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Jackson K. Drug Utilization Review: Our Patients Deserve Our Very Best. Int J Pharm Compd 2023; 27:450-453. [PMID: 38100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
In 1990, the Omnibus Budget Reconciliation Act included requirements for Medicaid patients in an effort to save the federal government money. The requirements included a prospective drug utilization review, patient counseling, and maintenance of patient records. Subsequently, in 1993, when the pharmacy practice requirements went into effect, this federal regulation became the standard of care for pharmacists and part of their professional duty. This article suggests that the pharmacy should review all active pharmaceutical ingredients and excipients that are dispensed at the pharmacy and list all interactions or potential side effects in the review, so that a proper drug utilization review can be performed.
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Hussain M, Wong C, Taguedong E, Verma S, Mahsin M, Karim S, Lee-Ying R, Ezeife DA. Impact of Oncology Drug Review Times on Public Funding Recommendations. Curr Oncol 2023; 30:7706-7712. [PMID: 37623039 PMCID: PMC10453657 DOI: 10.3390/curroncol30080558] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/26/2023] [Accepted: 08/06/2023] [Indexed: 08/26/2023] Open
Abstract
New oncology drugs undergo detailed review prior to public funding in a single-payer healthcare system. The aim of this study was to assess how cancer drug review times impact funding recommendations. Drugs reviewed by the pan-Canadian Oncology Drug Review (pCODR) between the years 2012 and 2020 were included. Data were collected including Health Canada approval dates, initial and final funding recommendations, treatment intent, drug class, clinical indications, and incremental cost-effectiveness ratios (ICER). Univariable and multivariable analyses were used to determine the association between funding recommendations and review times. Of the 164 applications submitted, 130 received a positive final recommendation. Median time from Health Canada (HC) approval to final recommendation was longer for drugs indicated for the treatment of gastrointestinal (GI) and lung cancer compared to breast, genitourinary (GU), and other tumours (205 vs. 198 vs. 111 vs. 129 vs. 181 days, respectively; Kruskal-Wallis p = 0.0312). Drugs with longer review times were more likely to receive a negative pCODR recommendation, even when adjusting for tumour type, drug class, and intent of therapy (157 vs. 298 days; Wilcoxon p = 0.0003, OR 1.002 95% CI [1.000-1.004].). There was no association between funding recommendation and tumour type or class of drug. The exploration of factors associated with variance in review times will be important in ensuring timely patient access to cancer drugs.
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Affiliation(s)
- Marya Hussain
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (S.K.); (R.L.-Y.); (D.A.E.)
| | - Chelsea Wong
- Faculty of Arts, Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Eddy Taguedong
- Department of Medicine, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Saurav Verma
- London Regional Cancer Program, Department of Medical Oncology, London Health Sciences Centre, London, ON N6A 5W9, Canada;
| | - Md Mahsin
- Precision Oncology Hub, Alberta Health Services, Calgary, AB T2N 4Z6, Canada;
| | - Safiya Karim
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (S.K.); (R.L.-Y.); (D.A.E.)
| | - Richard Lee-Ying
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (S.K.); (R.L.-Y.); (D.A.E.)
| | - Doreen A. Ezeife
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (S.K.); (R.L.-Y.); (D.A.E.)
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Liao PA, Pan SW, Chen CY, Deng CY, Dong YH. Prescription Patterns of New Use of Fixed-Dose Combination Inhalers in Patients with Chronic Obstructive Pulmonary Disease: Long-Acting β2 Agonists Plus Long-Acting Muscarinic Antagonists versus Long-Acting β2 Agonists Plus Inhaled Corticosteroids. Int J Chron Obstruct Pulmon Dis 2023; 18:553-563. [PMID: 37069844 PMCID: PMC10105570 DOI: 10.2147/copd.s393392] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/27/2023] [Indexed: 04/19/2023] Open
Abstract
Background The clinical guideline recommends use of long-acting β2 agonists/long-acting muscarinic antagonists (LABA/LAMA) or long-acting β2 agonists/inhaled corticosteroids (LABA/ICS) combination therapies for patients with severe chronic obstructive pulmonary disease (COPD). The fixed-dose combination (FDC) inhalers of LABA/LAMA and LABA/ICS were reimbursed in Taiwan in 2015 and in 2002, respectively. This study aimed to examine prescription patterns of new use of either FDC therapy in real-world practice. Methods We identified COPD patients who initiated LABA/LAMA FDC or LABA/ICS FDC between 2015 and 2018 from a population-based Taiwanese database with 2 million, randomly sampled beneficiaries enrolled in a single-payer health insurance system. We compared number of LABA/LAMA FDC and LABA/ICS FDC initiators in each calendar year, from different hospital accreditation levels, and cared for by different physician specialties. We also compared baseline patient characteristics between LABA/LAMA FDC and LABA/ICS FDC initiators. Results A total of 12,455 COPD patients who initiated LABA/LAMA FDC (n=4019) or LABA/ICS FDC (n=8436) were included. Number of LABA/LAMA FDC initiators increased apparently (n=336 in 2015 versus n=1436 in 2018), but number of LABA/ICS FDC initiators decreased obviously (n=2416 in 2015 versus n=1793 in 2018) over time. The preference of use of LABA/LAMA FDC varied across clinical environments. The proportions of LABA/LAMA FDC initiators were more than 30% in the setting of non-primary care clinics (eg, medical centers) and in the services of chest physicians; but were only less than 10% in primary care clinics and non-chest physicians' services (eg, family medicine physicians). LABA/LAMA FDC initiators appeared to be older, male, to have more comorbidities, and to utilize resources more frequently compared to LABA/ICS FDC initiators. Conclusion This real-world study found evident temporal trends, variations in healthcare provider, and differences in patient characteristics among COPD patients who initiated LABA/LAMA FDC or LABA/ICS FDC.
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Affiliation(s)
- Pei-An Liao
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Yu Chen
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Yeh Deng
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yaa-Hui Dong
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Yoon D, Song I, Jeon HL, Bea S, Choi A, Lee H, Shin JY. Clinical and Cost-Saving Effects of the Drug Utilization Review Modernization Project in Inpatient and Outpatient Settings in Korea. J Patient Saf 2022; 18:605-610. [PMID: 35587895 DOI: 10.1097/pts.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Korea's national health insurance authority introduced a drug utilization review modernization pilot project in which health professionals provided follow-up services to monitor adverse drug events. We aimed to evaluate the effects of the project on clinical and economic outcomes. METHODS We conducted difference-in-differences analysis using National Health Insurance claims data from the Health Insurance Review and Assessment Service. We calculated the number of adverse drug events and allergic reactions as a clinical indicator and medical costs incurred to manage these events as an economic indicator. Absolute difference in each outcome measure was defined as the value after the project minus the value before the project. Difference-in-differences was defined as a difference in absolute differences between the intervention group and the control group. RESULTS Overall, difference-in-differences were -43 and -826 for the number of drug-related adverse events and allergic reactions and -$198,700 and $53,318 for medical costs in the inpatient and outpatient settings, respectively. For outpatients, the monthly number of adverse drug events and allergic reactions has grown higher for the control group than for the intervention group after implementation of the pilot project. CONCLUSIONS Implementation of the pilot project lowered the number of adverse drug events and allergic reactions in the inpatient and outpatient setting. The project also lowered medical costs incurred to manage these events in the inpatient setting only. Based on our findings, we recommend that the pilot project be expanded on a nationwide level at least in the inpatient setting.
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Affiliation(s)
- Dongwon Yoon
- From the School of pharmacy, Sungkyunkwan University, Suwon
| | - Inmyung Song
- College of Nursing and Health, Kongju National University, Gongju
| | - Ha-Lim Jeon
- School of Pharmacy, Jeonbuk National University, Jeonju, Jeonbuk
| | - Sungho Bea
- From the School of pharmacy, Sungkyunkwan University, Suwon
| | - Ahhyung Choi
- From the School of pharmacy, Sungkyunkwan University, Suwon
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Jang W, Hwang H, Jo HU, Cha YH, Kim B. Effect of discontinuation of an antimicrobial stewardship programme on the antibiotic usage pattern. Clin Microbiol Infect 2021; 27:1860.e1-1860.e5. [PMID: 34325066 DOI: 10.1016/j.cmi.2021.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/11/2021] [Accepted: 07/11/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study aimed to analyse the effect of discontinuation of antimicrobial stewardship programme (ASP) activity on the usage pattern of antibiotics. METHODS An interrupted time-series analysis assessing the trends in antibiotic use was conducted between September 2015 and August 2019 in an 859-bed university-affiliated hospital in Korea, where all ASP activities were discontinued in March 2018. The major activity of the ASP was a restrictive antibiotic programme. RESULTS The use of restrictive antibiotics increased immediately after the discontinuation of the ASP by 41.06 days of therapy (DOT)/1000 patient-days in the general ward (95% confidence interval (CI) 21.04-61.08) and by 391.04 DOT/1000 patient-days in the intensive care unit (ICU) (95%CI 207.56-574.51). In addition, there were positive changes in the slope for the use of restrictive antibiotics in the general ward (7.06 DOT/1000 patient-days per month, 95%CI 4.63-9.50) and ICU (35.95 DOT/1000 patient-days per month, 95%CI 18.70-53.19). The use of broad-spectrum antibiotics in the general ward significantly decreased (-87.54 DOT/1000 patient-days, 95%CI -149.29 to -25.79). For non-broad-spectrum antibiotics, there were positive changes in the slope in the general ward (16.54 DOT/1000 patient-days per month, 95%CI 12.99-20.09) and ICU (12.85 DOT/1000 patient-days per month, 95%CI 2.32-23.38). CONCLUSIONS After discontinuation of the ASP, antibiotic usage patterns rapidly returned to the patterns prior to the implementation of the programme.
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Affiliation(s)
- Wooyoung Jang
- School of Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hyeonjun Hwang
- Center for Service Industry, Korea Institute for Industrial Economics and Trade, Sejong, South Korea
| | - Hyun-Uk Jo
- Department of Urology, Eulji University College of Medicine, Daejeon, South Korea; Department of Urology, Good Munhwa Hospital, Busan, South Korea
| | - Yong-Han Cha
- Department of Orthopaedics, Eulji University Hospital, Daejeon, South Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea.
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Rijal KR, Banjara MR, Dhungel B, Kafle S, Gautam K, Ghimire B, Ghimire P, Dhungel S, Adhikari N, Shrestha UT, Sunuwar DR, Adhikari B, Ghimire P. Use of antimicrobials and antimicrobial resistance in Nepal: a nationwide survey. Sci Rep 2021; 11:11554. [PMID: 34078956 PMCID: PMC8172831 DOI: 10.1038/s41598-021-90812-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/18/2021] [Indexed: 01/21/2023] Open
Abstract
Nepal suffers from high burden of antimicrobial resistance (AMR) due to inappropriate use of antibiotics. The main objective of this study was to explore knowledge, attitude and practices of antibiotics uses among patients, healthcare workers, laboratories, drug sellers and farmers in eight districts of Nepal. A cross-sectional survey was conducted between April and July 2017. A total of 516 individuals participated in a face-to-face interview that included clinicians, private drug dispensers, patients, laboratories, public health centers/hospitals and, livestock and poultry farmers. Out of 516 respondents, 62.8% (324/516) were patients, 16.9% (87/516) were clinicians, 6.4% (33/516) were private drug dispensers. A significant proportion of patients (42.9%; 139/324) thought that fever could be treated with antibiotics. Majority (79%; 256/324) of the patients purchased antibiotics over the counter. The knowledge of antibiotics used among patients increased proportionately with the level of education: literate only [AOR = 1.4 (95% Cl = 0.6-4.4)], versus secondary education (8-10 grade) [AOR = 1.8 (95% Cl = 1.0-3.4)]. Adult patients were more aware of antibiotic resistance. Use of antibiotics over the counter was found high in this study. Knowledge, attitude and practice related to antibiotic among respondents showed significant gaps and need an urgent effort to mitigate such practice.
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Affiliation(s)
- Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Binod Dhungel
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Samarpan Kafle
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Kedar Gautam
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Bindu Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | | | - Nabaraj Adhikari
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | - Dev Ram Sunuwar
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
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Kusama Y, Muraki Y, Tanaka C, Koizumi R, Ishikane M, Yamasaki D, Tanabe M, Ohmagari N. Characteristics and limitations of national antimicrobial surveillance according to sales and claims data. PLoS One 2021; 16:e0251299. [PMID: 33974635 PMCID: PMC8112693 DOI: 10.1371/journal.pone.0251299] [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] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 04/23/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose Antimicrobial use (AMU) is estimated at the national level by using sales data (S-AMU) or insurance claims data (C-AMU). However, these data might be biased by generic drugs that are not sold through wholesalers (direct sales) and therefore not recorded in sales databases, or by claims that are not submitted electronically and therefore not stored in claims databases. We evaluated these effects by comparing S-AMU and C-AMU to ascertain the characteristics and limitations of each kind of data. We also evaluated the interchangeability of these data by assessing their relationship. Methods We calculated monthly defined daily doses per 1,000 inhabitants per day (DID) using sales and claims data from 2013 to 2017. To assess the effects of non-electronic claim submissions on C-AMU, we evaluated trends in the S-AMU/C-AMU ratio (SCR). To assess the effects of direct sales of S-AMU, we divided AMU into generic and branded drugs and evaluated each SCR in terms of oral versus parenteral drugs. To assess the relationship between S-AMU and C-AMU, we created a linear regression and evaluated its coefficient. Results Median annual SCRs from 2013 to 2017 were 1.046, 0.993, 0.980, 0.987, and 0.967, respectively. SCRs dropped from 2013 to 2015, and then stabilized. Differences in SCRs between branded and generic drugs were significant for oral drugs (0.820 vs 1.079) but not parenteral drugs (1.200 vs 1.165), suggesting that direct sales of oral generic drugs were omitted in S-AMU. Coefficients of DID between S-AMU and C-AMU were high (generic, 0.90; branded, 0.84) in oral drugs but relatively low (generic, 0.32; branded, 0.52) in parenteral drugs. Conclusions The omission of direct sales information and non-electronically submitted claims have influenced S-AMU and C-AMU information, respectively. However, these data were well-correlated, and it is considered that both kinds of data are useful depending on the situation.
