Drug Utilization Study Research Articles

INCREASED COST BURDEN ON PATIENTS OF MENTAL DISORDERS CORRELATED WITH POOR MEDICATION ADHERENCE: A CROSS-SECTIONAL STUDY AT A TERTIARY CARE HOSPITAL IN NORTH INDIA DURING COVID-19 PANDEMIC

Objective: This study was planned to evaluate the correlation between cost borne by the patient and medication adherence in common mental disorder patients during COVID-19 pandemic. Methods: A descriptive cross-sectional drug utilization study was undertaken in 200 patients. Pattern of psychotropic drugs usage was analyzed as per WHO/INRUD guidelines and average monthly cost borne by the patient/hospital per prescription was correlated with medication adherence of the patients. Results: The average monthly costs borne by patients and hospital were observed to be more during the pandemic as compared to pre-pandemic time. It was observed that patients bearing some cost on their own had significantly lower medication adherence compared to those patients whose cost of treatment was borne by the government-funded hospital (p-value of 0.017). The medication adherence in patients of mental disorders was found to be negatively correlated to the cost was borne by the patients. Conclusion: The COVID-19 pandemic has escalated the total cost borne by the patients as well as the financial burden on government-funded hospitals.

Biologics Used for Psoriasis: A Drug Utilization Study Based on Two Nationwide Danish Data Sources.

Biological treatment has been a game changer in the management of moderate-to-severe psoriasis. In Denmark, biological treatment for psoriasis is registered in two data sources. We aimed to describe the utilization of biologics for psoriasis in Denmark using data from both data sources separately. We used data from two different nationwide Danish data sources: The healthcare registries and the clinical quality database, Dermbio. Utilization patterns were described by three different parameters: (1) distribution of drugs used in the first treatment episodes, (2) treatment cascade on a population level, and (3) drug survival using Kaplan Meier (KM) analysis and the proportion of patients covered (PPC) method. From January 1, 2011, to December 31, 2018, we found 1878 users of biologics in the healthcare registries and 2264 in Dermbio. Adalimumab, ustekinumab, and secukinumab were the most common first-choice treatments throughout the study period. According to the healthcare registries, it was most common to have more than one treatment episode with the same drug. In Dermbio, most were registered to have only one observable treatment episode overall in the study period. Ustekinumab showed the longest drug survival in both databases. Drug survival was longer for all biologics in Dermbio than in the healthcare registries. Adalimumab, ustekinumab, and secukinumab were the most common first-choice treatments in Denmark. Overall, ustekinumab showed the longest drug survival. We observed important differences in treatment cascades and drug survival between Dermbio and the healthcare registries, which should be considered when using these data sources to perform drug utilization studies on biologics.

Drug utilization study of antidepressant drugs in psychiatric outdoor patients at a tertiary care hospital in Southern Rajasthan

Background: The World Health Organization (WHO) defines “Drug Utilization” as the marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social, and economic consequences. Antidepressants are used to treat depressive illnesses and anxiety disorders. However, these are also employed in the pharmacotherapy of several psychiatric disorders. Very few studies were found regarding the pattern of prescription of antidepressants in outdoor patients in southern Rajasthan. So, this study has been planned to learn about the prescription pattern of antidepressant drugs as per WHO Core Drugs Prescribing indicators at a tertiary care hospital in southern Rajasthan. Methods: A cross-sectional observational study was conducted among 375 patients by convenient sampling over one year duration, in the outdoor Department of Psychiatry at RNT Medical College, Udaipur, Rajasthan. Patient’s prescriptions were analyzed for drug utilisation pattern in OPD after relevant consent. All data was compiled in MS Excel and analyzed using statistical methods. Results: Out of 375 prescriptions analyzed, 48.8% were males and 51.2% were females. Most commonly, patients had a diagnosis of depressive disorder (42.93%), followed by bipolar affective disorder (14.4%). The most common drug class prescribed was SSRI (88.86%). Escitalopram (41.65%) was the most prescribed drug, followed by Sertraline (30.51%). Conclusions: Among the prescribed antidepressants SSRIs were the most common class of drug followed by TCA. Escitalopram was the most common drug to be prescribed followed by sertraline. More than half of the patients receiving antidepressants suffered from non-depressive disorders. Monotherapy was preferred over combination therapy. All patients were prescribed generic drugs.

