Biomedical subjects

Richard A Hansen

Publications and source records attributed to Richard A Hansen.

At least 19 recordsLinked to original sources

PubMed2006

A simple and valid tool distinguished efficacy from effectiveness studies.

OBJECTIVE: To propose and test a simple instrument based on seven criteria of study design to distinguish effectiveness (pragmatic) from efficacy (explanatory) trials. STUDY DESIGN: Currently no validated definition of effectiveness studies exists. We asked the directors of 12 Evidence-based Practice Centers to select six studies each: four that they considered to be examples of effectiveness trials and two considered efficacy studies. We then applied our proposed criteria to test the construct validity using the selected studies as if they had been identified by a gold standard. RESULTS: Based on the rationale to identify effectiveness studies reliably with minimal false positives (i.e., a high specificity), a cutoff of six criteria produced the most desirable balance between sensitivity and specificity. This setting produced a specificity of 0.83 and a sensitivity of 0.72. CONCLUSION: When applied in a standardized manner, our proposed criteria can provide a valid and simple tool to distinguish effectiveness from efficacy studies. The applicability of systematic reviews can improve when analysts place more emphasis on the generalizability of included studies. In addition, clinicians can also use our criteria to determine the external validity of individual studies, given an appropriate population of interest.

Drug Therapy↗

PubMed2006

The burden of gastrointestinal and liver diseases, 2006.

BACKGROUND: Digestive and liver diseases are a source of significant morbidity, mortality, and health-care costs for the U.S. population. An annual report of the toll of these diseases could be helpful to clinicians, policymakers, and researchers. AIM: To describe the epidemiology of gastrointestinal and liver diseases in the United States using data from privately and publicly held databases. METHODS: We collected data from the National Center for Health Statistics, the National Ambulatory Medical Care Survey, the National Inpatient Sample, the Centers for Disease Control and Prevention, and the National Cancer Institute, as well as proprietary pharmaceutical databases to construct a report on the impact of gastrointestinal and liver diseases on the U.S. population. We compiled information on causes of death, hospitalization, clinic visits, cancer incidence, and mortality and infectious disease incidence from these databases, and extracted data specific to gastrointestinal diseases. Because of the high costs associated with medications used to treat gastrointestinal diseases, we also include in this year's report a special section on pharmacoepidemiology and pharmacoeconomics. RESULTS: Colorectal cancer continues to be the leading cause of GI-related death, although the data indicate a downward trend in deaths. Abdominal pain, diarrhea, vomiting, and nausea are the most common GI symptoms precipitating a visit to the physician, and GERD is the most common GI-related diagnosis given in office visits. Chest pain not specified to be cardiac in origin is the most common cause of inpatient admission possibly related to GI disease, with cholelithiasis and pancreatitis following. Americans spend in excess of US dollars 10 billion/yr on proton pump inhibitors (PPIs), and two of the top five selling drugs in the United States are PPIs. Trends in PPI use demonstrate turbulent changes, likely reflecting both new drug entries into the field, as well as drug marketing. The number of PPI prescriptions/yr in the United States has doubled since 1999. Twenty-three drugs used for gastrointestinal diseases are among the top 200 generic drugs used in the United States. CONCLUSIONS: Gastrointestinal and liver diseases are significant contributors to the morbidity, mortality, and health-care expenditures of the U.S. population.

Female↗

PubMed2006

Types of medication errors in North Carolina nursing homes: a target for quality improvement.

