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Biomedical subjects

F Teitelbaum

Publications and source records attributed to F Teitelbaum.

6 recordsLinked to original sources
PubMed2000

Compliance with and dosing of angiotensin-converting-enzyme inhibitors before and after hospitalization.

Compliance with and dosing of angiotensin-converting-enzyme (ACE) inhibitors as they occur before and after hospitalization for heart failure were studied, and factors predictive of compliance with and dosing of ACE inhibitors after hospitalization were identified. Two hundred thirty-six patients hospitalized with heart failure between October 1, 1995, and April 30, 1996, were identified. Compliance with and use and dosing of ACE inhibitors were examined over the 180-day period before admission and the 180-day period after discharge using an integrated pharmacy and medical claims database. Use of an ACE inhibitor was defined as at least one claim for an ACE inhibitor over the period examined, and dosing was assessed by calculating the mean percentage of an adequate daily dose dispensed. Before hospitalization 109 patients (46.2%) used ACE inhibitors, and after hospitalization 148 (62.7%) used them--a significant increase. ACE inhibitor use before hospitalization was a predictor of postdischarge use. Younger patients were more likely to take ACE inhibitors after hospitalization than older ones, and men had better compliance after hospitalization than women. Additional analyses revealed that, among hospitalized patients, compliance was lower in individuals who also took an antidepressant. Dosing increased from 72% to 85% of an adequate daily dose after hospitalization among patients who took ACE inhibitors during both prehospitalization and posthospitalization periods. However, almost one third of hospitalized patients stopped taking their ACE inhibitor within six months of hospital discharge. The study found few significant predictors of patient compliance after hospitalization. Dosing of ACE inhibitors before and after hospitalization needs to be improved.

Adult↗
PubMed1999

Angiotensin-converting enzyme inhibitor compliance and dosing among patients with heart failure.

BACKGROUND: The efficacy of angiotensin-converting enzyme (ACE) inhibitors in treating heart failure is well established, but there is concern that these agents are underutilized. Proper treatment is contingent both on appropriate medication dosing by the physician and on patient compliance with therapy. This study examined dosing and compliance with ACE inhibitors in routine clinical practice. METHODS AND RESULTS: Data were integrated medical and pharmacy claims from 869 patients with heart failure. Compliance and dosing of ACE inhibitors was examined for each patient over a 10- to 17-month period. Patients had ACE inhibitors available on 71% of the days assessed. At 180 days after their index prescription, 86% of patients continued to take an ACE inhibitor. The mean percentage of an adequate daily dose of ACE inhibitors dispensed per prescription was 79%, but only 34% of patients were dispensed >/=100% of an adequate daily dose. A number of variables were found to independently predict compliance and dosing levels in the multivariate analyses. CONCLUSIONS: Both physician-dependent and patient-dependent factors contributed significantly to ACE inhibitor underutilization. Each of these factors must be addressed to improve compliance and dosing of ACE inhibitors in routine clinical care.

Adrenergic beta-Antagonists↗
PubMed1998

Course of antidepressant treatment drug type, and prescriber's specialty.

OBJECTIVE: The study examined whether the relationship between the course of antidepressant treatment and the type of prescriber-psychiatrist or nonpsychiatrist-varied by whether a tricyclic antidepressant or a selective serotonin reuptake inhibitor (SSRI) was prescribed. METHODS: Pharmacy claims from a nationwide database were analyzed retrospectively. A total of 3,101 adults who did not have a prescription for antidepressants for nine months and who were then given a prescription for a tricyclic or an SSRI antidepressant were followed for 13 to 16 months after the initial prescription. Outcome measures were rates of treatment termination before one month and subtherapeutic dosing, defined as having received no prescribed daily dosages at or above commonly cited thresholds. RESULTS: Among tricyclic-treated patients, psychiatrists' patients were significantly more likely than nonpsychiatrists' patients to continue in treatment for more than one month (72 percent versus 62 percent). Among patients taking tricyclics for at least three months, those with at least one prescription from a psychiatrist had a significantly higher rate of therapeutic dosing than those with all prescriptions from a nonpsychiatrist (70 percent versus 25 percent). For SSRI-treated patients, rates of termination and therapeutic dosing did not differ significantly by prescriber type. In multivariate equations that controlled for selected differences, effects of drug type and prescriber type were independent when persistence in treatment was analyzed, and interactive when subtherapeutic dosing was analyzed. CONCLUSIONS: Policy making about antidepressant pharmacotherapy should include assessments of the relationships between drug selection and patient outcome across a variety of clinical settings.

Adult↗
PubMed1997

Course of antidepressant treatment with tricyclic versus selective serotonin reuptake inhibitor agents: a comparison in managed care and fee-for-service environments.

We compared course of treatment with tricyclic antidepressant drugs (TCADs) and selective serotonin reuptake inhibitors (SSRIs) to assess interactive effects of antidepressant type with payer type and patient characteristics. A nationwide sampling of adults (n = 4,252) from approximately equal numbers of health maintenance organization (HMO) and indemnity enrollees were prescribed no antidepressants for 9 months, and thereafter prescribed a TCAD or SSRI. Using a retrospective analysis of prescription claims, these cohorts of TCAD and SSRI utilizers were followed for 13 to 16 months after their initial antidepressant prescription. Outcome measures included (1) termination of antidepressant treatment before 1 month; and (2) failure to receive at least one therapeutic dose during treatment lasting 3 months or more. Rates of premature termination and subtherapeutic dosing were significantly higher for TCAD-treated than SSRI-treated patients, and for HMO than indemnity enrollees. The interaction of HMO enrollment and TCAD use was associated with particularly high rates. Excluding patients terminating in the first month, the proportions of TCAD and SSRI utilizers remaining in treatment over time were not significantly different. We conclude that SSRIs may provide advantages in treatment adherence and therapeutic dosing, particularly in environments with limited prescriber time. The first month of treatment may be especially critical in determining compliance.

Adult↗
PubMedDate not supplied

The 'shoe-box effect'.

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Drug Prescriptions↗