Biomedical subjects

Colleen Metge

Publications and source records attributed to Colleen Metge.

11 recordsLinked to original sources

PubMed2006

Validity of a prescription claims database to estimate medication adherence in older persons.

BACKGROUND: Prescription claims data have been used to estimate refill medication adherence through calculations of cumulative medication acquisition (CMA) and cumulative medication gap (CMG) values. Few studies have assessed the validity of these calculated rates. OBJECTIVES: We sought to assess the validity of CMA and CMG calculated from the Manitoba prescription claims database (DPIN) against pill count medication adherence, targeting overall medications and angiotensin converting enzyme inhibitors (ACEIs). METHODS: Using a survey of a convenience sample of subjects recruited through community pharmacies, subjects who were eligible for study (ie, 65 years or older, noninstitutionalized, taking 2 or more "discrete" prescribed medications, including an ACEI, and willing to provide informed consent) were studied. Pill counts were conducted on all prescribed medicines during 3 home interviews over the course of 4 months. Ten months of DPIN data also were collected on each subject. RESULTS: The concordance between CMA and pill count for overall medications was 411/522 (79%) and for ACEIs was 89/101 (88%) with no systematic differences (McNemar's P = 0.68 and P = 0.097, respectively). CMG and pill count showed even better concordance of 438/514 (85%) for overall medications and 96/101 (95%) for ACEIs, although systematic differences were noted for overall medications (McNemar's P = 0.0012) but not for ACEIs (McNemar's P = 0.500). Spearman's rank correlations were weak for all comparisons. CONCLUSIONS: The high concordance between prescription claims database and pill counts suggested that the rate with which patients refill their medications usually is consistent with the rate they consume them. DPIN is not accurate for nondiscrete dosage forms or medications prescribed for "as-required" use.

Aged↗

PubMed2005

Pharmaceutical use among older adults: using administrative data to examine medication-related issues.

Medication use is recognized as the least expensive, most cost-effective health care intervention. In older adults this is especially important, as they are the largest consumer of prescription medications. We describe the use of a linked data set including pharmaceutical, medical, and hospital claims to examine pharmaceutical use in the population of older adults and then give several examples of its application. Indicators to describe the population's overall use of medication and the appropriate use of specific medication have been developed. Indicators of appropriate use are characterized using the dispensation of benzodiazepines to older adults.We have found that a significant proportion of new users of benzodiazepines are still prescribed a long-acting version (over 10%), signifying potential inappropriate use. The data are also able to describe some significant outcomes from the use of pharmaceuticals such a death, fracture, and population-based clinical measures where available.

Aged↗

PubMed2005

Potential impact of oral contraceptive choice on myocardial infarction mortality and deep vein thrombosis.

OBJECTIVES: To summarise the epidemiological evidence on the relationship between second- (OC2) and third-generation (OC3) oral contraceptives (OC) and the mortality associated with deep vein thrombosis (DVT) and myocardial infarction (MI), and to extrapolate and balance the evidence for these risks to the population of French OC users. METHODS: All studies published on the risk of MI during OC2 and OC3 use were analysed. For DVT the Committee for Proprietary Medicinal Products public assessment report published in 2001 and more recent studies published on this topic were used. The estimates of odds ratios (OR) for risk of death from DVT or MI were extracted from the published manuscripts. ORs were used to calculate the aetiological fraction of risk for death from DVT and MI in the population; the relative impact of OC3 compared to OC2 use was expressed as an excess risk of death overall and by age group for French women. RESULTS: Compared with OC2, the use of OC3 would prevent a maximum of 24 deaths from MI per year and induce a maximum of 16 deaths. Conversely, OC3 would induce 282-940 excess cases of DVT per year, resulting in 28-94 pulmonary embolisms and 3-19 deaths in the 4.7 million French OC users. CONCLUSION: Balancing the evidence, it is difficult to conclude that the overall cardiovascular risk is significantly lower for either of the two OC schemes.

Adult↗

PubMed2004

Fracture risk among First Nations people: a retrospective matched cohort study.