BACKGROUND: Medication errors are an important problem in nursing homes, but little is known about the types of medications involved in errors in this setting. Gaining a better understanding of the types of medications commonly involved in medication errors in nursing homes would be an important step toward quality improvement. OBJECTIVES: This study sought to describe the types of medication errors most frequently reported to a statewide repository by North Carolina nursing homes. We also examined whether nursing homes reporting an error involving a drug on the updated Beers list of medications considered potentially inappropriate for use in the elderly were likely to report a greater number of medication errors or more harmful medication errors compared with nursing homes that did not report such an error. METHODS: Medication errors were defined as preventable events that had the potential to cause/lead to or actually caused/led to inappropriate medication use or patient harm. We analyzed summary reports of medication errors submitted to the State of North Carolina by licensed nursing homes for the 9-month period from January 1, 2004, to September 30, 2004, using a Web-based reporting system. Drugs commonly involved in medication errors were summarized for all nursing homes in the state. Errors involving medications on the updated Beers list also were identified. Nursing homes were profiled and compared according to the type of medication error and whether the error reached the patient and/or caused harm. RESULTS: Among the 384 licensed nursing homes included in our analysis, 9272 medication errors were reported. The specific medication involved was documented for 5986 of these errors. The medications most commonly involved in an error were lorazepam (457 errors [8%]), warfarin (349 [6%]), insulin (332 [6%]), hydrocodone and hydrocodone combinations (233 [4%]), furosemide (173 [3%]), and the fentanyl patch (150 [3%]). The medication errors disproportionately included central nervous system agents (16%) and analgesics (11%). Medications considered potentially inappropriate in the elderly were frequently involved in the reported errors (10% of all reported errors), with the greatest number of such errors associated with lorazepam (457 [8%]), alprazolam (130 [2%]), and digoxin (74 [1%]). Nursing homes reporting potentially inappropriate drugs among their 10 most common medication errors also reported a significantly greater mean number of errors compared with nursing homes that did not report such errors (26.9 vs 17.6, respectively; P < 0.001), as well as a significantly greater number of errors that reached the patient (6148 vs 1393; P < 0.001). CONCLUSION: Based on the experience in North Carolina, quality improvement efforts in nursing homes should focus on the medications commonly involved in errors and should continue to discourage or closely monitor the use of medications considered potentially inappropriate in the elderly.

Adverse Drug Reaction Reporting Systems↗

PubMed2006

Second-generation antidepressant discontinuation and depressive relapse in adult patients with bipolar depression: results of a retrospective database analysis.

BACKGROUND: To date, few postmarketing studies have addressed whether long-term prophylactic treatment with second-generation antidepressants (ADs) delays depressive episodes in patients with bipolar disorder. OBJECTIVE: The aim of this study was to compare the risk of depressive relapse between patients with bipolar disorder who took second-generation ADs>-6 months after depressive remission with those who discontinued AD use early. METHODS: Using a large US managed-care claims database, continuously enrolled bipolar subjects who took second-generation ADs after a depressive remission were identified between January 1, 1998, and December 31, 2002. Duration of AD and concurrent mood stabilizer use were based on coded diagnoses and pharmacy records. A Cox proportional hazards model was developed to predict time from depressive remission to next depressive relapse with continuous AD use, categorized as either >or=6 months or <6 months. Propensity scoring with greedy matching was used to help balance the observed background covariates and baseline disease severity between groups. RESULTS: Five hundred eighty-nine subjects met the inclusion criteria. A Kaplan-Meer estimate found that the median depressive relapse times for the continuous (ie, >or=6 months) and early discontinuation (ie, <6 months) AD treatment groups were 16.5 and 6.8 months, respectively (P<0.05). The Cox proportional hazards model with propensity score matching identified a significantly lower risk of depressive relapse over a 2-year period among those who continued AD treatment>or=6 months after remission, compared with those who discontinued treatment within 6 months (hazard ratio, 0.61 [95% CI, 0.42-0.88]; continuous vs early discontinuation, P<0.01). CONCLUSIONS: Continuous second-generation AD therapy for >or=6 months after depressive remission was associated with a lower risk of depressive relapse over a 2-year period in patients with bipolar depression. Given concerns regarding the risk of AD users with bipolar disorder switching to mania, an optimal prophylactic treatment after depressive remission should balance the risks between manic switching and depressive relapse.

Adolescent↗

PubMed2006

Evaluation of product switching after a state Medicaid program began covering loratadine OTC 1 year after market availability.

