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Vouri SM, Morris EJ, Usmani SA, Reise R, Jiang X, Pepine CJ, Manini TM, Malone DC, Winterstein AG. Evaluation of the key prescription sequence symmetry analysis assumption using the calcium channel blocker: Loop diuretic prescribing cascade. Pharmacoepidemiol Drug Saf 2022; 31:72-81. [PMID: 34553438 PMCID: PMC8688319 DOI: 10.1002/pds.5362] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate the prescription sequence symmetry analysis assumption regarding balance between marker drug (i.e., medication used to treat a drug-induced adverse event) initiation rates before and after initiation of an index drug (i.e., medication that is potentially associated with the drug-induced adverse event) in the absence of prescribing cascades, we used a well-described example of loop diuretic initiation to treat dihydropyridine calcium channel blockers (DH CCB)-induced edema. STUDY DESIGN AND SETTING The University of Florida Health Integrated Data Repository from June 2011 and July 2018 was used to assess temporal prescribing of DH CCB and loop diuretics within the prescription sequence symmetry analysis framework. Validation of the prescribing cascade was performed via clinical expert chart review. RESULTS Among patients without heart failure who were initiated on DH CCB, 26 and 64 loop diuretics initiators started within 360 days before versus after DH CCB initiation, respectively, resulting in an adjusted sequence ratio (aSR) of 2.27 (95% CI, 1.44-3.58). Overall, 35 (54.7%) patients were determined to have a prescribing cascade. Removing patients who experienced a prescribing cascade resulted in an aSR of 1.05, 95% CI 0.62-1.78). CONCLUSION Loop diuretic initiation rates before and after DH CCB initiation for reasons other a prescribing cascade were similar, thus confirming the prescription sequence symmetry analysis assumption.
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Affiliation(s)
- Scott M. Vouri
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL,University of Florida Health Physicians, Gainesville, FL,Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL
| | - Earl J. Morris
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Silken A. Usmani
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL,University of Florida Health Physicians, Gainesville, FL
| | - Rachel Reise
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL,University of Florida Health Physicians, Gainesville, FL
| | - Xinyi Jiang
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Todd M. Manini
- Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL
| | - Daniel C. Malone
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL,Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL
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Reise R, Huang Y, Usmani SA, Gruber L, Patel N, Green T, Swilley L, Dewar MA, Gums J. The Adaptation of a Clinic-Adjacent Parking Garage for Drive-In COVID-19 Vaccination. Health Serv Insights 2021; 14:11786329211042769. [PMID: 34526774 PMCID: PMC8436302 DOI: 10.1177/11786329211042769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose The distribution and vaccination of COVID-19 vaccines to billions of people worldwide will likely be one of the biggest public health undertakings in history. There has been a large focus on identifying processes to safely, efficiently, and effectively vaccinate large populations. We aimed to describe the development and operationalization of a drive-in COVID-19 vaccine site in a parking garage adjacent to outpatient clinics at University of Florida (UF) Health Physicians and how it was informed by the roll-out of SARS-CoV-2 testing and administration of respiratory vaccinations. Design/Methodology/Approach A technical description and analysis of a drive-in COVID-19 vaccine site. Findings We incrementally increased the number of vaccines performed per day from 300 in the first 2 weeks to 700 an additional 2 weeks later. By the end of January, we completed nearly 14 000 vaccinations. At this capacity, we estimate the site could performed 5000 vaccinations per week. Practical Implications This manuscript provides step-by-step guidance how to develop, operationalize, and implement a sustainable drive-in COVID-19 vaccination site. Originality/Value To our knowledge, this is the first description of a drive-in approach to COVID-19 vaccination. Our findings can help inform other health entities as they develop or expand vaccination efforts that may serve as a template for other sites to adapt.