The prescribing of opioids for chronic noncancer pain in the menopausal and postmenopausal population: a drug utilisation study in the United Kingdom.

Opioid use for chronic noncancer pain (CNCP) is consistently higher in menopausal/postmenopausal women than in younger women or men, elevating their risk of opioid-related adverse health outcomes. Since pain severity increases with hormonal changes accompanying menopause, these women should be a focus of opioid stewardship efforts. To examine opioid prescribing trends for CNCP in menopausal/postmenopausal women diagnosed with a musculoskeletal condition. Population-based drug utilisation study using IQVIA Medical Research Data UK. Annual opioid prescribing incidence, prevalence, and average duration of use were calculated for a cohort of women aged 50-79 with musculoskeletal conditions newly diagnosed between 2010-2021. Specific results were stratified by age, pain indication, and Townsend score. From 2010 to 2021, incident prescribing rates of opioids increased in women aged 50-54 (161.4 [95% CI 149.7-174.0] per 1000 PYAR in 2010 to 239.6 [95% CI 211.7-271.2] per 1000 PYAR in 2021); these women discontinued opioid use faster (~1 year) than older age groups (~2 years). Overall, opioid prescribing prevalence decreased from 23% in 2010 to 14% in 2021, and average opioid use duration decreased from 3 years to 1 year (2010 - post-2017) in women aged 50-79. The overall observed decrease in prevalence and average duration of opioid use is encouraging. Incident prescriptions are rising in women aged 50-54 and those with fibromyalgia while remaining steady in women aged 55-79. Understanding the impact of menopause/post-menopause on opioid use trends is important for effective opioid stewardship.

Antibacterial drug utilization study in patient of sepsis due to Staphylococcus aureus

Antibacterial drug utilization study in patient of sepsis due to Staphylococcus aureus

Antibiotics in inflammatory arthritis and background population one year before and after diagnosis: a nationwide drug utilisation study.

To describe antibiotic use in patients with inflammatory arthritis (IA) and in the background population (BP) within one year before and after IA diagnosis. Using data from Danish nationwide registries, we identified all adults with a first-time diagnosis of rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis/spondyloarthritis (AS/SpA) from 2010 through 2018. For each IA patient, we randomly sampled ten persons from the BP, matched on sex and birthdate. We calculated the prevalence (n [%]) of any antibiotic dispensing and the total antibiotic dispensing in the year before and after diagnosis. We identified 28 504 new-onset IA patients (RA, n = 16 130; PsA, n = 5,988; AS/SpA, n = 6,386) and 285 040 BP individuals. The one-year prevalence of any antibiotic dispensing was 42.1% in IA patients before diagnosis vs 30.7% in the BP. The total antibiotic dispensing was higher the one-year before both RA, PsA, and As/SpA compared with BP (prevalence rate ratios [PRR], 1.48 [1.46; 1.51]; 1.67 [1.62; 1.72]; 1.52 [1.47; 1.56], respectively), and increased with 22% in IA patients three months before diagnosis compared with the preceding three-month period. Although the prevalence of any antibiotic dispensing in IA patients decreased in the year following the diagnosis (IA; 40.6%), the total one-year antibiotic dispensing remained constant in RA (PRR 0.99 [0.97; 1.01]), decreased in PsA (0.91 [0.87; 0.94]), and increased in AS/SpA (1.08 [1.04; 1.12]) patients after diagnosis compared with before. Antibiotics are more frequently dispensed to individuals developing IA compared with the BP. Antibiotic utilisation patterns change after IA diagnosis with marked differences among IA subgroups.