OBJECTIVE: The conversion of loratadine from prescription (Rx)-only to over-the-counter (OTC) status on November 27, 2002, brought about the question of how OTC products may influence utilization of both OTC and Rx-only low-sedating antihistamines (LSAs) simultaneously. North Carolina (NC) Medicaid initially did not cover loratadine OTC but subsequently changed the policy 1 year after OTC conversion, on November 23, 2003. The objective of this study was to determine patterns of LSA utilization in relation to changes in OTC availability and Medicaid coverage policy and to assess the rate of product switching associated with these policies. METHODS: Administrative pharmacy claims from the NC Medicaid population of approximately 1.1 million eligible recipients were used to study the 3 years of LSA use between July 1, 2001, and June 30, 2004. Two general methods were employed to evaluate the extent of product switching. First, monthly rates of incident use, new starts (i.e., no LSA use in the prior 12-month period) and product switching in time series were determined. These series were constructed to include a baseline period of no OTC availability, a period of OTC availability without coverage, and a period of OTC availability with coverage. Second, product switching was assessed through the use of rate-ratio calculations. Three equal 12-month periods were compared using rate ratios: (1) a baseline referent period (July 1, 2001, to June 30, 2002) during which loratadine OTC was not yet available, (2) a noncoverage period (July 1, 2002, to June 30, 2003) during which loratadine OTC was introduced to the market but not covered by NC Medicaid, and (3) a coverage period (July 1, 2003, to June 30, 2004). The primary comparison periods for the 3 years were the 5-month periods from February to June of each year. RESULTS: The use of individual drugs within the LSA class responded to coverage changes as expected, with alternative LSAs replacing loratadine use in the loratadine noncoverage period. Switching behavior for individual drugs within the LSA class was strongly associated with coverage changes. Recipients using loratadine were 2.16 times more likely to switch to an alternative Rx-only antihistamine in the noncoverage period (95% confidence interval [CI], 2.10-2.22) as compared with the baseline period. Yet they were only 1.11 times as likely not to use an Rx LSA during the last 5 months of the noncoverage period (95% CI, 1.09-1.13), as compared with the baseline period, suggesting minimal OTC uptake. The largest 12-month percentage increase in market share was observed for cetirizine (13.4%) although desloratadine accounted for the largest switch rate from loratadine at 3.10 (95% CI, 2.91-3.30), as compared with the baseline period, with a total market share increase of 7.8%. This suggests that new users of LSAs were most likely to initiate therapy with cetirizine, while existing loratadine users were most likely to switch to desloratadine. Compared with baseline switch rates, LSA users were only 0.34 (95% CI; 0.32-0.37) times as likely to switch to loratadine OTC from another (Rx-only) LSA during the subsequent OTC coverage period. LSA expenditure per member per month (PMPM) was essentially constant over time, at dollar 3.03 in the 5-month pre-OTC period, dollar 2.96 in the 5-month loratadine noncoverage period, and dollar 2.93 in the 5-month coverage period for loratadine OTC. Total LSA utilization increased slightly, from 1.37 days PMPM in the 5-month pre-OTC period to 1.41 in the 5-month loratadine noncoverage period and 1.45 in the 5-month coverage period for loratadine OTC. Loratadine OTC accounted for only 4.1% of the total LSA days of therapy and 4.2% of the LSA patients in the 5-month OTC coverage period from February to June 2004. CONCLUSION: Medicaid recipients switched to another covered (Rx) LSA when loratadine became available as an OTC and was not covered. After the subsequent policy change 1 year later to cover loratadine OTC, there was little switching to loratadine OTC. Though the average cost per LSA claim dropped dollar 4.15 (6.6%), from dollar 62.79 in the baseline period to dollar 58.64 in the OTC coverage period, time-series and rate-ratio results suggest that an additional dollar 6.01 (10.2%) could have been saved per LSA claim had OTC coverage been in effect at the time of the conversion of loratadine to OTC status. Although coverage of loratadine OTC offers a substantial cost-savings opportunity for the Medicaid program compared with Rx-only LSAs, not covering the OTC product immediately at the time of OTC availability contributed to (a) increased switching to Rx-only LSA products and (b) little use of loratadine OTC in the subsequent OTC coverage period.

Cetirizine↗

PubMed2006

The comparative efficacy and safety of biologics for the treatment of rheumatoid arthritis: a systematic review and metaanalysis.

