Chronic Prescription Research Articles

Medication Adherence Assessment and Cost Analysis of COPD Treatment Under Out-Patient Clinic in Vietnam.

Chronic obstructive pulmonary disease (COPD) out-patient clinic is for stable patients but it requires patient's adherence to medicine and medical checkups. Our study aimed to assess COPD out-patient clinics management efficacy with respect to medication adherence and treatment costs at 3 out-patient clinics. Data were collected through 514 patient interviews and from medical records for statistical analysis. The most common comorbidity was hypertension (28.8%), and 52.9% of patients had experienced exacerbations in the past year requiring 75.7% of them to be hospitalized. According to the Morisky scale, 78.8% had high adherence and 82.9% were using inhaled corticosteroids regimens. The mean cost per year among different cohorts varied, with the out-patient cohort at $305.93, the acute exacerbations of COPD non-hospital cohort at $247.39, the standard admission cohort at $1275.3, and the emergency department cohort at $2132.5. Patients with low medication adherence had significantly lower annual costs ($238.25 vs $325.04, P = .001). In Vietnam, economic constraints have made Inhaled corticosteroids/ Long-acting β-2 agonists the main mode of treatment. However, the exclusion of Long-acting β-2 agonists/Long-acting anti-muscarinic antagonists drugs from health insurance coverage poses a challenge to Global Initiative for Chronic Obstructive Lung Disease-based prescription practices and increases the importance of monitoring medication adherence, particularly in patients with higher COPD Assessment Test scores.

Postpartum Care Visit Attendance Within 60Days of Delivery Among Women With and Without Opioid Use During Pregnancy: An Analysis of Commercial Insurance Data.

Postpartum care (PPC) is a key component of maternal health, particularly for people who use opioids during pregnancy. Little is known about the prevalence and correlates of PPC visit attendance among those using opioids compared with nonusers in a privately insured population. A retrospective cohort study was conducted using nationwide private insurance claims between 2011 and 2017 (N=1,291,352 women) comparing the following opioid use groups: nonusers, nonchronic prescription users, chronic prescription users, and women with opioid use disorder (OUD). Multivariable logistic and linear regressions evaluated the odds of PPC attendance and the mean time to an initial PPC visit for each user group. Stratified models identified factors associated with PPC attendance by opioid use type. Overall, 45% of the cohort attended a PPC visit and nearly 10% had any opioid use during pregnancy. More women in the three opioid use categories attended PPC than nonusers (50-56% vs. 45%). Opioid use regardless of type was associated with higher odds and earlier PPC visitation than women with no opioid use; nonchronic and chronic users had 17% and 40% greater odds of PPC than nonusers (adjusted odds ratio [aOR]: 1.17; 95% confidence interval [CI]: 1.16-1.19; aOR: 1.40, 95% CI: 1.34-1.46), whereas women with OUD had 7% higher odds (aOR: 1.07; 95% CI: 1.00-1.13). Antenatal care and psychiatric, hypertensive, and pain conditions were most strongly associated with higher odds of attending PPC; older maternal age was negatively associated with PPC. Stratified analysis showed opioid correlates varied similarly across user groups. PPC use was generally low in this study cohort of privately insured women. Women who used opioids and those with chronic conditions had greater odds of attending PPC. Improved efforts are needed to engage people in PPC, as well as service integration and coordination for people who use opioids during pregnancy.

Evaluating COVID-19's Impact on Patient Access to Care in the Community Pharmacy Setting.

