Days Of First Prescription Research Articles

Comparative Risk of Harm Associated with Zopiclone or Trazodone Use in Nursing Home Residents: a Retrospective Cohort Study in Alberta, Canada.

There is growing evidence of harm associated with trazodone and nonbenzodiazepine sedative hypnotics (e.g., zopiclone); however, their comparative risk of harm is unknown. We conducted a retrospective cohort study with linked health administrative data, which enrolled older (≥66 years old) nursing home residents living in Alberta, Canada, between December 1, 2009, and December 31, 2018; the last follow-up date was June 30, 2019. We compared the rate of injurious falls and major osteoporotic fractures (primary outcome) and all-cause mortality (secondary outcome) within 180 days of first prescription of zopiclone or trazodone with cause-specific hazard models and inverse probability of treatment weights to control for confounding; primary analysis was intention-to-treat and secondary analysis was per-protocol (i.e., residents censored if dispensed the other exposure drug). Our cohort included 1,403 residents newly dispensed trazodone and 1,599 residents newly dispensed zopiclone. At cohort entry, the mean resident age was 85.7 (standard deviation [SD] 7.4), 61.6% were female, and 81.2% had dementia. New zopiclone use was associated with similar rates of injurious falls and major osteoporotic fractures (intention-to-treat-weighted hazard ratio 1.15, 95% confidence interval [CI] 0.90-1.48; per-protocol-weighted hazard ratio 0.85, 95% CI 0.60-1.21) and all-cause mortality (intention-to-treat-weighted hazard ratio 0.96, 95% CI 0.79-1.16; per-protocol-weighted hazard ratio 0.90, 95% CI 0.66-1.23) compared to trazodone. Zopiclone was associated with a similar rate of injurious falls, major osteoporotic fractures, and all-cause mortality compared to trazodone-suggesting one medication should not be used in lieu of the other. Appropriate prescribing initiatives should also target zopiclone and trazodone.

P19 IV antimicrobial duration in practice

BackgroundTackling antimicrobial resistance by reducing unnecessary or inappropriate prescribing is a key priority.ObjectivesTo review current clinical practice at Guy's and St Thomas’ Hospital around duration of IV antimicrobial therapy framed with Start Smart Then Focus national guidelines.MethodsNewly started inpatient prescriptions for IV antimicrobials over three consecutive Mondays were reviewed. Prescriptions not for treatment of acute infections were excluded, as were patients admitted to critical care, obstetrics/gynaecology and paediatric wards. Each patient's record was reviewed at Day 0, 3 and 5. Data were analysed using IBM® SPSS Statistics version 27.ResultsIn total, 80 patients with 89 antibiotic prescriptions (71 = β-lactam, 5 = aminoglycoside, 2 = glycopeptide, 1 = ciprofloxacin, 9 = metronidazole, 1 = linezolid) were included. Median age was 66 (IQR 53–75). Documented indications were for suspected or proven infection of urinary tract (15%), respiratory tract (25%), skin/soft tissue (14%), sepsis (1.25%), intra-abdominal (15%), bacteraemia (7.5%), bone and joint infections (2.5%) or other (20%). Median initial NEWS2 on Day 0 was 3 (IQR 1–4), WCC 11.45 (IQR 8.27–14.15) and CRP 121 (IQR 47–208). Median length of stay was 7.5 days. Median duration of IV antimicrobial was 4 (IQR 2–6) days. By D3, 3 patients had died and 16 had been discharged. Of 61 remaining inpatients on D3, 4 had their antimicrobials switched, 14 had been switched to PO antimicrobials, 43 were continued on IV antibiotics. By D5, 17 further patients had been discharged, 44 remained inpatients. Twenty-two had stopped antimicrobials with 22 continuing IV therapy. A number of patients could have been switched from IV to oral therapy by current guidance but were not (D3 x = 11, D5 n = 8). Higher median D0 CRP was seen in those who continued on IV therapy on D3 (139 versus 79 mg/dL) as was higher D3 WCC (13.9 versus 11.9 × 109/L). There was no significant relationship between a NEWS2 score ≥3 and IV to PO switch at D3 or D5. Thirty-two patients had input from the Infection team within 7 days of first prescription. Fifteen patients (21%) received IV antibiotics for more than 7 days, and 14/15 had Infection team input. Three patients were discharged with OPAT.ConclusionsMedian duration of IV therapy for suspected/proven infections in our centre is less than 5 days and only 28% of patients were still receiving IV antibiotics by D5. A number of missed opportunities for earlier switch to oral therapy were identified. The potential for earlier safe discontinuation of IV therapy using patient-specific measures should be explored. A minority of patients received IV therapy for >7 days, and this was almost universally associated with specialist Infection involvement in complex infections with a view to optimizing patient management and antimicrobial stewardship.

