Date Of Receipt Research Articles

Healthcare utilization and costs in patients beginning pharmacotherapy for generalized anxiety disorder: a retrospective cohort study

BackgroundPatterns of healthcare utilization and costs in patients beginning pharmacotherapy for generalized anxiety disorder (GAD) have not been well characterized.MethodsUsing a large US health insurance database, we identified all patients with evidence of GAD (ICD-9-CM diagnosis code 300.02) who initiated pharmacotherapy with medications commonly used to treat GAD (eg, selective serotonin reuptake inhibitors [SSRIs], venlafaxine, benzodiazepines) between 1/1/2003 and 12/31/2007. We examined healthcare utilization and costs over the 12-month periods preceding and following date of initial receipt of such therapy ("pretreatment" and "follow-up", respectively). Patients with incomplete data were excluded.ResultsA total of 10,275 patients met all study inclusion criteria. Forty-eight percent of patients received SSRIs; 34%, benzodiazepines; and 6%, venlafaxine. SSRIs and venlafaxine were about three times more likely to be used on a long-term basis (> 90 days) than benzodiazepines (p < 0.01). In general, levels of healthcare utilization were higher during follow-up than pretreatment. Mean (SD) total healthcare costs increased from $4812 ($10,006) during pretreatment to $7182 ($22,041) during follow-up (p < 0.01); costs of GAD-related pharmacotherapy during follow-up were $420 ($485).ConclusionsMore than one-half of patients initiating pharmacotherapy for GAD receive either SSRIs or venlafaxine. Levels of healthcare utilization and costs are greater in the year following initiation of therapy than in the immediately preceding one.

Duration of Unrelated Donor Search for Hematopoietic Stem Cell Transplantation

Abstract 2046▪▪This icon denotes a clinically relevant abstract Objective:Donor search is a major challenge once the indication for allogeneic hematopoietic stem cell transplantation (HCT) has been established. For those patients who lack an HLA-identical sibling, unrelated donor search (UDS) needs to be initiated. Only if UDS is not successful, alternative stem cell sources like cord blood (CB) or alternative concepts like haploidentical HCT have to be considered. Since UDS is a time consuming process it is important to assess the probability to find a matched unrelated donor (UD) during prolonged UDS. Yet, very few data on the required times and the success rates of unrelated donor searches are available. Furthermore, information on the probability to find a donor within short time is crucial in the context of early allogeneic transplantation including HCT in aplasia after induction chemotherapy in AML or for the interpretation and planning of clinical trials employing donor versus no donor comparisons. Therefore, we have retrospectively analyzed the duration of UDS for a large cohort of patients. Methods:All unrelated donor searches of one large search unit, which were initiated between January 2004 and July 2010 were analyzed retrospectively. Throughout that period blood from all donor-recipient pairs has been typed for HLA-A, -B, -C, -DRB1 and –DQB1 at the allele level (4 digits). A full match was defined by HLA-identity for HLA-A, -B, -C and DRB1 (8/8), while a partial match was defined as a single mismatch in the HLA-A, -B, -C or DRB1 locus without additional DQB1 mismatch (9/10). The duration of UDS was calculated from the date of data entry to the date of receipt of confirmatory typing (CT) of the first 8/8 HLA-matched donor or the first 9/10 HLA-matched donor. When given as reasons for the termination of the search, poor clinical condition or death of a patient were considered as competing events. Unsuccessful searches were censored at the day of the receipt of the last typing request or when UDS was stopped for other reasons. Cumulative incidences of successful UDS were calculated with competing event statistics. Approximative 95% confidence intervals are provided for point estimates. Results:In the respective time period 852 UDS comprising 8477 donor requests were performed. In the Caucasian population, an HLA compatible UD (8/8) has been found for 29% (95% CI, 26% to 32%) of the patients within two weeks, 54% (95% CI, 51% to 58%) of patients within 4 weeks, and 61% (95% CI, 57% to 64%) of patients within 6 weeks (Figure 1). In high risk diseases and high urgent indications for allogeneic transplantation one antigen or allele mismatch may be acceptable. Therefore, we calculated the probabilities to find an HLA matched UD (8/8) or a partially matched UD (9/10) within defined times. The resulting probabilities of finding an acceptable donor who met these criteria for Caucasian patients were 35% (95% CI, 32% to 39%), 66% (95% CI, 63% to 70%) and 75% (95% CI, 72% to 78%) at two, four, and six weeks respectively. After six weeks of UDS the probability of finding a donor declined. Between the six week landmark and the 12 week landmark 8/8 HLA matched unrelated donors have been identified only for additional 4% of the patients. Extending UDS up to one year resulted in additional 3% HLA matched donors (8/8). The incidence of the competing events (death or deteriorated condition of the patient) was 10% (95% CI, 6.6% to 13.8%) at one year when the aim was to find an 8/8 HLA matched UD. Eight UDS (1%) were started for non-Caucasian patients. Only for one of the eight non-Caucasian patients an HLA-compatible donor (8/8) was found. Conclusions:For Caucasian patients HLA compatible UDs (8/8) can be identified in our population for 61% of the patients within six weeks. If donors with one mismatch (9/10) are accepted the probability increases to 75% at that time. Beyond that landmark, the probability of finding donors for the remaining patients declines steeply and alternatives like haploidentical or cord blood transplantation should be considered. Since an HLA matched donor can be identified for 29% of the patients within two weeks, UDS is a valid option even for very high urgent searches like in the context of allogeneic HCT in aplasia. Unrelated donor searches for patients with non-Caucasian ancestry are much less successful. Further analyses are planned in order to define the probability to find a donor related to the haplotype frequency of the patient. [Display omitted] Disclosures:Off Label Use: pentostatin is not licensed for use in acute GvHD.