Introduction: Community pharmacies across the country have been adapting the ways their patients receive medications and prescription information during the COVID-19 pandemic. In order to reduce the risk of COVID-19 infection, the CDC encouraged patients to use pharmacy drive-throughs, curbside pickup, or home delivery services to obtain medications. This research study is one of the first studies to analyze how patients utilize and access Medication Management Services (MMS) in the community pharmacy setting during the COVID-19 pandemic. Objective: To evaluate changes to patients' utilization of Medication Management Services in the community pharmacy setting during the COVID-19 pandemic. Methods: Eligible patients included persons 18 years old and older, and currently taking at least (1) chronic prescription medication in the last three months. Pharmacists were excluded from the study. Telephonic or video interviews were conducted with patients from community pharmacy settings. Descriptive statistics were used to summarize patient characteristics and responses to select interview questions. A qualitative thematic analysis was conducted with data collected from open-ended interview questions. Results: Thirty-five patients participated in interviews. Patients reported increased use of telehealth and technology, increases in quantity or days supply of medications, initiation of mail delivery services, and curbside pick-up. Five (14.3%) patients used telehealth or increased their technology usage due to the pandemic. Seven (20%) patients reported they were more proactive in refilling their medications. Eleven (31.4%) patients indicated they were currently using a prescription delivery service and were likely to continue the service. On the contrary, five (14.3%) patients experienced decreased healthcare professional interactions, while 3 (8.6%) patients encountered slowed pharmacy processing and 2 (5.7%) faced technology barriers. However, 58% of patients reported no changes to the way they utilized MMS during COVID-19. Conclusion: Like many other healthcare providers, the COVID-19 pandemic caused a shift in how community pharmacies care for the patients they serve. This study identified various changes in how the pandemic impacted the way patients accessed and utilized community pharmacy services. These findings can serve to inform community pharmacies on how to best serve their patients during this and future pandemic.

Chronic and Sustained High-Dose Opioid Use in an Integrated Health System

The Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain released in 2016 had led to decreases in opioid prescribing. This study sought to examine chronic and sustained high-dose prescription opioid use in an integrated health system. A serial cross-sectional study was conducted in 2021 to estimate the annual age-adjusted prevalence and incidence of chronic and high-dose opioid use among demographically diverse noncancer adults in an integrated health system in Southern California during 2013-2020. Interrupted time-series analysis with segmented regression was conducted to estimate changes in the trends in annual rates before (2013-2015) and after (2017-2020) the 2016 guideline, treating 2016 as a wash-out period. Prevalence and incidence of chronic use and sustained high-dose use had started to decrease after a health system intervention program before the 2016 Centers for Disease Control and Prevention guideline release and continued to decline after the guideline. Among those with sustained high-dose use, there was a substantial decrease in persons with an average daily dosage ≥90 morphine milligram equivalent and concurrent benzodiazepine use. An accelerated decrease in prevalent chronic use after the guideline was observed (slope change: -11.1 [95% CI= -20.3, -1.9] users/10,000 person-years, p=0.03). The incidence of chronic use and sustained high-dose use continued to decrease after the guideline release but at a slower pace. Implementing evidence-based prescribing guidelines was associated with a decrease in chronic and sustained high-dose prescription opioid use.

Abstract 13240: The Relationship Between History of Valve Surgery and Heart Failure Event in Japanese Atrial Fibrillation Patients: The Fushimi Af Registry

Background: We previously reported that valvular heart disease (VHD) was associated with an increased risk of hospitalization for heart failure (HF) in Japanese atrial fibrillation (AF) patients. However, the association of history of surgery for VHD with HF hospitalization remains unknown. Method: The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, which is a typical urban district of Japan. We started to enroll patients from March 2011, and follow-up data were available for 4,489 patients by the end of July 2021. In the entire cohort, 747 patients had VHD. We divided them to surgery group (n=182) and non-surgery group (n=565). We compared clinical characteristics and incidence rates of HF hospitalization between two groups. Result: Patients who received valve surgery were younger (72.0 years vs. 78.0 years, p<0.001), had lower systolic blood pressure (118 mmHg vs. 123 mmHg, p=0.02) and pulse rate (75.5 bpm vs. 79.1 bpm, p=0.003), more often paroxysmal type (46.7% vs. 31.0%, p<0.001), less likely to have hypertension (51.1% vs. 66.2%, p<0.001) and had lower CHADS2 score (2.09 vs. 2.55, p<0.001) than non-surgery group. Body weight, sex, prior HF, chronic kidney disease and prescription data were comparable between two groups. During the median follow-up of 1,679 days, the incidence rate of HF hospitalization was lower in surgery group than non-surgery group (2.58% vs. 4.43% per person-year, respectively, log rank p=0.001). On multivariate Cox regression analysis, history of surgery was not significantly associated with a lower risk of HF hospitalization (adjusted hazard ratio 0.76; 95% confidence interval 0.52-1.12, p=0.16). Conclusion: The incidence rate of HF hospitalization was lower in patients with valve surgery than non-surgery group. However, history of valve surgery was not independently associated with a lower risk of HF hospitalization in Japanese AF patients.

