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Noor MN, Abbasi HS, van Der Mark N, Azizullah Z, Linton J, Rahman-Shepherd A, Siddiqui AR, Khan MS, Hasan R, Shakoor S. Healthcare consumers' perceptions of incentive-linked prescribing: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003026. [PMID: 38935777 PMCID: PMC11210849 DOI: 10.1371/journal.pgph.0003026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/20/2024] [Indexed: 06/29/2024]
Abstract
Incentive-linked prescribing (ILP) is considered a controversial practice universally. If incentivised, physicians may prioritise meeting pharmaceutical sales targets through prescriptions, rather than considering patients' health and wellbeing. Despite the potential harms of ILP to patients and important stakeholders in the healthcare system, healthcare consumers (HCCs) which include patients and the general public often have far less awareness about the practice of pharmaceutical incentivisation of physicians. We conducted a scoping review to explore what existing research says about HCCs' perceptions of the financial relationship between physicians and pharmaceutical companies. To conduct this scoping review, we followed Arksey and O'Malley's five-stage framework: identifying research questions, identifying relevant studies, selecting eligible studies, data charting, and collating, summarising, and reporting results. We also used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses' extension for scoping reviews (PRISMA-ScR), as a guide to organise the information in this review. Quantitative and qualitative studies with patients and the general public, published in the English language were identified through searches of Scopus, Medline (OVID), EMBASE (OVID), and Google Scholar. Three themes emerged through the analysis of the 13 eligible studies: understanding of incentivisation, perceptions of hazards linked to ILP, and HCCs' suggestions to address it. We found documentation that HCCs exhibited a range of knowledge from good to insufficient about the pharmaceutical incentivisation of physicians. HCCs perceived several hazards linked to ILP such as a lack of trust in physicians and the healthcare system, the prescribing of unnecessary medications, and the negative effect on physicians' reputations in society. In addition to strong regulatory controls, it is critical that physicians self-regulate their behaviour, and publicly disclose if they have any financial ties with pharmaceutical companies. Doing so can contribute to trust between patients and physicians, an important part of patient-focused care and a contributor to user confidence in the wider health system.
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Affiliation(s)
- Muhammad Naveed Noor
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Haider Safdar Abbasi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Nina van Der Mark
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zahida Azizullah
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Janice Linton
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Afifah Rahman-Shepherd
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Mishal Sameer Khan
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rumina Hasan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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James CA, Dorsch MP, Piette JD, Nallamothu BK. Prescribing Mobile Health Applications. Circ Cardiovasc Qual Outcomes 2024; 17:e010654. [PMID: 38525595 PMCID: PMC11187676 DOI: 10.1161/circoutcomes.123.010654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Cornelius A. James
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Michael P. Dorsch
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI 48109
| | - John D. Piette
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109
- Department of Health Behavior and Health Education, University of Michigan, MI 48109
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Prawiroharjo P, Anggraini H, Geraldi IP, Octaviana F, Budikayanti A, Safri AY, Wiratman W, Indrawati LA, Fadli N, Harsono AR, Hakim M. Factors correlating to decisions for prescribing pharmacological treatment and referrals in suspected peripheral neuropathy cases in chat consultation-based application. Heliyon 2024; 10:e30713. [PMID: 38803849 PMCID: PMC11128825 DOI: 10.1016/j.heliyon.2024.e30713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/02/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Since the COVID-19 pandemic, there has been increasing use ofchat-based telemedicine, including for patients with neuropathy complaints. It is imperative to learn how to effectively use telemedicine. This study describes the characteristics of patients with neuropathy complaints in chat-based telemedicine services in Indonesia and their influence on treatment decisions and referrals. Methods This is a retrospective cross-sectional study during the COVID-19 pandemic era (March 2020 to December 2021) using anonymous secondary data from patient chat databases on Indonesian application-based telemedicine services (Halodoc, Alodokter, Good Doctor, and Milvik). We applied bivariate and multivariate analysis. Results We obtained 1051 patients with suspected peripheral nerve complaints (4 per 10,000) from a total of 2,199,527 user consultations, with the majority being 40-64 years old females and diabetes mellitus was the leading comorbid (90.7%). Most patients received treatment (90.7%) and only 11.4% patients were referred. Multivariate analysis showed that treatment was more likely to be given by a neurologist (p < 0.01). Chronic symptoms (p < 0.01) and previous laboratory/other tests (p = 0.01) decreased the likelihood of medication prescription. Referrals were more likely to be given to chronic onset (p = 0.02), hypertension and heart disease (p < 0.01), and previous laboratory/other tests (p = 0.02). The opposite was true for age≥65 years, female (p = 0.04), and neurologists or other specialists as responders (p < 0.01). Conclusion We identified several factors that influence the treatment decision such as female patients and onset. Meanwhile, age, sex, chronic symptoms, history of hypertension and heart disease, and previous laboratory/other tests may influence the referral decisions. General practitioners were more likely to refer the patients whereas neurologists or other specialists were more likely to give treatment. Chat-based telemedicine services can still be developed in the future to be better.
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Affiliation(s)
- Pukovisa Prawiroharjo
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Indonesia
- Medical Staff, Department of Neurology, Dr Cipto Mangunkusumo Hospital, Indonesia
- Department of Neurology, Universitas Indonesia Hospital, Indonesia
| | - Hikma Anggraini
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Indonesia
| | | | - Fitri Octaviana
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Indonesia
- Medical Staff, Department of Neurology, Dr Cipto Mangunkusumo Hospital, Indonesia
| | - Astri Budikayanti
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Indonesia
- Medical Staff, Department of Neurology, Dr Cipto Mangunkusumo Hospital, Indonesia
| | - Ahmad Yanuar Safri
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Indonesia
- Medical Staff, Department of Neurology, Dr Cipto Mangunkusumo Hospital, Indonesia
| | - Winnugroho Wiratman
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Indonesia
- Medical Staff, Department of Neurology, Dr Cipto Mangunkusumo Hospital, Indonesia
- Department of Neurology, Universitas Indonesia Hospital, Indonesia
| | - Luh Ari Indrawati
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Indonesia
- Medical Staff, Department of Neurology, Dr Cipto Mangunkusumo Hospital, Indonesia
| | - Nurul Fadli
- Medical Staff, Department of Neurology, Dr Cipto Mangunkusumo Hospital, Indonesia
- Department of Neurology, Universitas Indonesia Hospital, Indonesia
| | - Adrian Ridski Harsono
- Medical Staff, Department of Neurology, Dr Cipto Mangunkusumo Hospital, Indonesia
- Department of Neurology, Universitas Indonesia Hospital, Indonesia
| | - Manfaluthy Hakim
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Indonesia
- Medical Staff, Department of Neurology, Dr Cipto Mangunkusumo Hospital, Indonesia
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Saka SA, Osineye TR. Considerations, barriers and enablers of deprescribing among healthcare professionals in Ogun State, Southwest, Nigeria: a cross-sectional survey. BMC Health Serv Res 2024; 24:661. [PMID: 38789975 PMCID: PMC11127322 DOI: 10.1186/s12913-024-11101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Deprescribing is a clinical intervention aimed at managing polypharmacy and improving older adults' health outcomes. However, evidence suggests that healthcare professionals (HCPs) may face challenges in implementing the intervention. This study aimed to explore the considerations, barriers and enablers of deprescribing among HCPs in Southwest Nigeria. METHODS A quantitative cross-sectional survey was carried out among consecutively sampled HCPs including physicians, pharmacists and nurses in two public tertiary healthcare hospitals in Ogun State, Southwest, Nigeria. A structured 43-item self-administered questionnaire was used to explore the participants' sociodemographics, HCPs' experience, considerations, barriers and enablers of deprescribing in older adults. The data were summarised using descriptive statistics including frequency and percentage. The Kruskal-Wallis test was used to determine differences in perceptions among the groups on a Likert scale. A p-value < 0.05 was considered significant. RESULTS Overall, 453 copies of the questionnaire were analysed. Of the participants 204 (45.0%) were within the age group of 20-30 years; 173 (38.2%) claimed that older adults occasionally requested deprescribing of their medications. The majority (417; 92.1%) considered patients' quality of life to be very important in deprescribing; 423 (93.4%) opined that having a care goal known to members of the HCP team is an enabler for deprescribing while 308 (68.0%) disagreed or strongly disagreed that lack of incentives and remuneration for HCPs that de-prescribe is a barrier to deprescribing. There is a significant difference among the participants across professional groups on the assertion that pressure from pharmaceutical companies is a barrier to deprescribing in older adults (p = 0.037). CONCLUSIONS The participants in this study had various considerations for deprescribing medication in older adults including patients' quality of life. Having a care goal known to every HCP involved in managing a patient is an enabler for deprescribing while the lack of incentives and remuneration for HCPs that de-prescribe may not necessarily be a barrier to deprescribing. There is a need for regulations and policies to support the identified enablers among HCPs and reduce the barriers to effective deprescribing process.
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Affiliation(s)
- Sule Ajibola Saka
- Department of Clinical Pharmacy & Bio-Pharmacy, Olabisi Onabanjo University, Sagamu Campus, Nigeria.
| | - Tolulope Ruth Osineye
- Department of Clinical Pharmacy & Bio-Pharmacy, Olabisi Onabanjo University, Sagamu Campus, Nigeria
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Modh US, Suthar S, Zula PM, Patel M, Pipalava AK, Gandhi R. Exploring Patterns of Medication Usage in Affective Disorder Patients: A Comprehensive Investigation at a Psychiatry Outpatient Clinic of a Tertiary Care Hospital. Cureus 2024; 16:e60290. [PMID: 38872682 PMCID: PMC11174148 DOI: 10.7759/cureus.60290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Affective disorders impose a significant burden on public health due to their high prevalence and associated suffering. This study addresses gaps in current literature and clinical practice by providing insights into medication usage trends, which can inform treatment strategies and optimize patient care. The study aims to investigate drug utilization patterns, particularly focusing on defined daily dose/1000/day, among individuals attending a psychiatric outpatient department of a tertiary care hospital. METHODS This cross-sectional, prospective drug utilization study included 600 affective disorder patients aged 18 years and above. The study period spanned 12 months, from March 2021 to February 2022. Data on demographics, diagnosis, treatment, and counseling were collected and analyzed using descriptive statistics. RESULTS Among the 600 patients analyzed, bipolar mood disorder was the most prevalent (239 patients, 39.83%), followed by depressive disorder (208 patients, 34.67%). Triple therapy was the most common prescription regimen, accounting for 308 encounters (51.33%). The average number of drugs per encounter was 3.75 ± 1.01. A combination of psychotherapy and medication counseling sessions was provided to 594 patients or their relatives, representing 99% of the total encounters. CONCLUSION The study highlights the prevalent use of triple therapy in managing affective disorders, especially bipolar mood disorder and mania disorder. Effective utilization of essential drug lists and comprehensive patient counseling underscores the importance of holistic care in psychiatric outpatient settings. RECOMMENDATION Given the high prevalence of triple therapy, further research into the efficacy and safety of this treatment approach is warranted. Additionally, continued emphasis on patient education and counseling can enhance treatment adherence and overall outcomes in individuals with affective disorders.