OBJECTIVE: Biologics are an important therapeutic option for treating patients with rheumatoid arthritis (RA). However, they are associated with rare but severe adverse events such as serious infections, lymphoma, or chronic heart failure. In addition, dosing regimens and routes of administration differ substantially among biologics. In a systematic review, we assessed the comparative efficacy and safety of biologic agents for RA. METHODS: We searched electronic databases up to May 2006. We limited evidence to controlled trials for efficacy but included observational evidence for safety. Outcomes of interest were clinical response, radiographic progression, and quality of life. Given the paucity of head-to-head evidence, we conducted adjusted, indirect comparisons of placebo-controlled trials. RESULTS: Twenty-six controlled trials provided efficacy data; 18 additional studies assessed safety. The only evidence directly comparing 2 biologic agents was a nonrandomized, open-label trial that found no differences in effectiveness and safety between etanercept and infliximab. Adjusted indirect comparisons indicate no significant differences in efficacy between anti-tumor necrosis factor (TNF) drugs. However, anti-TNF drugs appear to be more efficacious than anakinra, although not all comparisons reached statistical significance. Because of the lack of sound longterm safety data, evidence is insufficient to draw firm conclusions about the comparative safety of biologics. CONCLUSION: Anti-TNF drugs appear to be more efficacious than anakinra but do not differ significantly among each other. Clinical considerations such as comorbidities, route of administration, dosing regimens, and specific side effect profiles may guide the choice of an anti-TNF drug.

Antirheumatic Agents↗

PubMed2005

Efficacy and safety of second-generation antidepressants in the treatment of major depressive disorder.

BACKGROUND: Reviews have compared the efficacy and tolerability of newer second-generation antidepressants with those of placebo or older treatments, but comparative evidence for use of second-generation antidepressants to treat major depressive disorder has not been evaluated. PURPOSE: To systematically evaluate comparative data on the efficacy, effectiveness, and tolerability of commonly prescribed second-generation antidepressants (selective serotonin reuptake inhibitors, bupropion, duloxetine, mirtazapine, and venlafaxine) in the treatment of major depressive disorder. DATA SOURCES: MEDLINE, EMBASE, and PsychLit; the Cochrane Library; and the International Pharmaceutical Abstracts were searched from January 1980 through February 2005 for reviews; randomized, controlled trials; meta-analyses; and observational studies. STUDY SELECTION: The authors reviewed 46 head-to-head randomized, controlled trials comparing one second-generation antidepressant with another. Twenty-four observational studies and placebo-controlled trials were also included for assessment of safety and tolerability. DATA EXTRACTION: Two researchers independently reviewed titles and abstracts. Trained reviewers abstracted data from each study and assigned an initial quality rating. A second reviewer verified the data extraction and quality rating. DATA SYNTHESIS: According to fair to good evidence, the second-generation antidepressants that were compared had only minimal differences in efficacy, and 88% of comparative efficacy studies reported no statistically significant difference in any outcome measure at the end of the study. One effectiveness trial rated good and 2 effectiveness trials rated fair reported no statistically significant differences in primary outcome measures for compared drugs. Meta-analyses showed a modest but statistically significant additional treatment effect for sertraline and venlafaxine compared with fluoxetine. About 96% of comparative trials were sponsored by or had at least 1 author affiliated with a pharmaceutical company; the remaining trials did not report funding sources. Adverse event profiles differed among drugs; however, the degree and quality of adverse event assessment varied and only 13% of trials used a standardized scale to assess adverse events. LIMITATIONS: Quantitative analyses could not be done for many drug comparisons because the quantity and quality of the evidence were inadequate. Most published evidence was from trials sponsored by pharmaceutical companies, and publication bias may have occurred. CONCLUSIONS: Overall, second-generation antidepressants probably do not differ substantially for treatment of major depressive disorder. Choosing the agent that is most appropriate for a given patient is difficult.

Antidepressive Agents, Second-Generation↗

PubMed2005

Osteoporosis beliefs and antiresorptive medication use.

OBJECTIVE: Although a number of prescription medications are effective for the prevention and treatment of osteoporosis, little is known about the role of beliefs and attitudes in women decisions to use these drugs. The objectives of this study were (1) to assess the role of beliefs and attitudes regarding osteoporosis and prescription antiresorptive drugs in the decision to use newer antiresorptive medicines (such as bis-phosphonates, selective estrogen receptor modulators, and calcitonin nasal) and (2) to assess the role of these same beliefs and attitudes in the decision to use hormone therapy. DESIGN: Data were collected using a cross-sectional survey mailed to 1700 community dwelling women age 45 and older residing in Minnesota. Respondents completed measures of health belief model constructs, medication profiles and demographics. Data were analyzed using multivariate logistic regression models. RESULTS: A total of 983 usable survey forms were returned, yielding an adjusted response rate of 60.7%. More than one quarter of respondents reported using a prescription antiresorptive agent, with 90 (9.2%) currently taking a newer antiresorptive agent and 163 (16.6%) using hormone therapy. Several health belief model components were predictive of newer antiresorptive medicine use, including higher perceptions of susceptibility to osteoporosis (OR 1.34, 95% CI 1.20-1.49), perceptions of strong benefits of antiresorptive medicines (OR 1.34, 95% CI 1.10-1.63), and perceptions of few barriers to the use of antiresorptive medicines (OR 0.51, 95% CI 0.38-0.67). Several cues to action also were predictive of newer antiresorptive medicine use. Use of hormone therapy was associated with a single cue to action (being tested for osteoporosis (OR 1.74, 95% CI 1.14-2.66) and the perception of few barriers to the use of prescription antiresorptives (OR 0.65, 95% CI 0.55-0.77). CONCLUSION: Several health belief model constructs were associated with the decision to use newer antiresorptive drugs relative to no prescription therapy. However, few model components as operationalized in this study were predictive of the use of hormone therapy. Although the health belief model appears to provide a plausible model of the decision to undertake newer antiresorptive drug therapy, it explains little about women use of hormone therapy.