Characterizing OPRM1 DNA methylation in prescription opioid users with chronic musculoskeletal pain.

Many patients with chronic pain use prescription opioids. Epigenetic modification of the μ-opioid receptor 1 (OPRM1) gene, which codes for the target protein of opioids, may influence vulnerability to opioid abuse and response to opioid pharmacotherapy, potentially affecting pain outcomes. Our objective was to investigate associations of clinical and sociodemographic factors with OPRM1 DNA methylation in patients with chronic musculoskeletal pain on long-term prescription opioids. Sociodemographic variables, survey data (Rapid Estimate of Adult Health Literacy in Medicine-Short Form, Functional Comorbidity Index [FCI], PROMIS 43v2.1 Profile, Opioid Risk Tool, and PROMIS Prescription Pain Medication Misuse), and saliva samples were collected. The genomic DNA extracted from saliva samples were bisulfite converted, amplified by polymerase chain reaction, and processed for OPRM1-targeted DNA methylation analysis on a Pyrosequencing instrument (Qiagen Inc, Valencia, CA). General linear models were used to examine the relationships between the predictors and OPRM1 DNA methylation. Data from 112 patients were analyzed. The best-fitted multivariable model indicated, compared with their counterparts, patients with > eighth grade reading level, degenerative disk disease, substance abuse comorbidity, and opioid use < 1 year (compared with >5 years), had average methylation levels that were 7.7% (95% confidence interval [CI] 0.95%, 14.4%), 11.7% (95% CI 2.7%, 21.1%), 21.7% (95% CI 10.7%, 32.5%), and 16.1% (95% CI 3.3%, 28.8%) higher than the reference groups, respectively. Methylation levels were 2.2% (95% CI 0.64%, 3.7%) lower for every 1 unit increase in FCI and greater by 0.45% (95% CI 0.08%, 0.82%) for every fatigue T score unit increase. OPRM1 methylation levels varied by several patient factors. Further studies are warranted to replicate these findings and determine potential clinical utility.

Social Needs Are Associated With Greater Anticipated Needs During an Emergency and Desire for Help in Emergency Preparedness Planning.

Most emergency preparedness planning seeks to identify vulnerable population subgroups; however, focusing on chronic conditions alone may ignore other important characteristics such as location and poverty. Social needs were examined as correlates of anticipated needs and desire for assistance during an emergency. A retrospective, secondary analysis was conducted using assessments of 8280 adult Medicaid beneficiaries in Louisiana, linked with medical (n = 7936) and pharmacy claims (n = 7473). The sample was 73% female; 47% Black; 34% White; mean age 41 y. Many had at least 1 chronic condition (75.9%), prescription (90.3%), and social need (45.2%). Across assessments, many reported food (40%), housing (34%), and transportation (33%) needs. However, far more people anticipated social needs during an emergency than in the next month. Having social needs increased the odds of anticipating any need (odds ratio [OR] = 1.5, 1.44-1.56) and desire for assistance during an emergency, even after controlling for significant covariates including older age, race, geographic region, Medicaid plan type, and prescriptions. Chronic conditions were significantly correlated with all anticipated needs in bivariate analyses, but only modestly associated (OR = 1.03, 1.01-1.06) with anticipated medication needs in multivariable analyses. Identifying individuals with social needs, independent of their chronic disease status, will benefit emergency preparedness outreach efforts.