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Affiliation(s)
- Urvashi S Modh
- Pharmacology, GMERS (Gujarat Medical Education and Research Society) Medical College, Junagadh, IND
| | - Satish Suthar
- Pharmacology, Shri M. P. Shah Government Medical College, Jamnagar, IND
| | - Priyadarshini M Zula
- Clinical Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Monika Patel
- Community and Family Medicine, Shri M. P. Shah Government Medical College, Jamnagar, IND
| | - Anurag K Pipalava
- Pharmacology, GMERS (Gujarat Medical Education and Research Society) Medical College, Junagadh, IND
| | - Rohankumar Gandhi
- Community and Family Medicine, Shri M. P. Shah Government Medical College, Jamnagar, IND
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AlOmeir O, Almuqbil M, Hussam Alsawadi A, Mohamed Genedy A, fawaz Almutairi A, Talal Alaydaa H, Alanazi SA, Alabdan N, Alshakrah M, Gilkaramenthi R, Asdaq SMB, Nayeem N. An exploration of factors influencing the selection of generic and innovator medicines in Saudi Arabia using an observational cross-sectional study. Saudi Pharm J 2024; 32:102021. [PMID: 38497088 PMCID: PMC10943484 DOI: 10.1016/j.jsps.2024.102021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/03/2024] [Indexed: 03/19/2024] Open
Abstract
Background and objectives Generic medications are cost-effective without compromising therapeutic outcomes. Therefore, the goal of this study was to investigate, using a cross-sectional study design, the factors influencing Saudi Arabian consumers' preferences between innovator and generic medications. Methods This cross-sectional study was carried out in Saudi Arabia using a Google survey form. For data collection, a simple random sampling strategy was used. The recruited participants were surveyed using a validated questionnaire that focused on six influencing domains: physician, pharmacist, perceived effectiveness, price, information availability, and confidence based on prior experience. The obtained data was used to analyze factors that have an association with any of the six domains using multinomial regression analysis. A correlation analysis was performed to examine the relationship between domains. Results The 317 participants included 64.4 % females, 52 % aged ≥ 26, and a large proportion of Saudi nationals (82.6 %) and university graduates (78.9 %). Being employed (OR:3.029; P = 0.006; CI: 6.715-1.366), a healthcare providers (OR:2.298; P = 0.043; CI: 5.151-1.025), and having insurance coverage (OR:1.908; P = 0.017; CI: 3.245-1.122) had a greater influence on medication selection. Participants with linguistic and business educational backgrounds (OR:3.443; P = 0.022; CI: 9.950-1.191), those living in the northern region of Saudi Arabia (OR:3.174; P = 0.009; CI: 7.585-1.328), having chronic ailments (OR:3.863; P = 0.013; CI: 11.274-1.324), and possess insurance (OR:1.748; P = 0.039; CI: 2.971-1.028) get readily influenced by pharmacist. People who were married and lived in Saudi Arabia's southern region were influenced by perceived effectiveness when choosing medicine. Participants from the northern region were found to be influenced by the price of the medicines, information about the medicines, and confidence based on previous experience. The price of medicines has a significant impact on those suffering from chronic diseases. At a significant level of P = 0.01, all six influencing domains were found to be positively correlated with each other. Conclusion The study shows that healthcare providers, drug prices, perceived efficacy, and information availability all have a big influence on the Saudi Arabian population's choice of medications. Educational background, location, and chronic disease status are associated with several influencing domains. Aside from public awareness campaigns, healthcare professionals should be involved in the implementation of the generic medication policy.
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Affiliation(s)
- Othman AlOmeir
- Department of Clinical Pharmacy, College of Pharmacy, Shaqra University, Shaqra 11961, Saudi Arabia
| | - Mansour Almuqbil
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Asmaa Hussam Alsawadi
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | - Alaa Mohamed Genedy
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | - Ashwag fawaz Almutairi
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | - Hams Talal Alaydaa
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | - Saleh A. Alanazi
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Numan Alabdan
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Meshal Alshakrah
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Rafiulla Gilkaramenthi
- Department of Emergency Medical Services, College of Applied Sciences, AlMaarefa University, Diriyah, 13713 Riyadh, Saudi Arabia
| | | | - Naira Nayeem
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Northern Border University, Rafha 91911, Saudi Arabia
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Takata ET, Eschert J, Stafford K, Alejo A, Yu AS, Saffer R, Shaikhly M, Luong L, O’Connor C, Motupally S, Staff I, Walker A, Finkel KJ. Attitudes Towards Conflicts of Interest in Medical Research: A Survey of US Medical Students. MEDICAL SCIENCE EDUCATOR 2024; 34:429-437. [PMID: 38686160 PMCID: PMC11055806 DOI: 10.1007/s40670-024-02002-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 05/02/2024]
Abstract
Industry funds nearly two-thirds of US healthcare research, and industry-sponsorship may produce more favorable research results and conclusions. Medical students report feeling inadequately prepared to avoid negative industry influence. Research of educational interventions that educate students on the potential effects of industry influence is lacking, and no interventions have demonstrated long-term benefit. Surveying and assessing student opinions of the relationship between industry and research may help improve future educational interventions. We surveyed preclinical and clinical students at seven US medical schools regarding their attitudes towards industry conflicts of interest (COIs) in medical research. A total of 466 medical students including 232 preclinical and 234 clinical students completed the survey. Of those who had research experience, clinical students were more likely than preclinical students to look for COIs (62.0% v 45.9%, p = .014) and to consider whether author COIs are pertinent to the article (68.1% v 54.1%, p = .023). Many disagreed that they felt adequately educated on the issue of COIs (42.7%), but most agreed that medical school should take a role in guiding student interactions with industry (65.0%). Students responded that all listed financial relationships between industry and investigator, except for providing food and/or beverage, would likely bias the investigator's research. Many students feel inadequately educated on industry issues in biomedical research, and most believe medical schools should help guide interactions with industry. Our findings support further development of educational interventions that prepare students to navigate the relationship between industry and medical research during and after medical school.
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Affiliation(s)
- Edmund T. Takata
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY USA
| | - John Eschert
- Integrated Anesthesia Associates, Hartford Hospital, Hartford, CT USA
| | - Kerri Stafford
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY USA
| | - Andrew Alejo
- Northeast Ohio Medical University, Rootstown, OH USA
| | | | - Ryan Saffer
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL USA
| | - Marianna Shaikhly
- Kansas City University College of Osteopathic Medicine, Kansas City, MO USA
| | - Lucas Luong
- University of Connecticut School of Medicine, Farmington, CT USA
| | - Cameron O’Connor
- Quinnipiac University Frank H. Netter M.D. School of Medicine, North Haven, CT USA
| | - Saagar Motupally
- Integrated Anesthesia Associates, Hartford Hospital, Hartford, CT USA
| | - Ilene Staff
- Research Program, Hartford Hospital, Hartford, CT USA
| | - Aseel Walker
- Integrated Anesthesia Associates, Hartford Hospital, Hartford, CT USA
| | - Kevin J. Finkel
- Integrated Anesthesia Associates, Hartford Hospital, Hartford, CT USA
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Wallis KA, Dikken PJS, Sooriyaarachchi P, Bohnen AM, Donald M. Lessons from the Netherlands for Australia: cross-country comparison of trends in antidepressant dispensing 2013-2021 and contextual factors influencing prescribing. Aust J Prim Health 2024; 30:NULL. [PMID: 38056885 DOI: 10.1071/py23168] [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: 09/08/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND There is concern internationally about increasing antidepressant use. Most antidepressants are prescribed in general practice. The aim of this study was to compare trends in antidepressant dispensing in Australia and the Netherlands over the 9years from 2013 to 2021, and to explore reasons for differences. METHODS A convergent mixed methods study including analysis of publicly available antidepressant dispensing data obtained from Australia's Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme and the Dutch Foundation for Pharmaceutical Statistics and a search of relevant literature to compare contextual factors influencing prescribing were undertaken. RESULTS In 2013, antidepressant dispensing rates in Australia were nearly twice as high as those in the Netherlands (82.5 versus 44.3DDD/1000/day) and increased to be more than twice as high by 2021 (115.6 versus 48.8DDD/1000/day). Antidepressant dispensing increased by 40% in Australia over the nine study years, but by only 10% in the Netherlands. Our scan of the literature confirms that while population factors, health system structure, and clinical guideline recommendations are largely consistent across the two countries, a multifaceted approach in the Netherlands involving improved access to non-pharmacological alternatives, initiatives targeting safer antidepressant prescribing, and tight regulation of pharmaceutical industry influence on prescribers, has successfully curtailed increasing antidepressant use. CONCLUSIONS Australia may learn from the Netherlands' approach to redress increasing antidepressant use.
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Affiliation(s)
- Katharine A Wallis
- General Practice Clinical Unit, Medical School, The University of Queensland, Brisbane, Qld 4029, Australia
| | - Pieter J S Dikken
- General Practice Clinical Unit, Medical School, The University of Queensland, Brisbane, Qld 4029, Australia; and Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Piumika Sooriyaarachchi
- General Practice Clinical Unit, Medical School, The University of Queensland, Brisbane, Qld 4029, Australia
| | - Arthur M Bohnen
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Maria Donald
- General Practice Clinical Unit, Medical School, The University of Queensland, Brisbane, Qld 4029, Australia
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Jamaluddin J, Mohamed Kamel MA. Underprescription of Fibrate Among Patients With Diabetic Retinopathy in Perak, Malaysia. Cureus 2024; 16:e51434. [PMID: 38298309 PMCID: PMC10828978 DOI: 10.7759/cureus.51434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 02/02/2024] Open
Abstract
Objectives Diabetic retinopathy (DR) is a major cause of blindness and its prevalence is increasing. Fibrate, specifically fenofibrate, has been shown to be efficacious in reducing the progression of DR. This study aims to determine the five-year trend of and factors associated with the prescription of fibrate among patients with DR in Perak. Methods Data on all patients with DR in 76 government health clinics in Perak who were audited between 2018 and 2022 were extracted from the National Diabetes Registry (NDR), excluding those who were lost to follow-up. Multivariable logistic regression was used to identify factors associated with the prescription of fibrates. Results Data from 4028 patients were analysed. Commonly prescribed medications were statins (n = 3466, 86.0%), metformin (n = 3212, 79.7%), and angiotensin-converting enzyme inhibitors (n = 2318, 57.5%). Only 63 (1.6%) patients were prescribed fibrate. Factors associated with the prescription of fibrates were patients from the clinics in northern (adjusted odds ratio (aOR) = 0.33, 95% CI: 0.12-0.65) and southern clusters (aOR = 0.23, 95% CI: 0.08-0.655), triglycerides > 1.7 mmol/L (aOR = 4.85, 95% CI: 1.85-12.70), and prescription of insulin (aOR = 2.77, 95% CI: 1.07-7.18) and statin (aOR = 0.10, 95% CI: 0.04-0.27). Conclusion The prescription of fibrate among patients with DR was low, highlighting a missed opportunity for early treatment and improved outcomes in primary care. The prescription of fibrates to reduce the progression of DR should be expanded to primary care. Clinicians should consider the factors associated with the non-prescription of fibrate identified when prescribing to these patients. Policies, including those at the ministry level, to enhance the availability of these medicines, including financial resources for procurement, are necessary to guarantee easy access for patients in different areas. It is crucial for healthcare providers to be knowledgeable about and follow guidelines. Moreover, improving the overall management of DR in patients with multiple comorbidities can be achieved by addressing worries about the side effects of combination therapies through educational campaigns and providing clear directives. Nevertheless, the study's findings should be interpreted in light of the limitations discussed.