Health Care Utilization and Costs in Patients with Generalized Anxiety Disorder Initiating Add-on Therapy with Benzodiazepines

ObjectivesTo examine patterns of health care utilization and costs in patients with generalized anxiety disorder (GAD) who begin treatment with benzodiazepine anxiolytics as add-on therapy. Study DesignIn a large US health insurance database, we identified all patients with evidence of GAD (International Classification of Diseases, 9th Revision, Clinical Modification diagnosis code 300.02) who received ≥90 days of therapy with a selective serotonin reuptake inhibitor or venlafaxine between January 1, 2003 and December 31, 2007. Among these patients, we selected those who initiated a course of benzodiazepine add-on therapy. Designating the date of initial receipt of a benzodiazepine as the “index date,” we examined health care utilization and costs over the 6-month period preceding this date (“pre-index”) and the 12-month period following it (“follow-up”). ResultsA total of 2131 patients met all study inclusion criteria. Patients averaged 32 days of therapy with benzodiazepines (median [interquartile range] = 20 [10-30]); 13% of patients received >90 days of therapy, however. In general, levels of health care utilization during the first 6 months of follow-up were higher than those during the pre-index period; between months 7 and 12 of follow-up, however, they were somewhat lower than pre-index levels. Mean (SD) total health care costs were $5148 ($10,658), $6325 ($15,741), and $5373 ($11,230) during pre-index, months 1-6 of follow-up, and months 7-12 of follow-up, respectively. ConclusionsLevels of health care utilization and costs increase following initiation of add-on therapy with a benzodiazepine in patients with GAD receiving selective serotonin reuptake inhibitors or venlafaxine. Although duration of add-on therapy is typically brief, some patients are treated for >90 days, raising potential concerns about risks of dependency and sedation.

Benchmarking of oncology clinical trial metrics across AACI member centers.

e16613 Background: Benchmarking through the utilization of standardized metrics is critical to understanding baseline performance, capturing best practices, and identifying systemic barriers across institutions. We apply this principle to analyze the approval times of oncology clinical trials (CT) in cancer centers within the Association of American Cancer Institutes (AACI). Methods: A 36-item survey was developed based upon study demographic and timing data for specific CT development milestones. 40 AACI member centers were invited to share data on all oncology therapeutic trials submitted for development between 1/2008 and 1/2009. Results were analyzed for data integrity, variation across institutions, and overall portfolio composition. Results: 35% centers participated in submitting a total of 1,161 studies. No study had complete timing data in the survey. Missing data for various data elements ranged from 20% for first receipt date to over 75% for elements involved with contract negotiations. The predominate type of trials were Industry (44%), Cooperative Group (36%), and Investigator initiated (13%). Development time from first submission to CT activation was 185 days; time to first patient enrollment was 66 days. Contract negotiation required the greatest amount of time compared to the other categories (Mann-Whitney: p<0.001). Conclusions: This study highlights the findings that opening of an oncology CT is a long process, highly variable, and inconsistently captured. Additionally this research identifies the need for a standardized methodology to capture metrics across groups of cancer centers. Industry Cooperative group Investigator initiated Consortium Other Total n mdn (IQR) n mdn (IQR) n mdn (IQR) n mdn (IQR) n mdn (IQR) n mdn (IQR) Scientific review 321 25 (12-50) 182 7 (1-15) 96 52 (16-80) 8 33 (27-56) 39 27 (9-79) 646 19 (7-44) Institutional Review Board 350 35 (21-59) 231 36 (18-57) 112 42 (27-73) 9 15 (8-46) 37 48 (40-61) 739 37 (21-59) Contracts 195 75 (39- 151) 3 61 (1-210) 23 84 (42-131) – – 19 181 (131-207) 240 76 (35-152) Total development time 283 214 (153-304) 210 120 (64-198) 76 239 (153-343) 8 112 (82-184) 31 287 (107-313) 608 185 (109-300) Time to 1st patient 97 57 (22 - 117) 68 78 (23-213) 32 65 (43-139) – – 2 183 199 66 (24-146)