Evaluation of a non-pharmacological interdisciplinary pain rehabilitation and functional restoration program for chronic pain in veterans.

To conduct a quality improvement evaluation of the Empower Veterans Program (EVP), an interdisciplinary pain rehabilitation/functional restoration program option for functional restoration for high-impact chronic pain, offered in a large metro-area Veterans Health Administration (VHA) system. VHA Corporate Data Warehouse electronic medical record data for patients treated by EVP between 2015 and 2019. This retrospective design first compared EVP patients considered engaged or not engaged in completing treatment in terms of demographic characteristics and post-treatment changes in clinical measures related to opioid use and mental health. We then compared mortality risk between matched groups of treated and untreated patients with chronic pain and concurrent opioid prescriptions using propensity score matching and Cox proportional hazards methods. "Treated" in the matched groups was defined as any level of EVP participation (i.e., both engaged and not engaged). We first identified 1053 EVP patients with 1year of pre-and post-treatment follow-time and determined their engagement level. From those with chronic pain and prescription opioids, we matched 237 EVP patients to 375 untreated patients. Engaged patients (57.4% of treated patients), were somewhat older than the non-engaged (mean age 57.1 vs. 53.7, Cohen's D=0.30), and achieved lower mean PHQ9 depression scores in the post-treatment year (9.2 vs. 10.6, Cohen's D=0.20). Participation in EVP was associated with a 65% lower mortality risk among Veterans with chronic pain and opioid use when compared to the untreated patients: (HR: 0.35, 95% CI: 0.17, 0.75). EVP was associated with a large reduction in mortality risk for Veterans with both chronic pain and opioid use. This result could inform the decision process in a VA station or region when considering providing or expanding access to an interdisciplinary rehabilitation/functional restoration program for chronic pain.

Application of a person-centered prescription model improves pharmacotherapeutic indicators and reduces costs associated with pharmacological treatment in hospitalized older patients at the end of life.

ObjectiveThis study sought to investigate whether applying an adapted person-centered prescription (PCP) model reduces the total regular medications in older people admitted in a subacute hospital at the end of life (EOL), improving pharmacotherapeutic indicators and reducing the expense associated with pharmacological treatment.DesignRandomized controlled trial. The trial was registered with ClinicalTrials.gov (NCT05454644).SettingA subacute hospital in Basque Country, Spain.SubjectsAdults ≥65 years (n = 114) who were admitted to a geriatric convalescence unit and required palliative care.InterventionThe adapted PCP model consisted of a systematic four-step process conducted by geriatricians and clinical pharmacists. Relative to the original model, this adapted model entails a protocol for the tools and assessments to be conducted on people identified as being at the EOL.MeasurementsAfter applying the adapted PCP model, the mean change in the number of regular drugs, STOPPFrail (Screening Tool of Older Persons' Prescriptions in Frail adults with limited life expectancy) criteria, drug burden index (DBI), drug–drug interactions, medication regimen complexity index (MRCI) and 28-days medication cost of chronic prescriptions between admission and discharge was analyzed. All patients were followed for 3 months after hospital discharge to measure the intervention's effectiveness over time on pharmacotherapeutic variables and the cost of chronic medical prescriptions.ResultsThe number of regular prescribed medications at baseline was 9.0 ± 3.2 in the intervention group and 8.2 ± 3.5 in the control group. The mean change in the number of regular prescriptions at discharge was −1.74 in the intervention group and −0.07 in the control group (mean difference = 1.67 ± 0.57; p = 0.007). Applying a PCP model reduced all measured criteria compared with pre-admission (p < 0.05). At discharge, the mean change in 28-days medication cost was significantly lower in the intervention group compared with the control group (−34.91€ vs. −0.36€; p < 0.004).ConclusionApplying a PCP model improves pharmacotherapeutic indicators and reduces the costs associated with pharmacological treatment in hospitalized geriatric patients at the EOL, continuing for 3 months after hospital discharge. Future studies must investigate continuity in the transition between hospital care and primary care so that these new care models are offered transversally and not in isolation.