Abstract P1-13-05: Completeness and timeliness of EMR integrated pharmacy dispensing data for early detection of non-adherence to breast cancer adjuvant endocrine therapy

Abstract Background: Adjuvant endocrine therapy (AET) significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of AET, many breast cancer survivors either fail to fill their first medication order (primary non-adherence), fail to refill their AET at the prescribed frequency (inadequate adherence), or discontinue therapy early (non-persistence), increasing their risk of death from recurrence. Unfortunately, there is no systematic way whereby oncology providers are notified when their patients do not initially fill or refill their AET prescriptions at the prescribed frequency. EMR integrated pharmacy dispensing data (EIPDD) bridges the gap between pharmacies, clinicians, and patients by providing medication dispensing tracking in the electronic health record. EIPDD could be used to identify and address the documentation and notification gaps with the goal of improving adherence and persistence to AET. This study seeks to evaluate the completeness and timeliness of EIPDD for early detection of primary medication non-adherence events to breast cancer adjuvant endocrine therapy. Materials and Methods: Data was extracted from the Epic EMR of an urban academic medical center for patients with documented Stage 0-III breast cancer with first prescription from a breast oncologist for AET between 2016-2019. Surescripts was used as the EIPDD data source integrated into the local Epic EMR. Patients were classified as having sufficient or insufficient data available based on the pharmacy dispense refresh event occurring within 365 days of AET order. The early detection of primary medication adherence was defined as the first dispense event completed within 90 days of first prescription. Primary non-adherence was defined as the failure to have the prescription for AET dispense event within 90 days of first prescription. Patients whose orders were not sent to an EIPDD contracted pharmacy (non-contract pharmacy) were excluded from the primary adherence evaluation and deemed to have incomplete data. Results: Detailed results are shown in the table, but in summary, 963 patients with stage 0-III breast cancer had 963 first prescription orders for AET between 2016-2019 routed to 646 unique pharmacies of which 634(98%) were contract and 12(2%) were non-contract pharmacies. Among the 948 patients with a first prescription sent to a contract pharmacy, 113(11.9%) had incomplete EIPDD refresh events to assess primary adherence. Among the 835 patients with at least one EIPDD refresh event following their first prescription, 80% of those events occurred within 90 days of the first prescription order, sufficiently timely for early detection of primary adherence. However, among those with primary non-adherence, only 4% had EIPDD refresh events within 90 days. Overall, 33.5% of patients would benefit from an intervention to verify or improve primary adherence to AET. Conclusions: EIPDD presents an opportunity to improve provider awareness of AET primary medication adherence. While the frequency of refreshing data could be improved to support more timely and complete data, EIPDD data represents a promising opportunity to provide clinical decision support to breast cancer survivorship teams with the goal of improving primary adherence to AET. Primary Medication Adherence and Timeliness for Early DetectionCategoryCountPercentageStage 0-III breast cancer 1st prescribed AET by breast provider 2016 -2019963100%Prescription sent to non-contract pharmacy151.5%Prescription sent to contract pharmacy94898.5%Failure to have pharmacy dispense data refresh event within 365 days of AET order11311.9%At least one pharmacy dispense data refresh event within 365 days of AET order83588.1%No AET dispense event within 90 days of prescription order16820.1%Non-primary adherence adequate early detection74.2%Non-primary adherence inadequate early detection16195.8%At least one AET dispense event within 90 days of prescription order (primary medication adherence)66779.9%Primary adherence adequate early detection53279.7%Primary adherence inadequate early detection13520.3% Citation Format: Mia Levy, Shirlene Paul, Jordan Lieberenz. Completeness and timeliness of EMR integrated pharmacy dispensing data for early detection of non-adherence to breast cancer adjuvant endocrine therapy [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-13-05.