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Affiliation(s)
- Yoshiki Kusama
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
- * E-mail:
| | - Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Chika Tanaka
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ryuji Koizumi
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masahiro Ishikane
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Daisuke Yamasaki
- Department of Infection Control and Prevention, Mie University Hospital, Tsu, Mie, Japan
| | - Masaki Tanabe
- Department of Infection Control and Prevention, Mie University Hospital, Tsu, Mie, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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Abstract
This cohort study examines trends in medication use among patients hospitalized for COVID-19–related treatment in a large US university health care system from the start of stay-at-home orders in March 2020 throughout the rest of the year.
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Affiliation(s)
- Jonathan H. Watanabe
- Department of Clinical Pharmacy Practice, University of California Irvine School of Pharmacy & Pharmaceutical Sciences, Irvine
| | - Jimmy Kwon
- Department of Statistics, University of California, Irvine Donald Bren School of Information and Computer Sciences, Irvine
| | - Bin Nan
- Department of Statistics, University of California, Irvine Donald Bren School of Information and Computer Sciences, Irvine
| | - Shira R. Abeles
- Antimicrobial Stewardship, Infection Prevention and Clinical Epidemiology, Department of Medicine, University of California, San Diego School of Medicine, La Jolla
| | - Stanley Jia
- Department of Clinical Pharmacy Practice, University of California Irvine School of Pharmacy & Pharmaceutical Sciences, Irvine
| | - Sanjay R. Mehta
- Infectious Disease Section, VA San Diego Clinical Microbiology Laboratory, VA San Diego, La Jolla, California
- Department of Medicine, UC San Diego School of Medicine, La Jolla, California
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Gupta V, Woodyard J, Begley K, Curtis S, Tran D. Assessment of drug utilization review activities within United States colleges of pharmacy. Curr Pharm Teach Learn 2021; 13:520-525. [PMID: 33795104 DOI: 10.1016/j.cptl.2021.01.012] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/15/2020] [Accepted: 01/06/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Limited literature exists regarding current practices in teaching and assessment of drug utilization review (DUR) skills in pharmacy schools. This manuscript aimed to: (1) examine how assessment is conducted for DUR activities using survey results and (2) summarize the assessment strategies of DUR activities via analysis of tools in colleges of pharmacy. METHODS A survey was administered to members of the American Association of Colleges of Pharmacy Laboratory Instructors Special Interest Group via Qualtrics. Descriptive statistics were used to evaluate survey results and the assessment tools (i.e. rubrics/checklists) collected were analyzed qualitatively to determine common content areas. RESULTS Out of the 113 institutions emailed, 48 (42.5%) responses were complete and represented individual colleges. Thirty-four of those 48 both implemented and assessed DUR activities. Fourteen institutions (41%) utilized one DUR assessment tool throughout the entire curriculum. The majority (62%) used the assessment tool in the first professional year, with a paper tool being the most frequently utilized (74%). "Identification of drug-related problems" (97%) and "determination of the pharmacist's action" (85%) were listed as important components of the assessment tool. Faculty noted that the assessment tool was easy to use (55%) and adequately assessed students' knowledge/skills (55%). A validated assessment tool (85%) and inclusion of technology (50%) would improve delivery of student feedback. CONCLUSIONS Wide variability existed in how schools incorporated and assessed DUR activities. Developing a standardized method of teaching and assessing DUR is important to adequately prepare the next generation of pharmacists.
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Affiliation(s)
- Vasudha Gupta
- Roseman University College of Pharmacy, Henderson, NV, 11 Sunset Way, Henderson, NV 89014, United States.
| | - Jamie Woodyard
- Purdue University College of Pharmacy, 575 Stadium Mall Drive, RHPH 349, West Lafayette, IN 47907, United States.
| | - Kimberley Begley
- Creighton University School of Pharmacy and Health Professions, 2500 California Plaza, Vinardi Center 235, Omaha, NE 68178, United States.
| | - Stacey Curtis
- University of Florida College of Pharmacy, 1225 Center Drive, HPNP 2336, Gainesville, FL 32610, United States.
| | - Deanna Tran
- University of Maryland School of Pharmacy, 20 North Pine St, Room N421, Baltimore, MD 21201, United States.
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Orlando V, Coscioni E, Guarino I, Mucherino S, Perrella A, Trama U, Limongelli G, Menditto E. Drug-utilisation profiles and COVID-19. Sci Rep 2021; 11:8913. [PMID: 33903671 PMCID: PMC8076316 DOI: 10.1038/s41598-021-88398-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 03/24/2021] [Indexed: 02/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has substantially challenged healthcare systems worldwide. By investigating population characteristics and prescribing profiles, it is possible to generate hypotheses about the associations between specific drug-utilisation profiles and susceptibility to COVID-19 infection. A retrospective drug-utilisation study was carried out using routinely collected information from a healthcare database in Campania (Southern Italy). We aimed to discover the prevalence of drug utilisation (monotherapy and polytherapy) in COVID-19 versus non-COVID-19 patients in Campania (~ 6 million inhabitants). The study cohort comprised 1532 individuals who tested positive for COVID-19. Drugs were grouped according to the Anatomical Therapeutic Chemical (ATC) classification system. We noted higher prevalence rates of the use of drugs in the ATC categories C01, B01 and M04, which was probably linked to related comorbidities (i.e., cardiovascular and metabolic). Nevertheless, the prevalence of the use of drugs acting on the renin-angiotensin system, such as antihypertensive drugs, was not higher in COVID-19 patients than in non-COVID-19 patients after adjustments for age and sex. These results highlight the need for further case-control studies to define the effects of medications and comorbidities on susceptibility to and associated mortality from COVID-19.
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Affiliation(s)
- Valentina Orlando
- CIRFF, Center of Drug Utilisation and Pharmacoeconomics, University of Naples Federico II, 80131, Naples, Italy.
- Department of Pharmacy, Center of Drug Utilisation and Pharmacoeconomics, University of Naples Federico II, 80131, Naples, Italy.
| | - Enrico Coscioni
- Division of Cardiac Surgery, AOU San Giovanni di Dio E Ruggi d'Aragona, 84131, Salerno, Italy
| | - Ilaria Guarino
- CIRFF, Center of Drug Utilisation and Pharmacoeconomics, University of Naples Federico II, 80131, Naples, Italy
| | - Sara Mucherino
- CIRFF, Center of Drug Utilisation and Pharmacoeconomics, University of Naples Federico II, 80131, Naples, Italy
- Department of Pharmacy, Center of Drug Utilisation and Pharmacoeconomics, University of Naples Federico II, 80131, Naples, Italy
| | - Alessandro Perrella
- Infectious Disease of Healthcare Direction, AORN Antonio Cardarelli, 80131, Naples, Italy
| | - Ugo Trama
- Regional Pharmaceutical Unit, Campania Region, 80143, Naples, Italy
| | - Giuseppe Limongelli
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli, Monaldi Hospital, 80131, Naples, Italy
| | - Enrica Menditto
- CIRFF, Center of Drug Utilisation and Pharmacoeconomics, University of Naples Federico II, 80131, Naples, Italy.
- Department of Pharmacy, Center of Drug Utilisation and Pharmacoeconomics, University of Naples Federico II, 80131, Naples, Italy.
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Romero Viamonte K, Salvent Tames A, Sepúlveda Correa R, Rojo Manteca MV, Martín-Suárez A. Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital. Antimicrob Resist Infect Control 2021; 10:12. [PMID: 33436096 PMCID: PMC7805169 DOI: 10.1186/s13756-020-00843-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/27/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences. METHODS A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25. RESULTS The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR = 2.79, P = 0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR = 1.33, P = 0.649). Also, a significant relationship was found between SSI and patient age (χ2 = 8.08, P = 0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations. CONCLUSIONS Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.
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Affiliation(s)
- Katherine Romero Viamonte
- Faculty of Health Sciences, Technical University of Ambato, Ambato, Ecuador
- Pharmaceutical Sciences Department, University of Salamanca, Salamanca, Spain
| | | | | | - María Victoria Rojo Manteca
- Pharmaceutical Sciences Department, University of Salamanca, Salamanca, Spain
- Provincial Pharmacists Chamber, Ávila, Spain
| | - Ana Martín-Suárez
- Pharmaceutical Sciences Department, University of Salamanca, Salamanca, Spain
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12
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Martín-Asenjo R, Gregson J, Rossello X, Van de Werf F, Medina J, Danchin N, Pocock S, Bueno H. Number of Antithrombotic Drugs Used Early and In-hospital Outcomes in Acute Coronary Syndromes. J Cardiovasc Transl Res 2021; 14:790-798. [PMID: 33420682 DOI: 10.1007/s12265-020-10094-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/16/2020] [Indexed: 11/25/2022]
Abstract
Antithrombotic drug use for acute coronary syndromes (ACS) varies considerably. The number of antithrombotic drugs (excluding oral anticoagulants) used pre- and in-hospital was recorded in ACS survivors enrolled at hospital discharge in the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) registry ( NCT01171404 ), a prospective cohort study. Among 10,568 patients, the number of antithrombotic drugs used early/patient ranged from 0 to 8 (interquartile range = 3-4). Overall, 250 patients (2.4%) experienced ≥ 1 in-hospital ischemic event and 343 (3.2%) ≥ 1 non-fatal bleeding event. While there was no difference in the rate of ischemic events (p = 0.75 for-trend) according to the number of antithrombotic drugs, a significantly higher incidence of non-fatal bleeds was observed (p < 0.0001 for-trend), with OR = 1.68 (95%CI = 1.51-1.88) per additional antithrombotic drug, which remained after adjustment by patient characteristics. In conclusion, careful balancing of the short-term risks for ischemic and bleeding events should be considered when adding new antithrombotic drugs.
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Affiliation(s)
- Roberto Martín-Asenjo
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Xavier Rossello
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jesús Medina
- Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Nicolas Danchin
- Hôpital Européen Georges Pompidou & René Descartes University, Paris, France
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain
| | - Héctor Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain.
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Madrid, Spain.
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
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Hubbuch A, Peter R, Willi B, Hartnack S, Müntener C, Naegeli H, Gerspach C. Comparison of antimicrobial prescription patterns in calves in Switzerland before and after the launch of online guidelines for prudent antimicrobial use. BMC Vet Res 2021; 17:2. [PMID: 33402182 PMCID: PMC7786965 DOI: 10.1186/s12917-020-02704-w] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 12/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increasing threat of bacterial resistance promotes the need for antibiotic stewardship programs to foster responsible antimicrobial use. Therefore, guidelines for prudent use supported by an online stewardship tool (AntibioticScout.ch) were introduced in Switzerland in December 2016. They recommend (with decreasing preference) a first, second or third line antimicrobial for treatment. The objective of this study was to evaluate antimicrobial prescriptions for Swiss calves before (2016) and after (2018) the launch of these guidelines. Cases of calves with pneumonia, diarrhea and otitis from a university hospital and eight private practices in Switzerland were included. Data on anamnesis, clinical findings, diagnostic work-up and treatment were collected. Type and percentages [95% confidence interval] of antimicrobial prescriptions were compared between 2016 and 2018. RESULTS Of the total number of calves, 88.2% [85.4-90.6] in 2016 (n = 625) and 88.4% [85.7-90.7] in 2018 (n = 655) were treated with antibiotics. The use of highest priority critically important antimicrobials (HPCIAs) decreased from 52.7% [48.6-56.9] in 2016 to 38.0% [34.2-41.9] in 2018; this decrease was found at the university hospital and in private practice and in cases with pneumonia and diarrhea. Particularly the use of fluoroquinolones decreased (2016: 43.1% [39.2-47.2]; 2018: 31.1% [27.6-34.8]). Overall, the number of first line treatments increased from 12.8% [10.4-15.6] in 2016 to 20.2% [17.3-23.4] in 2018. In cases of pneumonia, first line treatments increased (2016: 15.3% [11.6-19.9]; 2018: 26.5% [21.8-31.9]) and third line treatments decreased (2016: 43.5% [38.0-49.3]; 2018: 27.9% [23.1-33.3]); this was seen at the university hospital, whereas in private practice only a decrease of third line treatments was observed. In cases of diarrhea, more second line at the expense of unlisted antimicrobials were prescribed at the university hospital in 2018. Antimicrobial treatment of calves with otitis did not change from 2016 to 2018. CONCLUSIONS After the introduction of AntibioticScout.ch, more prudent use was observed in the treatment of calves with pneumonia and diarrhea as less HPCIAs, particularly fluoroquinolones, and more first line antimicrobials were prescribed. However, the overall frequency of antimicrobial treatment did not change and the use of HPCIAs was still common in 2018, especially in private practices. Therefore, further antimicrobial stewardship activities are necessary.
