Anatomical Therapeutic Chemical Classification Codes Research Articles

The Association between Birthweight and Use of Cardiovascular Medications: The Role of Health Behaviors.

There is limited evidence on the effect of low birthweight on the use of cardiovascular medications and the role of health behaviors. This study aims to determine the independent effect of low birthweight and its combination with adult health behaviors on the number of dispensed cardiovascular medications. We included 15618 participants with information on birthweight and self-reported health behaviors. Dispensed cardiovascular medications were identified from the Prescribed Drug Register based on a three-digit level Anatomical Therapeutic Chemical classification code (C01 to C10 and B01) and categorized into 0, 1, and ≥2 different types of medications. We applied multinomial logistic regression models estimating odds ratios (ORs) and 95% confidence intervals (CIs). Participants with low birthweight had a higher estimated OR of using ≥2 types of cardiovascular medications (OR = 1.46, 95% CI = 1.06, 2.01). Further, an increased risk for using ≥2 types of cardiovascular medications was found in participants with poor health behaviors for normal (OR = 2.17, 95% CI = 1.80, 2.62) and high (OR = 1.84, 95% CI = 1.29, 2.62) birthweight. The strongest effect on using ≥2 types of cardiovascular medications was found for low birthweight and poor health behaviors (OR = 3.14, 95% CI = 1.80, 5.50). This cohort study provides evidence that low birthweight increases the risk of using more types of cardiovascular medications in adulthood. This study also suggests that ideal health behaviors reduce this risk.

Development and validation of a case definition for problematic menopause in primary care electronic medical records

BackgroundMenopause is a normal transition in a woman’s life. For some women, it is a stage without significant difficulties; for others, menopause symptoms can severely affect their quality of life. This study developed and validated a case definition for problematic menopause using Canadian primary care electronic medical records, which is an essential step in examining the condition and improving quality of care.MethodsWe used data from the Canadian Primary Care Sentinel Surveillance Network including billing and diagnostic codes, diagnostic free-text, problem list entries, medications, and referrals. These data formed the basis of an expert-reviewed reference standard data set and contained the features that were used to train a machine learning model based on classification and regression trees. An ad hoc feature importance measure coupled with recursive feature elimination and clustering were applied to reduce our initial 86,000 element feature set to a few tens of the most relevant features in the data, while class balancing was accomplished with random under- and over-sampling. The final case definition was generated from the tree-based machine learning model output combined with a feature importance algorithm. Two independent samples were used: one for training / testing the machine learning algorithm and the other for case definition validation.ResultsWe randomly selected 2,776 women aged 45–60 for this analysis and created a case definition, consisting of two occurrences within 24 months of International Classification of Diseases, Ninth Revision, Clinical Modification code 627 (or any sub-codes) OR one occurrence of Anatomical Therapeutic Chemical classification code G03CA (or any sub-codes) within the patient chart, that was highly effective at detecting problematic menopause cases. This definition produced a sensitivity of 81.5% (95% CI: 76.3-85.9%), specificity of 93.5% (91.9-94.8%), positive predictive value of 73.8% (68.3-78.6%), and negative predictive value of 95.7% (94.4-96.8%).ConclusionOur case definition for problematic menopause demonstrated high validity metrics and so is expected to be useful for epidemiological study and surveillance. This case definition will enable future studies exploring the management of menopause in primary care settings.

Inventory of real-world data sources in Japan: Annual survey conducted by the Japanese Society for Pharmacoepidemiology Task Force.

The Database Task Force of the Japan Society for Pharmacoepidemiology began its annual surveys of databases available for clinico and pharmacoepidemiological studies in 2010. In this report, we summarize the characteristics of the databases available in Japan based on the results of our 2021 survey to illustrate the recent developments in the infrastructure for database research in Japan. We included 20 major databases from the academia, government, or industry that were accessible to third parties. We used a web-based questionnaire to ask the database providers about their characteristics, such as their organization, data source(s), numbers of individuals enrolled, age distribution, code(s) used, and average follow-up periods. We received responses from all 20 databases approached: eight hospital-based databases, six insurer-based databases, four pharmacy-based databases, and two in the "other" category. Among them, 17 contained information from medical claims, pharmacy claims, and/or Diagnosis Procedure Combination data. Most insurer databases contained health check-up data that could be attached to the claims component. Some hospital-based databases had data from electronic medical records. Most insurer-based databases collected data from the insurers of working-age employees and therefore had limited coverage of older people. Most databases coded their medication data using the Japanese reimbursement codes, and many provided Anatomical Therapeutic Chemical Classification codes. The number of databases available for clinico and pharmacoepidemiological research and the proportion of the population they cover are increasing in Japan. The differences in their characteristics mean that the appropriate database must be selected for a particular study purpose.

