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Biomedical subjects

James M Wright

Publications and source records attributed to James M Wright.

At least 19 recordsLinked to original sources
PubMed2005

First-line first? Trends in thiazide prescribing for hypertensive seniors.

BACKGROUND: Evidence of reduced cardiovascular morbidity and mortality as well as cost support thiazide diuretics as the first-line choice for treatment of hypertension. The purpose of this study was to determine the proportion of senior hypertensives that received thiazide diuretics as first-line treatment, and to determine if cardiovascular and other potentially relevant comorbidities predict the choice of first-line therapy. METHODS AND FINDINGS: British Columbia PharmaCare data were used to determine the cohort of seniors (residents aged 65 or older) who received their first reimbursed hypertension drug during the period 1993 to 2000. These individual records were linked to medical and hospital claims data using the British Columbia Linked Health Database to find the subset that had diagnoses indicating the presence of hypertension as well as cardiovascular and other relevant comorbidities. Rates of first-line thiazide prescribing as proportion of all first-line treatment were analysed, accounting for patient age, sex, overall clinical complexity, and potentially relevant comorbidities. For the period 1993 to 2000, 82,824 seniors who had diagnoses of hypertension were identified as new users of hypertension drugs. The overall rate at which thiazides were used as first-line treatment varied from 38% among senior hypertensives without any potentially relevant comorbidity to 9% among hypertensives with previous acute myocardial infarction. The rate of first-line thiazide diuretic prescribing for patients with and without potentially relevant comorbidities increased over the study period. Women were more likely than men, and older patients were more likely than younger, to receive first-line thiazide therapy. CONCLUSIONS: Findings indicate that first-line prescribing practices for hypertension are not consistent with the evidence from randomized control trials measuring morbidity and mortality. The health and financial cost of not selecting the most effective and least costly therapeutic options are significant.

Age Factors↗
PubMed2004

Effect of periodic letters on evidence-based drug therapy on prescribing behaviour: a randomized trial.

BACKGROUND: The effect of regular and expected printed educational materials on physician prescribing behaviour has not been studied. We sought to measure the impact of a series of evidence-based drug therapy letters mailed to physicians in British Columbia on prescribing to newly treated patients. METHODS: A paired, cluster randomized community design was used. The study population included 499 physicians from 24 local health areas in British Columbia. Local health areas were paired by number of physicians, and 1 of each pair was randomly selected and its physicians assigned to an intervention group or a control group. The intervention was 12 issues of an evidence-based series called Therapeutics Letter. Physicians in the control group (n = 241) received the letters 3-8 months after physicians in the intervention group (n = 258). The impact on prescribing to newly treated patients (defined as patients who had not previously made a claim for any medication from the class of drugs profiled in the letter) was analyzed using the drug claims database of BC Pharmacare, a publicly funded drug benefits program that covered all seniors and people receiving social assistance. RESULTS: The probability of prescribing a drug recommended in the Therapeutics Letter rather than another drug in the same class increased by 30% in the 3 months after the mailing of the letter relative to the preceding 3 months, adjusted for any before-after changes in the control group (relative risk 1.30; 95% confidence interval 1.13-1.52). No letter achieved statistical significance on its own. However, 11 of the 12 letters produced prescribing changes in the predicted direction such that the overall result was significant when their effect was combined. INTERPRETATION: The combined effect of an ongoing series of printed letters distributed from a credible and trusted source can have a clinically significant effect on prescribing to newly treated patients.

Adult↗
PubMed2004

Better Prescribing Project: a randomized controlled trial of the impact of case-based educational modules and personal prescribing feedback on prescribing for hypertension in primary care.

OBJECTIVE: The purpose of this study was to assess the impacts of individualized prescribing feedback and interactive small group education aimed at encouraging evidence-based prescribing in family/general practice. METHODS: A two-by-two factorial randomized controlled trial was carried out involving 200 family physicians in British Columbia, Canada. The physicians met monthly in 28 peer learning groups within the Practice-Based Small Group (PBSG) learning programme. Personalized prescribing feedback related to hypertension was provided through 'prescribing portraits' which graphically displayed comparative rates of individual and peer group prescribing, together with a concise guide for evidence-based prescribing. A case-based educational module, containing the same evidence-based message, was discussed in small groups. Groups were matched and randomized into four arms of seven groups each: control (n = 56), prescribing portrait only (n = 48), educational module only (n = 47), both portrait and module (n = 49). The main outcome measure was changes in 'prescribing preferences' to new patients among those medications used to treat hypertension (i.e. probability that a patient would receive the evidence-based medication as first-line therapy). RESULTS: Using data from the provincial pharmacy registry (PharmaNet), prescribing preferences for antihypertensive agents were determined for all groups for a 6 month period before and after the interventions, based on 4394 patients receiving a first-line antihypertensive. Significant absolute increases in prescribing preference for thiazides were documented for both the module +0.068 (confidence interval [CI] 0.022-0.115) and the portrait +0.065 (CI 0.018-0.111). Preference in the group receiving both module and portrait increased by +0.115 (CI 0.040-0.189). CONCLUSIONS: Evidence-based educational interventions combining personalized prescribing feedback with interactive group discussion can lead to modest but meaningful changes in physician prescribing. Clear messages, proper trial design and sensitive outcomes are necessary to demonstrate these changes.

Antihypertensive Agents↗
PubMed2004

Comparison of the automated non-invasive oscillometric blood pressure monitor (BpTRU) with the auscultatory mercury sphygmomanometer in a paediatric population.