Antibiotics for hospitalized children with community-acquired pneumonia in Japan: Analysis based on Japanese national database

IntroductionCommunity-acquired pneumonia (CAP) is one of the most common causes of pediatric infection requiring hospitalization. Antimicrobial resistance due to the inappropriate use poses a threat worldwide. Our objective is to analyze and optimize the trends of antibiotics used for pediatric inpatients with CAP in a claims database provided by the Ministry of Health, Labour and Welfare. MethodsOur database randomly sampled 10% of the hospitalized patients every October from 2011 to 2014. Patients aged <15 years in whom antibiotic therapy was initiated within two days of admission were listed. Subsequently, we investigated the antibiotics administered on the first day of prescription. ResultsA total of 4,831 antibiotics were prescribed for 3,909 patients. Many patients aged ≤ five years were treated with β-lactams alone whereas many patients aged ≥ six years were treated with a single antibiotic, such as a macrolide, tetracycline, and quinolone, which covers atypical bacteria. Combination therapy was primarily used in children aged ≥ six years (nearly 30%); the main combination was a β-lactam and non-β-lactam covering atypical bacteria. Ampicillin–sulbactam was the most frequently prescribed β-lactam in children of all ages other than infants. Ampicillin, however, was most often prescribed in infants, but its usage rate was low at other ages. ConclusionsAntibiotics were appropriately prescribed and were similar to that recommended in the 2011 guidelines for pediatric inpatients with CAP. However, combination therapy was frequently prescribed in children aged ≥ six years. According to the revised guidelines in 2017, ampicillin should be used more frequently for patients hospitalized with CAP.

Identification of Patients with Painful Diabetic Peripheral Neuropathy Who Have a Favorable Cost Profile with Pregabalin Treatment

To characterize patient populations with favorable costs after the initiation of pregabalin for the treatment of painful diabetic peripheral neuropathy (pDPN) relative to duloxetine, gabapentin, and amitriptyline. Patients were identified from MarketScan having ≥1 claim for pDPN (ICD-9-CM codes 250.6 or 357.2) within 60days of first prescription (index) for pregabalin, duloxetine, gabapentin, or amitriptyline in 2008 and continuous enrollment 12months pre- and postindex. Pregabalin patients were propensity-score-matched to each comparator. Using cutoff values ≥80% proportion of days covered (PDC) and ≥65years for age, pre- to postindex changes in healthcare costs were estimated for pregabalin vs. comparators. Of 987 patients initiated on pregabalin, 349 matched to duloxetine; 987 to gabapentin; 276 to amitriptyline. The pre- to postindex changes in total healthcare costs were similar between cohorts: $3272 with pregabalin vs. $2290 with duloxetine (P=0.5280); $3687 with pregabalin vs. $5498 with amitriptyline (P=0.5863); $3869 with pregabalin vs. $4106 with gabapentin (P=0.8303). For the high-age/high-PDC population, the pre- to postindex differences in mean total costs were significantly lower with pregabalin (P<0.001) relative to comparators ($3573 vs. $8288 for duloxetine; $1423 vs. $3167 for gabapentin; $2285 vs. $6160 for amitriptyline). The association of lower total costs among older individuals with pDPN who maintain high adherence to pregabalin therapy relative to key comparators suggests a pharmacoeconomic advantage of pregabalin in this population combined with a need for strategies promoting adherence.

Detection of fluoroquinolone‐induced tendon disorders using a hospital database in Japan

Tendinitis and tendon rupture are well-known side effects of fluoroquinolones (FQs) in Western countries. In Japan, some case reports have been reported; however, the incidence of FQ-induced tendon disorders has not been investigated. The aims of this study were to measure the occurrence of tendon disorders associated with FQs in Japanese patients and to compare the observed risk with that of previous reports. Moreover, the observed risk in FQ-prescribed patients was compared with that in cephalosporin-prescribed patients. The Hamamatsu University Hospital database was examined to determine the risk of tendon disorders that occurred in all inpatients and outpatients between the first day of prescription of an oral FQ or cephalosporins to the calculated end date plus 30 days. The risk of tendon disorders, the risk ratio, and their 95% confidence intervals (CIs) were evaluated. From April 1996 to December 2009, FQs were prescribed to 17 147 patients, 14 of whom had tendon disorders (risk: 0.082%, 95%CI: 0.049-0.137). The risk of a tendon disorder in FQ-prescribed patients was significantly higher than that in cephalosporin-prescribed patients (five tendon disorders in 38 517 patients, risk: 0.013%, 95%CI: 0.006-0.030, and p < 0.001). The risk ratio of a tendon disorder in FQ-prescribed patients in relation to cephalosporin-prescribed patients was 6.29 (95%CI: 2.27-17.46). A large discrepancy in the risk of tendon disorders was not observed between our findings and previous reports. A hospital database search revealed that the risk of tendon disorders in Japanese patients administered with FQs was higher than in those administered with cephalosporins.