P.081 Evolving treatment of pediatric-onset multiple sclerosis in Alberta

Background: Pediatric-onset multiple sclerosis (MS) is associated with a high rate of disease activity. However, only a single DMT – fingolimod – has been approved by Health Canada for children, in 2018. In this study, we describe trends in the treatment of pediatric-onset MS in Alberta. Methods: We performed a retrospective review of Alberta administrative health databases, identifying cases of MS under 19 years of age from January 1, 2011 - December 31, 2020. Pharmacy dispenses of MS DMTs were identified by Anatomical Therapeutic Chemical classification code and grouped as injectables (glatiramer acetate, interferon-beta) or newer agents (all others). Results: 79 incident cases of pediatric MS were identified during the study period. 47/79 (59%) had at least one DMT dispense, with the first dispense occurring a median 263 days (IQR 134.5-988) from the index date at a median age of 17.2 years (IQR 16.0-18.6). Injectables accounted for all initial DMT dispenses < 19 years of age prior to 2019, while from 2019-2020 injectables accounted for only 3/15 (20%) initial dispenses, with rituximab (5/15, 33%) being the most common initial DMT in those years. Conclusions: The treatment of children with MS in Alberta has rapidly evolved, shifting shift towards earlier treatment using newer high-efficacy agents.

Treatment Patterns and Resource Utilization of Pregnant Women with Inflammatory Rheumatic Diseases or Psoriasis in Germany: A Claims Database Analysis

BackgroundUncontrolled inflammatory disease activity can impact pregnancy outcomes and the health of the mother and child. This retrospective claims database analysis assessed treatment patterns before, during, and after pregnancy among women with inflammatory rheumatic disease (IRD; axial spondyloarthritis [axSpA], psoriatic arthritis [PsA], and rheumatoid arthritis [RA]) or psoriasis (PSO) in Germany.MethodsData were extracted from the BARMER sickness fund (2013–2017). Pregnant women (18–45 years) with documented IRD or PSO diagnoses were compared with age-matched controls from the same database for the analysis of patient characteristics, healthcare resource utilization, and pharmacological treatment during pregnancy. Reported measures included the proportion of women with pharmacological prescriptions or hospitalization/new prescription of corticosteroids or biologics in the 180 days before pregnancy, during pregnancy, and 180 days after delivery. Pre-specified prescription categories (such as disease-specific drugs [not including biologics]) were identified by anatomical therapeutic chemical classification codes. Extrapolated values to the German statutory health insurance population are reported.ResultsOverall, 2702 pregnant women with IRD (axSpA: 1063; PsA: 660; RA: 979) and 6527 with PSO were identified. The proportion of women with IRD receiving prescriptions for disease-specific drugs reduced during pregnancy and remained stable after delivery (before: 15.0%; during: 9.0%; after: 9.7%). The proportion of women with PSO receiving prescriptions for disease-specific drugs was low (before: 0.6%; during: 0.3%; after: 0.1%). The proportion of women with hospitalization/new prescription of corticosteroids or biologics decreased during pregnancy, compared with pre-pregnancy, and increased after delivery in women with IRD (before: 9.0%; during: 5.1%; after: 11.1%) and PSO (before: 3.5%; during: 1.9%; after: 2.7%).ConclusionsA reduction in pharmacological treatment during pregnancy was observed for women with IRD in Germany. Many women with IRD did not return to pre-pregnancy treatments after delivery, despite signs of disease exacerbation, such as hospitalization and initiation of treatment with corticosteroids/biologics, in this period.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-021-00347-3.