BACKGROUND: Canadian First Nations people have unique cultural, socioeconomic and health-related factors that may affect fracture rates. We sought to determine the overall and site-specific fracture rates of First Nations people compared with non-First Nations people. METHODS: We studied fracture rates among First Nations people aged 20 years and older (n = 32 692) using the Manitoba administrative health database (1987-1999). We used federal and provincial sources to identify ethnicity, and we randomly matched each First Nations person with 3 people of the same sex and year of birth who did not meet this definition of First Nations ethnicity (n = 98 076). We used a provincial database of hospital separations and physician billing claims to calculate standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for each fracture type based on a 5-year age strata. RESULTS: First Nations people had significantly higher rates of any fracture (age- and sex-adjusted SIR 2.23, 95% CI 2.18-2.29). Hip fractures (SIR 1.88, 95% CI 1.61-2.14), wrist fractures (SIR 3.01, 95% CI 2.63-3.42) and spine fractures (SIR 1.93, 95% CI 1.79-2.20) occurred predominantly in older people and women. In contrast, craniofacial fractures (SIR 5.07, 95% CI 4.74-5.42) were predominant in men and younger adults. INTERPRETATION: First Nations people are a previously unidentified group at high risk for fracture.

Adult↗

PubMed2004

Encouraging physician appropriate prescribing of non-steroidal anti-inflammatory therapies: protocol of a randomized controlled trial [ISRCTN43532635].

BACKGROUND: Traditional non-steroidal anti-inflammatory drugs (NSAIDs) are a widely used class of therapy in the treatment of chronic pain and inflammation. The drugs are effective and can be relatively inexpensive thanks to available generic versions. Unfortunately the traditional NSAIDs are associated with gastrointestinal complications in a small proportion of patients, requiring costly co-therapy with gastro-protective agents. Recently, a new class of non-steroidal anti-inflammatory agents known as coxibs has become available, fashioned to be safer than the traditional NSAIDs but priced considerably higher than the traditional generics. To help physicians choose appropriately and cost-effectively from the expanded number of anti-inflammatory therapies, scientific bodies have issued clinical practice guidelines and third party payers have published restricted reimbursement policies. The objective of this study is to determine whether an educational intervention can prompt physicians to adjust their prescribing in accordance with these expert recommendations. METHODS: This is an ongoing, randomized controlled trial. All primary care physicians in Manitoba, Canada have been randomly assigned to a control group or an intervention study group. The educational intervention being evaluated consists of an audit and feedback mechanism combined with optional participation in a Continuing Medical Education interactive workshop. The primary outcome of the study is the change, from pre-to post-intervention, in physicians' appropriate prescribing of non-steroidal anti-inflammatory therapies for patients requiring chronic treatment. Three classes of non-steroidal anti-inflammatory therapies have been identified: coxib therapy, traditional NSAID monotherapy, and traditional NSAID therapy combined with gastro-protective agents. Appropriate prescribing is defined based on international clinical practice guidelines and the provincial drug reimbursement policy in Manitoba.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2004

Comparison of anti-infective drug use in elderly persons in Manitoba, Nova Scotia, and Saskatchewan, Canada: relationship to drug insurance reimbursement policies.