Effects of Opioid Prescribing Cap Laws on Opioid and Other Pain Treatments Among Persons with Chronic Pain.

Many states have adopted laws that limit the amount or duration of opioid prescriptions. These limits often focus on prescriptions for acute pain, but there may be unintended consequences for those diagnosed with chronic pain, including reduced opioid prescribing without substitution of appropriate non-opioid treatments. To evaluate the effects of state opioid prescribing cap laws on opioid and non-opioid treatment among those diagnosed with chronic pain. We used a difference-in-differences approach that accounts for staggered policy adoption. Treated states included 32 states that implemented a prescribing cap law between 2017 and 2019. A total of 480,856 adults in the USA who were continuously enrolled in medical and pharmacy coverage from 2013 to 2019 and diagnosed with a chronic pain condition between 2013 and 2016. Among individuals with chronic pain in each state: proportion with at least one opioid prescription and with prescriptions of a specific duration or dose, average number of opioid prescriptions, average opioid prescription duration and dose, proportion with at least one non-opioid chronic pain prescription, average number of such prescriptions, proportion with at least one chronic pain procedure, and average number of such procedures. State laws limiting opioid prescriptions were not associated with changes in opioid prescribing, non-opioid medication prescribing, or non-opioid chronic pain procedures among patients with chronic pain diagnoses. These findings do not support an association between state opioid prescribing cap laws and changes in the treatment of chronic non-cancer pain.

Multimorbidity and chronic co-prescription networks and potential interactions in adult patients with epilepsy: MorbiNet study.

We constructed epilepsy multimorbidity networks to study associations with chronic conditions, and co-prescriptions and drug-disease networks to assess potential interactions.We conducted a population-based study in Catalonia, Spain, with electronic files of 3,135,948 adult patients with multimorbidity, 32,625 of them with epilepsy (active diagnosis any time during 2006-2017). We constructed epilepsy comorbidity networks using logistic regression models from odds ratio estimates adjusted by age, sex, and comorbidities with R software and generated trajectories to study the progression of epilepsy. We constructed drug-disease and co-prescription networks using mixed models with repeated measures adjusting by age, sex, and period with chronic prescription invoiced data.Comorbidity more frequently preceding epilepsy included cerebrovascular accident (OR: 3.59), congenital anomalies (2.18), and multiple sclerosis (1.33); and following epilepsy: dementia (1.91), personality disorder (1.59), alcohol abuse (1.22), and Parkinson (1.21). Mental retardation (13.08), neurological cancer (8.49), benign neoplasm (4.69), infections (3.14), and psychosis (1.58) might precede or not epilepsy. A common progression was to schizophrenia, dementia, and other neurological diseases (mainly cerebral palsy and other degenerative diseases of nervous system).Co-prescription associations with major-moderate potential interactions were 54% for carbamazepine, 61% phenytoin, 53% phenobarbital, and 32% valproate. Major potential interactions were with antipsychotic, anxiolytic, opioid, cardiovascular, and other anti-seizure medications (ASMs).The most frequent comorbidities of epilepsy were congenital, cerebrovascular, and neurological and psychiatric conditions. High comorbidity and co-prescription with potential interactions can increase the complexity of care of patients with epilepsy.

Medications for Chronic Conditions and Mortality in Older Adults.

With the population aging, examining the relationship between polypharmacy and mortality based on population data sources is important for clinical management and policy direction. This study aimed to examine the association between the number of chronic medications and the risk of mortality in older adults. This population-based retrospective cohort study used data from the National Health Insurance Research Database in Taiwan for information regarding chronic medication use (over 4 years) in older adults aged 65 years and older. The association between medication use and mortality numbers was analyzed using Cox proportional hazards regression models adjusted for demographic variables and comorbidity. The number of medications was significantly associated with high mortality risk. Within polypharmacy, being 65-74 years old, male, living in northern Taiwan, having one type of comorbid disease, and receiving <84 days of refillable chronic prescription were associated with greater mortality risk. Subgroup analyses' results regarding comorbidity showed significant positive associations between the number of medications and mortality in most comorbid diseases except for mental disorders and diseases of the skin and subcutaneous tissue. General practitioners should know that chronic polypharmacy is associated with increased mortality risk. Recognizing the possible adverse effects of multiple medication use could help physicians optimize drug regimens in the future.