Real-World Evidence of the Incidence of and Risk Factors for Type 1 Diabetes Mellitus and Hypothyroidism as Immune-Related Adverse Events Associated With Programmed Cell Death-1 Inhibitors

ObjectiveThe incidence of type 1 diabetes mellitus (T1DM) and hypothyroidism as immune-related adverse events (irAEs) after programmed cell death-1 inhibitor (PD-1i) administration has not yet been sufficiently evaluated in a real clinical setting. To assess the incidence of T1DM and hypothyroidism among PD-1is and to identify the risk factors associated with hypothyroidism using a large claims database. MethodsThis cohort study used the Shizuoka Kokuho database in Japan from 2012 to 2018, including approximately 2.2 million people. We enrolled 695 PD-1i-treated patients. T1DM and hypothyroidism as irAEs were identified using International Classification of Diseases 10th Revision and Anatomical Therapeutic Chemical classification codes. Risk factors for hypothyroidism were explored using the multivariable Fine and Gray regression model after adjusting for age group and sex, treating death as a competing risk. ResultsThe cumulative incidences of T1DM and hypothyroidism were 0.3% and 8.3%, respectively. We described the detailed onset timing of irAEs in patients with T1DM and hypothyroidism; hypothyroidism was observed evenly within 1 year of the PD-1i prescription. Sex and certain cancer types, such as lung and urothelial cancers, were significantly associated with subdistribution hazard ratio (sHR) (female: sHR, 2.04 [95% CI, 1.20-3.47]; lung cancer: sHR, 0.55 [95% CI, 0.32-0.95]; and urothelial carcinoma: sHR, 2.40 [95% CI, 1.05-5.49]). ConclusionThe incidence of T1DM and hypothyroidism as irAEs and associated risk factors identified in this analysis were comparable to those found in previous studies. The use of a large claims database to detect irAEs, such as T1DM and hypothyroidism, may lead to safer use of PD-1is.

A Pediatrics Utilization Study in The Netherlands to Identify Active Pharmaceutical Ingredients Suitable for Inkjet Printing on Orodispersible Films.

Background: The use of medication in pediatrics, children aged 0–5 years, was explored so as to identify active pharmaceutical ingredients (APIs) suitable for inkjet printing on a plain orodispersible film (ODF) formulation in a pharmacy. Methods: The database IADB.nl, containing pharmacy dispensing data from community pharmacies in the Netherlands, was used to explore medication use in the age group of 0–5 years old, based on the Anatomical Therapeutic Chemical classification code (ATC code). Subsequently, a stepwise approach with four exclusion steps was used to identify the drug candidates for ODF formulation development. Results: there were 612 Active Pharmaceutical Ingredients (APIs) that were dispensed to the target group, mostly antibiotics. Of the APIs, 221 were not registered for pediatrics, but were used off-label. After the exclusion steps, 34 APIs were examined regarding their suitability for inkjet printing. Almost all of the APIs were sparingly water soluble to practically insoluble. Conclusion: Pharmaceutical inkjet printing is a suitable new technique for ODF manufacturing for pediatric application, however the maximal printed dose as found in the literature remained low. From the selected candidates, only montelukast shows a sufficiently high water-solubility to prepare a water-based solution. To achieve higher drug loads per ODF is ambitious, but is theoretically possible by printing multiple layers, using highly water-soluble APIs or highly loaded suspensions.

Epidemiology of knee osteoarthritis in general practice: a registry-based study

ObjectivesThe present study investigated (1) trends in the prevalence and incidence of knee osteoarthritis over a 20-year period (1996–2015); (2) trends in multimorbidity and (3) trends in drug prescriptions.DesignRegistry-based study.SettingPrimary...

Complexity of Drug Substitutions Caused by Drug Tenders: A Mixed-Methods Study in Denmark.