Aged↗

PubMed2005

Factors influencing the shift of patients from one proton pump inhibitor to another: the effect of direct-to-consumer advertising.

BACKGROUND: Switching from one proton pump inhibitor (PPI) to another is common, and may be related to factors other than efficacy and tolerability. OBJECTIVES: The purposes of this study were to describe the incidence of therapeutic switching among PPI users, quantify direct ambulatory medical costs of switching, and characterize the relationship between product switching and variables hypothesized to influence a switch (eg, direct-to-consumer [DTC] advertising, structure of insurance coverage, disease diagnosis). METHODS: This was a retrospective cohort study of health plans using 1998 data. The subjects were employees and dependents with employer-sponsored health insurance contributing to the Medstat Market-Scan administrative dataset. Using a commercially available database to quantify DTC advertising by marketing area, market-specific expenditures were matched to eligible subjects. Among PPI users, we identified those who switched from one product to another (switchers) and compared their utilization and spending with nonswitchers. We then evaluated the relationship between drug use and variables hypothesized to affect switching: DTC advertising, insurance characteristics, patient diagnosis, diagnostic procedures, comorbidities, age, and sex. RESULTS: The analysis used data for 396,500 individuals from 47 unique markets that were geographically well distributed, with population density similar to that of the United States overall. The sample was also comparable with US census estimates for age and sex among working adults and their dependents. Only 620 (6.3%) of PPI users switched products during the 1998 calendar year. Annual diagnostic and drug costs were >US $400 higher for switchers than nonswitchers. Subjects in areas with high levels of DTC advertising were 43% more likely to switch from lansoprazole to omeprazole than those in the low-expenditure areas. Additionally, patients paying prescription drug copayments >US $5 were 12% less likely to switch from lansoprazole to omeprazole than patients paying lower copayments. CONCLUSIONS: In these privately insured patients using PPIs, product switching was associated with increased treatment costs. DTC advertising and patient cost-sharing were important predictors of product switching.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed2005

The association of consumer cost-sharing and direct-to-consumer advertising with prescription drug use.

BACKGROUND: Previous research on the impact of various cost-sharing strategies on prescription drug use has not considered the impact of direct-to-consumer (DTC) advertising. OBJECTIVE: To explore the association of cost-containment strategies with prescription drug use and to determine if the association is moderated by DTC prescription drug advertising. METHODS: The study population included 288 280 employees and dependents aged 18 to 65 years with employer-sponsored health insurance contributing to the MEDSTAT MarketScan administrative data set. Person-level enrollment and claims data were obtained for beneficiaries enrolled continuously during July 1997 through December 1998. Direct-to-consumer advertising data were obtained from Competitive Media Reporting and linked to the MEDSTAT enrollment files. Localized DTC advertising expenditures for one class of medication were evaluated and matched with prescription claims for eligible MEDSTAT contributors. The association of various types and levels of cost-sharing incentives with incident product use was evaluated, controlling for the level of DTC advertising, health status, and other demographic covariates. RESULTS: The relationship of cost-sharing amounts with drug use was modified by the level of DTC advertising in a geographic market. This relationship was dependent on the type of cost-sharing, distinguishing between co-payments for provider visits and co-payments for prescription drugs. Compared with low-advertising markets, individuals residing in markets with high levels of advertising and paying provider co-payments of $10.00 or more were more likely to use the advertised product. In the same markets, higher prescription drug co-payments were associated with a decreased likelihood of using the advertised product. A similar relationship was not observed for the nonadvertised competitor. CONCLUSIONS: Among insured individuals, response to cost-sharing strategies is moderated by DTC prescription drug advertising. The relative ability of cost-sharing strategies to influence drug use should be interpreted with caution in the presence of DTC advertising.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed2005

Methodological challenges surrounding direct-to-consumer advertising research--the measurement conundrum.