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Affiliation(s)
- Alina Hubbuch
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
| | - Ruth Peter
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
| | - Barbara Willi
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
| | - Sonja Hartnack
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 270, CH-8057 Zurich, Switzerland
| | - Cedric Müntener
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
| | - Hanspeter Naegeli
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
| | - Christian Gerspach
- Clinic for Ruminants, Department for Farm Animals, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
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Gardiner SJ, Basevi AB, Hamilton NL, Metcalf SC, Chambers ST, Withington SG, Chin PK, Freeman JT, Dalton SC. Point prevalence surveys of antimicrobial use in adult inpatients at Canterbury District Health Board Hospitals. N Z Med J 2020; 133:18-33. [PMID: 33223545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIMS To determine the nature and appropriateness of antimicrobial prescribing in adult inpatients at Canterbury District Health Board (CDHB). METHODS Multidisciplinary teams collected clinical details for all adult inpatients on antimicrobial therapy at three CDHB facilities (~1,100 beds) and made standardised assessments based on the Australian National Antimicrobial Prescribing Survey (http://naps.org.au) against local guidelines and national funding criteria. RESULTS Antimicrobial therapy was prescribed to 42% of inpatients (322/760), usually to treat infections [377/480 prescriptions (79%)], with amoxicillin+clavulanic acid the agent most commonly prescribed [72/480 prescriptions (15%)]. Of assessable prescriptions, 74% (205/278) were guideline compliant, 98% (469/480) were funding criteria compliant, and 83% (375/451) were appropriate clinically. Prescriptions for the most common indications-surgical prophylaxis [66/480 (14%)] and community-acquired pneumonia [56/480 (12%)]-were often non-compliant with guidelines (32% and 41%, respectively) and inappropriate (18% and 21%, respectively). Overall, the indication was documented in 353/480 (74%) prescriptions, the review/stop date documented in 145/480 (30%) prescriptions, and surgical prophylaxis stopped within 24 hours in 53/66 (80%) prescriptions. CONCLUSIONS Most antimicrobial prescriptions were appropriate and complied with guidelines. Compliance with key quality indicators (indication documented, review/stop date documented, and surgical prophylaxis ceased within 24 hours) were well below target (>95%) and needs improvement.
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Affiliation(s)
- Sharon J Gardiner
- Antimicrobial Stewardship Pharmacist, Infectious Diseases, Clinical Pharmacology and Pharmacy Departments, Christchurch Hospital, Canterbury District Health Board, Christchurch
| | - Ari B Basevi
- Medical Student, Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch
| | - Niall L Hamilton
- Clinical Pharmacology Registrar, Clinical Pharmacology Department, Christchurch Hospital, Canterbury District Health Board, Christchurch
| | - Sarah Cl Metcalf
- Infectious Diseases Physician, Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch
| | - Stephen T Chambers
- Infectious Diseases Physician, Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch; Pathology Department, University of Otago, Christchurch
| | - Stephen G Withington
- Rural Hospital Medicine Physician, Ashburton Hospital, Canterbury District Health Board, Ashburton
| | - Paul K Chin
- Clinical Pharmacologist, Clinical Pharmacology Department, Christchurch Hospital, Canterbury District Health Board, Christchurch
| | - Joshua T Freeman
- Clinical Microbiologist, Microbiology, Canterbury Health Laboratories, Christchurch
| | - Simon C Dalton
- Infectious Diseases Physician, Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch
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Redding L, Grunwald H, Cole S, Rankin S, Nolen-Walston R. Modification of empirical antimicrobial regimens in large animal medicine. Vet Rec 2020; 187:e78. [PMID: 32994359 PMCID: PMC7799415 DOI: 10.1136/vr.106039] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/13/2020] [Accepted: 09/04/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Empirical antimicrobial regimens can be modified following new diagnostic information or when empirical treatment fails. Little is known about the frequency or clinical context in which these modifications occur. We characterised these modifications in a large animal hospital to identify when antimicrobial use could be optimised. METHODS Chart reviews were performed for all inpatients and outpatients administered antimicrobials at a large animal veterinary referral and teaching hospital in 2017-2018 (n=1163 visits) to determine when and why empirical regimens were modified. Multinomial logistic regression was performed to identify factors associated with reasons for modification. RESULTS Empirical antimicrobial regimens were modified in 17.3 per cent of visits. The main reasons were parenteral-oral conversions in horses and failure of disease prevention or treatment in ruminants. Empirical therapy for disease prevention was more likely to be modified because of complications in ruminants and in animals on the emergency/critical care service. Empirical therapy for disease treatment was more often modified for reasons other than de-escalation in ruminants and in animals with longer lengths of stay. CONCLUSIONS Empirical antimicrobial regimens were modified infrequently and mostly for purposes of parenteral-oral conversion in horses and lack of response in ruminants. De-escalation of antimicrobials administered for disease treatment, when guided by diagnostics, is a major tenet of judicious antimicrobial use. However, more research is needed to determine when and how antimicrobial regimens administered for disease prevention should be modified.
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Affiliation(s)
- Laurel Redding
- Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - Haley Grunwald
- Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - Stephen Cole
- Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Shelley Rankin
- Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Rose Nolen-Walston
- Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
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Plewniak KM, Kintzer E, Eisenberg R, Fazzari M, Shin JH. Examining Reduced Opioid Prescriptions after Gynecologic Laparoscopy: A Randomized Controlled Trial. J Minim Invasive Gynecol 2020; 28:366-373. [PMID: 32652243 DOI: 10.1016/j.jmig.2020.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/15/2020] [Accepted: 07/06/2020] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To examine whether prescribing 5 tablets, as opposed to 10 tablets, of 5-mg oxycodone adequately treats pain after gynecologic laparoscopy. DESIGN Single-blinded randomized trial. SETTING Academically affiliated ambulatory surgery center. PATIENTS One hundred twenty women scheduled to undergo minor gynecologic laparoscopy. INTERVENTIONS Patients scheduled for ambulatory gynecologic laparoscopy were allocated to the standard tablet or low-tablet number prescription groups (10 tablets or 5 tablets of 5-mg oxycodone). The patients also received prescriptions for acetaminophen and ibuprofen. MEASUREMENTS AND MAIN RESULTS Telephone surveys were conducted on postoperative days 1 and 7 to assess medication use and pain. The primary outcome was the number of oxycodone tablets used by days 1 and 7. Prespecified secondary outcomes included unscheduled patient contacts and pain scores. With N = 50 in each group and assuming standardized effect sizes, the study was powered to detect a 0.6 difference or greater when comparing the primary outcome between the groups. Forty-five and 47 patients in the 5-tablet and 10-tablet groups, respectively, completed the day-7 survey. The median number of oxycodone tablets taken by day 7 was 2.0 (interquartile range 0.0, 4.0) in the 5-tablet group and 2.5 (interquartile range 0.0, 5.0) in the 10-tablet group (p = .36). Most of the patients in both groups reported taking 3 oxycodone tablets or fewer by day 7. There were no significant differences in unscheduled patient contacts, need for additional prescriptions, or pain scores. There were significantly fewer unused tablets in the 5-tablet group by day 7. CONCLUSION Prescribing 5 tablets of 5-mg oxycodone, acetaminophen, and ibuprofen is likely sufficient for most patients after minor laparoscopic surgery.
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Affiliation(s)
- Kari M Plewniak
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center (Drs. Plewniak, Kintzer, and Shin).
| | - Emily Kintzer
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center (Drs. Plewniak, Kintzer, and Shin)
| | - Ruth Eisenberg
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine (Dr. Fazzari and Ms. Eisenberg), Bronx, New York
| | - Melissa Fazzari
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine (Dr. Fazzari and Ms. Eisenberg), Bronx, New York
| | - Ja Hyun Shin
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center (Drs. Plewniak, Kintzer, and Shin)
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Kwiatkowska R, Shen X, Lu M, Cheng J, Hickman M, Lambert H, Wang D, Oliver I. Patients without records and records without patients: review of patient records in primary care and implications for surveillance of antibiotic prescribing in rural China. BMC Health Serv Res 2020; 20:564. [PMID: 32571303 PMCID: PMC7310238 DOI: 10.1186/s12913-020-05308-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/07/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We need to monitor patterns of antibiotic prescribing in order to develop and evaluate antibiotic stewardship interventions in rural China. As part of a multidisciplinary study of antibiotic use in Anhui Province we assessed the validity of electronic records (e-records) as a source of surveillance data. METHODS One township healthcare centre and one village clinic were selected in each of three different counties. Patients with symptoms of Upper Respiratory Tract Infection (URTI), exacerbation of Chronic Obstructive Pulmonary Disease (COPD) or Urinary Tract Infection (UTI) were recruited consecutively. Researchers observed and documented clinic consultations and interviewed each of the study participants. E-records were compared to clinic observations and patient interviews. RESULTS A total of 1030 patients were observed in clinic. Antibiotics were prescribed in 917 (89%) of consultations. E-records were created only for individuals with health insurance, with considerable between-site variation in completeness (0 to 98.7% of clinic consultations) and in the timing of documentation (within-consultation up to weeks afterwards). E-record accuracy was better in relation to antibiotics (82.8% of e-records accurately recorded what was prescribed in clinic) than for diagnosis and symptoms (45.0 and 1.1% accuracy). Only 31 participants (3.0%) presented with UTI symptoms. CONCLUSIONS We have confirmed very high rates of outpatient antibiotic prescribing in rural Anhui province. E-records could provide useful information to inform stewardship interventions, however they may be inaccurate and/or biased. Public Health authorities should focus on improving technical infrastructure and record-keeping culture in outpatient settings. Further research is needed into community treatment of UTIs.
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Affiliation(s)
- Rachel Kwiatkowska
- NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Medical School, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
- Field Service, National Infection Service, Public Health England, 3rd floor, 2 Rivergate, Bristol, BS1 6EH, UK.
| | - Xingrong Shen
- School of Health Service Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Manman Lu
- School of Health Service Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Jing Cheng
- School of Health Service Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Matthew Hickman
- NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Medical School, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Helen Lambert
- Population Health Sciences, Bristol Medical School, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Debin Wang
- School of Health Service Management, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Isabel Oliver
- NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Medical School, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Field Service, National Infection Service, Public Health England, 3rd floor, 2 Rivergate, Bristol, BS1 6EH, UK
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Rieckert A, Reeves D, Altiner A, Drewelow E, Esmail A, Flamm M, Hann M, Johansson T, Klaassen-Mielke R, Kunnamo I, Löffler C, Piccoliori G, Sommerauer C, Trampisch US, Vögele A, Woodham A, Sönnichsen A. Use of an electronic decision support tool to reduce polypharmacy in elderly people with chronic diseases: cluster randomised controlled trial. BMJ 2020; 369:m1822. [PMID: 32554566 PMCID: PMC7301164 DOI: 10.1136/bmj.m1822] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the effects of a computerised decision support tool for comprehensive drug review in elderly people with polypharmacy. DESIGN Pragmatic, multicentre, cluster randomised controlled trial. SETTING 359 general practices in Austria, Germany, Italy, and the United Kingdom. PARTICIPANTS 3904 adults aged 75 years and older using eight or more drugs on a regular basis, recruited by their general practitioner. INTERVENTION A newly developed electronic decision support tool comprising a comprehensive drug review to support general practitioners in deprescribing potentially inappropriate and non-evidence based drugs. Doctors were randomly allocated to either the electronic decision support tool or to provide treatment as usual. MAIN OUTCOME MEASURES The primary outcome was the composite of unplanned hospital admission or death by 24 months. The key secondary outcome was reduction in the number of drugs. RESULTS 3904 adults were enrolled between January and October 2015. 181 practices and 1953 participants were assigned to electronic decision support (intervention group) and 178 practices and 1951 participants to treatment as usual (control group). The primary outcome (composite of unplanned hospital admission or death by 24 months) occurred in 871 (44.6%) participants in the intervention group and 944 (48.4%) in the control group. In an intention-to-treat analysis the odds ratio of the composite outcome was 0.88 (95% confidence interval 0.73 to 1.07; P=0.19, 997 of 1953 v 1055 of 1951). In an analysis restricted to participants attending practice according to protocol, a difference was found favouring the intervention (odds ratio 0.82, 95% confidence interval 0.68 to 0.98; 774 of 1682 v 873 of 1712, P=0.03). By 24 months the number of prescribed drugs had decreased in the intervention group compared with control group (uncontrolled mean change -0.42 v 0.06: adjusted mean difference -0.45, 95% confidence interval -0.63 to -0.26; P<0.001). CONCLUSIONS In intention-to-treat analysis, a computerised decision support tool for comprehensive drug review of elderly people with polypharmacy showed no conclusive effects on the composite of unplanned hospital admission or death by 24 months. Nonetheless, a reduction in drugs was achieved without detriment to patient outcomes. TRIAL REGISTRATION Current Controlled Trials ISRCTN10137559.