Objective: The objective of this study was to investigate factors influencing the complexity of drug substitutions caused by drug tenders in a Danish hospital setting. Methods: A sequential explanatory mixed-methods approach was employed. In the first phase, a custom-made, self-administered questionnaire was distributed to 58 pharmacists and pharmaconomists employed at the Hospital Pharmacy in the North Denmark Region. The questionnaire consisted of 13 questions, which helped to obtain quantitative information on factors complicating drug substitutions. The results were used to inform the construction of an interview guide for a focus group interview held in the following qualitative second phase of the study. The focus group included 11 pharmacists and pharmaconomists from the Hospital Pharmacy in the North Denmark Region working with drug substitutions. The focus group interview was conducted to facilitate validation of results from the questionnaire survey and to add further perspectives on identified factors influencing the complexity of drug substitutions. Results: Findings from both phases of the study revealed that implementation of drug substitutions is more complex when drug strength or pharmaceutical form of a drug changes, compared with changes of drug trade name or package size. Furthermore, it was established that Anatomical Therapeutic Chemical classification codes could be used to identify drug substitutions that are typically complex, for example, L01 and N05. Several external factors were also found to influence implementation of drug substitutions, for example, related to drug usage, number of end users, and hospital wards. Conclusions: From a hospital pharmacy point of view, multiple factors were identified that could influence and complicate the implementation of drug substitutions with different impact size. Those factors included both changed characteristics of drugs, Anatomical Therapeutic Chemical classification codes involved in substitution, and external factors.

Dispensing Patterns of Blood Pressure Lowering Agents in Older Australians From 2006 to 2016

Increasing numbers of blood pressure lowering (BPL) agents are being prescribed for both primary and secondary prevention of cardiovascular disease, especially in the older population. The aim of this study is to describe the temporal trends and patterns of BPL dispensing among older Australians (aged ≥65 years). We utilized prescription claims data from the Australian Pharmaceutical Benefits Scheme (PBS) for a 10% random sample of people aged ≥65 years. The PBS, funded by the Federal government, provides subsidies to make medicines more affordable for Australian residents. We restricted our analysis to "long-term concession" individuals, who would use PBS for the majority of their medication needs. BPL agents were identified using the World Health Organization Anatomical Therapeutic Chemical classification codes. The annual prevalences and proportional distributions of BPL dispensing by categories were summarized from 2006 to 2016. Direct standardization was applied to indicate changes of BPL dispensing over time. Age-standardized dispensing of BPL agents increased by 8% among older Australians from 2006 to 2016 (58%-66%). BPL dispensing in males has exceeded that in females since 2009. Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers were the dominant BPL agents dispensed, with more than 55% of all BPL users over time. Dispensing of diuretics decreased from 27% to 21%, calcium channel blockers decreased from 30% to 25%, while β-blockers remained stable (29%-31%). The use of fixed-dose combinations increased over time from 23% to 31%. The prevalence of BPL dispensing steadily increased among older Australians from 2006 to 2016. The changes in the patterns of BPL dispensing were largely in line with contemporary changes to clinical guidelines for an aging population.

PUK13 - THE TREATMENT OF IRON DEFICIENCY/ANAEMIA IN PATIENTS WITH NON-DIALYSIS CHRONIC KIDNEY DISEASE IN GERMANY – A CLAIMS DATABASE ANALYSIS

Iron deficiency/anaemia (ID/A) has been reported as a frequent comorbidity in non-dialysis chronic kidney disease (ND CKD) and is associated with reduced functional capacity, poor quality of life, and increased mortality. Study aims were to compare health-related outcomes and healthcare costs of ND CKD patients with ID/A and specific iron treatment in Germany. A retrospective, matched cohort analysis was conducted. German claims data from the InGef research database containing over 4 million covered lives were used. ND CKD patients stages 3 and 4 with ID/A were identified by ICD-10-GM codes in 2014 with individual pre- and post-index periods of 4 quarters. Incident iron treatment defined the index quarter and was stratified by oral, low dose (<1000mg) and high dose (≥1000mg) intravenous iron based on Anatomical Therapeutic Chemical Classification codes and Pharmacy Central Numbers. A 1:1:1 propensity score matching was performed including the parameters age, gender, Charlson Comorbidity Index, and baseline costs to assess health-related outcomes. In total, n=1,889 ND CKD patients received oral iron, n=156 low dose intravenous, and n=49 high dose intravenous iron with over 90% being treated with Ferric Carboxymaltose. After matching, 44 patients remained in each treatment cohort. Significant differences were observed concerning all-cause hospitalizations (oral iron vs. high dose intravenous iron (90.9% vs. 72.7%, p=0.035)) and ID/A-related hospitalizations (oral iron vs. low dose intravenous iron (56.8% vs. 27.3%, p=0.007) and oral iron vs. high dose intravenous iron (56.8% vs. 29.6%, p=0.007)). The cost comparison revealed significantly higher average ID/A-related hospitalization costs for the oral iron cohort and lowest costs for the high intravenous iron cohort. The oral iron cohort had the highest observable mortality. The results showed that the use of high dose intravenous iron treatment was associated with the lowest all-cause hospitalization and the highest cost savings, compared to oral and low dose intravenous iron.