OBJECTIVES: Numerous studies have focused on the impact of direct-to-consumer (DTC) prescription drug advertising on consumer behavior and health outcomes. These studies have used various approaches to assess exposure to prescription drug advertising and to measure the subsequent effects of such advertisements. The objectives of this article are to (1) discuss measurement challenges involved in DTC advertising research, (2) summarize measurement approaches commonly identified in the literature, and (3) discuss contamination, time to action, and endogeneity as specific problems in measurement design and application. METHODS: We conducted a review of the professional literature to identify illustrative approaches to advertising measurement. Specifically, our review of the literature focused on measurement of DTC advertising exposure and effect. We used the hierarchy-of-effects model to guide our discussion of processing and communication effects. Other effects were characterized as target audience action, sales, market share, and profit. RESULTS: Overall, existing studies have used a variety of approaches to measure advertising exposure and effect, yet the ability of measures to produce a valid and reliable understanding of the effects of DTC advertising can be improved. Our review provides a framework for conceptualizing DTC measurement, and can be used to identify gaps in the literature not sufficiently addressed by existing measures. CONCLUSIONS: Researchers should continue to explore correlations between exposure and effect of DTC advertising, but are obliged to improve and validate measurement in this area.

Advertising↗

PubMed2005

The study of direct-to-consumer advertising for prescription drugs.

OBJECTIVES: The objectives of this article are to (1) identify key methodological issues related to investigating the effects of direct-to-consumer advertising (DTCA) for prescription drugs, (2) highlight opportunities and challenges that these issues pose, and (3) provide suggestions to address these challenges and opportunities from a social and administrative pharmacy perspective. METHODS: Through a review of existing literature and consultation with research colleagues, we identified 3 broad issues regarding the study of DTCA for prescription drugs: (1) the importance of problem formulation, (2) the role of health behavior and decision-making perspectives, and (3) data collection and data analysis challenges and opportunities. Based upon our findings, we developed recommendations for future research in this area. RESULTS: Clear problem formulation will be instructive for prioritizing research needs and for determining the role that health behavior and decision-making perspectives can serve in DTCA research. In addition, it appears that cluster bias, nonlinear relationships, mediating/moderating effects, time effects, acquiescent response, and case mix are particularly salient challenges for the DTCA research domain. CONCLUSIONS: We suggest that problem formulation, selection of sound theories upon which to base research, and data collection and data analysis challenges are key methodological issues related to investigating the effects of DTCA for prescription drugs.

Advertising↗

PubMed2005

Distinguishing characteristics of patients who seek more information or request a prescription in response to direct-to-consumer advertisements.

OBJECTIVE: The objective of this study was to examine demographic and psychographic profiles of individuals who sought additional information or requested a prescription drug based on a direct-to-consumer advertisement. METHODS: A cross-sectional descriptive survey was used for collecting data from a random sample of 200 Minnesotans during Fall 2002. Chi-square and Mann-Whitney U tests were used as nonparametric tests for assessing differences in distributions between our categories of study subjects. RESULTS: Out of 177 deliverable surveys, 81 (46%) were returned. Of these, 80 surveys were usable for analysis. The results showed that the distinguishing characteristics of individuals who sought additional information based on an advertisement were associated with demographic variables such as number of drugs taken daily and monthly out-of-pocket expenditures for prescription drugs. In contrast, distinguishing characteristics of individuals who requested prescription drugs (in addition to seeking information) based on an advertisement were psychographic in nature such as (1) viewing themselves as having greater influence on their physician, (2) having a stronger relationship with their physician, (3) expressing greater satisfaction with their current therapy, (4) viewing prescriptions as less of a burden, and (5) having higher outcome expectations for prescription drugs compared to the respondents who did not ask for a prescription drug based on a direct-to-consumer advertisement. CONCLUSIONS: Distinguishing characteristics of information seekers were demographic in nature, whereas those characteristics of prescription requesters were psychographic in nature.

