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Pharmacy Database (pharmacy + database)
Selected AbstractsPhysician characteristics associated with prescription of inappropriate medications using Beers criteriaGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2007Hirohisa Imai Background: The prescription of potentially inappropriate medications (PIM) for elderly patients represents a major problem. In the published work, various practice characteristics associated with physicians prescribing habits have been reported. However, existing data has shed little light on the characteristics of physicians who tend to prescribe PIM. We examined whether personal, professional or practice characteristics differ between physicians who prescribe PIM and those who do not. Methods: The subjects comprised primary care and general practice physicians. Physicians were identified from the pharmacy database of a managed care organization as having prescribed medications for Medicare patients over 65 years enrolled in a managed care plan. We adopted Beers criteria to describe the prevalence of PIM use. The physicians were divided into three groups according to number of PIM prescribed. To examine the extent of associations between all the physician-related characteristics studied, polychotomous logistic regression was conducted. Results: Physicians who prescribed one to five PIMs were 0.63 (95% confidence interval [CI], 0.41,0.98) times more likely to have publications than physicians who prescribed no PIM. Physicians who prescribed more than six PIM were 3.18 (95% CI, 2.05,4.95) times more likely to be certified by an internal medicine board, 0.48 (95% CI, 0.30,0.78) times more likely to have publications, and 1.84 (95% CI, 1.01,3.35) times more likely to be in solo practice than physicians who prescribed no PIM. Conclusion: In this study, we found three predictors of PIM prescribing incidence. Since the current study could only describe associations and not causality, further research is necessary. [source] Divalproex sodium vs. valproic acid: drug utilization patterns, persistence rates and predictors of hospitalization among VA patients diagnosed with bipolar disorderJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2007S. U. Iqbal MBA MPH MD Summary Objectives:, To compare divalproex sodium and valproic acid for therapeutic patterns, persistence rates and predictors of hospitalization among bipolar patients on monotherapy in the Veterans Affairs (VA) healthcare system. Methods:, Using VA administrative data bases, we conducted a retrospective inception cohort study of VA patients', 18 years of age who had at least one outpatient diagnoses of bipolar disorder and two continuous prescription records for the study drugs in the VA PBM pharmacy database during the study period of 1st April 2001 to 30th September 2003. Persistence for the comparative drugs was reported as continuous variable and compared using t -tests. Logistic regression models were used to examine the risk of hospitalization whereas Cox proportional hazard regression models were used to evaluate the time to hospitalization and time to interruption of therapy for the two drug groups. Results:, We identified 4624 bipolar patients on monotherapy with valproic acid (n = 4036) and divalproex sodium (n = 588) during the study period. The descriptive statistics included sociodemographics, disability and comorbidity status and were similar for the two groups. For the crude persistence rates there were no statistically significant differences between divalproex sodium (120 days) and valproic acid (110 days). The logistic regression model for risk of hospitalization showed no statistically significant difference between the two comparators [odds ratio = 1·06, 95% confidence interval (CI) = 0·787,1·444]. The Cox model for time to interruption of therapy showed an insignificant hazard ratio (HR) for divalproex sodium vs. valproic acid (HR = 0·928, 95% CI = 0·844,1·020) and for time to hospitalization also no statistically significant difference in the HR for the two drugs (HR = 0·984, 95% CI = 0·784,1·295). Conclusion:, The study showed a comparable profile of generic valproic acid with divalproex sodium for persistence and predictors of hospitalization for bipolar patients on monotherapy in the VA. Results have important healthcare implications for treatment and costs. [source] Clinical interest: a study of the influence on general practitioners' prescribing,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2007Dorte Gilså Hansen MD Abstract Purpose To analyse the association between general practitioners' clinical interest and prescribing rates in four clinical areas: dyspepsia, depression, headache and diabetes. Methods Data concerning general practitioners' prescribing during 2004 were retrieved from a pharmacy database and linked with data from a physician questionnaire and the National Health Insurance Register. To counterbalance differences in practice populations all 1-year prevalences of prescribing were standardised according to age and gender. Participants were asked ,To what extent do you find the following areas interesting from a professional point-of- view?' Four rating categories were used. The association between clinical interest and standardised prescribing rates was investigated using logistic regression, the Kruskal-Wallis test and a trend test. Results A total of 68 (72%) single-handed general practitioners representative of the total group completed the questionnaire. We observed a two-fold ratio between the 90% and the 10% percentiles of the 1-year prevalences of antisecretory drugs, antidepressants, migraine drugs as well as anti-diabetics. The variation in prescribing of antidepressant and antisecretory drugs was far above chance level. No significant association with clinical interest could, however, be observed for any of the four clinical areas. Conclusion General practitioners' prescribing of the four classes of medical drugs varied