Methodological issues for measuring pharmacotherapy treatment and its calibration with patient outcomes using real-world data

IntroductionHealth system and administrative data sources, although collected for process/procedural healthcare use, have recently been leveraged for research purposes. Complex methodologies such as data linkages, defined algorithms, and proxy measures are needed to validate the use of these data. Alberta has exceptionally rich health system data to be explored.&#x0D; Objectives and ApproachOur objectives were to explore data sources in Alberta regarding pharmacotherapy treatments, patient outcomes, and develop methods to calibrate associations. We scoped data sources for pharmacotherapy treatment and patient outcomes in Alberta, Canada. Using a cohort of patients with multiple sclerosis (MS) as an example, we developed algorithms to measure medication possession ratio (MPR), proportion of days covered (PDC), and treatment discontinuation (TD). Patient outcomes included: ambulatory care visits, physician claims and hospitalizations. We explored different algorithms for statistical modeling of patient treatments and outcomes. Optimal cut-points and statistical model performance of MPR/PDC and TD with patient outcomes were evaluated.&#x0D; ResultsWe utilized six Albertan data sources to examine treatment patterns and patient outcomes. From the year 2000, the pharmaceutical information network (PIN) and Alberta Blue Cross drug datasets collected: service dates, dosages, drug identification numbers, anatomical therapeutic chemical classification codes, and days of supplies; which were used to calculate MPR, PDC and TD. MPR and PDC were calculated using three different methods: (1) fixed follow-up period; (2) with and without last fill; and (3) adjustment for hospitalization periods. No significant differences between methods were found. In addition, TD using 60- and 90-day gaps, while considering the medication day supplies, were calculated. Adherence with optimal cut-point 0.8 of MPR/PDC and TD were significantly associated with ambulatory care visits, physician claims, and hospitalizations (p=0.000; C-statistic range: 0.78-0.89).&#x0D; Conclusion/ImplicationsThe PIN data can be utilized for measuring pharmacotherapy treatment in patient outcomes research. To understand the impact of therapies on outcomes in a real-world setting, however, comprehensive methods for measuring treatment indicators as well as patient outcomes should be developed to control for inherent biases in observational data.

Identifying drug substances of screening tool for older persons\u2019 appropriate prescriptions for Japanese

BackgroundIn 2015, the Japan Geriatric Society (JGS) updated “the Guidelines for Medical Treatment and its Safety in the elderly,” accompanied with the Screening Tool for Older Persons’ Appropriate Prescriptions for Japanese (STOPP-J): “drugs to be prescribed with special caution” and “drugs to consider starting.” The JGS proposed the STOPP-J to contribute to improving prescribing quality; however, each decision should be carefully based on medical knowledge. The STOPP-J shows examples of commonly prescribed drug substances, but not all relevant drugs. This research aimed to identify substances using such coding, as a standardized classification system would support medication monitoring and pharmacoepidemiologic research using such health-related information.MethodsA voluntary team of three physicians and two pharmacists identified possible approved medicines based on the STOPP-J, and matched certain drug substances to the Anatomical Therapeutic Chemical Classification (ATC) and the Japanese price list as of 2017 February. Injectables and externally used drugs were excluded, except for self-injecting insulin, since the STOPP-J guidelines are intended to cover medicines used chronically for more than one month. Some vaccines are not available in the Japanese price list since they not reimbursed through the national health insurance.ResultsThe ATC 5th level was not available for 39 of the 235 identified substances, resulting in their classification at the ATC 4th level. Furthermore, among 26 combinations, 10 products were matched directly to the ATC 5th level of the exact substances, and others were linked to the ATC representing the combination or divided into multiple substances for classification if the combination was not listed in the ATC.ConclusionThis initial work demonstrates the challenge of matching ATC codes and the Japan standard commodity classification codes corresponding to STOPP-J substances. Since coding facilitates database analysis, the proposed drug list could be applied to research using large databases to examine prescribing patterns in patients older than 75 years or who are frail. Since ATC is not available for some substances, Japanese medicines need the process to be registered in the ATC for an effective screening tool to be developed for STOPP-J.