From ‘pain management’ to ‘integrated health clinic’: a quality improvement project to transition patients on chronic opioid therapy to more evidence-based therapies for chronic pain

BackgroundThe State of New York, along with the whole nation, is struggling to combat the opioid epidemic. Major authoritative bodies on chronic pain and addiction have advocated against the use...

Chronic Prescription Medication Is Associated With A History Of Exercise Associated Muscle Cramps In Runners

INTRODUCTION: The prevalence of chronic prescription medication (CPM) use in recreational distance runners is 12.5%. CPM use in endurance athletes is associated with a history of exercise associated muscle cramps (hEAMC), but which main categories of CPM are associated with hEAMC has not been explored. PURPOSE: To determine the association between the use of main categories of CPM and a hEAMC. METHODS: 76654 consenting entrants (71.8% of all entrants) in two annual races (21.1 km & 56 km) were studied from 2012-2015. CPM use and type of medication in 8 main categories were self-reported as part of an online pre-race medical screening questionnaire at race entry. Entrants reported demographics (age, sex, and race distance), CPM use in 8 categories (blood pressure-lowering, asthma, cholesterol-lowering, anxiety/depression, allergy, any diabetes, any heart, other medication) and hEAMC. The prevalence (%; 95%CI) and prevalence ratio’s (PR; 95%CI) of main categories of CPM use in runners with (E group) and without hEAMC (C group) are reported, using a multinominal logistic regression model (adjusted for age, gender, and race distance). RESULTS: CPM use was significantly higher in the E vs. C group for main categories of medication use (prevalence in %; PR in decreasing order; 95%CIs): allergy (E: 1.5; 1.2-1.8 vs C: 0.8; 0.7-0.9, PR = 2.1; 1.7-2.6; p < 0.0001); asthma (E: 3.9; 3.5-4.3 vs C: 2.4; 2.3-2.5, PR = 1.8; 1.6-2.0; p < 0.0001); anxiety/depression (E: 3.0; 2.6-3.4 vs C: 2.1; 2.0-2.2, PR = 1.6; 1.4-1.8; p < 0.0001); any diabetes (E: 0.9; 0.7-1.1 vs C: 0.6; 0.6-0.7, PR = 1.5; 1.2-2.0; p < 0.01); blood pressure-lowering (E: 3.8;3.4-4.2 vs C: 3.0;2.8-3.2, PR = 1.4;1.3-1.6; p < 0.0001); cholesterol-lowering (E: 3.6; 3.2-4.0 vs C: 2.9; 2.7-3.0, PR = 1.4; 1.2-1.6; p < 0.0001). CONCLUSIONS: CPM use is associated with hEAMC in endurance athletes and may contribute to EAMC. Specific main categories of medication associated with >1.5X risk of hEAMC are allergy medication, asthma medication, medication to treat anxiety/depression, and any diabetes medication.