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Andre N, Ben Shmuel A, Yahav L, Muallem L, Golan Tripto I, Horev A. Is corticophobia spreading among pediatricians?-Insights from a self-efficacy survey on the management of pediatric atopic dermatitis. Transl Pediatr 2023; 12:1823-1834. [PMID: 37969117 PMCID: PMC10644026 DOI: 10.21037/tp-23-271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/15/2023] [Indexed: 11/17/2023] Open
Abstract
Background Atopic dermatitis (AD) is a chronic dermatological condition, often diagnosed and managed by pediatricians. However, pediatricians have difficulties with adhering to guidelines, which recommend the use of topical corticosteroids (TCS) as a first-line treatment and oral corticosteroids (OCS) for resistant cases. Our aim was to assess pediatricians' self-confidence in using steroids in the management of pediatric AD, and investigate which characteristics are related to high self-confidence in prescribing corticosteroids (CS). Methods We conducted a cross-sectional questionnaire study among Israeli pediatricians between April 2022 and June 2022. Participants were asked to answer questions dealing with self-assessment of prescribing CS in the management of AD. Results A total of 171 residents and pediatricians participated in the survey; 86.6% and 28.1% admitted feeling either average or below-average confidence in the prescription of OCS and TCS, respectively. Physicians who were exposed to higher AD patients (P=0.048) and worked at the clinics (88.2% vs. 60.4%, P<0.001) had high self-confidence in treating AD with TCS. Males (20.3% vs. 8%, P=0.03), and having gone to medical school outside Israel (22.2% vs. 10.4%, P=0.09) were all related to high self-efficacy in prescribing OCS. In total, 11.7% of participants confessed to refraining from prescribing steroids because of fear of side effects. Conclusions Most pediatricians have below-average confidence in prescribing OCS for the treatment of AD. Males, working in a community setting, and previous exposure improve the confidence level and can be easily considered in future pediatric training programs.
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Affiliation(s)
- Nicolas Andre
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Atar Ben Shmuel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- School of Health Profession Education, Maastricht University, Maastricht, the Netherlands
| | - Lior Yahav
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Liezl Muallem
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Pediatrics Department, Soroka University Medical Center, Beer Sheva, Israel
| | - Inbal Golan Tripto
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Pediatrics Department, Soroka University Medical Center, Beer Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Amir Horev
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Pediatric Dermatology Service, Soroka University Medical Center, Beer Sheva, Israel
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Lin D, Pilon D, Morrison L, Shah A, Lafeuille MH, Lefebvre P, Benson C. A Cross-Sectional Study of Patient Out-of-Pocket Costs for Antipsychotics Among Medicaid Beneficiaries with Schizophrenia. Drugs Real World Outcomes 2023; 10:471-480. [PMID: 37289413 PMCID: PMC10491554 DOI: 10.1007/s40801-023-00376-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Patient affordability is an important nonclinical consideration for treatment access among patients with schizophrenia. OBJECTIVE This study evaluated and measured out-of-pocket (OOP) costs for antipsychotics (APs) among Medicaid beneficiaries with schizophrenia. METHODS Adults with a schizophrenia diagnosis, ≥ 1 AP claim, and continuous Medicaid eligibility were identified in the MarketScan® Medicaid Database (1 January 2018-31 December 2018). OOP AP pharmacy costs ($US 2019) were normalized for a 30-day supply. Results were descriptively reported by route of administration [ROA; orals (OAPs), long-acting injectables (LAIs)], generic/branded status within ROAs, and dosing schedule within LAIs. The proportion of total (pharmacy and medical) OOP costs AP-attributable was described. RESULTS In 2018, 48,656 Medicaid beneficiaries with schizophrenia were identified (mean age 46.7 years, 41.1% female, 43.4% Black). Mean annual total OOP costs were $59.97, $6.65 of which was AP attributable. Overall, 39.2%, 38.3%, and 42.3% of beneficiaries with a corresponding claim had OOP costs > $0 for any AP, OAP, and LAI, respectively. Mean OOP costs per patient per 30-day claim (PPPC) were $0.64 for OAPs and $0.86 for LAIs. By LAI dosing schedule, mean OOP costs PPPC were $0.95, $0.90, $0.57, and $0.39 for twice-monthly, monthly, once-every-2-months, and once-every-3-months LAIs, respectively. Across ROAs and generic/branded status, projected OOP AP costs per-patient-per-year for beneficiaries assumed fully adherent ranged from $4.52 to $13.70, representing < 25% of total OOP costs. CONCLUSION OOP AP costs for Medicaid beneficiaries represented a small fraction of total OOP costs. LAIs with longer dosing schedules had numerically lower mean OOP costs, which were lowest for once-every-3-months LAIs among all APs.
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Affiliation(s)
- Dee Lin
- Janssen Scientific Affairs, LLC., Titusville, NJ USA
| | - Dominic Pilon
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
| | - Laura Morrison
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
| | - Aditi Shah
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
| | - Marie-Hélène Lafeuille
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
| | - Patrick Lefebvre
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC H3B 0G7 Canada
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12
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Mahmoud F, Mullen A, Sainsbury C, Rushworth GF, Yasin H, Abutheraa N, Mueller T, Kurdi A. Meta-analysis of factors associated with antidiabetic drug prescribing for type 2 diabetes mellitus. Eur J Clin Invest 2023; 53:e13997. [PMID: 37002856 DOI: 10.1111/eci.13997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/09/2023] [Accepted: 03/22/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND There is a lack of consensus on prescribing alternatives to initial metformin therapy and intensification therapy for type 2 diabetes mellitus (T2DM) management. This review aimed to identify/quantify factors associated with prescribing of specific antidiabetic drug classes for T2DM. METHODS Five databases (Medline/PubMed, Embase, Scopus, Web of Science) were searched using the synonyms of each concept (patients with T2DM, antidiabetic drugs and factors influencing prescribing) in both free text and Medical Subject Heading (MeSH) forms. Quantitative observational studies evaluating factors associated with antidiabetic prescribing of metformin, sulfonylurea, thiazolidinedione, Dipeptidyl-peptidase 4 inhibitors (DPP4-I), sodium glucose transporter 2 inhibitors (SGLT2-I), Glucagon-Like peptide receptor agonist (GLP1-RA) and insulin in outpatient settings and published from January 2009 to January 2021 were included. Quality assessment was performed using a Newcastle-Ottawa scale. The validation was done for 20% of identified studies. The pooled estimate was measured using a three-level random-effect meta-analysis model based on odds ratio [95% confidence interval]. Age, sex, body mass index (BMI), glycaemic control (HbA1c) and kidney-related problems were quantified. RESULTS Of 2331 identified studies, 40 met the selection criteria. Of which, 36 and 31 studies included sex and age, respectively, while 20 studies examined baseline BMI, HbA1c and kidney-related problems. The majority of studies (77.5%, 31/40) were rated as good and despite that the overall heterogeneity for each studied factor was more than 75%, it is mostly related to within-study variance. Older age was significantly associated with higher sulfonylurea prescription (1.51 [1.29-1.76]), yet lower prescribing of metformin (0.70 [0.60-0.82]), SGLT2-I (0.57 [0.42-0.79]) and GLP1-RA (0.52 [0.40-0.69]); while higher baseline BMI showed opposite significant results (sulfonylurea: 0.76 [0.62-0.93], metformin: 1.22 [1.08-1.37], SGLT2-I: 1.88 [1.33-2.68], and GLP1-RA: 2.35 [1.54-3.59]). Both higher baseline HbA1c and having kidney-related problems were significantly associated with lower metformin prescription (0.74 [0.57-0.97], 0.39 [0.25-0.61]), but more insulin prescriptions (2.41 [1.87-3.10], 1.52 [1.10-2.10]). Also, DPP4-I prescriptions were higher for patients with kidney-related problems (1.37 [1.06-1.79]) yet lower among patients with higher HbA1c (0.82 [0.68-0.99]). Sex was significantly associated with GLP1-RA and thiazolidinedione prescribing (F:M; 1.38 [1.19-1.60] and 0.91 [0.84-0.98]). CONCLUSION Several factors were identified as potential determinants of antidiabetic drug prescribing. The magnitude and significance of each factor differed by antidiabetic class. Patient's age and baseline BMI had the most significant association with the choice of four out of the seven studied antidiabetic drugs followed by the baseline HbA1c and kidney-related problems which had an impact on three studied antidiabetic drugs, whereas sex had the least impact on prescribing decision as it was associated with GLP1-RA and thiazolidinedione only.