considerably. However, only part of this variation was based on chance. This study did not confirm our hypothesis that general practitioners' level of clinical interest in one area corresponds with their prescribing of drugs used within that area. Copyright © 2007 John Wiley & Sons, Ltd. [source] Agreement between patient self-report and a Veterans Affairs national pharmacy database for identifying recent exposures to antibioticsPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 1 2003Joshua P. Metlay MD Abstract Purpose The dramatic rise in antibiotic drug resistance among community pathogens has stimulated interest in the epidemiological relationship between antibiotic exposure and drug resistance. In assessing the strength of this relationship, studies are hampered by the lack of data on the accuracy of subject self-report of antibiotic exposure. The authors compared self-report with pharmacy dispensing data to determine the accuracy of self-reported antibiotic exposure. Methods The study design was a cross-sectional survey of veterans seen at the Philadelphia Veterans Affairs (VA) Medical Center in 1999 and 2000. Subjects reported exposures to antibiotics, antihypertensive drugs and nonsteroidal anti-inflammatory drugs through a structured telephone interview. The instrument included open-ended questions, condition-specific prompts and drug-specific prompts. Subject responses were linked to a national VA pharmacy database that served as the reference standard for evaluating self-reported exposures. Results The authors found that the sensitivity of self-report of antibiotic exposure increased with increasing use of prompts. A comprehensive assessment of antibiotic exposure identified 73% of antibiotic exposures, compared to 73% of antihypertensive drug exposures and 92% of nonsteroidal anti-inflammatory drug exposures. Conclusions Assessment of antibiotic exposure appears to be comparable to assessment of other chronic and episodic drugs. Multistep assessment of exposure improves the sensitivity of assessment. Copyright © 2002 John Wiley & Sons, Ltd. [source] L-type calcium channel blockers and Parkinson disease in DenmarkANNALS OF NEUROLOGY, Issue 5 2010Beate Ritz MD Objective This study was undertaken to investigate L-type calcium channel blockers of the dihydropyridine class for association with Parkinson disease (PD), because some of these drugs traverse the blood,brain barrier, are potentially neuroprotective, and have previously been evaluated for impact on PD risk. Methods We identified 1,931 patients with a first-time diagnosis for PD between 2001 and 2006 as reported in the Danish national hospital/outpatient database and density matched them by birth year and sex to 9,651 controls from the population register. The index date for cases and their corresponding controls was advanced to the date of first recorded prescription for anti-Parkinson drugs, if prior to first PD diagnosis in the hospital records. Prescriptions were determined from the national pharmacy database. In our primary analyses, we excluded all calcium channel blocker prescriptions 2 years before index date/PD diagnosis. Results Employing logistic regression analysis adjusting for age, sex, diagnosis of chronic pulmonary obstructive disorder, and Charlson comorbidity score, we found that subjects prescribed dihydropyridines (excludes amlodipine) between 1995 and 2 years prior to the index date were less likely to develop PD (odds ratio, 0.73; 95% confidence interval, 0.54,0.97); this 27% risk reduction did not differ with length or intensity of use. Risk estimates were close to null for the peripherally acting drug amlodipine and for other antihypertensive medications. Interpretation Our data suggest a potential neuroprotective role for centrally acting L-type calcium channel blockers of the dihydropyridine class in PD that should be further investigated in studies that can distinguish between types of L-type channel blockers. ANN NEUROL 2010;67:600,606 [source] Statin Therapy Is Associated with Decreased Mortality in Patients with InfectionACADEMIC EMERGENCY MEDICINE, Issue 3 2009Michael W. Donnino MD Abstract Objectives:, The objective was to investigate the association between statin therapy and mortality in emergency department (ED) patients with suspected infection. Methods:, A secondary analysis of a prospective, observational cohort study was conducted at an urban, academic ED with approximately 50,000 annual visits. Data were collected between December 2003 and September 2004. Inclusion criteria consisted of age , 18 years, clinical suspicion of infection, and hospital admission. Patients were divided by those receiving statin therapy and those not receiving statins while hospitalized. Medication data were collected from an inpatient pharmacy database. Comparisons were conducted with Fisher's exact test or Wilcoxon rank sum test. To adjust for baseline differences, multivariable logistic regression analysis controlling for gender, severity of illness (Mortality in Emergency Department Sepsis [MEDS] score), Charlson Comorbidity Index, and duration of statin therapy was performed. Results:, Of 2,132 patients with suspected infection, 2,036 (95%) had interpretable pharmacy data and were analyzed. The cohort had a median age of 61 years (interquartile range [IQR] = 46,78 years) and a mortality of 3.9% (95% confidence interval [CI] = 3.1% to 4.8%). Patients who received statins (n = 474) had a lower unadjusted crude mortality (1.9%; 95% CI = 0.6% to 3.3%) compared to those who did not (4.5%; 95% CI = 3.4% to 5.4%; p , 0.01). When adjusting for gender, MEDS score, Charlson Comorbidity Index, and duration of statin therapy, the odds of death for statin patients was 0.27 (95% CI = 0.1 to 0.72; p , 0.01). Conclusions:, Patients who were admitted to the hospital with infection and received statin therapy while hospitalized had a significantly lower in-hospital mortality compared to patients who did not receive a statin. [source] | ||||||||||