Drug Utilization Study of Anticancer Drugs in Breast Cancer Patients at a Tertiary Care Teaching Hospital

This study aimed to assess the drug utilization of anticancer drugs in breast cancer patients at a tertiary care teaching hospital. The objectives were to identify the most commonly prescribed chemotherapeutic drugs and to study the side-effect profile using the CTCAE grading. A prospective observational study was conducted in the medical oncology department. Data was collected from 93 patients and analyzed for prescribing patterns, drug utilization, and side-effects. The majority of patients were aged 46-55 years (48.38%) and in stage III cancer (62.36%). Luminal B was the most common molecular subtype (35.48%). Neoadjuvant therapy was administered to 59.13% of patients, while 40.86% received adjuvant therapy. Trastuzumab was the most frequently prescribed drug in both neoadjuvant (34.54%) and adjuvant (36.84%) therapies. Ondansetron, aprepitant, dexamethasone, and olanzapine were commonly used as supportive treatments. Side-effects were experienced by 76.34% of patients, with 71.83% having grade 1 and 28.16% having grade 2 side-effects. The most frequent side-effects were nausea, vomiting, and alopecia. The onset of side-effects was highest after the 3rd chemotherapy cycle (28.16%). The study provides valuable information about the prescribing patterns and side-effect profile of anticancer drugs in breast cancer patients

Studying the Impact of European Union Regulatory Interventions for Minimising Risks From Medicines: Lessons Learnt and Recommendations.

The European Medicines Agency's (EMA) Pharmacovigilance Risk Assessment Committee (PRAC) launched a strategy to examine the public health impact of major regulatory interventions aimed at minimising risks of medicinal products. We conducted a lessons learnt analysis of impact studies completed between 2015 and 2023. We surveyed PRAC Sponsors and (Co-)Rapporteurs involved in the evaluation of 12 impact studies (10 commissioned by EMA and 2 conducted collaboratively by Member States) to explore how these support regulatory decision-making. Questions covered achievement of study objectives, risk minimisation effectiveness, added value for regulatory decision-making, and recommendations for future impact studies. Themes were generated using thematic content analysis. Survey responses from 15 PRAC Sponsors and (Co-)Rapporteurs from 10 European Union Member States were included in the analysis. Among four cross-sectional surveys and eight drug utilisation studies, 50% achieved all objectives, the other studies partially due to limitations. Two studies concluded that risk minimisation measures were overall effective, two were effective with variation across countries, two were partially effective and four studies showed limited effectiveness. Two studies were deemed inconclusive due to limitations. The reasons for the limited effectiveness of risk minimisation may be explored using mixed-method approaches. Assessment of study feasibility and a priori discussion of effectiveness measurements is important. Despite limitations, impact research adds value to regulatory decision-making by addressing knowledge gaps and providing additional information on unintended consequences of regulatory interventions. Our recommendations will help to improve planning, conducting and interpretating future impact studies.

Prescriptions of respiratory medications in children aged 0–10 years: A longitudinal drug utilization study in the POMME database

IntroductionRespiratory tract disorders are common in children. However, there is no available data on the prescription of respiratory medications for children in France. This study aimed to provide an overview of medications for obstructive airway diseases prescriptions for children during the initial ten years of their lives within POMME, a French population-based cohort of children. Material and methodsThis longitudinal, population-based study used data from the French POMME birth cohort, comprising children born in Haute Garonne between July 2010 and June 2011. Anonymous medical information, including medication reimbursement data, was collected between ages 0 and 10 years. Exposure was defined as at least one prescription for respiratory medications (ATC code R03*), focusing on specific subclasses. Data were analyzed by age, season, and prescribing physicians' specialties. ResultsOut of 5956 children, 4951 (83.1 %) received respiratory medication prescriptions. Inhaled corticosteroids (ICSs) were the most prescribed (95.3 %), followed by short-acting β2-agonists (68.8 %). The number of prescriptions increased with age, except for ICSs alone, which peaked between 6 months and 2 years. The average number of prescriptions per child was relatively low. DiscussionThis study highlighted high prescription rates of respiratory medications in children under 10 years, with ICSs being the most prevalent. While these medications are primarily intended for asthma management, the findings suggested a significant proportion of off-label prescriptions, especially in young children. Further research and clinical guidance are warranted to ensure appropriate medication use in the pediatric population.