BACKGROUND: Antimicrobial drug resistance continues to be a concern. Inappropriate use of antimicrobial agents is a well-documented contributory factor in the development of resistance. Canadian publicly funded drug insurance (pharmacare) programs have various approaches to reimbursement for antimicrobial drugs and promoting the appropriate prescribing of these agents. OBJECTIVE: The objective of this study was to examine changes in antimicrobial use over a 3-year period in relation to the reimbursement policies of the public drug insurance programs for elderly persons in Manitoba, Nova Scotia, and Saskatchewan. METHODS: The pharmacare databases of the 3 provincial drug insurance programs were accessed for fiscal years 1995/96, 1996/97, and 1997/98. Antimicrobial drug use was reported as mean age- and sex-standardized defined daily doses (DDDs) dispensed per 1000 beneficiaries per year. Provincial antimicrobial drug use was compared and related to provincial reimbursement policies. RESULTS: The rates and types of antimicrobial drugs dispensed to elderly beneficiaries of the Manitoba, Nova Scotia, and Saskatchewan pharmacare programs varied. Between fiscal years 1995/96 and 1997/98, DDDs of antimicrobials per 1000 beneficiaries per year decreased by 11.5% in Saskatchewan and increased by 1.2% in Manitoba and 6.2% in Nova Scotia. Rates of use of broadspectrum agents such as amoxicillin/clavulanate, azithromycin, clarithromycin, and fluoroquinolones were lower in the provinces that had reimbursement guidelines. Even when reimbursement policies were similar, as for fluoroquinolones in Manitoba and Saskatchewan, rates of use varied markedly, possibly as a result of the method of implementing the reimbursement guidelines. Use of fluoroquinolones, macrolides, penicillins, beta-lactamase-resistant penicillins, and tetracyclines was lower and use of sulfonamides and trimethoprim was greater in Saskatchewan than in Nova Scotia and Manitoba. CONCLUSIONS: The reimbursement guidelines of provincial drug insurance programs are among the factors affecting the use of antimicrobial agents. Both the type of reimbursement policy and the policy implementation mechanism affected the rate of utilization. Further research is needed to link drug-use information with data such as antimicrobial resistance patterns, diagnoses, physician visits, and hospitalizations.

Aged↗

PubMed2003

The association between corticosteroid use and development of fractures among IBD patients in a population-based database.

OBJECTIVES: Because the rate of fracture among patients with inflammatory bowel disease (IBD) is only slightly higher than that in the general population, it is important to define high-risk groups worthy of diagnostic evaluation or prophylactic interventions. Corticosteroid use has been considered in other diseases to be a risk for fracture, although not all studies in IBD are concordant on this point. We aimed to determine whether patients with IBD drawn from a population-based database who sustain fractures are more likely to have been using corticosteroids than a matched group of IBD patients who did not fracture. METHODS: We extracted from our population-based University of Manitoba Inflammatory Bowel Disease Epidemiology Database the number of patients with a new diagnosis of fracture between the years 1997-2000. From within our Inflammatory Bowel Disease Epidemiology Database, we extracted a control group of IBD patients who did not develop fractures matched to the case group who did by age, gender, diagnosis, year of diagnosis, and geographic area of residence. We linked our cohorts with Manitoba Health's Drug Program Information Network to study corticosteroid use within 2 yr before fracture diagnosis. The Drug Program Information Network is a population-based database, established in 1995, which records all prescription drugs. RESULTS: Fractures were identified in 13 patients with Crohn's disease and in 28 patients with ulcerative colitis. The control group included 103 Crohn's disease and 173 ulcerative colitis patients who did not fracture. In Crohn's disease, for the group who fractured compared with the controls who did not fracture, corticosteroid use before fracture was evident in seven (54%) compared with 21 (22%) who did not fracture (chi(2) = 4.45, df = 1, p = 0.035). In ulcerative colitis, for the group who fractured compared with the controls who did not fracture, corticosteroid use before fracture was evident in five (18%) compared with 37 (21%) who did not fracture (chi(2) = 0.031, df = 1, p = 0.861). Fracture cases were more likely to be exposed to oral corticosteroids (OR = 1.75; 95% CI = 0.82-3.75), but this result is not significant. Regarding corticosteroid dosing among the 12 patients with IBD who fractured and used corticosteroids, the mean total days supply was 314 days +/- 236 days compared with 258 days +/- 278 days in those who did not fracture (p = 0.16). The prescribed daily dose among corticosteroid users was comparable for those who fractured versus those who did not fracture (18 mg/day vs 21 mg/day, p = 0.90). CONCLUSIONS: Patients who require corticosteroids in Crohn's disease should be considered at risk for fracture. Further research is required to delineate after how much corticosteroid use are subjects at risk and/or after what duration of active disease.

Adult↗

PubMed2003

Does the use of 5-aminosalicylates in inflammatory bowel disease prevent the development of colorectal cancer?