BACKGROUND: To directly compare the accuracy of the BpTRU (an automated oscillometric blood pressure device) with standard auscultatory mercury sphygmomanometry in a pediatric population. DESIGN: The BpTRU was connected in parallel with a standard mercury sphygmomanometer. Two observers measured the blood pressures at the same time as it was being measured by the BpTRU. The observers and the BpTRU were all blinded from each other. METHODS: For each of the demographic data--subject age, sex and arm sizes--the mean, standard deviation (SD) and range was calculated. The difference between the mean BpTRU and the standard reference measurements (observer average) was calculated with SD and ranges. The percentage of measurements within 5, 10 and 15 mmHg agreement was expressed. RESULTS: From the 36 subjects recruited aged 3-18 years, 162 pairs of sitting blood pressures were included. The difference between the mean BpTRU readings and the reference standard measurements (as determined by the observers) was 1.45+/-5.67 mmHg for systolic blood pressures, and -3.24+/-7.39 mmHg for diastolic pressure and 0.20+/-2.47 bpm for heart rate. CONCLUSION: The BpTRU is of similar accuracy in measuring blood pressure in children as it was in an adult population.

Adolescent↗
PubMed2004

Overall accuracy of the BpTRU--an automated electronic blood pressure device.

BACKGROUND: The objective of this report is to combine the data from an earlier adult study with the data from a paediatric study in order to determine the overall accuracy of the BpTRU (BPM-100 model) as compared to the recognized standard, auscultatory mercury sphygmomanometer. DESIGN: The individual blood pressure points recorded for both adult and paediatric studies were compared directly to its corresponding observer reference measurements from data collected and stored from the two separate studies. There were 255 sets of readings in the adult study and 162 sets from the paediatric study, which were combined to make 417 pairs of blood pressure readings for this study. METHODS: The overall observer standard reference mean for the 417 measurements was calculated and the difference between this and the overall mean BPM-100 was calculated with SD and ranges. Measurements within 5, 10 and 15 mmHg agreement were expressed as percentages. RESULTS: A total of 121 subjects were included for this study (85 from the adult study and 36 from the paediatric study). From these, 417 paired measurements were recorded. The mean difference between the BpTRU and the reference standard systolic blood pressure (BP) was 0.47+/-5.40 mmHg with 89.2% measurements within 5 mmHg, 96.4% within 10 mmHg and 99.3% within 15 mmHg. The mean difference between the BpTRU and reference diastolic BP was -2.12+/-5.93 mmHg with 81.1% within 5 mmHg, 92.1% within 10 mmHg and 97.6% within 15 mmHg. CONCLUSION: The BpTRU has been shown to be an accurate non-invasive blood pressure monitoring device in the general population over a wide range of ages (3-83 years). This combined study meets all requirements of the Association of Advancement of Medical Instrumentation and achieved a grade 'A' in the BHS protocol.

Adolescent↗
PubMed2003

Commitment to change statements can predict actual change in practice.

INTRODUCTION: Statements of commitment to change are advocated both to promote and to assess continuing education interventions. However, most studies of commitment to change have used self-reported outcomes, and self-reports may significantly overestimate actual performance. As part of an educational randomized controlled trial, this study documented changes that family physicians committed to make in their prescribing and then used third-party data to examine actual changes. METHOD: Following participation in a continuing medical education program using interactive small groups, physicians were asked to identify changes that they planned to make in their practices. For prescribing changes related to four conditions, data from a provincial pharmacy registry were analyzed for 6-month periods before and after the educational intervention. RESULTS: A total of 207 physicians participated in the project, which involved monthly meetings of 30 peer learning groups. Ninety-nine physicians received experimental case-based educational modules +/- personal prescribing feedback, and 91 of these indicated that they planned to make at least one change in practice. Of the 209 intended changes, 71% were directly related to the prescribing messages in the materials. DISCUSSION: In three of four indicator conditions, physicians who expressed a commitment to change were significantly more likely to change their actual prescribing for the target medications in the following 6 months. The percentage of physicians who did change their prescribing varied significantly by condition. Further study of the process of translating commitment to change into real practice change is needed.

Attitude of Health Personnel↗
PubMed2002

The double-edged sword of COX-2 selective NSAIDs.

The launch of the cyclooxygenase-2 (COX-2) selective NSAIDs was based on 2 hypotheses: (1) the major adverse effects limiting the usefulness of nonselective NSAIDs are gastrointestinal in nature and (2) COX-2 selective NSAIDs are associated with fewer gastrointestinal adverse effects than nonselective NSAIDs. At the time of the launch, neither of these hypotheses had been proven and, as documented in this review, both remain uncertain. The increased incidence of total and nongastrointestinal serious adverse events, with the COX-2 selective NSAIDs as compared with nonselective NSAIDs, in the Celecoxib Long-term Arthritis Safety Study (CLASS) and the Vioxx Gastrointestinal Outcomes Research (VIGOR) study remains a major concern. The increased morbidity associated with the COX-2 selective NSAIDs may be a manifestation of the COX-2 selectivity of rofecoxib and celecoxib or the supramaximal doses of these drugs used in the trials. Proof that the increased harm was not caused by the COX-2 selectivity of the drugs depends on demonstration in a randomized controlled trial that COX-2 selective NSAIDs at usual doses are as effective as nonselective NSAIDs and cause fewer gastrointestinal serious adverse events without increasing the incidence of total nongastrointestinal serious adverse events.

Anti-Inflammatory Agents, Non-Steroidal↗