Epidemiology and Medication Pattern Change of Psoriatic Diseases in Taiwan from 2000 to 2013: A Nationwide, Population-based Cohort Study.

To analyze the trend of prevalence and incidence rates for psoriatic arthritis (PsA) and psoriasis in Taiwan, and to determine the changes in medication patterns. Data were collected from the Taiwan National Health Insurance Research Database, which covered at least 95% of the population from 2000 to 2013. International Classification of Diseases, 9th edition (ICD-9) was used to identify PsA (ICD-9 696.0) and other psoriasis (ICD-9 696.1). Medications were identified by Anatomical Therapeutic Chemical Classification code. We calculated the annual age standardized prevalence and incidence rate of PsA and psoriasis in individuals aged ≥ 16 years from 2000 to 2013, and used the Poisson regression to test the trends by Wald chi-square statistic. The prevalence (per 100,000 population) of psoriatic diseases between 2000 and 2013 increased from 11.12 to 37.75 for PsA, and from 179.2 to 281.5 for psoriasis. The incidence (per 100,000 person-yrs) increased from 3.64 to 6.91 in PsA, while there was no significant change in psoriasis. Prevalence and incidence in PsA were more rapidly increased than in psoriasis. Sex ratio (men to women) of PsA decreased from 2.0 to 1.5 in 2000 and 2013, respectively. There was an increase in the use of disease-modifying antirheumatic drugs (DMARD), especially biologics, which is significantly different from topical therapies. The prevalence and incidence rates of psoriatic disease, especially PsA, were increasing in Taiwan. The medication pattern showed an increase in DMARD and biologics, while use of topical therapies decreased.

Detection and analysis of drug-drug interactions among hospitalized cardiac patients in the Mohammed V Military Teaching Hospital in Morocco.

IntroductionDrug-drug interactions (DDIs) are defined as two or more drugs interacting in such a manner that the effectiveness or toxicity of one or more drugs is altered. Patients with cardiovascular disorders are at higher risk for DDIs because of the types and number of drugs they receive. The aim of the present study was to assess the prevalence of DDIs in patients admitted to the cardiology department of a hospital in Morocco.MethodsA prospective observational study from June 2016 to September 2016 was carried out in the cardiology department of a hospital in Morocco. Those patients who were taking at least two drugs and had a hospital stay of at least 48 hours were included in the study. The medications of the patients were analysed for possible interactions. All the prescriptions of the study population were screened for drug-drug interactions using a computerized DDI database system (Theriaque®).ResultsDuring the study period, 138 patients were included; 360 interactions were detected among 94 patients, with an average number of drugs taken of 5.2. The prevalence of DDIs was estimated at 68.11%, the most common of which concerned Kardegic/Plavix (12.22%), Kardegic/Heparin (8.33%), and Lasilix/Spironolactone (5.83%). Among the 726 prescribed drugs, (372 [51.24%]) were drugs of the cardiovascular system, followed by blood and hematopoietic organ drugs (288 [39.67%]) according to the Anatomical Therapeutic Chemical Classification codes. These interactions were categorized on the basis of level of severity: interactions with major severity accounted for 11.11% (40) of the total DDIs while those with moderate and minor severity accounted for 37.22% (134) and 51.66% (186), respectively.ConclusionThis study reports the prevalence of DDIs in patients admitted to the cardiology department of a hospital in Morocco. This study shows that DDIs are frequent among hospitalized cardiac patients and highlights the need to screen prescriptions of cardiovascular patients for possible DDIs, as this helps in their detection and prevention.Pan African Medical Journal – ISSN: 1937- 8688 (www.panafrican-med-journal.com)Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net)Pan African Medical Journal – ISSN: 1937- 8688 (www.panafrican-med-journal.com)Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net)