Advertising↗

PubMed2005

Factors associated with potentially inappropriate drug utilization in a sample of rural community-dwelling older adults.

BACKGROUND: Many medications present special risks when used by older adults (ie, those aged > or = 65 years) and are considered potentially inappropriate for this population. The Beers criteria are often used to identify such medications. Past research has documented that use of Beers drugs is common among older adults. OBJECTIVE: The aim of this work was to examine factors associated with potentially inappropriate drug use among rural community-dwelling older adults using a conceptual framework adapted from the Andersen-Newman behavioral model of health service use. METHODS: This was a population-based, cross-sectional survey. Data were collected via face-to-face home interviews between 2002 and 2004. Rural community-dwelling older adults residing in a single county in North Carolina were eligible. Potentially inappropriate drug use was operationalized using the Beers criteria. Data concerning predisposing (ie, age, sex, race, education, and marital status), enabling (ie, social support and insurance status), need (ie, disability and history of major depression, hypertension, osteoarthritis, back problems, or other comorbidities), and utilization factors (ie, number of medications used) were collected. RESULTS: Data were gathered from 892 people, with information on medication use available for 800. Two hundred thirteen of these 800 participants (26.6%) used > or = 1 Beers drug. Compared with individuals who used no Beers drugs, those who used > or = 1 Beers drug reported lower levels of social support (odds ratio [OR], 0.94; 95% CI, 0.90-0.99) and higher levels of disability (OR, 1.48; 95% CI, 1.11-1.97), used more medications (OR, 1.07; 95% CI, 1.01-1.13), and were more likely to have a history of major depression (OR, 1.67; 95% CI, 1.05-2.66), hypertension (OR, 1.58; 95% CI, 1.07-2.33), osteoarthritis (OR, 1.58; 95% CI, 1.09-2.29), and back problems (OR, 1.72; 95% CI, 1.19-2.47). CONCLUSION: As suggested by the Andersen-Newman model, the risk of potentially inappropriate drug use is highest among those with the greatest medication needs, as evidenced by poorer health status in this sample of rural community-dwelling older patients.

Adult↗

PubMed2005

Discontinuation rates for selective serotonin reuptake inhibitors and other second-generation antidepressants in outpatients with major depressive disorder: a systematic review and meta-analysis.

The present study aimed to systematically compare overall loss to follow-up, discontinuation rates because of adverse events and discontinuation rates because of a lack of efficacy in published studies assessing the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) compared to other second-generation antidepressants in treating outpatients with major depressive disorder (MDD). We searched MEDLINE, Embase, The Cochrane Library, PsychLit and the International Pharmaceutical Abstracts from 1980 to 2004 (April). Twenty double-blinded, randomized controlled trials met our eligibility criteria and compared SSRIs to other second-generation antidepressants in adult outpatients with MDD. Pooled relative risks of discontinuation rates because of (i) any reason (overall loss to follow-up), (ii) adverse events and (iii) a lack of efficacy did not differ substantially between SSRIs as a class and other second-generation antidepressants. Taking the similar efficacy of second-generation antidepressant into account, our findings suggest that clinicians can focus on other practically or clinically relevant considerations such as costs, differences in side-effect profiles, onset of action or aspects of health-related quality of life to tailor a treatment to an individual patient's needs.

Antidepressive Agents, Second-Generation↗

PubMed2004

Resorptive drug use among community-dwelling women in Minnesota.

PURPOSE: The frequency of and factors associated with the use of resorptive medications among community-dwelling women age 45 years or older in Minnesota were studied. METHODS: The study was a secondary analysis of a cross-sectional survey mailed to 1700 community-dwelling women age 45 years or older in Minnesota. The survey was designed to collect information about women's attitudes and beliefs regarding osteoporosis and antiresorptive medications. Respondents were also asked to give a detailed list of all prescription medications they currently used, including the quantity and directions for use. Descriptive statistics were calculated for the demographic, health, and medication-use characteristics of all respondents and for the subset of those using resorptive medications. Chi-square analysis and logistic regression were used to test bivariate and multivariate relationships. RESULTS: Of the 990 usable surveys returned (adjusted response rate of 61.1%), 84 respondents (8.5%) reported using a resorptive drug. Age, health status, and the use of health care services (monthly physician visits and prescription use) were associated with resorptive drug use, controlling for other variables in the model. Women using resorptive medications were nearly 2.5 times more likely to report osteoporosis and osteopenia than women not using these medications. CONCLUSION: The use of resorptive medications in community-dwelling women in Minnesota was highest among those 75-84 years of age, women who were in poor health, and those frequently using health care services. These women were more likely to report using newer antiresorptive medications but were not more likely to use hormone therapy or calcium supplementation.