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Affiliation(s)
- Anja Rieckert
- Institute of General Practice and Family Medicine, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany
| | - David Reeves
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, University of Manchester, UK
| | - Attila Altiner
- Institute of General Practice, Rostock University Medical Center, Rostock, Germany
| | - Eva Drewelow
- Institute of General Practice, Rostock University Medical Center, Rostock, Germany
| | - Aneez Esmail
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, University of Manchester, UK
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Mark Hann
- Centre for Biostatistics, School for Health Sciences, University of Manchester, UK
| | - Tim Johansson
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Renate Klaassen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Germany
| | | | - Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Rostock, Germany
| | | | - Christina Sommerauer
- Institute of General Practice and Family Medicine, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany
| | - Ulrike S Trampisch
- Institute of General Practice and Family Medicine, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany
| | - Anna Vögele
- Institute for Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Adrine Woodham
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, University of Manchester, UK
| | - Andreas Sönnichsen
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, University of Manchester, UK
- Department of General Practice and Family Medicine, Center of Public Health, Medical University of Vienna, Vienna, Austria
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Smith RG. Mitigating the Opioid Crisis for Wound Care Providers Using Opioid Stewardship. Wounds 2020; 32:146-151. [PMID: 32804662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Opioids are an effective form of analgesia for pain treatment during wound treatment. Overprescribing of opioid agents has become detrimental to the public health of the United States. One of the most difficult challenges for any wound care prescriber is to balance the potential benefits versus the potential risks of opioid prescribing. Addressing the opioid crisis requires an interprofessional team approach. The utilization of an opioid stewardship program provides the necessary framework to identify gaps in the quality and development in the implementation of a change of long-standing opioid culture and practice. These programs address opioid prescribing, treatment for opioid use disorder, educational initiatives, and the use of information technology. A few acronyms have been created to assist providers to guide them when prescribing opioids. The purpose of this article is to explore the central theme of responsible opioid pain management. It will introduce, define, and defend with clinical-based evidence a proposed acronym, "MORPHINE," to assist and help shape prescription opioid strategies used for wound care treatment. Implications for practicing wound care specialists need to acknowledge the potential harm that prescribing opioids may cause to their patients.
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Gazelka HM, Clements CM, Cunningham JL, Geyer HL, Lovely JK, Olson CL, Philpot LM, Porter SB, Witt TJ, Zavaleta KW, Habermann EB. An Institutional Approach to Managing the Opioid Crisis. Mayo Clin Proc 2020; 95:968-981. [PMID: 32171474 DOI: 10.1016/j.mayocp.2019.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/29/2019] [Accepted: 11/20/2019] [Indexed: 01/08/2023]
Abstract
The opioid crisis is a major concern of most health care institutions, including our large academic center. In this article, an organized approach to managing the epidemic institutionally is discussed. An Opioid Stewardship Program was instituted at our tertiary-care center with multiple sites and states of practice, which included diverse membership and expertise. Charges of the program included reviewing current practice, workflows, and external and internal guidelines and evaluating and standardizing prescribing practices. The development of an Opioid Stewardship Program resulted in: (1) an understanding of our diverse prescribing practices and the formation of patient- and procedure-specific guidelines to manage them, (2) education tools for our patients and providers, and (3) workflows and practice advisories within the electronic health record to support appropriate prescribing and monitoring of patients. This ongoing work continues to evolve in response to the needs of our patients, changing regulatory environments, and our improved understanding of our practices.
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Affiliation(s)
- Halena M Gazelka
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN.
| | | | | | - Holly L Geyer
- Division of Hospital Internal Medicine, Mayo Clinic, Phoenix, AZ
| | | | - Cheri L Olson
- Department of Family Medicine, Mayo Clinic Health System-Franciscan Healthcare in La Crosse, WI
| | - Lindsey M Philpot
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Steven B Porter
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Terrence J Witt
- Department of Family Medicine, Mayo Clinic Health System in Eau Claire, WI
| | - Kathryn W Zavaleta
- Department of Management Engineering and Consulting, Mayo Clinic, Rochester, MN
| | - Elizabeth B Habermann
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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Al-Hadithi D, Al-Zakwani I, Balkhair A, Al Suleimani YM. Evaluation of the appropriateness of meropenem prescribing at a tertiary care hospital: A retrospective study in Oman. Int J Infect Dis 2020; 96:180-186. [PMID: 32339716 DOI: 10.1016/j.ijid.2020.04.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the use of meropenem in terms of indication and continuation of treatment at Sultan Qaboos University Hospital (SQUH), Muscat, Oman. METHODS A retrospective observational study, conducted by reviewing the medical records of 400 adults, admitted patients who received at least one dose of meropenem during the study period (January 2017 to September 2017). The analysis was performed using univariate statistics. RESULTS Meropenem was prescribed empirically in 382/400 (96%) of the cases. The majority (315/361 (87%)) of the patients received the proper meropenem dose. The indication for meropenem was considered appropriate in only 196/400 (49%) of the cases. The continuation of treatment was evaluated according to culture and sensitivity results in 202 cases, out of which 112 (55%) were justified. Most of the inappropriate uses were seen in oncology and hematology cases (31/42 (74%) and 61/101 (60%), respectively) and among respiratory and urinary tract infections (126/155 (81%) and 40/46 (87%), respectively). CONCLUSIONS Approximately half of the meropenem orders at SQUH in Oman were inappropriate and unjustified by culture-test results. New strategies are needed to optimize the rational use of meropenem and to ensure appropriate de-escalation and discontinuation of meropenem whenever indicated.
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Affiliation(s)
- Dunia Al-Hadithi
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Muscat, Sultanate of Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Muscat, Sultanate of Oman
| | - Abdullah Balkhair
- Infectious Diseases Unit, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Yousuf M Al Suleimani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Muscat, Sultanate of Oman.
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Grayson AD, Garnett F, Davies M, Connor N, Hughes C, Cooper JP. A consultant-led anticoagulation review of all patients in one clinical commissioning group to prevent atrial fibrillation related stroke. Int J Clin Pract 2020; 74:e13465. [PMID: 31854038 DOI: 10.1111/ijcp.13465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Ensuring patients with Atrial fibrillation (AF) are appropriately anticoagulated across NHS Bedfordshire Clinical Commissioning Group (BCCG) with the primary goal of reducing AF-related strokes. METHODS With Inspira Health, BCCG adopted the Primary Care Atrial Fibrillation (PCAF) Service which is led by Consultant Cardiologists. PCAF uses retrospective clinical audit to identify patients who require prospective face-to-face review on the need for anticoagulation. RESULTS 34 GP practices participated covering a 376 311 population (80% of BCCG). 12 573 patients' medical records were audited. The initial AF register was 7301 patients (AF prevalence 1.9%) and an additional 265 patients were identified through AF casefinder resulting in an AF prevalence of 2.0%. From 7566 patients with AF, 5831 were already on anticoagulants (77.1%), with 50.5% (n = 2947) on VKA medications and 49.5% (n = 2884) on direct oral anticoagulants (DOACs). Of the DOAC patients, 595 (20.6%) required dosage review or up to date blood tests. Case notes were reviewed for 1735 patients not on anticoagulation, with 901 (51.9%) patients deemed not eligible for anticoagulation. This left 834 (48.1%) patients who were eligible for, but not on, anticoagulation. A further 407 (13.8%) patients currently taking VKA medications were deemed sup-optimal with regards to INR control with TTR < 65%. In total 1241 patients were invited for review by a Consultant Cardiologist at their local GP practice, with an attendance rate of 90%. From all face to face and virtual consultations, 908 patients had anticoagulants prescribed, changed, management of INRs improved or were in the process of being anticoagulated at the time of follow-up. From this we would expect 36.3 AF related strokes prevented and a cost saving to the NHS of £470 200 per year. CONCLUSION Through comprehensive audit, BCCG have been able to ensure that patients with AF are appropriately anticoagulated in 80% of their catchment population. This has improved anticoagulation to prevent AF-related stroke.
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Affiliation(s)
| | - Fiona Garnett
- Medicines Optimisation, Bedfordshire Clinical Commissioning Group, Bedford, UK
| | - Matthew Davies
- Medicines Optimisation, Bedfordshire Clinical Commissioning Group, Bedford, UK
| | | | | | - John P Cooper
- Cardiology Department, Bedford Hospital, Bedford, UK
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Carpenter JE, Murray BP, Mazer-Amirshahi M, Laes JR, Nacca N, Nelson LS, Perrone J, Schwarz ES, Wiegand TJ, Wax PM. Leadership Roles in Opioid Stewardship and the Treatment of Patients with Opioid Use Disorder Among Medical Toxicologists. J Med Toxicol 2020; 16:204-211. [PMID: 31863312 PMCID: PMC7099099 DOI: 10.1007/s13181-019-00752-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite significant efforts, deaths due to drug overdose remain at near record levels. In efforts combat this crisis, the Joint Commission now requires that accredited hospitals implement safe opioid prescribing practices. Emergency department visits and hospitalizations related to opioid use disorder (OUD) provide an opportunity to initiate evidence-based treatment. However, both situations require the presence of qualified physician leaders and clinicians, which many facilities lack. Medical toxicologists have the expertise needed to fill these voids, but the scope and prevalence of their involvement are unknown. We sought to determine the engagement of medical toxicologists in leading opioid stewardship initiatives and the treatment of patients with OUD. METHODS Members of the American College of Medical Toxicology (ACMT) were surveyed about their leadership roles in opioid stewardship and clinical practices regarding OUD from March-June 2019. ACMT represents more than 80% of the nation's board-certified medical toxicologists. The electronic survey utilized branching logic and results are presented descriptively; thus, responses are presented as a percentage of the number of respondents to individual questions rather than the total number of participants. RESULTS One hundred and thirty-one out of 382 eligible individuals from at least 76 institutions responded to the survey. A majority (60%) had a DATA 2000 X-waiver, 21% were board-certified in addiction medicine (AM), and an additional 22% were definitely or possibly planning to pursue board certification in AM. Sixteen percent of respondents reported having a formal leadership role to address opioid pain management and stewardship, and 17% had a formal leadership role that specifically addresses clinical treatment for OUD within their institution. Fifty-seven respondents prescribed buprenorphine in emergency medicine practice, 41 as inpatient consultants, and 23 in an outpatient clinic. CONCLUSIONS Medical toxicologists can serve as leaders to promote safe opioid prescribing practices through both institutional and governmental opioid task forces and opioid stewardship programs. They also provide important addiction-related clinical care to patients with OUD.
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Affiliation(s)
- Joseph E Carpenter
- Emory University School of Medicine, 50 Hurt Plaza SE, Suite 600, Atlanta, GA, 30303, USA.
| | - Brian Patrick Murray
- Emory University School of Medicine, 50 Hurt Plaza SE, Suite 600, Atlanta, GA, 30303, USA
- Wright-Patterson Medical Center, Wright-Patterson AFB, OH, USA
| | | | | | - Nicholas Nacca
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Evan S Schwarz
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | - Paul M Wax
- University of Texas Southwestern Medical School, Dallas, TX, USA
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Fynn A, Helberg E, Godman B, Meyer JC. Drug utilization review of tramadol hydrochloride in a regional hospital in South Africa; findings and implications. Hosp Pract (1995) 2020; 48:92-99. [PMID: 32013641 DOI: 10.1080/21548331.2020.1724454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/29/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Drug utilization reviews (DURs) can be used to promote rational prescribing and ensure compliance with standard treatment guidelines. In recent years, the use of tramadol hydrochloride (HCl) for pain has increased significantly across countries. We sought to determine prescribing patterns and the use of tramadol in a regional hospital in South Africa to provide future guidance in view of increasing concerns with the prescribing of tramadol. METHOD A prospective, quantitative and descriptive study was conducted over two months. Outpatient and inpatient prescriptions and ward requisitions where tramadol HCl was prescribed or ordered were identified, which included outpatients collecting antiretroviral treatment. Prescriptions were reviewed and evaluated to determine the level of compliance to the Standard Treatment Guidelines and Essential Medicines List (STGs/EML) for South Africa as a measure of rational prescribing. Quantities issued to the inpatient wards and expenditure incurred by the pharmacy departments were assessed to determine overall usage and total costs. RESULTS In total, 415 tramadol HCl prescriptions were collected over a 2-month period. Compliance was 70.1% to the STGs/EML. The outpatient pharmacy department had the highest compliance at 76.4% while the antiretroviral pharmacy compliance was 29.1%. Most prescriptions dispensed at the outpatient pharmacy were from the Surgical Outpatient Department (140; 33.7%) and the Orthopedic Outpatient Department (108; 26.0%). The outpatient pharmacy had the highest tramadol HCl consumption and expenditure at $4,874.13 (R72,054.28), while the inpatient pharmacy's expenditure was $2,526.63 (R37,351.20), and the antiretroviral pharmacy $590.13 (R8,722.75). The hospital's tramadol HCl expenditure increased when compared to previous financial years, from $10,576.04 (R156,326.00) in 2014-2015 to $39,584.00 (R585,088.80) in 2016-2017. CONCLUSION This study highlights the need for the implementation of monitoring and evaluation tools to enhance rational prescribing and use of tramadol HCl. These are being implemented and will be evaluated in future projects.