Refining an antidepressant-based indicator to improve the ascertainment of depression from Australian administrative data

ABSTRACTObjectivesIn the absence of whole-of-population data regarding depression in Australia, antidepressant supply identified through pharmaceutical data has been used by some as an indicator of depression. This approach has been criticised on the basis that up to 30% of antidepressants are prescribed for indications other than depression, including anxiety disorders, insomnia and pain. This study examines whether the identification of patients treated for depression can be improved by refining this antidepressant-based indicator via a series of pre-determined algorithms.ApproachPharmaceutical Benefits Scheme (PBS) and Medicare Benefits Scheme (MBS) records were linked to follow-up questionnaires completed between September 2012 and December 2014 by participants of the 45 and Up Study - a cohort study of residents of New South Wales, Australia, aged 45 years and older. After exclusions, 58,425 participants were included in the analyses. According to the basic antidepressant-based indicator, the supply of any antidepressant (Anatomical Therapeutic Chemical classification (ATC) code beginning with N06A) in the 30 days prior to the survey completion date was considered indicative of depression treatment in the last month. This algorithm was refined to: i) exclude tricyclic antidepressants (ATC code N06AA), which are commonly prescribed for insomnia and pain; and ii) re-categorise as ‘not treated for depression’ those antidepressant recipients who were also supplied an anxiolytic or sedative (ATC codes beginning with N05B and N05C) in the 12 months prior to the survey. Self-reported receipt of treatment for depression in the last month, from the questionnaire data, was used as a gold standard.ResultsThe basic antidepressant-based indicator returned a sensitivity (Sn) of 59.9%, a positive predictive value (PPV) of 43.4% and a specificity (Sp) of 94.7%. When refined algorithm i) was applied, the PPV and Sp increased to 51.8% and 96.5% respectively, while Sn decreased to 54.6%. Refined algorithms ii) yielded similar PPVs and Sps to algorithm i) while Sns were lower. Further refinements to the indicator will be explored using primary care (MBS) data. Although MBS data do not contain diagnoses, they do contain indicators of when certain mental health services were provided, allowing for algorithms in which the prescription of antidepressants for mental health reasons is distinguished from their prescription for physical health problems.ConclusionThe algorithms developed in this study can be applied to identify depression in future research based on Australian administrative health data.&#x0D; We acknowledge the Commonwealth Department of Human Services for supplying PBS and MBS data.

Do general practitioners prescribe more antimicrobials when the weekend comes?

Inappropriate antimicrobial prescribing contributes to the global spread of antimicrobial resistance. The pending weekend with changed availability of general practitioners (GP) and increased patient concern may increase the intention to prescribe antimicrobials. The aim of this study is to analyse variation in antimicrobial prescribing between weekdays and weekend in Irish general practice. All prescribing data over a 15 month period was obtained from the 30 practices participating in the Supporting the Improvement and Management of Prescribing for urinary tract infection (SIMPle) study. Antimicrobials were classified using anatomical therapeutic chemical classification code guidelines. Prescribing of antimicrobials per total number of prescriptions was compared between weekdays (Monday to Thursday) and the weekend (Friday to Sunday). Antimicrobials were generally more often prescribed during weekends; the antimicrobial prescribing rate was greater by 9.2 % on Friday compared to average prescribing on other weekdays (21.4 vs. 19.6 %). The chance of an antimicrobial prescription was 1.07 (95 % CI 1.04–1.10) higher on weekend days compared to weekdays. This was reflected in increased prescriptions for ampicillin, co-amoxiclav, nitrofurantoin, quinolones and macrolides. However, if antimicrobials were prescribed, no significant differences were observed between weekdays and weekend among the different classes of antimicrobials. GPs prescribe relatively more antimicrobials during the weekend compared to weekdays. However, the patterns of antimicrobial prescribing did not differ according to the day of prescription.Trial Registration The intervention was registered with ClinicalTrials.gov on 26 July 2013, ID number NCT01913860

Association between Selective Serotonin Reuptake Inhibitor Therapy and Suicidality: Analysis of U.S. Food and Drug Administration Adverse Event Reporting System Data.