Troublesome Tidings? Investors’ Response to a Wells Notice

Scant evidence has amassed about how a Wells notice might affect stock prices. We find that prices fall significantly in the three days around a first-time Wells disclosure and, for disclosures that involve subsequent timely litigation, stock prices drop more sharply, by more than three percent. For companies that report the receipt date of a Wells notice, we observe no market reaction on that date but, rather, a negative reaction 2-4 days after receipt date, especially for disclosures made in a later 10-Q or 10-K. These results suggest that prior studies of market reaction to SEC or shareholder litigation events may have understated investors’ response. Consistent with investors’ negative response to a Wells notice, we further find a significant shift from insider buying to selling up to four weeks before disclosure, although this tracks best with stock return in the same period. From the standpoint of disclosure policy, our results imply that investors consider a Wells disclosure as a material event.

Propulsion System of Jet-Flapped Subsonic Civil Transport Aircraft Design

DESIGN FORUM papers range from design case studies to presentations of new methodologies to speculations about emerging design trends. They vary from 2500 to 12,000 words (where a figure or table counts as 200 words). Following informal review by the Editors, they may be published within a few months of the date of receipt. Style requirements are the same as for regular contributions (see inside back cover).

Healthcare costs in postmenopausal women with hormone-positive metastatic breast cancer

Objectives:This study examines costs for postmenopausal women with hormone receptor positive (HR+) metastatic breast cancer (mBC).Methods:Data were obtained from the IHCIS National Managed Care Benchmark Database from 1/1/2001 to 6/30/2006. Women aged 55–63 years were selected for the study if they met the inclusion criteria, including diagnoses for breast cancer and metastases, and at least two fills for a hormone medication. Patients were followed from the onset of metastases until the earliest date of disenrollment from the health plan or 6/30/2006. Patient characteristics were examined at time of initial diagnoses of metastases, while costs were examined post-diagnosis of metastases and prior to receipt of chemotherapy (pre-chemotherapy initiation period) and from the date of initial receipt of chemotherapy until end of data collection (post-chemotherapy initiation period). Costs were adjusted to account for censoring of the data.Results:The study population consisted of 1,266 women; mean (SD) age was 59.05 (2.57) years. Pre-chemotherapy initiation, unadjusted inpatient, outpatient, and drug costs were $4,392, $47,731, and $5,511, while these costs were $4,590, $57,820, and $38,936 per year, respectively, post-chemotherapy initiation. After adjusting for censoring of data, total medical costs were estimated to be $55,555 and $70,587 in the first 12 months and 18 months, respectively in the pre-chemotherapy initiation period. Post-chemotherapy initiation period, 12-month and 18-month adjusted total medical costs were estimated to be $87,638 and $130,738.Limitations:The use of an administrative claims database necessitates a reliance upon diagnostic codes, age restrictions, and medication use, rather than formal assessments to identify patients with post-hormonal women with breast cancer. Furthermore, such populations of insured patients may not be generalizable to the population as a whole.Conclusions:These findings suggest that healthcare resource use and costs – especially in the outpatient setting – are high among women with HR+ metastatic breast cancer.

Corrections and Clarifications

Reports: “Regulators of PP2C phosphatase activity function as abscisic acid sensors” by Y. Ma et al. (22 May, p. 1064; published online 30 April). The date of receipt was 27 October 2008, not the later date in the original Science Express publication. The date has been corrected both online and in print.