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Affiliation(s)
- Fatema Mahmoud
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Alexander Mullen
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Chris Sainsbury
- Department of Diabetes, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Gordon F Rushworth
- Highland Pharmacy Education & Research Centre, NHS Highland, Inverness, UK
| | - Haya Yasin
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Nouf Abutheraa
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Centre of Research and Strategic Studies, Lebanese French University, Erbil, Iraq
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Patil B, Patil J, Hugar L, Moharir G. Analysis of Prescribing Practices in the Dermatology Outpatient Department of a Tertiary Care Teaching Hospital. Cureus 2023; 15:e37910. [PMID: 37220430 PMCID: PMC10200007 DOI: 10.7759/cureus.37910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction The practice of appropriately prescribing and delivering pharmaceuticals to the right patient for the diagnosis, prevention, and treatment of diseases is referred to as "rational drug usage". Patients should receive pharmaceuticals that are appropriate for their clinical needs, given in doses that meet their needs, for long enough periods of time, and for the least amount of money possible. Minimizing drug therapy costs without sacrificing therapeutic effectiveness, avoiding unnecessary adverse medication reactions and drug-drug interactions, and improving therapeutic care while encouraging patient adherence are the main objectives of rational drug usage. The present study was planned to assess the current prescribing practices in the dermatology outpatient department of a tertiary care hospital. Materials and methods A prospective descriptive study was conducted in the department of dermatology at a tertiary care teaching hospital after receiving permission from the institutional ethics committee. The study was conducted from November 2022 to February 2023 and followed the WHO recommendation for sample size. A total of 617 prescriptions were analyzed thoroughly. Results Regarding the demographic profile of the 617 prescriptions, 299 were male and 318 were female. The patients had diverse diseases, with the most common being tinea infection (57 cases, 9%) and acne vulgaris (53 cases, 8.5%), followed by scabies (38 cases, 6%), urticaria, and eczema (30 cases, 5%). Twenty-six (4%) prescriptions were not written in capital letters, 86 (13%) prescriptions did not mention the route of drug administration, and the consultant's or physician's name and signature were missing in 13 (2%), and six (1%) prescriptions, respectively. None of the prescriptions were written using the generic names of the drugs. Polypharmacy was observed in 51 (8%) prescriptions. Moreover, potential drug-drug interactions were identified in 12 (1.9%) instances. The most prescribed drugs were antihistaminics, with 393 (23%) prescriptions. Antifungal drugs were the second most prescribed, with 291 (17%) prescriptions. Corticosteroids were also commonly prescribed, with 271 (16%) prescriptions. Antibiotics were prescribed in 168 (10%) cases; other drugs were prescribed in 597 (35%) cases, including retinoids, anti-scabies drugs, antileprotic drugs, moisturizers, sunscreens, etc. Conclusion The study highlighted the prescription errors in writing the drugs in capital letters, mentioning the dose, route, and frequency of drugs, etc. It provided insight into the common diseases in dermatology and routine prescribing patterns and addressed the frequency of polypharmacy and drug-drug interactions.
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Affiliation(s)
- Bapugouda Patil
- Pharmacology and Therapeutics, Bijapur Lingayat District Educational Association (BLDEA) (Deemed to be University) Shri BM Patil Medical College Hospital and Research Center, Vijayapura, IND
| | - Jyoti Patil
- Pharmacology and Therapeutics, Bijapur Lingayat District Educational Association (BLDEA) (Deemed to be University) Shri BM Patil Medical College Hospital and Research Center, Vijayapura, IND
| | - Leela Hugar
- Pharmacology and Therapeutics, Bijapur Lingayat District Educational Association (BLDEA) (Deemed to be University) Shri BM Patil Medical College Hospital and Research Center, Vijayapura, IND
| | - Gurudatta Moharir
- Pharmacology and Therapeutics, Dr.Ulhas Patil Medical College and Hospital, Jalgaon, IND
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Fernandez-Guzman D, Caira-Chuquineyra B, Baca-Rondan F, Yucra-Sosa MC, Ccami-Bernal F, Soriano-Moreno DR, Nieto-Gutierrez W, Benites-Zapata VA. Association between self-reported evidence-based medicine competencies and prescribing of drugs without scientific evidence against mild COVID-19 among recently graduated physicians in Peru. Heliyon 2023; 9:e15366. [PMID: 37064449 PMCID: PMC10082469 DOI: 10.1016/j.heliyon.2023.e15366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023] Open
Abstract
Objective To evaluate the association between self-rated evidence-based medicine (EBM) competencies and the prescription of drugs without scientific evidence against mild COVID-19 (present with any of the signs and symptoms of COVID-19 but who do not have shortness of breath, dyspnea, or abnormal chest imaging) among recently graduated physicians in Peru. Methods We conducted an analytical cross-sectional study where we evaluated a non-probability sample of recently graduated physicians during June and July 2021 (end of second wave of COVID-19 in Peru). Self-rated EBM competencies were assessed by four domains (formulation of a clinical question, search, analysis, and application) using a Likert scale with scores from zero to four ("Very inadequate" = 0, to "Very Adequate" = 4), it was considered as "Adequate" if the score was three or four. In addition, the variable "General competence on EBM" was rated as "Adequate" if in all domains evaluated it presented an adequate self-rating. For the outcome, drug prescription, we considered the use of ivermectin, azithromycin, other antibiotics, hydroxychloroquine, dexamethasone, and anticoagulants (drugs with no efficacy demonstrated for patients with mild COVID-19). To assess the association, we used Poisson regression models with robust variances and obtaining crude (cPR) and adjusted (aPR) prevalence ratios with their 95% confidence intervals (95%CI). Results Of a total of 239 physicians included 70.7% prescribed at least one drug without scientific evidence. A total of 51.1% reported adequate ratings in all evaluated domains of EBM. Self-rating the "Clinical Question Formulation" competency as adequate was associated with a lower frequency of prescribing medications for mild COVID-19 (aPR: 0.93; 95% CI: 0.91-0.95). While self-rating as adequate the competency of "Identify possible implications of investigations" was associated with an increase in the prescription of such drugs (aPR: 1.14; 95% CI: 1.09-1.20). Additionally, self-rating all domains as adequate were associated with less prescription (aPR: 0.93; 95% CI: 0.90-0.96). Conclusion Seven out of ten recently graduated physicians prescribed some type of medication without scientific evidence to treat patients with mild COVID-19. Having adequate self-perceived EBM competencies was associated with a lower frequency of prescribing medications without scientific evidence to manage patients with mild COVID-19.
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Affiliation(s)
| | | | - Fiorella Baca-Rondan
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru
| | - Maria Cristina Yucra-Sosa
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru
| | - Fabricio Ccami-Bernal
- Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa, Peru
| | - David R Soriano-Moreno
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru
| | | | - Vicente A Benites-Zapata
- Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
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Fujiwara N, Fujiwara T, Ise Y. Prescription factors influencing baloxavir prescription during the 2018/2019 and 2019/2020 seasons: a administrative database study in Japan. J Pharm Health Care Sci 2023; 9:3. [PMID: 36721190 PMCID: PMC9890836 DOI: 10.1186/s40780-023-00274-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/10/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We aimed to evaluate the factors associated with baloxavir prescription in Japanese hospitals using a health insurance claim-based database (MDV analyzer), during the 2018/2019 and 2019/2020 influenza seasons. The MDV analyzer contains anonymized claims data from approximately 420 Diagnosis Procedure Combination hospitals, and does not contain data from clinics. METHODS Data were collected for influenza patients treated with anti-influenza drugs during the 2018/2019 and 2019/2020 influenza seasons. Multivariate analysis was used to identify factors associated with baloxavir prescription. RESULTS During the study period, 322,063 influenza patients were included for analyses. In multivariate analysis, children, female sex, inpatient, hospital bed capacity, and private hospitals were negatively associated with baloxavir prescription. Compared to elderly patients, the adjusted odds ratio (OR) for baloxavir prescription was 0.612 (95% confidence interval (CI), 0.587-0.637) in children aged 6-11 years, and 0.119 (95% CI, 0.111-0.128) in children aged 0-5 years. Compared to small hospitals (bed capacity, 20-299), the adjusted OR for baloxavir prescription was 0.559 (95% CI, 0.540-0.578) in large hospitals (bed capacity, ≥ 500). CONCLUSION Children, female sex, inpatient, hospital bed capacity, and private hospitals were negatively associated with baloxavir prescription.
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Affiliation(s)
- Naomi Fujiwara
- grid.416279.f0000 0004 0616 2203Department of Pharmacy, Nippon Medical School Hospital, Sendagi 1-1-5, Bunkyo-Ku, Tokyo, 113-8602 Japan
| | - Takashi Fujiwara
- grid.416629.e0000 0004 0377 2137Department of Public Health Research, Kurashiki Clinical Research Institute, Miwa 1-1-1, Kurashiki City, Okayama, 710-8602 Japan
| | - Yuya Ise
- grid.416279.f0000 0004 0616 2203Department of Pharmacy, Nippon Medical School Hospital, Sendagi 1-1-5, Bunkyo-Ku, Tokyo, 113-8602 Japan
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Farah S, Bilszta JL. Teaching medical students how to interact with the pharmaceutical industry: A scoping review. GMS JOURNAL FOR MEDICAL EDUCATION 2022; 39:Doc57. [PMID: 36540557 PMCID: PMC9733477 DOI: 10.3205/zma001578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/24/2022] [Accepted: 08/04/2022] [Indexed: 06/17/2023]
Abstract
Objectives: The influence of the pharmaceutical industry is of significant concern in physician prescribing decisions; medical students may not be fully equipped with the knowledge or skills to manage interactions with industry prior to graduation. The aim of this study was to evaluate the characteristics of educational interventions undertaken to improve students' knowledge, attitudes, and skills in managing interactions with the pharmaceutical industry. Methods: A systematic search of Ovid Medline, EMBASE, CINAHL and ERIC databases identified 3210 primary studies with keywords related to "pharmaceutical industry" and "undergraduate medical education". Eleven articles were included for review. Results: Disparate methods of teaching medical students how to interact with the pharmaceutical industry were identified, making it difficult to compare the effectiveness of different educational interventions. All the included studies achieved the aims of the described intervention, at least in the short term, suggesting perhaps any education related to interactions with the pharmaceutical industry can aid students in managing these situations. Conclusions: The lack of an evidence-base means more research into the identification of educational interventions which engender durable changes in students' knowledge, attitudes, and skills to manage interactions with the pharmaceutical industry are required. Any intervention will likely be context-dependent, as a universal approach is hindered by the fact different countries have different laws governing pharmaceutical industry-physician interaction.
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Affiliation(s)
- Samiyah Farah
- University of Melbourne, Melbourne Medical School, Department of Medical Education, Melbourne, Australia
| | - Justin L. Bilszta
- University of Melbourne, Melbourne Medical School, Department of Medical Education, Melbourne, Australia
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Chen X, Wang CY, Ko Y. An investigation of physicians' prescribing behaviors related to antidiabetic agents for Type 2 diabetes mellitus patients and associated factors in Taiwan. Curr Med Res Opin 2022; 38:1815-1821. [PMID: 35866660 DOI: 10.1080/03007995.2022.2105539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study aimed to examine the factors that may influence physicians' choice of antidiabetic agents. In addition, we investigated physicians' decision-making process and treatment of T2DM patients with chronic kidney disease (CKD). Finally, we wanted to determine whether physicians knew the latest recommendations for T2DM treatment. METHODS The study was conducted as a cross-sectional survey using an online self-administered questionnaire to collect data from physicians in Taiwan. We enrolled licensed physicians who worked in hospitals or clinics with an average monthly T2DM patient load of 100 patients. Descriptive statistics, the independent samples t-test, and the Chi-square test were used for data analysis. Moreover, the association was examined between respondents' demographics and the proportion of respondents who answered each T2DM treatment question correctly. RESULTS A total of 986 invitations were sent out, and 324 completed questionnaires were received. The most important factors that may influence physicians' choice of antidiabetic agents in each factor category were major comorbidities of patients, coverage of insurance, guideline recommendations, cardiovascular disease benefit, and whether a drug is the brand-name drug, respectively. When choosing second-line antidiabetic agents for T2DM patients with CKD, the most common reasons for doing so were recommendations of clinical guidelines (83.6%) and patients' renal function (59.6%) while SGLT2is were respondents' most commonly chosen treatment. Respondents were more familiar with ADA recommendations for patients with certain major comorbidities than with the drugs' labeled indications. Moreover, physicians who were younger, female, specialty in diabetes, or working in medical centers were more likely to give correct answers to certain questions about ADA guidelines (all p < .05). CONCLUSION This study provides a better understanding of the influential factors, treatment choices, and reasoning related to physicians' prescribing of antidiabetic agents in Taiwan. In addition, knowledge gaps in various physician groups were identified.