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Affiliation(s)
- Akhona Fynn
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University , Ga-Rankuwa, South Africa
- KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | - Elvera Helberg
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University , Ga-Rankuwa, South Africa
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University , Ga-Rankuwa, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow, UK
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm, Sweden
- Health Economics Centre, University of Liverpool Management School , Liverpool, UK
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University , Ga-Rankuwa, South Africa
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Abstract
OBJECTIVES To describe an approach using concomitant medication log records for the construction of treatment episodes. Concomitant medication log records are routinely collected in clinical studies. Unlike prescription and dispensing records, concomitant medication logs collect utilisation data. Logs can provide information about drug safety and drug repurposing. DESIGN A prospective multicentre, multicohort observational study. SETTING Twenty-one clinical sites in the USA, Europe, Israel and Australia. PARTICIPANTS 415 subjects from the de novo cohort of the Parkinson's Progression Markers Initiative. METHODS We construct treatment episodes of concomitant medication use. The proposed approach treats temporal gaps as a stoppage of medication and temporal overlaps as simultaneous use or changes in dose. Log records with no temporal gaps were combined into a single treatment episode. RESULTS 5723 concomitant medication log records were used to construct 3655 treatment episodes for 65 medications. There were 405 temporal gaps representing a stoppage of medication; 985 temporal overlaps representing simultaneous regimens of the same medication and 2696 temporal overlaps representing a change in dose regimen. The median episode duration was 37 months (IQ interval: 11-73 months). CONCLUSIONS The proposed approach for constructing treatment episodes offers a method of estimating duration and dose of treatment from concomitant medication log records. The accompanying recommendations guide log data collection to improve their quality for drug safety and drug repurposing.
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Affiliation(s)
- Lisa K Kuramoto
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Boris G Sobolev
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael W Tang
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacquelyn J Cragg
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, British Columbia, Canada
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Maeda M, Muraki Y, Anno Y, Sawa A, Kusama Y, Ishikane M, Ohmagari N, Ohge H. Development of the predicted and standardized carbapenem usage metric: Analysis of the Japanese Diagnosis Procedure Combination payment system data. J Infect Chemother 2020; 26:633-635. [PMID: 32146108 DOI: 10.1016/j.jiac.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/01/2020] [Accepted: 02/11/2020] [Indexed: 11/18/2022]
Abstract
This study aimed to develop a metric for standardized and predicted carbapenem consumption using the Diagnosis Procedure Combination payment system database and patients' characteristics. Based on Diagnosis Procedure Combination data analysis, the developed metric will provide useful benchmarks that stewardship programs can use to help drive improvements.
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Affiliation(s)
- Masayuki Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
| | - Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Yuka Anno
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan
| | - Akihiro Sawa
- Laboratory of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Hiroshima International University, Hiroshima, Japan
| | - Yoshiki Kusama
- Antimicrobial Resistance Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masahiro Ishikane
- Antimicrobial Resistance Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Antimicrobial Resistance Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
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Affiliation(s)
- Jack S Resneck
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Dermatology, School of Medicine, University of California, San Francisco
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Abstract
INTRODUCTION The growing emphasis on value-based health care has created a need for innovative population health management strategies. Pharmacists are underused resources for implementation of meaningful population health models that ensure appropriate medication use through optimization of electronic medical record (EMR) technology and pharmacist knowledge. The objective of our program was to improve the health outcomes of a patient population with diabetes while also reducing costs. PROGRAM DESCRIPTION A virtual pharmacy review (ViPRx) program was used to remotely provide previsit comprehensive medication reviews for patients in the defined population. The pharmacist used the EMR to review medications and relevant histories and to intervene when needed to ensure appropriate medication use. Pharmacist recommendations and supporting statements were delivered to the provider's EMR in-box 1-2 days before a scheduled visit. The information technology resources and virtual model allow the pharmacist to manage patient care and collaborate with providers electronically across multiple clinic locations. OBSERVATIONS The pharmacist managed a panel of over 700 patients in this virtual model. The program has yielded improvements in key diabetes metrics. Most notable is a 6% increase in the percentage of patients with a hemoglobin A1c (HbA1c) value of 9% or less and a 7% improvement in the controlled low-density lipoprotein (LDL) measure. Monitoring parameters (nephropathy screening, HbA1c, and LDL) increased by 8%-12% from baseline. Additional positive outcomes include improved medication adherence in the defined population as seen by a 1.5% improvement in medication possession ratio for diabetes medications. Reductions in per member per month (PMPM) prescription costs are estimated at $11 per month through discontinuation of unnecessary and duplicate medications. IMPLICATIONS The results of this case study on the effect of a virtual pharmacy review program demonstrate an opportunity for pharmacists to engage in a population health management model that improves patient outcomes and may reduce the rate at which PMPM prescription drug costs increase. DISCLOSURES No outside funding supported this work. The authors have no conflicts of interest to disclose. This work was presented at the 2017 Vizient Connections Summit; April 6, 2017; Las Vegas, NV, and the 2018 Cerner Health Conference; October 10, 2018; Kansas City, MO.
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Affiliation(s)
| | | | - Brad Myers
- University of Missouri Health Care, Columbia
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29
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Tsapepas D, Der-Nigoghossian C, Patel K, Berger K, Vawdrey DK, Salmasian H. Medication stewardship using computerized clinical decision support: A case study on intravenous immunoglobulins. Pharmacol Res Perspect 2019; 7:e00508. [PMID: 31485333 PMCID: PMC6715593 DOI: 10.1002/prp2.508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/06/2019] [Indexed: 11/08/2022] Open
Abstract
Background Healthcare delivery organizations face increasing pressure to manage the use of medications in terms of safety, waste reduction, and cost containment. Objective To describe a computerized provider order entry (CPOE) system intervention to optimize use of a commonly ordered, high-cost therapeutic: intravenous immune globulin (IVIG). Design Description of IVIG order configuration, medication use patterns, and subsequent order set configuration development in a CPOE system. Measurements IVIG orders were extracted from the CPOE system before and after the implementation of a specialty orderset to determine the indications for use, dosing, and duration of therapy. Orders were compared to a theoretical dosing schedule created from published evidence and data from a prior medication use evaluation. Results During 36 months before the implementation of the IVIG order set, 1965 IVIG orders were reviewed. The prescribed IVIG dose varied considerably from the expected dose (mean = -1.8, range = -4.9-1.5). In the 27 months after order set implementation, 848 IVIG orders were reviewed. The prescribed IVIG dose was closer to the expected dose (mean = -1.2, range = -3.9-2.6, P < .0001). Conclusions Order configuration processes are cumbersome and time-consuming, but can be streamlined to enhance a medication's usage in the healthcare system. A better understanding of institution-specific ordering patterns may facilitate more efficient and effective order configuration and optimize drug use.
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Affiliation(s)
- Demetra Tsapepas
- NewYork‐Presbyterian HospitalNew YorkNYUSA
- Columbia UniversityNew YorkNYUSA
| | | | | | | | - David K Vawdrey
- NewYork‐Presbyterian HospitalNew YorkNYUSA
- Columbia UniversityNew YorkNYUSA
| | - Hojjat Salmasian
- NewYork‐Presbyterian HospitalNew YorkNYUSA
- Columbia UniversityNew YorkNYUSA
- Brigham and Women’s HospitalBostonMAUSA
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Abstract
To examine whether the Medicare Part D program had an impact on the generic drug prescription rate among residents in long-term care facilities.We analyzed prescription data for 3 drug classes (atypical antipsychotic, proton pump inhibitor, and statin) obtained from a regional online pharmacy serving long-term care centers in Pennsylvania from January 2004 to December 2007.Difference-in-difference is used as a primary analysis method, and different regression methods (probit and multinomial) are used to accommodate different types of outcome measures.Contrary to expectations, the Part D program did not have a statistically significant impact on the generic prescription rate in the long-term care setting during the study period. Only the statin class showed a dramatic increase in generic drug prescriptions, mainly due to the loss of patent protection for one of the most popular brand-name drugs in the class.The complex dynamics of the prescription drug market, particularly the availability of generic versions of popular prescription medications, had a bigger role in increasing the prescription rate of generic drugs than the Part D program. This warrants the need to relax prescription medicines' patent policies and for further study on the impact of such policies.
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Affiliation(s)
- Changmi Jung
- Carey Business School, Johns Hopkins University, Baltimore, MD
| | - Rema Padman
- The H. John Heinz III College, Carnegie Mellon University, Pittsburgh, PA
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31
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Korai U, Naqvi GR, Zafar F, Ali H, Naeem S, Alam N, Saeed R, Farooqi S, Hussain T. Drug utilization evaluation of Piperacillin/Tazobactam: A prospective and cross sectional investigation in tertiary care setup. Pak J Pharm Sci 2019; 32:1861-1867. [PMID: 31680084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Drug utilization evaluation (DUE) is an arrangement of continuous, orderly, criteria-based assessment of medication utilizes to guarantee that medicines are utilized suitably. In the event that treatment is regarded to be improper, provider and patient intervention may be important to optimize therapeutic efficacy. In the present study drug utilization evaluation of Piperacillin/Tazobactam was carried out in prospective manner. A well structured data collection form was constructed to collect the related information regarding demographic, clinical use, indication, culture sensitivity criteria, outcomes of therapy, renal impairment cases of dose adjustments and appropriate use. Results of chi square indicated insignificant relationship between gender and as p value was found to be p=0.446 and 0.111 for use of drug alone and in combination. Similarly insignificant relationship between gender and use of drug in combination with other antibiotics as p value was found to be p=0.111. It was found that from 61-70 years (Therapeutic Effectiveness; n=12, 9.37%), (Therapeutic Failure; n=10, 45.45%) and mortality (n=1, 50%) were quite higher. The prescription pattern was in accordance with standard guidelines. Study indicated need to elevate prescribers to pursue generic prescribing and rationally utilize antibiotics to avert advancement of resistance at the level of hospital and community. These sorts of studies are valuable for acquiring data about medication utilize designs and for recognizing inconceivable expense of medicines.
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Affiliation(s)
| | - Ghazala R Naqvi
- Faculty of Pharmacy, Federal Urdu University, Karachi, Pakistan
| | - Farya Zafar
- Faculty of Pharmacy and Pharmaceutical Sciences, University, Karachi, Karachi, Pakistan
| | - Huma Ali
- Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Sadaf Naeem
- Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Nausheen Alam
- Faculty of Pharmacy, Federal Urdu University, Karachi, Pakistan
| | - Rehana Saeed
- Faculty of Pharmacy and Pharmaceutical Sciences, University, Karachi, Karachi, Pakistan
| | - Sadaf Farooqi
- Faculty of Pharmacy and Pharmaceutical Sciences, University, Karachi, Karachi, Pakistan
| | - Tazeen Hussain
- Faculty of Pharmacy and Pharmaceutical Sciences, University, Karachi, Karachi, Pakistan
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32
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Abstract
Despite improvements in antibiotic use in tertiary hospitals, problems remain in other parts of the health system, say Ping He and colleagues
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Affiliation(s)
- Ping He
- China Center for Health Development Studies, Peking University, Beijing 100191, China
| | - Qiang Sun
- School of Health Care Management, Shandong University, Shandong Jinan 250012, China
| | - Lizheng Shi
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing 100191, China
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Nassif A, Katoue MG, Wake DJ, George J. Management of Low Density Lipoprotein Cholesterol at a primary care diabetes clinic in Kuwait. Prim Care Diabetes 2019; 13:259-265. [PMID: 30578166 DOI: 10.1016/j.pcd.2018.11.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 11/17/2022]
Abstract
AIMS To evaluate the impact of clinical audit and focused interventions on reducing cardiovascular diseases risk by treating Low Density Lipoprotein Cholesterol (LDL-C) in patients with type 2 diabetes attending a primary care clinic in Kuwait. METHODS Using LDL as a surrogate for cardiovascular risk, the audit team performed a clinical audit with focus on the care process indicator of statin prescription. The basic audit reviewed 100 patients' medical records retrospectively to assess patients' lipid profiles and statin prescription. A lipid management protocol and algorithm based on national clinical practice guidelines distributed to all healthcare professionals and was implemented for 3 months followed by re-audit of another 100 records. Descriptive and comparative statistics (pre and post) were performed using SPSS, version 22. RESULTS Statin prescription increased significantly from (26%) in the basic audit to (85%) in the post-intervention audit (p<0.001). The mean LDL-C value decreased significantly from 3.37±0.67mmol/L to 2.71±0.79mmol/L, p<0.001. Mean total cholesterol was significantly reduced from 5.15±0.73mmol/L to 4.68±0.88mmol/L, p<0.001. Ten years CHD risk decreased from 18.46±11.1% to 16.8±12.23%, p=0.152. CONCLUSIONS Implementing a clinical audit coupled with focused intervention was successful in improving management of LDL-C among patients with type 2 diabetes mellitus attending the primary healthcare sector in Kuwait.