Brimleyana(1979–1998): publication dates of issues and zoological names

The journal Brimleyana, published between 1979 and 1998 in 25 issues, contained a total of 84 new zoological names. The dates printed on the covers, footers of articles, and reprints conflict with actual publication dates in some instances, and as a result, some articles and taxonomic names have been cited with the incorrect year of publication. Discrepancies in year of publication affect nine names (two genus group, seven species group), and discrepancies in month of publication affect 21 names (one genus group, 20 species group). Therefore, the actual dates of publication, as established by mailing dates in the journal, are given for all issues of Brimleyana along with a complete list of new taxonomic names and new name combinations that appeared in the journal. Receipt date stamps on issues of Brimleyana from twelve libraries in the eastern United States were compared to the stated mailing dates, and receipt dates substantiate the validity of the mailing dates.

National Heart, Lung, and Blood Institute

I am pleased to provide an update on the policies and programs of the National Heart, Lung, and Blood Institute (NHLBI). This is an exciting time of many transitions for the federal government as a whole and the National Institutes of Health (NIH) in particular. As these changes take form, I want to assure you of our unwavering commitment to support our community of heart, lung, and blood investigators and to the goals articulated in the NHLBI Strategic Plan. My goal in the present article is to discuss the NHLBI budget for the 2009 fiscal year (FY) (October 1, 2008, to September 30, 2009, FY 2009) and to describe new policies that we are implementing for early stage investigators and for revised grant applications. The NIH is operating under a continuing resolution (CR),1 which means that Congress has not provided the NIH with an appropriation for FY 2009. This requires us to operate at the same level of funding as we had in FY 2008. Because we are obligated to provide FY 2009 cost of living increases, the actual purchasing power of the FY 2008 appropriation is reduced in FY 2009. The CR authorizes us to fund noncompeting research grants at 90% of the previously committed levels until a FY 2009 appropriation is made. The CR expires March 6, 2009, but we must be prepared for the possibility that the CR amount will become the FY 2009 appropriation. Accordingly, the NHLBI is currently operating with a CR budget of $2.922 billion. Similar to FY 2008, noncompeting awards will be provided a 1% inflation rate. Detailed information can be found in the NHLBI FY 2009 Funding and Operating Guidelines.2 We …

SUPPORT Generics giant Teva will fund ACS grants for newly tenured faculty

The U.S. branch of generic pharmaceutical giant Teva Pharmaceutical Industries is providing ACS with all required funding to establish a philanthropic grant program to support academic researchers in organic and medicinal chemistry. The new Teva USA Scholars grants will be administered by the ACS Office of Research Grants, which also manages the ACS Petroleum Research Fund. The program will award three grants, each consisting of $100,000 per year for three years, to three faculty members in Ph.D.-granting departments at institutions in the U.S. Recipients must have earned tenure within four years of the date of receipt of their applications. Successful results of work supported by the Teva grants would be expected to advance the discovery of organic compounds useful for human medicines. “This program fills a niche in the chemistry community that can’t be filled by the Petroleum Research Fund,” says W. Christopher Hollinsed, director of the ACS Office of Research Grants. “There are many ...

Use of Pregabalin in Patients with Painful Neuropathic Disorders under the Care of General Practitioners in the U.K.

To examine the use of pregabalin in patients with painful neuropathic disorders under the care of general practitioners (GPs) in the U.K. Using a large U.K. database of GP encounters, we identified all persons aged > or = 18 years with at least one GP encounter with a diagnosis of a painful neuropathic disorder (eg, postherpetic neuralgia, diabetic peripheral neuropathy) between January 1, 2004 and July 31, 2006. Among these patients, we then identified those who initiated therapy with pregabalin; the date of initial receipt of pregabalin was designated the "index date." We then examined use of pregabalin over the 6-month period following this date ("follow-up"), as well as changes in the use of other pain-related medications (eg, opioids, tricyclic antidepressants [TCAs], other antiepileptics [AEDs]) between the 6-month period preceding the index date ("pretreatment") and follow-up. Patients with less than 6 months of pretreatment and follow-up data were excluded, as were those without any encounters during pretreatment for a painful neuropathic disorder. A total of 1,400 patients (1.4% of all identified patients with painful neuropathic disorders) initiated therapy with pregabalin and met all other entry criteria; mean age was 62 years, and 58% were women. During pretreatment, most (54%) patients received three or more different types of pain-related medications. During follow-up, patients averaged four prescriptions for pregabalin, totaling 93 therapy days. Compared with pretreatment, fewer patients received other pain-related medications during follow-up, including TCAs (37% during pretreatment vs. 27% during follow-up), opioids (64% vs. 55%), and AEDs other than pregabalin (36% vs. 16%) (all P < 0.01). In the U.K., many patients prescribed pregabalin by their GPs may have been refractory to other pain-related medications. Use of these medications declined following initiation of pregabalin therapy.