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Affiliation(s)
- Xiao Chen
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
| | - Chih-Yuan Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu Ko
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Research Center for Pharmacoeconomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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Kim W, Koo H, Lee HJ, Han E. The Effects of Cost Containment and Price Policies on Pharmaceutical Expenditure in South Korea. Int J Health Policy Manag 2022; 11:2198-2207. [PMID: 34814666 PMCID: PMC9808296 DOI: 10.34172/ijhpm.2021.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/19/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Policy-makers have proposed and implemented various cost-containment policies for drug prices and quantities to regulate rising pharmaceutical spending. Our study focused on a major change in pricing policy and several incentive schemes for curbing pharmaceutical expenditure growth during the 2010s in Korea. METHODS We constructed the longitudinal dataset from 2008-2017 for 12 904 clinics to track the prescriber behavior before and after the implemented policies. Applying an interrupted time series model, we analyzed changes in trends in overall monthly drug expenditure and antibiotic drug expenditure per prescription for outpatient claims diagnosed with three major diseases before and after the policies' implementation. RESULTS Significant price reductions and incentives for more efficient drug prescriptions resulted in an immediate decrease in monthly drug expenditures in clinics. However, we found attenuated effects over the long run. The top-spending clinics showed the highest rate of increase in drug costs. CONCLUSION Future policy interventions can maximize their effects by targeting high-spending providers.
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Affiliation(s)
- Woohyeon Kim
- Korea Institute of Public Finance, Sejong, South Korea
| | - Heejo Koo
- College of Pharmacy, Yonsei Institute of Pharmaceutical Research, Yonsei University, Seoul, South Korea
| | - Hye-Jae Lee
- College of Pharmacy, Woosuk University, Wanju, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Research, Yonsei University, Seoul, South Korea
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Larid G, Baudens G, Dandurand A, Coquerelle P, Goeb V, Guyot MH, Marguerie L, Maury F, Veillard E, Houvenagel E, Salmon JH, Flipo RM, Gervais E. Differential retention of adalimumab and etanercept biosimilars compared to originator treatments: Results of a retrospective French multicenter study. Front Med (Lausanne) 2022; 9:989514. [PMID: 36275803 PMCID: PMC9582272 DOI: 10.3389/fmed.2022.989514] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Previous studies demonstrated equivalence in terms of efficacy and safety of biosimilars (bsDMARDs) compared to original treatments (boDMARDs) and in switching situations. Less is known about what happens when initiating a bsDMARD in a molecule naïve patient. The objectives of our study were to compare the retention of treatment of subcutaneous boDMARDs and bsDMARDs globally, depending on the disease [rheumatoid arthritis (RA), spondyloarthritis (SpA), or psoriatic arthritis (PsA)], molecule [etanercept (ETN) or adalimumab (ADA)], line of treatment, or presence of citrate in the context of first use of each molecule (namely initiation) and to analyze treatment retention's predictive factors. Materials and methods This multicenter retrospective study used data from shared medical records of the RIC-FRANCE network, encompassing the prescription of hospital rheumatologists and attached practitioners, of patients with RA, SpA, or PsA, with the starting ETN between 03/10/2016 and 31/07/2020, or ADA between 23/10/2018 and 31/07/2020. Clinical data were collected from medical records. Retention analysis was performed using Kaplan-Meier curves and the log-rank test. Retention's predictive factors were analyzed using Cox proportional-hazard ratio. Results Eight hundred forty-five prescriptions were analyzed: 340 boDMARDs and 505 bsDMARDs. About 57% of prescriptions concerned women. The mean age was 51.8 years. About 38% were prescriptions for RA, 16% for PsA, and 46% for SpA. An increase in the initiation over time was observed for both ETN and ADA. The retention rate of bsDMARDs was superior to boDMARDs' one (39 vs. 23 months; p = 0.045). When molecules are compared, the difference was significant only for ETN (45 vs. 19 months for boDMARD; p = 0.0265). When comparing diseases, the difference in favor of bsDMARDs was significant in patients with RA only (p = 0.041). Citrated treatments displayed better retention compared to citrate-free treatments (p = 0.0137). Multivariable analysis of predictive factors for the cessation of treatment found shorter disease duration, boDMARD prescription, hospital practitioner prescription, late line of treatment, and female sex as significant. More side effects were observed with boDMARDs, especially more infections (17.8% vs. 7.8%). Conclusion Even if bsDMARDs' prescription increases over time, its penetration rate is still below expectations. bsDMARDs displayed better retention compared to boDMARDs, especially for ETN, and in patients with RA. Citrated treatments had better retention. Prescription by a full-time hospital-based rheumatologist is associated with poorer retention.
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Affiliation(s)
- Guillaume Larid
- Department of Rheumatology, CHU Poitiers, Poitiers, France,LITEC Laboratory, University of Poitiers, Poitiers, France,*Correspondence: Guillaume Larid, ; orcid.org/0000-0003-2317-2852
| | | | | | - Pascal Coquerelle
- Department of Rheumatology, Bethune Hospital Center, Bethune, France
| | - Vincent Goeb
- Department of Rheumatology, Hôpital Nord, University Hospital of Amiens-Picardie, Amiens, France
| | - Marie Hélène Guyot
- Department of Rheumatology, Hôpital Victor Provo, Hospital of Roubaix, Roubaix, France
| | - Laurent Marguerie
- Department of Rheumatology, Institut François Calot, Berck-Sur-Mer, France
| | | | | | - Eric Houvenagel
- Department of Rheumatology, Hôpital Saint Philibert, Hospital of Lomme, Lomme, France
| | - Jean-Hugues Salmon
- Department of Rheumatology, Hôpital Maison Blanche, Reims University Hospital, CEDEX, Reims, France
| | | | - Elisabeth Gervais
- Department of Rheumatology, CHU Poitiers, Poitiers, France,LITEC Laboratory, University of Poitiers, Poitiers, France
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Feldman R, Fulton BD, Godwin JR, Scheffler RM. Challenges with Defining Pharmaceutical Markets and Potential Remedies to Screen for Industry Consolidation. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2022; 47:583-607. [PMID: 35576314 DOI: 10.1215/03616878-9978131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CONTEXT Dramatic increases in pharmaceutical merger and acquisition (M&A) activity since 2010 suggest we are in the midst of a third wave of industry consolidation. METHODS The authors reviewed 168 economic, legal, medical, industry, and government sources to examine the effects of consolidation on competition and innovation and to explore how industry attributes complicate M&A regulation in a pharmaceutical context. FINDINGS The authors find that, in spite of certain metrics that might argue otherwise, consolidation consistently reduces innovation and harms the public good. They also find that several factors within the pharmaceutical industry impede proper evaluation of proposed mergers. Because consumer choice across substitutes is limited, pharmaceutical markets frustrate conventional methods of defining markets. Volume bargaining in the pharmaceutical supply chain and asset managers' common ownership of pharmaceutical firms further complicate the definitional process. Hence, the Herfindahl-Hirschman Index (HHI), one measure used by the Federal Trade Commission and the Department of Justice to screen for concerning M&A activity, sometimes depends on faulty market definitions and fails to capture the implications of consolidation for future market share. CONCLUSIONS The authors describe ways to improve how pharmaceutical markets are defined, highlight quantitative alterations to HHI to account for common ownership, and propose areas requiring further research.
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Affiliation(s)
- Robin Feldman
- University of California, Hastings College of the Law
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21
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Determinants of prescribing decisions for off-patent biological medicines in Belgium: a qualitative study. BMC Health Serv Res 2022; 22:1211. [PMID: 36175885 PMCID: PMC9520107 DOI: 10.1186/s12913-022-08591-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A competitive market for off-patent biologicals leads to more affordable and high-quality healthcare. In recent years, Belgium has been characterized by its low use of biosimilars and by its shifts from off-patent biologicals toward new alternative therapies. Yet, the prescribing decisions involved in these observations are poorly understood. This study aims to better understand prescribing choices among Belgian physicians in the ambulatory care setting. METHODS This study consisted of two phases. First, a scoping literature review to identify determinants of prescribing choices was conducted. Scientific databases (Embase and PubMed) were searched until 4 November 2021. Second, the nominal group technique (NGT) was employed during focus group discussions with Belgian physicians to consider and validate these determinants for off-patent biologicals in the Belgian context. The qualitative data resulting from the literature review and focus group discussions were analyzed using the thematic framework method. RESULTS Fifty-three scientific articles that discussed elements that determine prescribing choices were identified. Out of these, 17 determinants of prescribing choices were found. These were divided into five categories: (1) product-related, (2) physicians' personal, (3) healthcare system-related, (4) patient-related, and (5) determinants related to the pharmaceutical company or brand. Nineteen Belgian physicians from different therapeutic areas that regularly prescribe biologicals then participated in focus group discussions. Using the NGT, the group discussions revealed that prescribing choices for off-patent biologicals are determined by a complex set of elements. Clinical data, geographical region, working environment, pharmaceutical marketing, patient profile, clinical guidelines, and preference of key opinion leaders (KOL) were considered most influential. Physicians indicated that the importance of these determinants differs depending on product classes or therapeutic domain. CONCLUSIONS Multiple elements determine the choice of an off-patent biological or biosimilar product. The importance of each of these determinants varies depending on the context in which the prescribing choice is made. To increase the prescription of best-value biologicals in the Belgian ambulatory care, a set of synergistic measures is required including information for healthcare providers (HCP) and patients, prescribing feedback, prescribing targets, tangible incentives, KOL involvement, guidelines regarding pharmaceutical promotion, and regular revision of reimbursement modalities.