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Affiliation(s)
- Alfred Nassif
- Al-Naeem Diabetes Clinic, Primary Health Care, Jahra, Kuwait.
| | - Maram Gamal Katoue
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Kuwait
| | - Deborah Jane Wake
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Jacob George
- University of Dundee Ninewells Hospital, Dundee, Scotland, UK
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Abstract
IMPORTANCE Veterinarians are a subset of opioid prescribers. OBJECTIVE To assess the quantity and trends in prescribing and dispensing of several different opioids in the past 11 years in a large veterinary hospital in Philadelphia, Pennsylvania. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study inventoried all opioid tablets and/or patches dispensed or prescribed by veterinarians practicing in a multispecialty academic veterinary teaching hospital in Philadelphia for small animals and species, such as rabbits, birds, and reptiles, from January 1, 2007, through December 31, 2017. Prescribing data were obtained from all veterinarians who wrote a prescription for opioids by reviewing detailed pharmacy records of controlled substances for the study period. Data included all opioids dispensed, or prescribed to animals (patients) undergoing evaluation at the center or being followed up as outpatients by the veterinarians in the hospital. Statewide veterinarian prescribing data were used for comparison. Data were analyzed from December 24, 2017, through May 15, 2018. MAIN OUTCOMES AND MEASURES The trend in administration and prescribing of 4 specific opioid analgesics (codeine sulfate, hydrocodone bitartrate, and tramadol hydrochloride tablets as well as fentanyl citrate patch) during the 11-year study period. The individual opioids were converted to morphine milligram equivalents (MME) for comparison. RESULTS The study included 134 veterinarians (70.9% women) with 366 468 patient visits. During the study period, the hospital veterinarians prescribed 105 183 689 tablets of tramadol, 97 547 tablets of hydrocodone, 38 939 tablets of codeine, and 3153 fentanyl patches to dogs (73.0%), cats (22.5%), and exotic animals (4.5%). Overall, MME use increased 41.2%, whereas visits increased by 12.8%. The comparison data for Pennsylvania revealed a predominance of hydrocodone use (688 340 tablets prescribed), although data were not available for comparison with tramadol because it is a Schedule IV drug. CONCLUSIONS AND RELEVANCE Results of this study suggest that the large, increasing volume of opioids prescribed at 1 veterinary teaching hospital highlights concerns parallel to those about excessive opioid prescribing in humans. The extent to which these data may represent similar volumes of prescriptions from the general veterinary practices and hospitals across the United States is suggested by the accompanying Pennsylvania state data. These findings highlight an opportunity to assess the risk of veterinarian opioid prescriptions to safeguard public health.
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Affiliation(s)
- Dana L. Clarke
- Department of Clinical Sciences and Advanced Medicine,
University of Pennsylvania School of Veterinary Medicine, Philadelphia
| | - Kenneth J. Drobatz
- Department of Clinical Sciences and Advanced Medicine,
University of Pennsylvania School of Veterinary Medicine, Philadelphia
| | - Chloe Korzekwa
- currently anundergraduate student at Trinity College,
University of Dublin, Dublin, Ireland
| | - Lewis S. Nelson
- Department of Emergency Medicine, Rutgers New Jersey
Medical School, Newark
| | - Jeanmarie Perrone
- Division of Medical Toxicology, Department of
Emergency Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia
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Gradl G, Teichert M, Kieble M, Werning J, Schulz M. Comparing outpatient oral antibiotic use in Germany and the Netherlands from 2012 to 2016. Pharmacoepidemiol Drug Saf 2018; 27:1344-1355. [PMID: 30264894 PMCID: PMC6585743 DOI: 10.1002/pds.4643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/21/2018] [Accepted: 07/25/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE Overuse of antibiotics is of concern, but may differ between European countries. This study compares outpatient use of oral antibiotics between Germany (DE) and the Netherlands (NL). METHODS For DE, we used the DAPI database with information on dispensings at the expense of the Statutory Health Insurance Funds from > 80% of community pharmacies. For NL, data were obtained from the Dutch Foundation for Pharmaceutical Statistics. Use of oral antibiotics was estimated as defined daily doses per 1000 inhabitants per day (DID), except for age comparisons as packages per 1000 inhabitants annually. National time trends were assessed with linear regression, stratified for the major antibiotic classes, and individual substances. RESULTS From 2012 to 2016, outpatient antibiotic use was lower in NL than in DE (9.64 vs 14.14 DID in 2016) and non-significantly decreased slightly over time in both countries. In DE, dispensings of oral antibiotics to children were higher compared with NL for the age groups 2 to 5 (2.0-fold in 2016) and 6 to 14 years (2.7-fold in 2016). Use of cephalosporins was very low in NL (0.02 DID in 2016), but the second most frequently dispensed class in DE (2.95 DID in 2016). CONCLUSION From 2012 to 2016, outpatient use of oral antibiotics was lower in NL than in DE. Differences were primarily observed in the age groups 2 to 5 and 6 to 14 years, although the recommendations of evidence-based guidelines in both countries were in agreement.
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Affiliation(s)
- Gabriele Gradl
- German Institute for Drug Use Evaluation (DAPI)BerlinDEGermany
| | - Martina Teichert
- Department of Clinical Pharmacy and ToxicologyLeiden University Medical CenterLeidenThe Netherlands
| | - Marita Kieble
- German Institute for Drug Use Evaluation (DAPI)BerlinDEGermany
| | - Johanna Werning
- German Institute for Drug Use Evaluation (DAPI)BerlinDEGermany
| | - Martin Schulz
- German Institute for Drug Use Evaluation (DAPI)BerlinDEGermany
- Department of MedicineABDA—Federal Union of German Associations of PharmacistsBerlinDEGermany
- Department of Clinical Pharmacy and Biochemistry, Institute of PharmacyFreie Universitaet BerlinBerlinDEGermany
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Etxeberria A, Iribar J, Rotaeche R, Vrotsou K, Barral I. [Evaluation of an educational intervention and a structured review of polypharmacy in elderly patients in Primary Care]. Rev Esp Geriatr Gerontol 2018; 53:319-325. [PMID: 30097319 DOI: 10.1016/j.regg.2018.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 05/10/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Several interventions have been shown to reduce polypharmacy and potentially inappropriate prescription (PIP). The objective of the study was to evaluate the number of drugs and PIP before and after an educational intervention with the Primary Care physician (PCP), with electronic identification of PIP and structured medication review, in elderly patients with excessive polypharmacy (≥10 drugs). MATERIAL AND METHODS A before-after intervention study was conducted in the Gipuzkoa district of Osakidetza (Basque Country Health System), in a random sample of patients older than 80 years taking ≥ 10 drugs, and whose PCP attended training sessions. Primary outcomes: change in the number of drugs and PIP, registered in computerised health records. SECONDARY OUTCOMES benefit/risk ratio assessed by the PCP, safety problems, and therapeutic decision. RESULTS Of the 591 eligible patients, 88 were excluded (41: PCP did not attend training sessions, 47: death/transfer/admission), including a total of 503 patients with mean age of 84.9 years, with 67.7% women. The mean number of drugs and PIP per patient decreased significantly, -0.88 (95% CI: -1.04 to -0.72) and -0.19 (95% CI: -0.29 to -0.09), respectively (p<.0001), with a 25.8% reduction in the number of patients with excessive polypharmacy. SECONDARY OUTCOMES data collection sheets of 365 patients and 4,168 prescriptions were collected. The benefit-risk ratio was favourable for 75% of the prescriptions, with the most frequent decision being to maintain them (83%). Among the 911 prescriptions with an unfavourable/uncertain benefit/risk ratio, 47.3% were maintained. CONCLUSIONS The intervention is associated with a reduction in excessive polypharmacy and PPI under real-world conditions.
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Affiliation(s)
- Arritxu Etxeberria
- Farmacia de Atención Primaria, Centro de Salud de Hernani, OSI Donostialdea, Hernani, España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España
| | - Josune Iribar
- Farmacia de Atención Primaria, Centro de Salud de Hernani, OSI Donostialdea, Hernani, España.
| | - Rafael Rotaeche
- Centro de Salud de Alza, San Sebastián, OSI Donostialdea, San Sebastián, España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España
| | - Kalliopi Vrotsou
- Unidad de Investigación de Atención Primaria - OSIS Gipuzkoa , San Sebastián, España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Vizcaya, España; Centro de Investigación en Cronicidad Kronikgune, Barakaldo, Vizcaya, España
| | - Iosu Barral
- Instituto de Investigación Sanitaria Biodonostia, San Sebastián, España
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Sheehan R, Strydom A, Brown E, Marston L, Hassiotis A. Association of Focused Medication Review With Optimization of Psychotropic Drug Prescribing: A Systematic Review and Meta-analysis. JAMA Netw Open 2018; 1:e183750. [PMID: 30646263 PMCID: PMC6324597 DOI: 10.1001/jamanetworkopen.2018.3750] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Medication review has been proposed to achieve improved use of psychotropic drugs, but benefits have not been confirmed. OBJECTIVE To synthesize evidence for focused psychotropic medication review in medication optimization. DATA SOURCES Medline, PsycINFO, EMBASE, and CINAHL Plus were searched from inception to February 2018 using the index terms "drug utilization review" and "psychotropic drugs" and synonyms. Additional articles were retrieved using citation tracking and reference checking. STUDY SELECTION Full-length, peer-reviewed articles that reported focused psychotropic medication review were included. Inclusion was determined against prespecified criteria and assessed independently. DATA EXTRACTION AND SYNTHESIS Study quality was assessed using National Institutes for Health appraisal tools and informed a structured synthesis of results. Meta-analysis using a random effects model was conducted. MAIN OUTCOMES AND MEASURES Change in the number or dosage of psychotropic medications, change in clinical parameters, change in patient-reported outcomes, and economic data were collected. RESULTS A total of 26 studies met the inclusion criteria. Four studies were randomized clinical trials (n = 712 participants), while the remainder were before-after studies (n = 7844 participants). Most studies were conducted in elderly individuals, people with dementia, and adults with intellectual disability. Focused psychotropic medication review is a complex intervention; the professional(s) involved, target drug, degree of integration with usual care, and participant involvement varied greatly among the studies. Meta-analysis included 3 studies (n = 652 participants). Psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs compared with control (pooled odds ratio, 0.24; 95% CI, 0.14-0.39) in elderly participants with cognitive impairment living in nursing homes. Before-after studies consistently reported a change in psychotropic drug prescribing after medication review, regardless of the population. Studies that reported the effects of psychotropic medication review on clinical outcomes failed to demonstrate benefit. Economic implications of focused psychotropic medication review were not adequately assessed. The quality of evidence is poor and studies are at risk of bias. CONCLUSIONS AND RELEVANCE Focused psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs, but has not been shown to improve clinical outcomes or to provide economic benefit. More robust evidence is needed before programs of focused psychotropic medication review can be recommended as part of routine care for any patient group.
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Affiliation(s)
- Rory Sheehan
- Division of Psychiatry, University College London, London, United Kingdom
| | - André Strydom
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Emma Brown
- Division of Psychiatry, University College London, London, United Kingdom
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London, United Kingdom
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Jacobs MS, Schouten JF, de Boer PT, Hoffmann M, Levin LÅ, Postma MJ. Secondary adherence to non-vitamin-K antagonist oral anticoagulants in patients with atrial fibrillation in Sweden and the Netherlands. Curr Med Res Opin 2018; 34:1839-1847. [PMID: 29598152 DOI: 10.1080/03007995.2018.1459528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE There is limited evidence on patients' adherence and the impact of the prescribed dosing regimen in non-vitamin-K oral anticoagulants (NOACs). We aimed to assess secondary adherence to NOACs and to determine the impact of the dosing regimen in patients with atrial fibrillation. METHODS Patients using a NOAC between 2009 and 2013 were identified from the nation-wide Swedish Prescribed Drug Register and the Dutch regional IADB.nl database. Patients using a consistent dosage for at least 180 consecutive days were included. Adherence was calculated using the medication possession ratio (MPR) and adjusted for overlapping dates. Adherence was defined as a MPR ≥0.8. Sensitivity analyses were performed using a MPR ≥0.9. Logistic regression was performed to compare secondary adherence and to explore the influence of the dosing regimen. RESULTS A total of 5254 Swedish and 430 Dutch NOAC users were included. The mean MPR was 96.0% (SD 7.8%) in Sweden and 95.1% (SD 10.1%) in the Netherlands. Multivariable logistic regression analysis showed that a twice daily regimen had a lower likelihood of being secondary adherent compared to a once daily regimen in Sweden (odds ratio [OR] 0.21 [95% CI 0.12-0.35]). LIMITATIONS The influence of selection bias introduced by the inclusion criterion of ≥2 dispensations covering at least 180 days could not be excluded. CONCLUSIONS This study demonstrated that secondary adherence was high in this specific setting among patients with at least two initial dispensations of a NOAC covering a minimum of 180 days. The use of NOACs in a once daily regimen showed higher adherence compared to a twice daily regimen.