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Affiliation(s)
- Rachel Reise
- University of Florida Health Physicians, Gainesville, FL, USA.,University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Yushi Huang
- University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Silken A Usmani
- University of Florida Health Physicians, Gainesville, FL, USA.,University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Laura Gruber
- University of Florida Health Physicians, Gainesville, FL, USA
| | - Natasha Patel
- University of Florida Health Physicians, Gainesville, FL, USA
| | - Tracy Green
- University of Florida Health Physicians, Gainesville, FL, USA
| | - Lindsay Swilley
- University of Florida Health Physicians, Gainesville, FL, USA
| | - Marvin A Dewar
- University of Florida Health Physicians, Gainesville, FL, USA.,University of Florida College of Medicine, Gainesville, FL, USA
| | - John Gums
- University of Florida College of Pharmacy, Gainesville, FL, USA
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Hincapie-Castillo JM, Easey T, Hernandez C, Maguire M, Usmani SA, Vouri SM, Goodin A. Changes in Quantity of Opioids Dispensed following Florida's Restriction Law for Acute Pain Prescriptions. Pain Med 2021; 22:1870-1876. [PMID: 33502536 PMCID: PMC8346917 DOI: 10.1093/pm/pnab017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective To assess the impact of Florida’s 3-day opioid prescription supply law, effective July 2018, on opioids dispensed for acute pain patients. Methods Pharmacy claims from a health plan serving a large Florida employer from January 2015 through March 2019 were analyzed. We used an interrupted time series study design accounting for autocorrelation of trends before and after policy change. Acute pain patients met inclusion criteria if they had not received any opioid containing medications in the past 180 days. Patients could contribute to additional new use time if subsequent opioid claims occurred ≥180 days since the previous claim. Outcomes included mean number of units dispensed of the initial opioid prescription, mean morphine milligram equivalents (MMEs) per day of initial prescription by month, and mean total MMEs per initial prescription by month. Results A total of 8,375 enrollees had 10,583 unique opioid starts in the given timeframe. Following the policy, there was an immediate significant decrease in the units dispensed per prescription of 4.9 (95% confidence interval [CI] −8.95, −.82 units). Additionally, there was a significant immediate reduction in total MMEs dispensed per prescription of 25.6 (95% CI −44.76, −6.44 MMEs). Conclusions Among a group of privately-insured plan enrollees in Florida, and as a result of the law, there were significant decreases in the number of units dispensed, and total MMEs of opioid prescriptions. The immediate reduction in new opioid utilization following policy implementation suggests effective policy; however, impacts on chronic pain patients were not assessed.
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Affiliation(s)
- Juan M Hincapie-Castillo
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA.,Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA.,Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
| | - Taylor Easey
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
| | - Carlos Hernandez
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
| | - Michael Maguire
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA.,Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
| | - Silken A Usmani
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA.,UF Health Physicians, Gainesville, Florida, USA
| | - Scott Martin Vouri
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA.,Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA.,UF Health Physicians, Gainesville, Florida, USA
| | - Amie Goodin
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA.,Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
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Usmani SA, Hollmann J, Goodin A, Hincapie-Castillo JM, Adkins LE, Ourhaan N, Oueini R, Bhagwandass H, Easey T, Vouri SM. Effects of hydrocodone rescheduling on opioid use outcomes: A systematic review. J Am Pharm Assoc (2003) 2020; 61:e20-e44. [PMID: 33127312 DOI: 10.1016/j.japh.2020.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate opioid prescribing, dispensing, and use in relation to hydrocodone-containing product (HCP) rescheduling. METHODS Seven biomedical databases and grey literature sources were searched with keywords and database-specific controlled vocabulary relevant to HCP rescheduling for items published between January 2014 and July 2019. We included English-language quasi-experimental studies that assessed changes in HCP and other opioid prescribing, dispensing, utilization, and opioid-related health outcomes before and after HCP rescheduling. A data extraction sheet was created for this review. Two authors evaluated risk of bias for each included study. Two of 4 authors each independently extracted patient demographics and opioid-related outcomes from the included studies. Conflicts were resolved by a third author. RESULTS All studies identified (n = 44) were quasi-experimental in design with 10 using an interrupted time series approach. A total of 24 studies reported a decrease in HCP prescribing by 3.1%-66.0%. Six studies reported a decrease in HCP days' supply or doses by 14.0%-80.8%. There was increased prescribing of oxycodone-containing products by 4.5%-13.9% in 5 studies, tramadol by 2.7%-53.0% in 9 studies, codeine-containing products by 0.8%-1352.9% in 8 studies). Five studies reported a decrease in morphine equivalents by at least 10%, whereas 2 studies reported an increase in morphine equivalents. Differences in populations, sample sizes, and approaches did not allow for a meta-analysis. Details regarding approach and findings were limited in published conference abstracts (n = 16). CONCLUSIONS Hydrocodone rescheduling was associated with reductions in prescribing and use of HCPs but was also associated with increased prescribing and use of other opioids, both schedule II and nonschedule II.
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Abstract
This quality improvement study assesses the number of new opioid users and the number of units dispensed per prescription before and after implementation of Florida’s 2018 restriction law on opioid prescribing.
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Affiliation(s)
- Juan M. Hincapie-Castillo
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville
| | - Amie Goodin
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville
| | | | - Silken A. Usmani
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville
- UF Health Physicians, Gainesville, Florida
| | - Scott Martin Vouri
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville
- UF Health Physicians, Gainesville, Florida
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