Nickel-Mediated Coupling Reactions of Carboryne with Alkenes: A Synthetic Route to Alkenylcarboranes

This Communication was published without giving the date of receipt. The correct details for page 6575 (left column, bottom) are given here. The editorial office apologizes for this oversight. Received: April 25, 2008 Revised: June 6, 2008 Published online: July 30, 2008

Associate Editor, European Psychologist

Free AccessCall for NominationsAssociate Editor, European PsychologistPublished Online:May 01, 2008https://doi.org/10.1027/1016-9040.13.1.80PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInRedditE-Mail SectionsMoreThe EFPA Committee on Scientific Affairs is soliciting nominations for an Associate Editor for the European Psychologist, to take effect July 1, 2008. The Editor-in-Chief and Associate Editors enjoy full editorial independence and are responsible for the scientific content of the journal, which appears in four issues per annual volume. The current mission of the journal is to be the English-language voice of psychology in Europe, integrating all specializations in psychology and providing a general platform for communication and cooperation among psychologists throughout Europe and worldwide. It currently publishes original peer-reviewed articles and contemporary reviews as well as reports in a range of formats on major research, projects, and issues that are likely to be of interest to readers.The term of office is 3 years with the possibility of renewal for a maximum of one further 3-year term. Candidates should have prior experience in a role related to the editing of a peer-reviewed journal of some standing and have a solid record of own international publications. Support is provided in the form of an online submissions and manuscript handling software package, but candidates should also be in the position to offer the commitment of time and expertise that such a position requires.Nominations (including self-nominations), together with a short description of relevant qualifications, should be sent to the following e-mail address: callae2008@efpa.be. Further information can be obtained from the Editorial Office – please see www.europeanpsychologist.eu/The closing date for receipt of nominations is April 15, 2008.FiguresReferencesRelatedDetails Volume 13Issue 1March 2008ISSN: 1016-9040eISSN: 1878-531X InformationEuropean Psychologist (2008), 13, pp. 80-80 https://doi.org/10.1027/1016-9040.13.1.80.© 2008Hogrefe & Huber PublishersPDF download

Trends in Graduate Training in Social Psychology: Training Social Psychology's Trainers

We examine social psychology graduate training in the United States by analyzing the faculty members in doctoral degree-granting programs, using archival sources. About 500 full-time faculty work in the 105 social psychology doctoral programs in the United States. These faculty hold Ph.D.'s from 74 different U.S. (and 11 non-U.S.) social psychology programs, with a median degree receipt date of 1983. Increasing numbers of women faculty attain positions in doctoral programs in social psychology; in our sample, 48% of women received Ph.D.'s after 1990, compared to 30% for men. We examine 29 programs that provided 2 or more training faculty, from 1950–1990 and 1991–2004. The data demonstrate both stability and change in graduate training—programs that produced the majority of graduate trainers during the post-WWII period continue to produce new graduate trainers (ρ = .40, p < .05), though the creation of graduate trainers currently spreads across a larger array of programs. Average GRE scores of a training program's students does not predict a given program's likelihood of placing students in training positions.

Evaluation of maternal immunization in Ile-Ife, Nigeria

This study was carried out to assess the knowledge and the acceptance of tetanus toxiod (TT) and hepatitis B virus (HBV) vaccine among pregnant women in Nigeria. One hundred and sixty pregnant women selected by a systematic sampling method were interviewed and dates of actual receipt of vaccines were confirmed from antenatal records. Ninety-six per cent of respondents were aware of the maternal immunization (MI) programme. Ninety-five per cent expressed that MI is good and beneficial to both mothers and babies. TT was received by 87.5%. Two doses of TT were received by 73.75% within the second trimester of pregnancy, while 6.25% completed the TT regimen. Only 18.75% had received the HBV vaccine before being pregnant. Acceptance and actual receipt of TT was high but there was no screening for Hepatitis B surface antigen (HBsAg) nor HBV vaccines given to the women. Midwives and the government need to intensify the education of the public on maternal immunization.