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22
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The emergence of multimorbidity as a matter of concern: a critical review. BIOSOCIETIES 2022. [DOI: 10.1057/s41292-022-00285-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AbstractMultimorbidity is considered one of the greatest emerging challenges for contemporary health care systems. However, the meaning of the term ‘multimorbidity’ is not straightforward. Despite many attempts to clarify the definition and its measurement, the concept remains elusive. Still, academic interest in the study of multimorbidity has grown exponentially in the past ten years. In this paper, we trace the emergence of multimorbidity as a ‘matter of concern’ within health care research, exploring what has been called ‘the multimorbidity epidemic’ in the context of changing disease categories. We analyse how multimorbidity as a concept lays bare some major unresolved challenges within contemporary care services and summons up traditional primary care ideals of holistic, person-centred care. However, we argue that the current focus on the measurement and the identification of disease clusters falls short in contributing to better care for people who live with multiple long-term conditions now. Instead, we propose a novel understanding of ‘multimorbidity’ as an experience that manifests through people’s navigations of care infrastructures. To study this experience of multimorbidity, we discuss the potential of social science approaches that focus on ‘living well’ with illness.
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23
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Kim J, Je NK, Choo E, Jang EJ, Lee IH. Association between cost-sharing and drug prescribing in Korean elderly veterans with chronic diseases: A real-world claims data study. Medicine (Baltimore) 2022; 101:e30649. [PMID: 36123850 PMCID: PMC9478235 DOI: 10.1097/md.0000000000030649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This study aimed to investigate the relationship between cost-sharing and drug prescribing and its appropriateness in Korean elderly veterans with chronic conditions. This is a cross-sectional study using real-world claims data. Veterans with primary hypertension or dyslipidemia were compared with two controls with higher levels of cost-sharing. Study subjects (age ≥65 years) were selected through stratified random sampling and matching the individual attributes. The primary outcome was the annual amount of drugs prescribed per patient, and the secondary outcomes included several other measures investigating multifaceted aspects of drug prescribing, medical institution utilization behavior, and prescribing appropriateness. Gamma regression models or logistic regression models were employed. Veterans were prescribed 59%~74% more drugs (exp (β) = 1.59 [95% confidence interval [CI] = 1.55-1.64] ~ 1.74 [1.70-1.79]) compared to the National Health Insurance (NHI) patients. This was attributed mainly to longer prescribing days (44%) and slightly more prescriptions (6%~7%) than NHI patients. Veterans spent 14%~15% higher medication costs. Veterans were less likely to visit multiple medical institutions by estimates of 0.77 (0.76-0.79) ~ 0.80 (0.79-0.82). Similar but smaller differences were observed between veterans and medical aid (MedAid) patients. The veteran patients showed a more than 50% increased risk of therapeutic duplication than the other two controls (adjusted odds ratio [ORs] = 1.47 [1.37-1.57] ~ 1.61 [1.50-1.72]). Inappropriate drug prescribing was also more common in veterans than the two controls (adjusted ORs = 1.20 [1.11-1.31] ~ 1.32 [1.22-1.43]). In Korean elderly veterans with chronic illnesses, a level of cost-sharing was associated with having more prescribed medicines, and increased inappropriate prescribing.
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Affiliation(s)
- Jin Kim
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea
| | - Nam Kyung Je
- College of Pharmacy, Pusan National University, Busan, Republic of Korea
| | - Eunjung Choo
- College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Andong, Republic of Korea
| | - Iyn-Hyang Lee
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea
- *Correspondence: Iyn-Hyang Lee, College of Pharmacy, Yeungnam University, Gyeongsan 38541, Republic of Korea (e-mail: )
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24
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Davis WH, Magee MR, Monks SM, Geno KA, Crawford SB. Assessment of nationally recommended antibiotics for treatment of UTI in U.S.-Mexico border emergency departments. Am J Emerg Med 2022; 61:12-17. [PMID: 36027632 DOI: 10.1016/j.ajem.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/26/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) seen in the emergency department are commonly treated as an outpatient with oral antibiotics. Given that antibiotics are available for over-the-counter purchase in Mexico, there is speculation that potential misuse and overuse of antibiotics in United States-Mexico border areas could lead to antibiotic resistance patterns that would render some empiric treatments for UTIs less effective. The purpose of this study was to examine the effectiveness of Infectious Disease Society of America (IDSA) guideline-recommended antibiotics for treatment of outpatient UTI diagnosed in the emergency department. Data were collected from a county hospital on the U.S.-Mexico border with a metropolitan area of over 2 million people. Secondary analysis included frequency of urine culture isolated, resistance rates of urine pathogens, and prescriber habits. METHODS This study was a retrospective chart review of adult patients diagnosed and treated for UTI from August 1, 2019, to February 29, 2020. Culture results of included patients were analyzed against in vitro-tested antibiotics. Bacterial isolate frequency, resistance rates, and prescribing habits were collected. RESULTS A total of 985 patient charts were reviewed, of which 520 patients met inclusion criteria for analysis of prescribing habits. Of these, 329 positive bacterial culture growths were included in the analysis of antibiotic resistance rates. Oral antibiotics with comparatively lower resistance rates were amoxicillin/clavulanate, cefdinir, cefuroxime, and nitrofurantoin. Oral antibiotics with notably high resistance rates included trimethoprim-sulfamethoxazole (TMP-SMX), tetracycline, ciprofloxacin, levofloxacin, and cephalexin. Nitrofurantoin was prescribed most frequently for outpatient treatment of UTI/cystitis (41.6%) while cephalexin was the most commonly prescribed antibiotic for outpatient treatment of pyelonephritis (50%). CONCLUSION Our findings suggest that, while part of standard IDSA guidelines, fluoroquinolones and TMP-SMX are not ideal empiric antibiotics for treatment of outpatient UTI in the U.S.-Mexico border region studied due to high resistance rates. Although not listed as first line agents per current IDSA recommendations, 2nd and 3rd generation cephalosporins, and amoxicillin/clavulanate would be acceptable options given resistance patterns demonstrated in accordance with IDSA allowance for tailoring selection to local resistance. Nitrofurantoin appears to be consistent with recommendations and demonstrates a favorable resistance profile for treatment of outpatient UTI within this region.
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Affiliation(s)
- William H Davis
- Paul Foster School of Medicine, Texas Tech University Health Sciences El Paso, El Paso, TX, USA
| | - Matthew R Magee
- Paul Foster School of Medicine, Texas Tech University Health Sciences El Paso, El Paso, TX, USA
| | - Stormy M Monks
- Department of Emergency Medicine, Texas Tech University Health Sciences El Paso, El Paso, TX, USA
| | - K Aaron Geno
- Department of Pathology, Texas Tech University Health Sciences El Paso, El Paso, TX, USA
| | - Scott B Crawford
- Department of Emergency Medicine, Texas Tech University Health Sciences El Paso, El Paso, TX, USA.
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25
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Vaillancourt R, Dhalla R, Merks P, Lougheed T, Goldfield G, Mansell H, Cameron J. Concerns, beliefs and attitudes of pharmacists and pharmacy students on cannabis use in Canada. Can Pharm J (Ott) 2022; 155:219-229. [PMID: 35813525 PMCID: PMC9266375 DOI: 10.1177/17151635221102143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Since cannabis has been legalized in Canada for medical and recreational use, there has been an increased demand on pharmacists for cannabis counselling. The objective of this study was to determine the concerns, beliefs and attitudes of Canadian pharmacists and pharmacy students towards using cannabis. METHODS An online survey was synthesized under 3 broad themes: concerns, beliefs and attitudes about cannabis, consisting of 27 questions capturing demographics and Likert scale responding to survey questions. We examined whether there were differences in responses by geographic location (i.e., Ontario, Quebec, Canada), sex or practice setting (i.e., community, hospital). RESULTS Across Canada, there were 654 survey respondents, with 399 in Ontario and 95 in Quebec. Approximately 24% indicated they had used cannabis since legalization, 69% indicated they believed cannabis should be available for medical and recreational use and 34% indicated their perceptions towards cannabis had become more positive since legalization. Relative to Quebec or the rest of Canada, respondents from Ontario were significantly more likely to be comfortable providing counselling to and answering questions of patients on the safety and efficacy of medical cannabis use. Examining sex differences across Canada, male respondents were more comfortable than female counselling patients on the safety and efficacy of medical cannabis. CONCLUSION The current results reinforce the perceived need by pharmacists and pharmacy students for targeted education, and future research in cannabis education should consider potential gender differences in attitudes and beliefs surrounding cannabis therapy.
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Affiliation(s)
- Régis Vaillancourt
- Department of Pharmacy, Children’s Hospital of Eastern Ontario, Ottawa
- Department of Family Medicine, University of Ottawa Faculty of Medicine, Ottawa
| | | | - Piotr Merks
- Cardinal Stefan Wyszyński University, Faculty of Medicine, Warsaw and the Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium, Medicum, Bydgoszcz, Poland
| | - Taylor Lougheed
- Section of Emergency Medicine, Northern Ontario School of Medicine, Sudbury
| | - Gary Goldfield
- Healthy Active Living and Obesity (HALO) Research Group, Children’s Hospital of Eastern Ontario, Ottawa
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Jameason Cameron
- Department of Pharmacy, Children’s Hospital of Eastern Ontario, Ottawa
- Department of Family Medicine, University of Ottawa Faculty of Medicine, Ottawa
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Bose R, Hamdani SU, Minhas FA, Herr KJ. A comparison of real-world effectiveness of vortioxetine along the treatment algorithm for major depressive disorder. Curr Med Res Opin 2022; 38:661-671. [PMID: 35049384 DOI: 10.1080/03007995.2022.2031146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of vortioxetine in major depressive disorder (MDD) when used as a first-line versus second-line treatment or later. METHODS This was a post-hoc analysis of three 3-month non-interventional, prospective studies of vortioxetine in MDD - REVIDA (Malaysia, Philippines, Singapore, Thailand), PREVIDA (Pakistan) and TREVIDA (Taiwan). Improvements in depressive symptoms (PHQ-9, CGI-S), cognitive function (PDQ-D) and work productivity (WPAI) were compared between studies, and in a pooled analysis of patients using vortioxetine as the first line versus second-line treatment or later. Safety was compared between studies. RESULTS Overall, 798 patients were analyzed (PREVIDA = 425, REVIDA = 130, TREVIDA = 243). Most patients in PREVIDA (60.5%)/REVIDA (57.4%) used vortioxetine as first-line treatment versus TREVIDA (21.8%). Generally, greater improvements from baseline were observed across outcome measures in PREVIDA/REVIDA versus TREVIDA (Month 3, p < .0001). Vortioxetine as first-line treatment was associated with greater improvements in depression severity, cognition, functioning outcomes compared to second-line or later users (PHQ-9: -16.1 [6.4] vs -10.8 [8.9]; CGI-S: -2.7 [1.1] vs -2.0 [1.4]; PDQ-D: -29.5 [17.7] vs -18.5 [21.4]; p < .0001 at Month 3) as well as greater response (PHQ-9: 88.6% vs 61.5%; p < .0001) and remission rates (PHQ-9: 75.4% vs 47.7%; p < .0001). No new adverse events were reported outside of the product label. CONCLUSIONS In the Asian real-world setting, vortioxetine showed greater improvements in depressive and cognitive symptoms, work functioning, and response and remission rates when used as first-line versus second-line treatment or later. Vortioxetine was well-tolerated irrespective of the study population across Asia.
