaluated. This study aimed to evaluate the clinical responses to NAI therapy and GC therapy in pediatric patients with non-severe influenza. Materials and Methods: A total of 601 pediatric patients (<19 years of age) diagnosed with non-severe influenza were retrospectively recruited to evaluate the effects of NAI therapy and GC therapy. Post-admission fever duration and hospitalization duration were compared among four patient groups divided by the administered treatment: No therapy (n = 52), NAI therapy (n = 154), GC therapy (n = 123), and Both therapies (n = 272). Results: In a multivariate analysis with adjustment for confounding variables, the post-admission fever duration was not significantly different among the four patient groups. The post-admission fever duration tended to shorten with increasing age, longer pre-admission fever duration, and incidence of influenza A virus infection and lower respiratory tract infection. The type of administered treatment showed no significant effects on the post-admission fever duration in any subgroups according to patient age, pre-admission fever duration, influenza virus subtype, and clinical diagnosis. Conclusions: Symptomatic treatment rather than antiviral or GC therapy seems to be sufficient for patients with non-severe influenza, although the effects of NAI therapy and GC therapy according to their administered time and dose should be further evaluated.
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Affiliation(s)
- Ji Yoon Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.Y.H.); (E.A.Y.); (J.-W.R.)
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
| | - Eun Ae Yang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.Y.H.); (E.A.Y.); (J.-W.R.)
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
| | - Jung-Woo Rhim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.Y.H.); (E.A.Y.); (J.-W.R.)
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
| | - Seung Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.Y.H.); (E.A.Y.); (J.-W.R.)
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
- Correspondence: ; Tel.: +82-42-220-9218
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