Long-Term Prescription Opioid Use After Injury in Washington State 2015–2018

BackgroundPatients with injury may be at high risk of long-term opioid use due to the specific features of injury (e.g., injury severity), as well as patient, treatment, and provider characteristics that may influence their injury-related pain management. ObjectivesInform prescribing practices and identify high-risk populations through studying chronic prescription opioid use in the trauma population. MethodsUsing the Washington State All-Payer Claims Database (WA-APCD) data, we included adults aged 18–65 years with an incident injury from October 1, 2015–December 31, 2017. We compared patient, injury, treatment, and provider characteristics by whether or not the patients had long-term (≥ 90 days continuous prescription opioid use), or no opioid use after injury. ResultsWe identified 191,130 patients who met eligibility criteria and were included in our cohort; 5822 met criteria for long-term use. Most had minor injuries, with a median Injury Severity Score = 1, with no difference between groups. Almost all patients with long-term opioid use had filled an opioid prescription in the year prior to their injury (95.3%), vs. 31.3% in the no-use group (p < 0.001). Comorbidities associated with chronic pain, mental health, and substance use conditions were more common in the long-term than the no-use group. ConclusionAcross this large cohort of multiple, mostly minor, injury types, long-term opioid use was relatively uncommon, but almost all patients with chronic use post injury had preinjury opioid use. Long-term opioid use after injury may be more closely tied to preinjury chronic pain and pain management than acute care pain management.

Electronic health record data use in the assessment of quality indicators for glucocorticoid osteoporosis screening in systemic lupus erythematosus.

To determine whether electronic health record (EHR) data components could be identified and used to assess bone health quality indicators in patients with systemic lupus erythematosus as a foundation for population health management. We identified patients in our EHR system who had diagnosis codes for lupus from 2012 to 2017 and characterized them based on the frequency and dosage of prescribed glucocorticoid medications. The medical records of patients who received repeated high-dose glucocorticoid orders were further reviewed for osteoporosis, osteoporotic fractures, receipt of appropriate preventive screening, and orders for protective medications based on established quality indicators. Descriptive statistics were calculated to summarize results. We identified 617 patients with a lupus diagnosis; 414 received glucocorticoid prescriptions, 189 received chronic, high-dose; and 83 received chronic, low-dose prescription orders. Of those with chronic high-dose glucocorticoid prescriptions, 14% had an osteoporosis diagnosis, 3% had an osteoporotic fracture, 51% received a prescription for calcium/vitamin D, 43% had bone mineral density screening orders, 20% received a spine radiograph order, 29% had a documented T-score, 12% received a prescription for osteoporosis medication, and 6% had a documented osteoporosis screening. We were able to identify data elements in the EHR for all nine components of the osteoporosis management quality indicator. It is possible to identify data in the EHR for all attributes of the quality indicator for osteoporosis in lupus patients who receive chronic high-dose glucocorticoids. However, missing data and need to extract data from text-based notes may make development of population management tools challenging.

Factors Associated with the Usage of Pharmacy Value-Added Services at Public Health Clinics in the State of Perlis, Malaysia

Pharmacy value-added services were developed to make it easier for patients to refill their chronic prescriptions in public health facilities in Malaysia. However, little is known about patients’ awareness, attitudes and practice towards pharmacy value-added services provided by health clinics. This study was conducted to investigate factors associated with the usage of pharmacy value-added services at public health clinics in Perlis, Malaysia. A cross-sectional study was conducted from January to March 2021 at the pharmacy waiting area of all public health clinics in Perlis. All patients (≥18 years old) taking chronic medications and with the need to follow-up at the health clinic in Perlis were recruited in this study using quota sampling. Data was collected using a validated self-administered questionnaire. Descriptive analyses on the usage, awareness and attitudes of respondents were performed, followed by multiple logistic regression. A total of 582 patients responded to this study (response rate, 97.0%). Only 12.9% of respondents used pharmacy value-added services offered by health clinics. Age, gender, ethnicity, education level, occupation, monthly household income, length of stay in Perlis, distance from home to the clinic, total awareness and attitudes scores were factors significantly associated with the practice of pharmacy value-added services after adjusting for other variables (p&lt;0.05). In conclusion, the proportion of patients using pharmacy value-added services at health clinics in Perlis is still low. The study’s findings suggest that a more extensive promotion of pharmacy value-added services is needed to ensure more patients could benefit from these services.