Aged↗

PubMedDate not supplied

Medication therapy management services in North Carolina community pharmacies: current practice patterns and projected demand.

OBJECTIVE: To evaluate the types of cognitive services offered and the number of patients being served in community pharmacies, determine the number of pharmacies that plan to offer medication therapy management (MTM) services under the Medicare Part D prescription drug benefit, and assess whether current and expected practices will meet the potential needs of enrollees. DESIGN: Cross-sectional study. SETTING: North Carolina in January 2005. PARTICIPANTS: 1,593 community pharmacy managers. INTERVENTIONS: Survey using a Web-based tool. MAIN OUTCOME MEASURES: Provision of cognitive services and number of patients for whom services are provided. RESULTS: A total of 262 (16%) pharmacy managers provided usable responses. Approximately 42% of respondents (n = 110) indicated that they provide some type of cognitive service. Comprehensive MTM services, or services consistent with the professionwide consensus definition, were provided by 31% of respondents (n = 81). Independent pharmacies were more likely to offer some type of service compared with chain pharmacies (58% versus 31%, respectively; P < .001). Pharmacy managers with a doctor of pharmacy degree were less likely than pharmacy managers with a bachelor's degree to offer services in their pharmacies (P = .02), and pharmacies with pharmacists on staff who had received certificate training were more likely to offer cognitive services (P = .03). Of all respondents, 28% (n = 73) indicated that they planned to offer MTM services under the Medicare Part D prescription drug benefit. CONCLUSION: Comparing these results with those of a 1999 survey of North Carolina pharmacists that used some of the same items, the percentage of community pharmacies that provide cognitive services has increased in the intervening years but remains low. Among the services being offered in 2005, most were focused on patient education and training, coordinating and integrating care, and medication regimen reviews. Implementation of MTM services under the Medicare Part D prescription drug benefit should hasten the development and offering of these services in community pharmacies.

Ambulatory Care↗

PubMedDate not supplied

Efficacy and safety of inhaled corticosteroids in patients with COPD: a systematic review and meta-analysis of health outcomes.

PURPOSE: We wanted to review systematically the efficacy, effectiveness, and safety of inhaled corticosteroids with respect to health outcomes in patients with chronic obstructive pulmonary disease (COPD). METHODS: We searched MEDLINE, EMBASE, The Cochrane Library, and the International Pharmaceutical Abstracts to identify relevant articles. We limited evidence to double-blinded randomized controlled trials (RCTs) for efficacy, but we also reviewed observational evidence for safety. Outcomes of interest were overall mortality, exacerbations, quality of life, functional capacity, and respiratory tract symptoms. When possible, we pooled data to estimate summary effects for each outcome. RESULTS: Thirteen double-blinded RCTs determined the efficacy of an inhaled corticosteroid compared with placebo; 11 additional studies assessed the safety of inhaled corticosteroid treatment in patients with asthma or COPD. Overall, COPD patients treated with inhaled corticosteroids experienced significantly fewer exacerbations than patients taking placebo (relative risk [RR] = 0.67; 95% CI, 0.59-0.77). No significant difference could be detected for overall mortality (RR = 0.81; 95% CI, 0.60-1.08). Evidence on quality of life, functional capacity, and respiratory tract symptoms is mixed. Adverse events were generally tolerable; pooled discontinuation rates did not differ significantly between inhaled corticosteroid and placebo treatment groups (RR = 0.92; 95% CI, 0.74-1.14). Observational evidence, however, indicates a dose-related risk of cataract and open-angle glaucoma. Severe adverse events, such as osteoporotic fractures, are rare; the clinical importance of the additional risk is questionable. CONCLUSIONS: Overall, the risk-benefit ratio appears to favor inhaled corticosteroid treatment in patients with moderate to severe COPD. Existing evidence does not indicate a treatment benefit for patients with mild COPD.

Administration, Inhalation↗