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Affiliation(s)
- Maartje S Jacobs
- a Groningen Research Institute of Pharmacy , Unit of PharmacoTherapy, Epidemiology & Economics , University of Groningen , The Netherlands
- b Department of Clinical Pharmacy and Toxicology , Martini Hospital , Groningen , The Netherlands
| | - Jeroen F Schouten
- a Groningen Research Institute of Pharmacy , Unit of PharmacoTherapy, Epidemiology & Economics , University of Groningen , The Netherlands
| | - Pieter T de Boer
- a Groningen Research Institute of Pharmacy , Unit of PharmacoTherapy, Epidemiology & Economics , University of Groningen , The Netherlands
| | - Mikael Hoffmann
- c Division of Health Care Analysis, Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences , Linköping University , Linköping , Sweden
| | - Lars-Åke Levin
- c Division of Health Care Analysis, Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences , Linköping University , Linköping , Sweden
| | - Maarten J Postma
- a Groningen Research Institute of Pharmacy , Unit of PharmacoTherapy, Epidemiology & Economics , University of Groningen , The Netherlands
- d Institute for Science in Healthy Aging & healthcaRE (SHARE) , University Medical Center Groningen , Groningen , The Netherlands
- e Department of Epidemiology , University Medical Center Groningen , Groningen , The Netherlands
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Abstract
INTRODUCTION AND OBJECTIVES Statins have become an integral part of treatment to reduce cardiac events in patients with cardiovascular disease. However, their use within the public healthcare system in Brazil is unknown. Consequently, we sought to determine and characterize statin use in primary healthcare delivered by the public health system (SUS) in Brazil and evaluate associated patient factors to improve future use. METHODS Cross-sectional study with a national representative sample from five Brazilian regions, derived from the National Survey on Access, Use and Promotion of Rational Use of Medicines using a multi-stage complex sampling plan. Patients over 18 years old were interviewed from July 2014 to May 2015. The prevalences of statin use and self-reported statin adherence were determined amongst medicine users. The associations between statin use and sociodemographic/health condition variables were assessed using logistic regression. RESULTS A total of 8803 patients were interviewed, of whom 6511 were medicine users. The prevalence of statin use was 9.4% with simvastatin (90.3%), atorvastatin (4.7%) and rosuvastatin (1.9%) being the most used statins. Poor adherence was described by 6.5% of patients. Statin use was significantly associated with age ≥65 years old, higher educational level, residence in the South, metabolic and heart diseases, alcohol consumption and polypharmacy. CONCLUSIONS This is the first population based study in Brazil to assess statin use in SUS primary healthcare patients. Addressing inequalities in access and use of medicines including statins is an important step in achieving the full benefit of statins in Brazil, with the findings guiding future research and policies.
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Affiliation(s)
- R C R M do Nascimento
- a Post-graduated Program of Medicines and Pharmaceutical Assistance, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
| | - A A Guerra
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
- c Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
| | - J Alvares
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
- c Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
| | - I C Gomes
- d Faculdade de Ciências Médicas , Belo Horizonte , Minas Gerais , Brazil
| | - B Godman
- e Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
- f Division of Clinical Pharmacology , Karolinska Institutet , Stockholm , Sweden
- g Health Economics Centre , Liverpool University Management School , Liverpool , UK
| | - M Bennie
- e Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - A B Kurdi
- e Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - F A de Acurcio
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
- c Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
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Kalra S, Sahay R, Tiwaskar M. Need for Insulin Stewardship Programmes. J Assoc Physicians India 2018; 66:83-84. [PMID: 31325271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Sanjay Kalra
- Consultant Endocrinologist, Bharti Hospital, B.R.I.D.E., Karnal, Haryana
| | - Rakesh Sahay
- Consultant Endocrinologist, Osmania Medical College, Hyderabad, Telangana
| | - Mangesh Tiwaskar
- Consultant Physician and Diabetologist, Shilpa Medical Research Centre, Dahisar East, Mumbai, Maharashtra
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Afshan A. Rationale use of proton pump inhibitors: Observational study of hospital based prescriptions and role of clinical pharmacist. Pak J Pharm Sci 2018; 31:1217-1227. [PMID: 30033404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The rationale of acid suppressant therapy with PPIs was assessed to measure the treatments conformity in PGHI under clinical guidelines. The irrational use of PPIs was found to induce side effects in patients and increased budgetary constraint. In a 4 phase study, 2 groups of patients (784 and 2804) were selected; Pre intervention retrospective review of the prescriptions was done in phase I. Insightful awareness in clinicians and patients was created in phase II a and II b respectively. The ongoing prescriptions were intervened in phase III. The post-intervention retrospective audit of prescription was completed in phase IV. The data was recorded for chronic disease patients in the hospital, revealed a marked reduction (85%) in the frequency of PPI's prescriptions (784 to 117), Cost of PPI's /year reduced to 19.3% , from US$: 24522/- to US$: 4718/-. The side effects reported in patients' feedback was also reduced such as hypocalcaemia (59%), hypomagnesaemia (52%), anemia (28%), reflux dyspepsia (82%), C. difficile associated diarrhea (15%), pneumonia (5%), and nephritis in patients with CKD (11%). The intervention induced awareness in Clincians (85%), in patients (38%), reduction in PPIs prescription (45%), whereas cost of PPI's prescription in group 2 was reduced from US$ 36481/- to US$:10325/- i.e. (28%).
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Affiliation(s)
- Anjum Afshan
- Department of Pharmacy Services, Pakistan Atomic Energy Commission, General Hospital, Islamabad
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Först G, de With K, Weber N, Borde J, Querbach C, Kleideiter J, Seifert C, Hagel S, Ambrosch A, Löbermann M, Schröder P, Steib-Bauert M, Kern WV. Validation of adapted daily dose definitions for hospital antibacterial drug use evaluation: a multicentre study. J Antimicrob Chemother 2018; 72:2931-2937. [PMID: 29091214 DOI: 10.1093/jac/dkx244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/20/2017] [Indexed: 01/23/2023] Open
Abstract
Background The WHO/ATC (Anatomical Therapeutic Chemical) index DDD (WHO-DDD) is commonly used for drug consumption measurement. Discrepancies between WHO-DDD and actual prescribed daily doses (PDD) in hospitals have prompted alternative dose definitions adapted to doses recommended in hospital practice guidelines [recommended daily doses (RDD)]. Methods In order to validate RDD we performed modified point prevalence surveys in 24 acute care hospitals and recorded 20620 PDD of antibiotics given to 4226 adult patients on the day of the survey and the 6 preceding days. We calculated RDD and WHO-DDD and compared them with PDD. Results The rate of RDD corresponding to PDD was higher than the corresponding rate for WHO-DDD (pooled data, 55% versus 30%) and the differences were similar across the hospital sample, but varied according to drug/drug class, route of administration, indication and renal function. RDD underestimated actual consumption by 14% overall, while WHO-DDD overestimated total antibacterial consumption by 28% (pooled data; median values RDD -10% versus WHO-DDD +32%). The deviations of estimated from actual drug use volumes were largest for β-lactams (RDD -11% versus WHO-DDD +49%), in particular for penicillins (-11% versus +64%), if WHO-DDD were used. Conclusions Hospital antibiotic consumption surveillance systems using current WHO-DDD should address the uneven discrepancies between actual prescribing and consumption estimates according to drug class that may lead to misclassification in benchmark analyses. We recommend using validated RDD as a supplementary measure to the WHO-DDD for detailed analyses.
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Affiliation(s)
- Gesche Först
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
- Pharmacy Service, University Hospital and Medical Center, Freiburg, Germany
| | - Katja de With
- Clinical Infectious Disease Unit, Medical Center of the Carl Gustav Carus Technical University, Dresden, Germany
| | - Nadine Weber
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
| | - Johannes Borde
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
- Infectious Diseases Section, Ortenau-Klinikum, Achern-Oberkirch, Germany
| | - Christiane Querbach
- Pharmacy, 'Rechts der Isar' Hospital of the Technical University, Munich, Germany
| | | | - Claudia Seifert
- Pharmacy Service, Medical Center of the Carl Gustav Carus Technical University, Dresden, Germany
| | - Stefan Hagel
- Center for Infection and Infection Control, University Hospital, Jena, Germany
| | - Andreas Ambrosch
- Department of Laboratory Medicine, Microbiology and Infection Control, 'Barmherzige Brüder' Hospital, Regensburg, Germany
| | - Micha Löbermann
- Department of Infectious Diseases and Tropical Medicine, University Medical Center, Rostock, Germany
| | - Philipp Schröder
- Department of Medicine, Federal Armed Forces Hospital, Ulm, Germany
| | - Michaela Steib-Bauert
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
- Albert-Ludwigs-University Faculty of Medicine, Freiburg, Germany
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Joyce NR, Fishman J, Green S, Labiner DM, Wild I, Grabowski DC. Cost sharing for antiepileptic drugs: medication utilization and health plan costs. Am J Manag Care 2018; 24:e183-e189. [PMID: 29939508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To examine the association between health plan out-of-pocket (OOP) costs for antiepileptic drugs and healthcare utilization (HCU) and overall plan spending among US-based commercial health plan beneficiaries with epilepsy. STUDY DESIGN Retrospective cohort. METHODS The Truven MarketScan Commercial Claims database for January 1, 2009, to June 30, 2015, was used. Patients 65 years or younger with epilepsy and at least 12 months of continuous enrollment before index (date meeting first epilepsy diagnostic criteria) were included. Analyses were adjusted for age group, gender, beneficiary relationship, insurance plan type, and Charlson Comorbidity Index score. Primary outcomes included proportion of days covered (PDC), HCU, and healthcare spending in 90-day postindex periods. Associations between OOP costs and mean PDC, HCU, and plan healthcare spending per 90-day period were estimated. RESULTS Across 5159 plans, 187,241 beneficiaries met eligibility criteria; 54.3% were female, 41.7% were aged 45 to 65 years, and 62.4% were in preferred provider organization plans. Across postindex 90-day periods, mean (SD) PDC, epilepsy-specific hospitalizations, outpatient visits, and emergency department visits were 0.85 (0.26), 0.02 (0.13), 0.34 (0.47), and 0.05 (0.22), respectively. Median (interquartile range) spending per 90-day period was $1488 ($459-$4705); median epilepsy-specific spending was $139 ($18-$623). Multivariable linear regression without health plan fixed effects revealed that higher OOP spending was associated with a decrease in PDC (coefficient, -0.008; 95% CI, -0.009 to -0.006; P <.001) and an increase in overall spending (218.6; 95% CI, 47.9-389.2; P = .012). Health plan fixed effects model estimates were similar, except for epilepsy-specific spending, which was significant (120.6; 95% CI, 29.2-211.9; P = .010). CONCLUSIONS Increases in beneficiaries' OOP costs led to higher overall spending and lower PDC.
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Affiliation(s)
- Nina R Joyce
- Brown University School of Public Health, Box G-S121-6, 121 South Main St, Providence, RI 02198.
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Zanichelli V, Monnier AA, Gyssens IC, Adriaenssens N, Versporten A, Pulcini C, Le Maréchal M, Tebano G, Vlahović-Palčevski V, Stanić Benić M, Milanič R, Harbarth S, Hulscher ME, Huttner B. Variation in antibiotic use among and within different settings: a systematic review. J Antimicrob Chemother 2018; 73:vi17-vi29. [PMID: 29878219 PMCID: PMC5989604 DOI: 10.1093/jac/dky115] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives Variation in antibiotic use may reflect inappropriate use. We aimed to systematically describe the variation in measures for antibiotic use among settings or providers. This study was conducted as part of the innovative medicines initiative (IMI)-funded international project DRIVE-AB. Methods We searched for studies published in MEDLINE from January 2004 to January 2015 reporting variation in measures for systemic antibiotic use (e.g. DDDs) in inpatient and outpatient settings. The ratio between a study's reported maximum and minimum values of a given measure [maximum:minimum ratio (MMR)] was calculated as a measure of variation. Similar measures were grouped into categories and when possible the overall median ratio and IQR were calculated. Results One hundred and forty-three studies were included, of which 85 (59.4%) were conducted in Europe and 12 (8.4%) in low- to middle-income countries. Most studies described the variation in the quantity of antibiotic use in the inpatient setting (81/143, 56.6%), especially among hospitals (41/81, 50.6%). The most frequent measure was DDDs with different denominators, reported in 23/81 (28.4%) inpatient studies and in 28/62 (45.2%) outpatient studies. For this measure, we found a median MMR of 3.7 (IQR 2.6-5.0) in 4 studies reporting antibiotic use in ICUs in DDDs/1000 patient-days and a median MMR of 2.3 (IQR 1.5-3.2) in 18 studies reporting outpatient antibiotic use in DDDs/1000 inhabitant-days. Substantial variation was also identified in other measures. Conclusions Our review confirms the large variation in antibiotic use even across similar settings and providers. Data from low- and middle-income countries are under-represented. Further studies should try to better elucidate reasons for the observed variation to facilitate interventions that reduce unwarranted practice variation. In addition, the heterogeneity of reported measures clearly shows that there is need for standardization.