Intranasal corticosteroid users in The Netherlands: A drug utilization study

BackgroundTo improve (patient-tailored) instructions for intranasal corticosteroid (INC) administration we need to gain insight into specific characteristics of INC-users and co-medication use. ObjectiveWe examined INC drug prescriptions, obtained from the Dutch InterAction Database, to get insight into the prevalence- and incidence rates, INC-use in previous years and co-medication. MethodsWe retrospectively examined INC prescriptions between January 1, 2015, and December 31, 2019. Prevalence- and incidence rates were stratified by age and gender. The use of INCs in previous years and co-medication were analyzed. ResultsThe total number of INC prescriptions in 2019 was 172,563, dispensed to 75,048 individuals. The prevalence and incidence of INC users were 68.9 and 25.6 per 1,000 individuals respectively in 2019. INCs were used by all age-groups. More than half of the users in 2019 did not receive a prescription in 2018, almost a quarter received a prescription in five consecutive years. 28% of the users used an INC in combination with an inhaler, 29% with a systemic antihistamine, 9% with ocular medication and 1% with an intranasal antihistamine. Several corticosteroids-containing drugs are used in combination with INCs by 2 to 16%. ConclusionThis study gives insights into opportunities for patient-tailored instructions. INCs are used by various age groups and by new or intermittent users and continuous users. Based on this, patient-tailored instructions can be developed and then it needs to be studied if these instructions affect treatment adherence and efficacy. The insights gained about co-medication provide opportunities for improved evaluation of the INC administration technique. Altogether, these suggestions might lead to a more patient-tailored approach which might lead to improved treatment with intranasal corticosteroids.

Prescribing Practices in Pediatrics and Drug Utilization Studies Promoting Pediatric Health

Knowledge of drug administration in children and infants lags behind that of adults for many reasons. These include developmental differences that affect the pharmacodynamic and pharmacokinetic profiles of drugs, ethical and financial reasons, research capabilities, and regulatory guidelines and constraints. Most of the drugs prescribed for children have not been tested in the pediatric population due to the difficulties in carrying out clinical studies in children and ethical issues due to children not being able to make their own decisions to participate in a clinical trial. Epidemiological evaluation of medicine use in elderly is now a highly visible topic, but drug prescribing studies in pediatric patients have been limited. The higher incidence of infections in pediatric population as compared to adults leads to higher prescription of Antimicrobial Drugs (AMDs), at times more than two in single prescription. The use of antibiotics in children has been a major area of concern. . Periodic prescriptions analysis and effective feedback to clinician should be done based on results to ensure rational prescribing and effective health care management, which will ultimately lead to a better child health. In this review article, we will to analyze prescribing practices in pediatrics and drug utilization studies promoting pediatric health.

An observational study on prescription pattern of drugs and psychiatric disorders occurring in elderly patients in a tertiary care hospital

Abstract Background: Elderly age group is the most vulnerable age group for various health-related issues. Psychiatric disorders and their management are quite important, especially in this vulnerable population. With increased availability of newer drugs, rational prescription of drugs is essential. Objectives: The objectives of this study were as follows: (1) To assess the prescription pattern of antipsychotic drugs and other psychiatric drugs prescribed to elderly psychiatry patients, (2) to determine the psychiatric illness occurring among the elderly psychiatric patients, and (3) to estimate the polypharmacy and cost burden of drugs prescribed. Materials and Methods: It was an observational study conducted over a period of 6 months in “Government Hospital for Mental Care.” The prescriptions were collected from the outpatient medical records and were thoroughly analyzed to assess antipsychotics and other psychiatric drugs being prescribed and the disorders frequently came across in the elderly patients who visited the psychiatry outpatient department. Results: Two hundred and fifty prescriptions were analyzed during the study. Male patients outnumbered female patients. The majority of the patients were of age group 50–60 years. Schizophrenia was the most common disorder encountered in the study population followed by psychosis and bipolar. Among the drugs, trihexyphenidyl followed by quetiapine, olanzapine, risperidone, and so on were the most common drugs prescribed. Conclusion: In the current study the prescribing pattern of drugs is as per the norms with rational usage of more efficacious drugs. Polypharmacy is limited. Periodic drug utilization studies help to solve the issues related to polypharmacy and improve the quality of treatment given to the patients.