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Affiliation(s)
- Rohini Bose
- Lundbeck Singapore Pte Ltd, Singapore, Singapore
| | - Syed Usman Hamdani
- Human Development Research Foundation, Islamabad, Pakistan
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Fareed Aslam Minhas
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Karakoram International University, Gilgit, Pakistan
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Asmamaw G, Ejigu N, Tewihubo D, Ayenew W. Assessment of private health sector prescribing patterns and adherence to prescription format using World Health Organization core drug use indicators in Addis Ababa, Ethiopia. J Pharm Policy Pract 2022; 15:11. [PMID: 35232489 PMCID: PMC8886342 DOI: 10.1186/s40545-022-00408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Currently, the private healthcare sector's role in healthcare delivery is growing in Ethiopia. However, there are limited studies on private healthcare sector drug use patterns. This study aimed to evaluate the private healthcare sector prescribing practices and adherence to prescription format, using some of the World Health Organization (WHO) core drug use indicators in Addis Ababa, Ethiopia. Methods A retrospective cross-sectional study design was used to collect quantitative data from prescriptions prescribed and dispensed by private healthcare sectors in the Lemi-Kura sub-city, Addis Ababa. The study was conducted from June to July 2021. The WHO criteria were used to evaluate prescribing and prescription completeness indicators. Prescriptions, kept for the last 1 year that were prescribed between January 1, 2020, to January 1, 2021, by private drug outlets, were analyzed. Simple random and systematic sampling procedures were employed in selecting drug outlets and prescriptions, respectively. Results Of a total of 1,200 prescriptions, 2,192 drugs were prescribed and the average number of drugs per prescription was 1.83. Generic names, antibiotics, injections, and drugs on the Ethiopian essential medicines list accounted for 77.4, 63.8, 11.5, and 80.6% of all prescriptions, respectively. Among the patient identifiers, the patient card number (54.3%), weight (2.3%), and diagnoses (31.7%) were less likely to be completed. In terms of the drug-related information, the dosage form (35.5%) was the least likely to be completed. Only 36.6 and 25.8% of prescriptions contained the names and qualifications of the prescribers, respectively. It was difficult to obtain prescription papers with the dispenser identifier. Conclusion The study findings indicated prescribing and prescription completeness indicators all considerably deviated from WHO standards and hence unsuitable. This situation could be critical since a similar pattern is reported from public healthcare sectors, which might imply the extent of non-adherence to WHO core drug use standards. Consequently, it could play a considerable role in increasing irrational medicine use in Ethiopia. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-022-00408-0.
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28
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Bruno MK, Watanabe G, Ishikawa K, Chen JJ, Gao F, Nakagawa K, Taira D. Geographic Variation in Prescription Patterns of Parkinson's Disease Medications. Mov Disord 2022; 37:646-648. [PMID: 34859504 PMCID: PMC8940615 DOI: 10.1002/mds.28880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Michiko K. Bruno
- The Queen’s Medical Center, Honolulu, HI,John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Gina Watanabe
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Kyle Ishikawa
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - John J. Chen
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Fay Gao
- The Queen’s Medical Center, Honolulu, HI,John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Kazuma Nakagawa
- The Queen’s Medical Center, Honolulu, HI,John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Deborah Taira
- Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo, Hilo, HI
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29
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Seibert K, Stiefler S, Domhoff D, Wolf-Ostermann K, Peschke D. The influence of primary care quality on nursing home admissions in a multimorbid population with and without dementia in Germany: a retrospective cohort study using health insurance claims data. BMC Geriatr 2022; 22:52. [PMID: 35030993 PMCID: PMC8759199 DOI: 10.1186/s12877-021-02731-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/17/2021] [Indexed: 11/15/2022] Open
Abstract
Background Multimorbidity poses a challenge for high quality primary care provision for nursing care-dependent people with (PWD) and without (PWOD) dementia. Evidence on the association of primary care quality of multimorbid PWD and PWOD with the event of a nursing home admission (NHA) is missing. This study aimed to investigate the contribution of individual quality of primary care for chronic diseases in multimorbid care-dependent PWD and PWOD on the duration of ongoing residence at home before the occurrence of NHA. Methods We conducted a retrospective cohort study among elderly care-dependent PWD and PWOD in Germany for six combinations of chronic diseases using statutory health insurance claims data (2007–2016). Primary care quality was measured by 21 process and outcome indicators for hypertension, diabetes, depression, chronic obstructive pulmonary disease and heart failure. The primary outcome was time to NHA after initial onset of care-dependency. Multivariable Cox proportional hazard models were used to compare the time-to-event between PWD and PWOD. Results Among 5876 PWD and 12,837 PWOD 5130 NHA occurred. With the highest proportion of NHA for PWD with hypertension and depression and for PWOD with hypertension, diabetes and depression. Average duration until NHA ranged from 6.5 to 8.9 quarters for PWD and from 9.6 to 13.5 quarters for PWOD. Adjusted analyses show consistent associations of the quality of diabetes care with the duration of remaining in one’s own home regardless of the presence of dementia. Process indicators assessing guideline-fidelity are associated with remaining in one’s home longer, while indicators assessing complications, such as emergency inpatient treatment (HR = 2.67, 95% CI 1.99–3.60 PWD; HR = 2.81, 95% CI 2.28–3.47 PWOD) or lower-limb amputation (HR = 3.10, 95% CI 1.78–5.55 PWD; HR = 2.81, 95% CI 1.94–4.08 PWOD) in PWD and PWOD with hypertension and diabetes, increase the risk of NHA. Conclusions The quality of primary care provided to care-dependent multimorbid PWD and POWD, influences the time individuals spend living in their own homes after onset of care-dependency before a NHA. Health care professionals should consider possibilities and barriers of guideline-based, coordinated care for multimorbid care-dependent people. Further research on quality indicator sets that acknowledge the complexity of care for multimorbid elderly populations is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02731-8.
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Affiliation(s)
- Kathrin Seibert
- Faculty 11: Human and Health Sciences, Institute for Public Health and Nursing Research, University of Bremen, Grazer Str. 4, 28359, Bremen, Germany. .,High Profile Area Health Sciences, University of Bremen, Bremen, Germany.
| | - Susanne Stiefler
- Faculty 11: Human and Health Sciences, Institute for Public Health and Nursing Research, University of Bremen, Grazer Str. 4, 28359, Bremen, Germany.,High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Dominik Domhoff
- Faculty 11: Human and Health Sciences, Institute for Public Health and Nursing Research, University of Bremen, Grazer Str. 4, 28359, Bremen, Germany.,High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Karin Wolf-Ostermann
- Faculty 11: Human and Health Sciences, Institute for Public Health and Nursing Research, University of Bremen, Grazer Str. 4, 28359, Bremen, Germany.,High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Dirk Peschke
- Faculty 11: Human and Health Sciences, Institute for Public Health and Nursing Research, University of Bremen, Grazer Str. 4, 28359, Bremen, Germany.,High Profile Area Health Sciences, University of Bremen, Bremen, Germany.,Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
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A 5-year trend in the use of sodium-glucose co-transporter 2 inhibitors and other oral antidiabetic drugs in a Middle Eastern country. Int J Clin Pharm 2022; 44:1342-1350. [PMID: 36169802 PMCID: PMC9718883 DOI: 10.1007/s11096-022-01464-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/23/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Sodium glucose co-transporter 2 inhibitors (SGLT2is) are a novel class of oral antidiabetic drugs. To date, there are no pharmacoepidemiologic studies investigating the pattern of use of SGLT2is compared to other oral antidiabetic drugs in the Middle East, including Qatar. AIM This study aimed to explore the trends in the use of SGLT2is compared to other oral antidiabetic drugs in Qatar from 2016 to 2020. METHOD This is a descriptive, retrospective cross-sectional study where information on all oral antidiabetic drugs dispensed as in- or out-patient prescriptions from 2016 to 2020 in Hamad Medical Corporation hospitals, Qatar were collected. Outcomes included the number and relative frequency of quarterly prescriptions of different oral antidiabetic drug classes [biguanides, sulfonylureas, dipeptidyl peptidase 4 inhibitors, thiazolidinediones, meglitinides, α-glucosidase inhibitors, and SGLT2is] prescribed from 2016 to 2020. RESULTS SGLT2is prescriptions increased from 1045 (2.13%) in 2017 to 8375 (12.39%) in 2020, while sulfonylureas prescriptions declined from 10,436 (21.25%) to 9158 (13.55%) during the same period. Metformin use decreased from 23,926 (48.71%) in 2017 to 30,886 (45.70%) in 2020. The proportions of thiazolidinediones, meglitinides, α-glucosidase inhibitors prescriptions remained stable over the years. Among SGLT2is, empagliflozin prescriptions showed an increase from 537 (10.65%) to 2881 (34.40%) compared to dapagliflozin, which decreased by the end of 2018 from 4505 (89.35%) to 5494 (65.6%). CONCLUSION SGLT2is have largely replaced sulfonylureas in Qatar. The increasing trend in their use over the years is similar to that reported in other countries. The trend among SGLT2is suggests greater preference for empagliflozin over dapagliflozin.
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Hampton T, Ogden J, Higgins HM. Understanding doctors' emergency department antibiotic prescribing decisions in children with respiratory symptoms in the UK: a qualitative study. BMJ Open 2021; 11:e051561. [PMID: 34930732 PMCID: PMC8688728 DOI: 10.1136/bmjopen-2021-051561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Exploration of the factors that influence hospital doctors' antibiotic prescribing decisions when treating children with respiratory symptoms in UK emergency departments. METHODS A qualitative study using semistructured interviews based on a critical incident technique with 21 physicians of different grades and specialties that treat children in the UK. Interviews were audio-recorded then transcribed verbatim and analysed using thematic analysis. RESULTS Four themes were identified. These themes illustrate factors which influence clinician prescribing. The three principal themes were authorities, pressures and risk. The fourth transcending theme that ran through all themes was clinician awareness and complicity ('knowing but still doing'). CONCLUSIONS Hospital doctors prescribe antibiotics even when they know they should not. This appears to be due to the influence of those in charge or external pressures experienced while weighing up the immediate and longer term risks but clinicians do this with full insight into their actions. These findings have implications for invested parties seeking to develop future antimicrobial stewardship programmes. It is recommended that stewardship interventions acknowledge and target these themes which may in turn facilitate behaviour change and antimicrobial prescribing practice in emergency departments.