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Affiliation(s)
- Veronica Zanichelli
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Annelie A Monnier
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Céline Pulcini
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
- Université de Lorraine, APEMAC, F-54000 Nancy, France
| | | | | | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
- University of Rijeka, Medical Faculty, Rijeka, Croatia
| | - Mirjana Stanić Benić
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
| | | | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marlies E Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benedikt Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Blaszczyk AT, Mang BH, Garza H, Mathys M. The Impact of Cholinesterase Inhibitors with or without Memantine on Antipsychotic Prescribing. Consult Pharm 2018; 33:273-282. [PMID: 29789049 DOI: 10.4140/tcp.n.2018.273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Background Alzheimer's disease (AD) medications have been suggested to positively affect behavior, though not universally in all studies. Their impact on antipsychotic use is not well-defined. Methods This cross-sectional, retrospective study evaluated residents with AD on cholinesterase inhibitors, memantine, both, or neither throughout multiple long-term care facilities during July 2014. Patients were included if they: were between 65 and 89 years of age, had a diagnosis of AD, and had a cognitive assessment within three months of the study period. Patients residing in the facility for 100 days or fewer, or those having a Centers for Medicare & Medicaid Services-approved diagnosis for antipsychotic use were excluded. The primary outcome was the prevalence of antipsychotic prescribing in patients receiving AD medications compared with those without AD therapy. The Texas Tech University Health Sciences Center institutional review board approved the study protocol. Results Of 1,282 patients screened, 285 (161 AD medications and 124 no-AD medications) were analyzed. Median cognitive status scores suggested severe cognitive impairment. Patients receiving AD medications had higher antipsychotic utilization compared with those without AD medications (27% vs. 19%, respectively; P = 0.08). Patients receiving combination AD medications had the highest antipsychotic use. No statistically significant differences were detected in cognitive status subgroups. Of interest is that a post-hoc analysis found a statistically significant association with greater antipsychotic use and increasing number of AD medications. Conclusion Long-term care facility residents with AD receiving AD medications had higher rates of antipsychotic use compared with those not receiving AD treatment. The link between antipsychotic use and the number of AD medications may point to overprescribing in dementia with behavioral disturbances as a potential contributing factor.
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Del Giorno R, Ceschi A, Pironi M, Zasa A, Greco A, Gabutti L. Multifaceted intervention to curb in-hospital over-prescription of proton pump inhibitors: A longitudinal multicenter quasi-experimental before-and-after study. Eur J Intern Med 2018; 50:52-59. [PMID: 29274884 DOI: 10.1016/j.ejim.2017.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are indicated for a restricted number of clinical conditions, and their misuse can lead to several adverse effects. Despite that, the proportion of overuse is alarmingly high. OBJECTIVE To test the efficacy of a multifaceted strategy in order to achieve a significant reduction of new PPI prescriptions at discharge in hospitalized patients. DESIGN Multicenter longitudinal quasi-experimental before-and-after study conducted from July 1st, 2014 to June 30th, 2017. PARTICIPANTS 44,973 admissions in a network of 5 public teaching hospitals of the Italian-speaking region of Switzerland. INTERVENTION Multifaceted strategy consisting in a continuous transparent monitoring-benchmarking and in capillary educational interventions applied in the internal medicine departments. To confirm the causality of the results we monitored the trend of new PPI prescriptions in the, not exposed to the intervention, surgery departments of the same hospital network. MAIN MEASURES New PPI prescriptions at hospital discharge. KEY RESULTS Over the 36month study period 44,973 patient files were analyzed. At admission, comparing internal medicine vs. surgery departments, 44.9% vs. 23.3% of patients were already being treated with a PPI. The annual rate of new PPI prescriptions, for internal medicine showed a decreasing trend: 19, 19, 18, 16% in years 2014, 2015, 2016, 2017, respectively (p<0.001, 2014 vs. 2017; p-for-trend <0.001), while an increasing rate was found in the surgery departments in the same years: 30, 29, 36, 36%, respectively (p<0.001, 2014 vs. 2017; p-for-trend <0.001). The case mix was significantly associated with the probability of new PPI prescriptions in both departments (OR1.35, 95% CI 1.26-1.44 for internal medicine and 1.24, 95% CI 1.19-1.30 for surgery). CONCLUSIONS The introduction of a multifaceted intervention significantly reduced the time trend of PPI prescriptions at hospital discharge in internal medicine departments. Further studies are needed to confirm whether the strategy proposed could contribute to optimize the in-hospital drug prescription behavior in other healthcare settings as well.
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Affiliation(s)
- Rosaria Del Giorno
- Department of Internal Medicine and Nephrology, Regional Hospital of Bellinzona and Valli, Bellinzona, Switzerland.
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland; Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland.
| | - Michela Pironi
- Central Pharmacy Service, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
| | - Anna Zasa
- Quality and Patient Safety Service, La Carità Hospital, Locarno, Switzerland
| | - Angela Greco
- Quality and Patient Safety Service, La Carità Hospital, Locarno, Switzerland.
| | - Luca Gabutti
- Department of Internal Medicine and Nephrology, Regional Hospital of Bellinzona and Valli, Bellinzona, Switzerland; Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland.
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Ali H, Zafar F, Alam S, Beg AE, Bushra R, Manzoor A, Naqvi GR, Yasmeen R, Shafiq Y, Tariq A, Zubair S, Saleem S. Drug utilization and prescribing pattern of antibiotics in a tertiary care setups; trends and practices. Pak J Pharm Sci 2018; 31:691-697. [PMID: 29625943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Irrational, over and misuse of antibiotics arise as global concern in both hospital and community settings and lead to adverse events including antimicrobial resistance, associated health problems, amplified hospitalization stay and cost. Hence, Drug Utilization Evaluation (DUE) studies are designed to evaluate and improve the prescribing, administration and the rational use of medications. The present study was designed to assess the pattern of antimicrobial drug utilization in in-patients cohort of tertiary care setup in Karachi, Pakistan. This cross sectional observational study was conducted in retrospective manner. World health organization (WHO) guidelines and criteria are considered to evaluate the appropriateness of drug use in various disease conditions. ATC/DDD system was applied to determine the study outcome. High frequency of antibiotics utilization found in respiratory tract infections of both lower (LRTI) 16.8% (n=42) and upper (UTI) 13.2% (n=33). The estimated total number of drug units administered per month was greater with cefixime (46) and ciprofloxacin (45) both. DDD/100 bed days drug utilization of antibiotics was higher with ciprofloxacin, cefexime and meropenem (47, 46 and 29.25) correspondingly. In conclusion, the current investigation signifies extensive scope for progress in prescribing trend. Drug adherence to customary guidelines of disease management and constraint policies to endorse judicious drug use may be considered vital in healthcare setup.
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Affiliation(s)
- Huma Ali
- Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Farya Zafar
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| | - Shazia Alam
- Department of Pharmaceutics, Faculty of Pharmacy, Ziauddin University, Karachi, Pakistan
| | - Anwar Ejaz Beg
- Department of Pharmaceutics, Faculty of Pharmacy, Ziauddin University, Karachi, Pakistan
| | - Rabia Bushra
- Department of Pharmaceutics, Dow College of Pharmacy, DUHS, Karachi, Pakistan
| | - Ammara Manzoor
- Department of Medical Oncology, Jinnah Post Graduate Medical Centre [JPMC} Karachi, Pakistan
| | - Ghazala R Naqvi
- Department of Pharmaceutics, Faculty of Pharmacy, Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan
| | - Riffat Yasmeen
- Department of Pharmaceutics, Dow College of Pharmacy, DUHS, Karachi, Pakistan
| | - Yousra Shafiq
- Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Anum Tariq
- Department of Pharmaceutics, Faculty of Pharmacy, Ziauddin University, Karachi, Pakistan
| | - Saba Zubair
- Department of Pharmaceutics, Faculty of Pharmacy, Ziauddin University, Karachi, Pakistan
| | - Saima Saleem
- Department of Pharmaceutical Services, NICVD, Karachi, Pakistan
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Getz KD, Miller TP, Seif AE, Li Y, Huang YSV, Fisher BT, Aplenc R. Opioid utilization among pediatric patients treated for newly diagnosed acute myeloid leukemia. PLoS One 2018; 13:e0192529. [PMID: 29420604 PMCID: PMC5805309 DOI: 10.1371/journal.pone.0192529] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/25/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose A cohort of pediatric patients with AML treated at hospitals contributing to the Pediatric Health Information System was used to evaluate differences in opioid utilization by sex, age, race, and insurance. Methods Billing data were used to compute the prevalence of opioid exposure and to quantify rates of utilization among those exposed to opioids as days of use per 1000 inpatient days. Multivariable regressions were used to compare opioid prevalence, and rates of utilization among those exposed. Results On average across courses, 95.2% of patients were exposed to analgesics, 84.7% were exposed to non-opioid analgesics and 77.7% were exposed to opioids. The proportion of opioid-exposed patients increased with age, but did not differ by gender, race, or insurance status. Analyses limited to patients exposed to opioids revealed modest differences in days of opioid use among female patients (adjusted rate ratio (aRR) = 1.19, 95% CI: 1.11, 1.28), patients <1 year (aRR = 1.37, 95% CI: 1.21, 1.55) or ≥10 years of age (aRR = 1.63, 95% CI: 1.46, 1.82), whereas Asian patients received fewer days of opioids compared with white patients (aRR = 0.76, 95% CI: 0.61, 0.95). There was moderate hospital-level variability in both the prevalence of opioid utilization overall and preference for specific opioid medications. There was greater inconsistency in practice concerning choices for supplemental and alternative opioids than in first-line opioid utilization. Conclusion Additional work is needed to discern whether observed differences in opioid utilization by age and race reflect a difference in treatment or a difference in the experience of pain. Future studies should also explore the factors which guide decisions on opioid selections in an attempt to explain the variability across institutions.
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Affiliation(s)
- Kelly D. Getz
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Tamara P. Miller
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Alix E. Seif
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Yimei Li
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Center for Clinical Epidemiology and Biostatistics, Unive of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Yuan-Shung V. Huang
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Brian T. Fisher
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
- Center for Clinical Epidemiology and Biostatistics, Unive of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
- Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Richard Aplenc
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
- Center for Clinical Epidemiology and Biostatistics, Unive of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
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Affiliation(s)
- T Fayers
- Imperial College Ophthalmic Research Unit, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - G K Loh
- Imperial College Ophthalmic Research Unit, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - M F Cordeiro
- Imperial College Ophthalmic Research Unit, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - V Lee
- Imperial College Ophthalmic Research Unit, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - R Jain
- Imperial College Ophthalmic Research Unit, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - P M Fayers
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Devillers L, Sicsic J, Delbarre A, Le Bel J, Ferrat E, Saint Lary O. General Practitioner trainers prescribe fewer antibiotics in primary care: Evidence from France. PLoS One 2018; 13:e0190522. [PMID: 29370178 PMCID: PMC5784911 DOI: 10.1371/journal.pone.0190522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/15/2017] [Indexed: 02/01/2023] Open
Abstract
Purpose Antibiotic prescription is a central public health issue. Overall, 90% of antibiotic prescriptions are delivered to patients in ambulatory care, and a substantial proportion of these prescriptions could be avoided. General Practitioner (GP) trainers are similar to other GPs in terms of sociodemographic and medical activities, but they may have different prescription patterns. Our aim was to compare the antibiotic prescribing rates between GP trainers and non-trainers. Methods This observational cross-sectional study was conducted on administrative data claims from the French National Health Insurance. The antibiotic prescribing rate was calculated. The main independent variable was the training status of the GPs. Prescribing rates were adjusted for the various GPs’ characteristics (gender, age, location of the practice, number of visits per GP and the case-mix) in a multiple linear regression analysis. Results Between June 2014 and July 2015 the prescribing patterns of 860 GPs were analysed, among which 102 were GP trainers (12%). Over the year 363,580 patients were prescribed an antibiotic out of 3,499,248 visits for 1,299,308 patients seen over the year thus representing around 27.5% of patients. In the multivariate analyses, being a trainer resulted in a significant difference of 6.62 percentage points (IC 95%: [-8.55; -4.69]; p<0.001) in antibiotic prescriptions comparing to being a non-trainer, corresponding to a relative reduction of 23.4%. Conclusion These findings highlight the role of GP trainers in antibiotic prescriptions. By prescribing fewer antibiotics and influencing the next generations of GPs, the human and economic burden of antibiotics could be reduced.
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Affiliation(s)
- Louise Devillers
- Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles Saint-Quentin en Yvelines (UVSQ), Montigny-le-Bretonneux, France
- CESP, University Paris-Sud, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
- * E-mail:
| | - Jonathan Sicsic
- CESP, University Paris-Sud, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
| | - Angelique Delbarre
- CESP, University Paris-Sud, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
| | - Josselin Le Bel
- Department of Family Medicine, University Paris Diderot, Sorbonne Paris Cité, Paris, France
- UMR 1137, INSERM, IAME, Paris, France
| | - Emilie Ferrat
- University Paris-Est Créteil (UPEC), School of Medicine, Primary Care Department, Créteil, France
- University Paris-Est Créteil (UPEC), DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Créteil, France
| | - Olivier Saint Lary
- Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles Saint-Quentin en Yvelines (UVSQ), Montigny-le-Bretonneux, France
- CESP, University Paris-Sud, UVSQ, INSERM U1018, University Paris-Saclay, Villejuif, France
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