A Cross Sectional Study on Prescription Pattern of Antiepileptic Medication among Children of Southern Rajasthan in a Tertiary Care Teaching Hospital

Background: Drug utilization studies are powerful exploratory tools for establishing the role of drugs in society and also effective methods for assessing the prescribing pattern of clinicians. Around 4-10% of children suffer at least one seizure episode at 16 years of age. Even after the availability of several Antiepileptic drugs (AEDs), choosing the correct drug with accurate dosing will produce seizure-free generation. Hence, this study aims to examine the prescription patterns of drugs in epileptic children. Methods: This study was a cross sectional observational study. Children <16 years old visiting neurology department with a history of epileptic seizures and already on antiepileptic drug therapy were included in the study. The data comprised of demographic details, disease history, type of seizure, diagnosis, investigations done, along with prescribed medication noted in case record form. The total study duration was 13 months. Results: In this study, the maximum epilepsy encountering age in male and female children was below the 12-year age group, male predominance was higher than females (male 60.83% vs. female 39.16%). The majority of children were diagnosed with generalized tonic colonic seizures, 54.17%, followed by focal/or partial seizures, 39.17%. Sodium valproate 19.16%, carbamazepine 14.17%, oxcarbazepine 16.67%, and levetriacetam 13.33% were the most commonly prescribed single drug regimens for treating both types of seizures, followed by clobazam added as second and third adjuvant drug in resistant epilepsy to valproate 12.5%, oxcarbazepine 6.67%, and levetriacetam plus carbamazepine combination 5% respectively. Conclusion: Monotherapy was majorly followed in 70% of pediatric patients for maintaining better patient compliance. Both old and new AEDs regimens are prescribed for maintaining the quality of life in patients.

"Application of five different strategies to define a cohort of patients with knee osteoarthritis in a large primary care database".

Electronic health records (EHR) are frequently used for epidemiological research including drug utilisation studies in a defined population such as the population with knee osteoarthritis (KOA). We sought to describe the process of defining a cohort of patients with KOA from a large UK primary care database and estimate the annual incidence of diagnosed KOA between 2000 and 2015. This was a retrospective study using data from the clinical practice research datalink (CPRD). CPRD is a large primary care longitudinal electronic medical records' database that contains anonymous records of patients from general practices across United Kingdom. Five different cohort definition strategies were applied including symptoms-based or diagnosis-based strategies or a combination of both. To validate results, the annual incidence of KOA was estimated and compared to published data. The study defined 898,690 patients when symptoms-based strategy was applied, 137,541 patients when diagnosis based and 83,294 when a combination of both strategies were applied. The final cohort was defined using a diagnosis-based strategy that avoided overestimation (with symptoms-based definition) or underestimation (with a combination of symptoms and diagnosis). The incidence of KOA ranged from 1.33 per 1000 CPRD registrants in 2000, 1.76 in 2008 and 1.45 patients in 2015. This study logically/sensibly defined a cohort of patients with diagnosed KOA through the application of several strategies. This was an essential step to avoid subsequent over or underestimation of the prevalence of drug utilisation and the associated adverse clinical outcomes within primary care patients with KAO.

Exploring Patterns of Medication Usage in Affective Disorder Patients: A Comprehensive Investigation at a Psychiatry Outpatient Clinic of a Tertiary Care Hospital.

Affective disorders impose a significant burden on public health due to their high prevalence and associated suffering. This study addresses gaps in current literature and clinical practice by providing insights into medication usage trends, which can inform treatment strategies and optimize patient care. The study aims to investigate drug utilization patterns, particularly focusing on defined daily dose/1000/day, among individuals attending a psychiatric outpatient department of a tertiary care hospital. This cross-sectional, prospective drug utilization study included 600 affective disorder patients aged 18 years and above. The study period spanned 12 months, from March 2021 to February 2022. Data on demographics, diagnosis, treatment, and counseling were collected and analyzed using descriptive statistics. Among the 600 patients analyzed, bipolar mood disorder was the most prevalent (239 patients, 39.83%), followed by depressive disorder (208 patients, 34.67%). Triple therapy was the most common prescription regimen, accounting for 308 encounters (51.33%). The average number of drugs per encounter was 3.75 ± 1.01. A combination of psychotherapy and medication counseling sessions was provided to 594 patients or their relatives, representing 99% of the total encounters. The study highlights the prevalent use of triple therapy in managing affective disorders, especially bipolar mood disorder and mania disorder. Effective utilization of essential drug lists and comprehensive patient counseling underscores the importance of holistic care in psychiatric outpatient settings. Given the high prevalence of triple therapy, further research into the efficacy and safety of this treatment approach is warranted. Additionally, continued emphasis on patient education and counseling can enhance treatment adherence and overall outcomes in individuals with affective disorders.