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Affiliation(s)
- Thomas Hampton
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jane Ogden
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Helen Mary Higgins
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
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32
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Chen X. Pharmaceutical Sales Representatives in the United States and China: The Need for Professional Public Space. HEALTH CARE ANALYSIS 2021; 30:35-56. [PMID: 34761311 PMCID: PMC8580741 DOI: 10.1007/s10728-021-00438-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 12/26/2022]
Abstract
Pharmaceutical sales representatives (PSRs) are one of the most frequently used drug information sources for physicians in both the United States and China. During face-to-face interactions, PSRs use various promotional strategies to impact the prescribing behavior. In the United States, PSRs provide physicians small gifts, free drug samples, and “sincere friendships”, whereas in China, they played an indispensable role in medical corruption over the past three decades. To cope with the undue influence of PSRs, both these countries have taken positive but insufficient measures to eliminate the effect thus far. By comparing the strategies of American and Chinese PSRs, it was found that building a friendly personal relationship with physicians in a relatively closed private environment (such as physician’s office) is a key factor to exert an individualized influence on physicians, even in different social backgrounds and healthcare contexts. Therefore, this essay suggests that it is necessary to limit the establishment of personal relationships and maintain a more professional interaction to reduce the personalized psychological and emotional influences on physicians’ professional judgment. To achieve this goal, it is proposed to transfer the physician-PSR interaction to a professional public space as a supplement to current countermeasures and suggestions. The presence of others and the possibility of third party participation will stimulate more ethical and reputational concerns. It is hoped that the increased transparency of the interaction will promote participants to consider more professional norms and mitigate the undue influence of PSRs’ individualized strategies.
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Affiliation(s)
- Xiaoying Chen
- School of Humanities, Southeast University, 2 Southeast University Road, Jiangning District, Nanjing, 211189, People's Republic of China.
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Kurotschka PK, Tiedemann E, Wolf D, Thier N, Forster J, Liese JG, Gagyor I. Management of Common Infections in German Primary Care: A Cross-Sectional Survey of Knowledge and Confidence among General Practitioners and Outpatient Pediatricians. Antibiotics (Basel) 2021; 10:antibiotics10091131. [PMID: 34572713 PMCID: PMC8466449 DOI: 10.3390/antibiotics10091131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022] Open
Abstract
Outpatient antibiotic use is closely related to antimicrobial resistance and in Germany, almost 70% of antibiotic prescriptions in human health are issued by primary care physicians (PCPs). The aim of this study was to explore PCPs, namely General Practitioners' (GPs) and outpatient pediatricians' (PDs) knowledge of guideline recommendations on rational antimicrobial treatment, the determinants of confidence in treatment decisions and the perceived need for training in this topic in a large sample of PCPs from southern Germany. Out of 3753 reachable PCPs, 1311 completed the survey (overall response rate = 34.9%). Knowledge of guideline recommendations and perceived confidence in making treatment decisions were high in both GPs and PDs. The two highest rated influencing factors on prescribing decisions were reported to be guideline recommendations and own clinical experiences, hence patients' demands and expectations were judged as not influencing treatment decisions. The majority of physicians declared to have attended at least one specific training course on antibiotic use, yet almost all the participating PCPs declared to need more training on this topic. More studies are needed to explore how consultation-related and context-specific factors could influence antibiotic prescriptions in general and pediatric primary care in Germany beyond knowledge. Moreover, efforts should be undertaken to explore the training needs of PCPs in Germany, as this would serve the development of evidence-based educational interventions targeted to the improvement of antibiotic prescribing decisions rather than being focused solely on knowledge of guidelines.
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Affiliation(s)
- Peter Konstantin Kurotschka
- Department of General Practice, University Hospital Würzburg, 97080 Würzburg, Germany; (E.T.); (D.W.); (N.T.); (I.G.)
- Correspondence:
| | - Elena Tiedemann
- Department of General Practice, University Hospital Würzburg, 97080 Würzburg, Germany; (E.T.); (D.W.); (N.T.); (I.G.)
| | - Dominik Wolf
- Department of General Practice, University Hospital Würzburg, 97080 Würzburg, Germany; (E.T.); (D.W.); (N.T.); (I.G.)
| | - Nicola Thier
- Department of General Practice, University Hospital Würzburg, 97080 Würzburg, Germany; (E.T.); (D.W.); (N.T.); (I.G.)
| | - Johannes Forster
- Institute for Hygiene and Microbiology, University of Würzburg, 97080 Würzburg, Germany;
| | - Johannes G. Liese
- Department of Pediatrics, University Hospital Würzburg, 97080 Würzburg, Germany;
| | - Ildiko Gagyor
- Department of General Practice, University Hospital Würzburg, 97080 Würzburg, Germany; (E.T.); (D.W.); (N.T.); (I.G.)
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Karasneh RA, Al-Azzam SI, Ababneh MA, Basheti IA, Al-Azzeh O, Al Sharie S, Conway BR, Aldeyab MA. Exploring Information Available to and Used by Physicians on Antibiotic Use and Antibiotic Resistance in Jordan. Antibiotics (Basel) 2021; 10:963. [PMID: 34439013 PMCID: PMC8389019 DOI: 10.3390/antibiotics10080963] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
Evidence based information sources for physicians are needed for informed antibiotic prescribing practices. The aim of this study was to explore physicians' preferred sources of information and evaluate physicians' awareness of available information and initiatives on prudent antibiotic prescribing in Jordan. A cross-sectional study was conducted utilizing an online questionnaire and included physicians (n = 409) from all sectors and specialties in Jordan. Published guidelines (31.8%), the workplace (25.7%), colleagues or peers (20.0%), group or conference training (18.3%), and the medical professional body (18.1%) were the main sources of information about avoiding unnecessary antibiotic prescribing, with the influence of these sources on changing prescribers' views being 34.7%, 17.1%, 11%, 13.4%, and 7.6%, respectively. One-third of physicians (33.7%) reported no knowledge of any initiatives on antibiotic awareness and resistance. Regarding awareness of national action plans on antimicrobial resistance, 10.5%, 34%, and 55.5% of physicians were aware, unaware, and unsure of the presence of any national action plans, respectively. Physicians showed interest in receiving more information on resistance to antibiotics (58.9%), how to use antibiotics (42.2%), medical conditions for which antibiotics are used (41.3%), prescribing of antibiotics (35.2%), and links between the health of humans, animals, and the environment (19.8%). The findings can inform interventions needed to design effective antimicrobial stewardship, enabling physicians to prescribe antibiotics appropriately.
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Affiliation(s)
- Reema A. Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Sayer I. Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan; (S.I.A.-A.); (M.A.A.)
| | - Mera A. Ababneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan; (S.I.A.-A.); (M.A.A.)
| | - Iman A. Basheti
- Faculty of Pharmacy, Applied Sciences Private University, Amman 11931, Jordan;
| | - Ola Al-Azzeh
- Department of Pharmacy Practice, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia;
| | - Sarah Al Sharie
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Barbara R. Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK;
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Mamoon A. Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK;
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Mitchell AP, Trivedi NU, Gennarelli RL, Chimonas S, Tabatabai SM, Goldberg J, Diaz LA, Korenstein D. Are Financial Payments From the Pharmaceutical Industry Associated With Physician Prescribing? : A Systematic Review. Ann Intern Med 2021; 174:353-361. [PMID: 33226858 PMCID: PMC8315858 DOI: 10.7326/m20-5665] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Financial payments from the drug industry to U.S. physicians are common. Payments may influence physicians' clinical decision making and drug prescribing. PURPOSE To evaluate whether receipt of payments from the drug industry is associated with physician prescribing practices. DATA SOURCES MEDLINE (Ovid), Embase, the Cochrane Library, Web of Science, and EconLit were searched without language restrictions. The search had no limiting start date and concluded on 16 September 2020. STUDY SELECTION Studies that estimated the association between receipt of industry payments (exposure) and prescribing (outcome). DATA EXTRACTION Pairs of reviewers extracted the primary analysis or analyses from each study and evaluated risk of bias (ROB). DATA SYNTHESIS Thirty-six studies comprising 101 analyses were included. Most studies (n = 30) identified a positive association between payments and prescribing in all analyses; the remainder (n = 6) had a mix of positive and null findings. No study had only null findings. Of 101 individual analyses, 89 identified a positive association. Payments were associated with increased prescribing of the paying company's drug, increased prescribing costs, and increased prescribing of branded drugs. Nine studies assessed and found evidence of a temporal association; 25 assessed and found evidence of a dose-response relationship. LIMITATION The design was observational, 21 of 36 studies had serious ROB, and publication bias was possible. CONCLUSION The association between industry payments and physician prescribing was consistent across all studies that have evaluated this association. Findings regarding a temporal association and dose-response suggest a causal relationship. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Aaron P. Mitchell
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Niti U. Trivedi
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Renee L. Gennarelli
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan Chimonas
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sara M. Tabatabai
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Johanna Goldberg
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luis A. Diaz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deborah Korenstein
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Shenoy P, Govindarajan S. Drug prescribing patterns in pediatric urinary tract infections: A retrospective drug utilization analysis in an urban tertiary care hospital. J Pharm Bioallied Sci 2020; 12:423-427. [PMID: 33679088 PMCID: PMC7909065 DOI: 10.4103/jpbs.jpbs_235_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/26/2020] [Accepted: 06/26/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction: A constant update of antibiotic sensitivity of pathogens of the area, country, or institution helps in interventions that would improve the prescribing pattern and rational use of drugs in children. This study aimed to assess prescribing trends for urinary tract infection (UTI), a common distressful pediatric infection in a tertiary care teaching hospital. Materials and Methods: This study was a descriptive, retrospective, cross-sectional, and record-based analysis including pediatric patients aged <18 years of either gender diagnosed with UTI. The case record files retrieved from medical records department based on the International Classification of Diseases, 10th Revision (ICD-10) disease coding were analyzed for demographics, and details of drugs including dose and route of administration, frequency, and duration of treatment with antimicrobial used and other concurrent drugs were recorded. Results: Of 42 patients included in the study, 14 (33.3%) were males and 28 (66.67%) were females. Third-generation cephalosporins were the most commonly used antibiotics (71.4%) followed by aminoglycosides (35.7%), amoxicillin clavulanate (11.9%), fluoroquinolones (7.1%), and miscellaneous (doxycycline, metronidazole, and nitrofurantoin) (9.5%). Ceftriaxone among the cephalosporins and amikacin among the aminoglycosides were the most commonly used drugs. Intravenous route was the most commonly used route of administration followed by patients who received by both intravenous and oral routes. The average duration of therapy was 4.43 ± 1.9 days. Conclusion: This study concludes that third-generation cephalosporin is used as first-line drugs irrespective of the causative agent for UTI which should ideally be reserved for complicated UTIs. Moreover, existing guidelines also indicate that the duration of antimicrobial therapy should be seven to 14 days. These results highlight the necessity for a remedial education program within the health care system designed to improve pharmacotherapy of UTI.
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