Improvement in Survival Associated With Adult-to-Adult Living Donor Liver Transplantation

More than 2000 adult-to-adult living donor liver transplantations (LDLT) have been performed in the United States, yet the potential benefit to liver transplant candidates of undergoing LDLT compared with waiting for deceased donor liver transplantation (DDLT) is unknown. The aim of this study was to determine whether there is a survival benefit of adult LDLT. Adults with chronic liver disease who had a potential living donor evaluated from January 1998 to February 2003 at 9 university-based hospitals were analyzed. Starting at the time of a potential donor's evaluation, we compared mortality after LDLT to mortality among those who remained on the waiting list or received DDLT. Median follow-up was 4.4 years. Comparisons were made by hazard ratios (HR) adjusted for LDLT candidate characteristics at the time of donor evaluation. Among 807 potential living donor recipients, 389 underwent LDLT, 249 underwent DDLT, 99 died without transplantation, and 70 were awaiting transplantation at last follow-up. Receipt of LDLT was associated with an adjusted mortality HR of 0.56 (95% confidence interval [CI]: 0.42-0.74; P < .001) relative to candidates who did not undergo LDLT. As centers gained greater experience (>20 LDLT), LDLT benefit was magnified, with a mortality HR of 0.35 (95% CI: 0.23-0.53; P < .001). Adult LDLT was associated with lower mortality than the alternative of waiting for DDLT. This reduction in mortality was magnified as centers gained experience with LDLT. This reduction in transplant candidate mortality must be balanced against the risks undertaken by the living donors themselves.

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Obtaining Medical Records from Healthcare Facilities under the HIPAA Privacy Rule: The Experience of a National Longitudinal Cohort Study

The processes for acquiring medical records from healthcare facilities in longitudinal cohort studies have not been well examined post-HIPAA Privacy Rule. We examined the response rates, correlates of response rates, and response times for obtaining patient medical records from healthcare facilities under the HIPAA Privacy Rule. Medical records were requested from facilities across the country on adults 45 or older enrolled in the national longitudinal cohort study REGARDS (Reasons for Geographic and Racial Differences in Stroke) who reported physician encounters for potential stroke events. From October 2003 to October 2006, 1,439 medical records were received out of 1,518 reported eligible events (94.7%), with 39 (2.6%) requests pending at the time of the analysis. The refusal rate for record requests from healthcare facilities was only 0.4%. The median length of time to receipt of a record was 26 days (range 1–679 days). Hospitals had the fastest return time (22 days from date of request to date of receipt) compared with outpatient clinics (28 days), doctor’s offices (31 days), and long-term care facilities (55 days, p < 0.01). Healthcare facilities located in the Southern region had fastest return time compared with those in the Northwestern region (23 vs. 46 days, p = 0.048). Medical records retrieval in prospective research studies is still feasible under HIPAA regulation.

Use of Tricyclic Antidepressants in Older Patients With Diabetic Peripheral Neuropathy

To describe patterns of use of tricyclic antidepressants (TCAs) (eg, amitriptyline, nortriptyline) among older patients with diabetic peripheral neuropathy (DPN). Using a large, integrated, US health-insurance claims database, we identified all patients who received TCAs between January 1, 1999 and June 30, 2001 ("study period"). Among these persons, we then selected those who: (1) were aged >or=65 years as of the date of first receipt of a TCA during the study period; and (2) had one or more healthcare encounters with a diagnosis of DPN in the 30-day period immediately preceding date of first receipt of a TCA. We then examined the prevalence of selected comorbidities and concurrent use of medications which might render inappropriate the prescribing of TCAs, based on a listing of contraindications, warnings, and precautions found in the package inserts for these medications. Patterns of TCA prescribing were examined, based on information on paid claims. There were 349 DPN patients, aged >or=65 years, who received TCAs. Mean age was 73.8 years, 55.9% were women, and 17.9% had diagnoses of depression. Most patients (84.0%) began therapy with amitriptyline. Almost one-half of study patients had indicators of potentially inappropriate TCA use, primarily cardiovascular comorbidities. Mean TCA dose among patients with and without these indicators was 23.3 (+/-13.4) mg and 25.4 (+/-15.3) mg, respectively (P=0.42). The high prevalence of contraindications, warnings, or precautions and the low level of TCA exposure suggest that many older patients with DPN who receive TCAs may be inappropriately treated.