Trends and regional differences in antidiabetic medication use: a nationwide retrospective observational study

Background The prevalence of diabetes is increasing, and several new drug groups have been authorized and used successfully in the treatment of diabetes, while older drug groups are still in use. Our aim was to assess the utilization tendencies and regional differences in antidiabetic medication consumption in Hungary between 2015 and 2021 and to identify the possible determinants of regional differences in antidiabetic medication use.MethodsFor this retrospective drug utilization study, yearly wholesale database was used, which provides total coverage for ambulatory antidiabetic drug sales in Hungary, including both reimbursed and non-reimbursed medications. Data were expressed as Defined Daily Dose per 1000 inhabitants per day (DDD/TID), percentage of total use and the ratio of the highest and lowest utilization values among the counties (max/min ratio). To assess the potential reasons for regional differences in antidiabetic drug use, we analyzed the associations between regional drug utilization data and possible determinants.ResultsThe total national antidiabetic medication use has increased by 7.6% and reached 94.8 DDD/TID in 2021. Regarding antidiabetic subgroups, the use of metformin and novel antidiabetics (DPP4Is, GLP1As and SGLT2Is) and their combinations increased in all counties, while sulfonylurea consumption decreased, and insulin use was stable. In 2021, 19.2–24.1% of the total antidiabetic medication consumption was novel antidiabetics, 39.1–47.2% metformin, 14.8–25.8% sulfonylureas and 23.6–30.5% were insulins. Regional differences in antidiabetic medication consumption were considerable mainly in the case of GLP1As (max/min ratio:3.00), sulfonylureas (2.03) and SGLT2Is (1.92) in 2021. The association between antidiabetic medication use and possible determinants was confirmed in the case of unemployment rate and sulfonylurea use, the number of public medical card holders per ten thousand inhabitants and human insulin and sulfonylurea use. GLP1As were the only antidiabetic drug group that did not correlate with any of the investigated factors.ConclusionsAlthough novel antidiabetic drug use was growing dynamically in Hungary, sulfonylurea use is still considerable. Differences in antidiabetic drug consumption were substantial between the regions.

Drug utilization studies from secondary databases in latent tuberculosis: a scoping review protocol

This article introduces a protocol for a scoping review that aims to map and synthesize Drug utilization studies from secondary databases in latent tuberculosis The protocol is intended to document the processes involved in the methodological planning and execution of a scoping review guided by Joanna Briggs Institute guidelines and developed using the 2015 PRISMA-Protocols (PRISMA-P) checklist. The PCC strategy (population, concept and context) systematized the search for studies published in Pubmed, Scopus, BVS, Embase and Web of Science from January 2015 to December 2022. The selection of articles will be carried out in two steps (titles and abstracts, followed by the assessment of the full text of the articles), by two independent reviewers, with the resolution of disagreements by a third reviewer. The results will be analyzed qualitatively/quantitatively and will be organized by themes. The checklist present in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) will be used to guide the final review report. We hope that this scoping review will shed light on Drug Utilization Research in the field of latent tuberculosis, which is still understudied, especially in Brazil.