Selective serotonin reuptake inhibitors (SSRIs) are prescribed for the treatment of depression worldwide. SSRIs are suspected to increase the risk of suicidal ideation and behavior (suicidality) in children, adolescents, and young adults. We examined the association between SSRI therapy and suicidality by applying a logistic regression model to age-stratified data from the Food and Drug Administration (FDA) Adverse Event Reporting System database. We attempted to mitigate the effect of patient-related factors by data subsetting. We selected case reports for SSRIs as referred to in the World Health Organization Anatomical Therapeutic Chemical classification code N06AB. The association between SSRIs and "suicidal events" or "self-harm events" was calculated as a reporting odds ratio (ROR) and adjusted for covariates by logistic regression. For subjects <18 years old (y.o.) the adjusted RORs (95% confidence interval) of SSRI therapy with suicidal events were 9.58 (8.97-10.23) in the whole data analysis and 4.64 (4.15-5.19) in the subset analysis; those with self-harm events were 31.40 (27.71-35.58) and 16.31 (13.12-20.29), respectively. Although the adjusted RORs were lower in the subset analyses than in the whole data analyses, both analyses indicated associations between SSRI treatment and suicidal and self-harm events. In both analyses these associations were stronger in the <18 y.o. group than other age groups. Children and adolescents should be closely monitored for the occurrence of suicidality when they are prescribed SSRIs. In addition, we found that data subsetting might mitigate the effect of an intrinsic risk among patients taking the suspected drug.

Depression, antidepressants, and the risk of coronary heart disease: A population-based cohort study

BackgroundEvidence supporting a predictive role for depression in the pathgenesis of coronary heart disease (CHD) has mainly come from studies in Western countries. Conflicting data exist regarding the association between antidepressant use and the incidence of CHD. This population-based study tracked the risk of composite coronary events in a cohort with newly diagnosed depression compared to an age- and gender-matched cohort without depression. The association between antidepressant use and risk of coronary events in individuals with depression was also investigated. MethodsIn total, 39,685 individuals (7937 with depression and 31,748 without depression) aged 20–99years selected from a random sample of 106 beneficiaries of the Taiwan National Health Insurance Program were followed up for up to 9years with a median follow-up period of 8.76years. Coronary events were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedure codes. Antidepressant use was identified using Anatomical Therapeutic Chemical classification codes. ResultsThe multivariable-adjusted hazard ratio (HR) for newly detected coronary events was 1.49 (95% confidence interval (CI)=1.29–1.74, p<0.001) for individuals with depression compared to age- and gender-matched individuals without depression. Use of selective serotonin reuptake inhibitors and tricyclic antidepressants did not significantly impact the risk of the composite coronary events among individuals with depression. ConclusionsDepression is associated with an increased risk for CHD. No evidence supporting an association between antidepressants and coronary events was found.

Association Between Statin Use and Lupus-Like Syndrome Using Spontaneous Reports

Several case reports of lupus-like syndrome suggest that statins could have triggered the development of this rare autoimmune disease. However, data on the association between statin use and lupus-like syndrome are scarce. We assessed whether there was an association between statin use and the occurrence of lupus-like syndrome. A case/noncase study based on individual case safety reports listed in the World Health Organization global individual case safety reports database (VigiBase) was conducted. According to World Health Organization adverse reaction terminology, cases were defined as reports of lupus-like syndrome. Each case was matched with 5 noncases by age, gender, and time of reporting. Use of statins was classified according to the Anatomical Therapeutic Chemical classification code system. Covariates, ie, use of corticosteroids, immunosuppressive drugs, nonsteroidal anti-inflammatory drugs, antidepressants, antiepileptics, proton pump inhibitors, and cardiovascular drugs, were determined. Multivariate logistic regression was used to calculate the reporting odds ratios with 95% confidence intervals. We identified 3362 reports of lupus-like syndrome as cases and 27,092 reports of other adverse drug reactions as noncases. Statins were more frequently reported as suspected drug in cases (3.2%) than in noncases (1.5%). After adjustment for several covariates, statins were associated with the reporting of lupus-like syndrome (reporting odds ratios 2.01; 95% confidence intervals 1.61-2.51). We found an association between reporting of statins and lupus-like syndrome. Further studies are needed to confirm this finding in more detail and establish causality.