OBJECTIVES: There is increased interest in determining whether 5-aminosalicylate (5-ASA) use can prevent the development of colorectal cancer (CRC) among patients with inflammatory bowel disease (IBD). The aim of this study was to determine whether use of 5-ASA was associated with a reduced risk of CRC in these patients. METHODS: We extracted from our population-based University of Manitoba Inflammatory Bowel Disease Epidemiology Database the number of patients with a new diagnosis of CRC between the years 1997 and 2000. From within our Inflammatory Bowel Disease Epidemiology Database we extracted a control group of IBD patients who did not develop CRC matched to the case group who did develop CRC by age, sex, diagnosis, year of diagnosis, and geographic area of residence. We linked cases and controls with Manitoba Health's Drug Program Information Network to study 5-ASA use within 2 yr before CRC diagnosis. The Drug Program Information Network database is a population-based database that was established in 1995 and that records all prescription drugs. RESULTS: There were 25 cases of IBD identified as having CRC. These were matched with 348 cases of IBD who did not develop CRC. CRC cases were more likely to be exposed to 5-ASA (odds ratio = 1.46; 95% CI = 0.58-3.73) but this result was not statistically significant. The mean total days of use was 400.9 days +/- 185.9 among CRC cases versus 420.2 days +/- 241.7 among non-CRC cases (p = 0.92). The prescribed daily dose was 2295 mg/day +/- 1041 mg among CRC cases and 1811 mg +/- 520 mg among controls (p = 0.21). CONCLUSIONS: These data do not support 5-ASA as protective in preventing CRC.

Aminosalicylic Acids↗

PubMed2003

Establishing a regional bone density program: lessons from the Manitoba experience.

In 1997, the province of Manitoba, Canada developed a regional bone density program to address concerns related to access, waiting times, and quality assurance. We report our experience with this model of bone density service delivery, which is unique in North America, and confront the challenge of balancing accessibility, clear guidelines, and fiscal responsibility.

Absorptiometry, Photon↗

PubMed2002

Bone mineral density testing in healthy postmenopausal women. The role of clinical risk factor assessment in determining fracture risk.

The ease of measurement and the quantitative nature of bone mineral densitometry (BMD) is clinically appealing. Despite BMD's proven capability to stratify fracture risk, data indicate that clinical risk factors provide complementary information on fracture susceptibility that is independent of BMD. Methods to quantify fracture risk using both clinical and BMD variables would have great appeal for clinical decision-making. We describe a procedure for quantifying hip fracture risk (5-yr and remaining lifetime) based on (1) the individual's age alone (base model, assuming average clinical risk factors and bone density), (2) incorporation of multiple patient-specific clinical risk factor data in the base model, and (3) incorporation of both patient-specific clinical risk factor data and BMD results.

Age Factors↗

PubMedDate not supplied

Demographic risk factors for fracture in First Nations people.

BACKGROUND: Recently, First Nations people were shown to be at high fracture risk compared with the general population. However, factors contributing to this risk have not been examined. This analysis focusses on geographic area of residence, income level, and diabetes mellitus as possible explanatory variables since they have been implicated in the fracture rates observed in other populations. METHODS: A retrospective, population-based matched cohort study of fracture rates was performed using the Manitoba administrative health data (1987-1999). The First Nations cohort included all Registered First Nations adults (20 years or older) as indicated in either federal and/or provincial files (n = 32,692). Controls (up to three for each First Nations subject) were matched by year of birth, sex and geographic area of residence. After exclusion of unmatched subjects, analysis was based upon 31,557 First Nations subjects and 79,720 controls. RESULTS: Overall and site-specific fracture rates were significantly higher in the First Nations cohort. Income quintile, geographic area of residence, and diabetes were fracture determinants but the excess fracture risk of First Nations ethnicity persisted even after adjustment for these factors. CONCLUSION: First Nations people are at high risk for fracture but the causal factors contributing to this are unclear. Further research is needed to evaluate the importance of other potential explanatory variables.

Adult↗