Design and statistical analysis reporting among interrupted time series studies in drug utilization research: a cross-sectional survey

IntroductionInterrupted time series (ITS) design is a commonly used method for evaluating large-scale interventions in clinical practice or public health. However, improperly using this method can lead to biased results.ObjectiveTo investigate design and statistical analysis characteristics of drug utilization studies using ITS design, and give recommendations for improvements.MethodsA literature search was conducted based on PubMed from January 2021 to December 2021. We included original articles that used ITS design to investigate drug utilization without restriction on study population or outcome types. A structured, pilot-tested questionnaire was developed to extract information regarding study characteristics and details about design and statistical analysis.ResultsWe included 153 eligible studies. Among those, 28.1% (43/153) clearly explained the rationale for using the ITS design and 13.7% (21/153) clarified the rationale of using the specified ITS model structure. One hundred and forty-nine studies used aggregated data to do ITS analysis, and 20.8% (31/149) clarified the rationale for the number of time points. The consideration of autocorrelation, non-stationary and seasonality was often lacking among those studies, and only 14 studies mentioned all of three methodological issues. Missing data was mentioned in 31 studies. Only 39.22% (60/153) reported the regression models, while 15 studies gave the incorrect interpretation of level change due to time parameterization. Time-varying participant characteristics were considered in 24 studies. In 97 studies containing hierarchical data, 23 studies clarified the heterogeneity among clusters and used statistical methods to address this issue.ConclusionThe quality of design and statistical analyses in ITS studies for drug utilization remains unsatisfactory. Three emerging methodological issues warranted particular attention, including incorrect interpretation of level change due to time parameterization, time-varying participant characteristics and hierarchical data analysis. We offered specific recommendations about the design, analysis and reporting of the ITS study.

Rurality is associated with lower likelihood of dipeptidyl peptidase 4 inhibitor use for treatment intensification

BackgroundAntihyperglycemic drug utilization studies are conducted frequently and describe the uptake of new drug therapies across may jurisdictions. An increasingly important, yet often absent, aspect of these studies is the impact of rurality on drug utilization. Objective(s)The objective of this study was to explore the association between place of residence (rural, urban, metropolitan) and the use of dipeptidyl peptidase 4 inhibitors (DPP-4i) for first treatment intensification of type 2 diabetes. MethodsA retrospective cohort study was conducted from April 1, 2008 to March 31, 2019 of new metformin users. A multivariable logistic regression analysis was performed to determine the association between place of residence (using postal codes) and likelihood of DPP-4i dispensing. ResultsAfter adjusting for confounders, analysis revealed that rural-dwellers are less likely to have a DPP-4i dispensed, compared with metropolitan-dwellers (aOR:0.64; 95%CI:0.61–0.67) and over-time, the uptake in rural areas was slower. ConclusionsThis study demonstrates that rurality can have an impact on drug therapy decisions at first treatment intensification, with respect to the utilization of new therapies.

A study to Monitor Adverse drug reactions in a patients of Chronic Obstructive pulmonary Disease

Background: Inappropriate drug usage may preclude ideal benefit due to increased medical cost, adverse effects and mortality. Therefore drug utilization studies have become a plausible means in evaluating the healthcare systems. COPD management usually involves more than one drug which may escalate the risk of ADEs (adverse drug events). The present study aimed at assessing the current drug practice and ADEs in COPD management in ICU. Material and Methods: A prospective, single centered, observational and open labeled study was carried out in Department of Pulmonary Medicine and Pharmacology, Tertiary Care Teaching Hospital. The patient population was broadly divided into four categories based on diagnosis ‑ chronic obstructive pulmonary disease, Infections, Asthma and Others. Suspected ADRs were reported, analyzed, and causality assessment was carried out using Naranjo’s algorithm scal0065. Results: In our study, most important causative drug was Budesonide (11.1%). Causality assessment of ADR by Naranjo’s algorithm showed 11.9% probable and 88.1% possible reactions. According to WHO-UMC scale, 85.9% reactions are possible, 11.1% are probable, and 3% are unlikely. Among the 270 ADR reported, the most common ADR was oral thrush which accounted for 11.1% (n = 30) of the reported cases, followed by palpitation 11.1% (n = 30), sore throat 20 (7.4%), dizziness 17 (6.3%) cases, and headache 20 (7.4%) of reported ADR cases. Conclusion: Many research have been conducted separately on various respiratory diseases such as COPD, tuberculosis, asthma, respiratory tract infections (upper/lower), and so on. However, this study included some of the most common diseases in this field, such as COPD, tuberculosis, and respiratory tract infections. A routine patient follow-up is needed for the early detection and prevention of ADRs in order to improve patient adherence to drug therapy and provide improved drug therapy by avoiding associated morbidity and mortality.