Opioid and Alcohol Misuse in Veterans with Chronic Pain: A Risk Screening Study

In United States military veterans, chronic pain represents a risk factor for opioid and alcohol misuse, yet few studies have examined interactions among chronic pain, opioid prescription, and opioid and alcohol misuse. Previous work found substantial risk of co-morbid alcohol and opioid misuse in a community sample of opioid-prescribed individuals with chronic pain, a finding expanded upon here. Specifically, 211 veterans assessed within a chronic pain treatment service for opioid-prescribed individuals completed self-report measures of opioid misuse, alcohol misuse, pain intensity, depression, pain catastrophizing, and post-traumatic stress symptoms (PTS). Based on the substance misuse measures, 32% (n = 68) were misusing neither opioids nor alcohol, 23% (n = 48) were misusing both opioids and alcohol, 40% (n = 84) were misusing opioids alone, and 5% (n = 11) were misusing alcohol alone. Group comparisons indicated that individuals not misusing either substance were less distressed in comparison to those who were misusing opioids alone or both substances. The latter groups differed in PTS. Overall, misuse frequencies mirrored previous work, with approximately 1 of 3 misusing opioids and approximately 1 of 5 misusing both substances. There is a need for increased focus on both polysubstance misuse and the development of integrated treatment. PerspectiveOpioid and alcohol misuse was examined in 211 Veterans prescribed opioids for chronic pain. In total, 32% were not misusing either, 23% were misusing both, 40% were misusing opioids, and 5% were misusing alcohol. Veterans not misusing either were generally less disabled and distressed compared to those misusing opioids or both.

The Role of Informatics in Implementing Guidelines for Chronic Opioid Therapy Risk Assessment in Primary Care: A Narrative Review Informed by the Socio-Technical Model.

Approximately 2 million Americans live with opioid use disorder (OUD), most of whom also have chronic pain. The economic burden of chronic pain and prescription opioid misuse runs into billions of dollars. Patients on prescription opioids for chronic non-cancer pain (CNCP) are at increased risk for OUD and overdose. By adhering to the Center for Disease Control and Prevention (CDC) opioid prescribing guidelines, primary care providers (PCPs) have the potential to improve patient outcomes. But numerous provider, patient, and practice-specific factors challenge adherence to guidelines in primary care. Many of the barriers may be mediated by informatics interventions, but gaps in knowledge and unmet needs exist. This narrative review examines the risk assessment and harm reduction process in a socio-technical context to highlight the gaps in knowledge and unmet needs that can be mediated through informatics intervention.

COMPARISON BETWEEN FIRST AND SECOND/THIRD WAVE OF SARS-COV-2 MODERATE TO SEVERE INFECTION IN ELDERLY PATIENTS IN AN NORTH ITALIAN HOSPITAL SETTING

Objective: Worldwide spread of SARS-CoV-2 caused a pandemic as never were seen in the last fifty years and represented a major clinical problem in Lombardy, one of the most affected Italian Regions, in terms of death toll and long-term sequelae. This is particularly true when elder people are considered; therefore, we conducted a retrospective cohort study in the General Medicine of our Hospital. Design and method: In the present study we recorded data of patients older than 65 years, admitted to a COVID-19 unit during 2020 and 2021; we compared the characteristics of in-patients admitted in the first (March-May 2020) and the second/third pandemic waves (October 2020-May 2021) Results: A total of 407 patients 65 year-old and older were included, 185 during the first wave and 222 during second/third waves; 63 (34%) of them died during the first and 36 (16%) during the second/third wave. No significant differences were found according to main comorbidities and chronic prescriptions between the two groups of patients, whereas those admitted during the second/third wave were slightly older. Number of in-hospital adverse events were similar in the two samples. Main differences between the two groups were: a lower mean number of days with symptoms before hospitalization, and a less severe laboratory, respiratory ed radiologic profile. Further, steroid treatment was highly implemented during the second/third wave. Conclusions: Older patients admitted to hospital since the beginning of the pandemic showed diverse clinical severity profile according to different waves; patient admitted during the first wave had worse respiratory, radiological and laboratory parameters than those admitted in the second/third wave; further difference was found in COVID-19 treatment during hospital stay as steroids were largely administered during the latter waves