Increase In Prescription Rates Research Articles

Retrospective analysis of onychomycosis prescribing patterns using the medicare part D prescribers database 2016-2020.

Onychomycosis, defined as a fungal nail infection, affects 5.5% of the global population. Our objectives were to analyse prescription trends of onychomycosis medications using the Medicare Part D Prescribers database from 2016 to 2020, stratified by physician specialty. There was a 4% annual increase in the total cost of onychomycosis medications, with a notable decrease of 12.8% in 2020 during the COVID-19 pandemic. Physicians demonstrated a strong consideration for price when selecting treatments, with the least expensive medications (ciclopirox and terbinafine) accounting for nearly 99% of all prescriptions. In contrast, the more costly medications (efinaconazole and tavaborole) were rarely prescribed. In addition, physicians often opted for the less costly generic versions of ciclopirox and itraconazole, prescribing them 99% and 91% of the time, respectively. Notably, physician assistants and nurse practitioners had higher overall increases in prescription rates, at 15%, compared to 1%-6% for other specialties. There are no recent United States onychomycosis guidelines, and our study emphasizes cost considerations when prescribing onychomycosis treatments.

Temporal trends of antidepressant utilization patterns in children and adolescents in Hong Kong: A 14-year population-based study with joinpoint regression analysis

BackgroundThere is limited research on real-world antidepressant utilization patterns in children and adolescents, particularly in non-western countries. We aimed to examine temporal trends of antidepressant prescribing practice among Chinese children and adolescents in Hong Kong over 14-year period. MethodsThis population-based study identified 9566 patients aged 5–17 years who had redeemed at least one antidepressant prescription within 2005–2018, using data from health-record database of Hong Kong public healthcare services. We calculated annual prescription rates (per 1000 persons) for any antidepressant, antidepressant drug classes, and individual antidepressants. Joinpoint-regression analyses were performed to assess temporal antidepressant prescription trends, quantified by average annual-percent-change (AAPC), with 95 % confidence-intervals (CIs). ResultsOverall antidepressant prescription rate significantly increased over time (AAPC: 7.30 [95 % CI: 6.70–7.90]), from 3.883 in 2005 to 9.916 in 2018. The use of selective-serotonin-reuptake-inhibitors (SSRIs), serotonin-norepinephrine-reuptake-inhibitors (SNRIs), and other antidepressants significantly increased over 14 years, while tricyclic-antidepressants remained stable. SSRI represented the most commonly-prescribed drug class. Fluoxetine and sertraline constituted the two most frequently-prescribed individual antidepressants, while desvenlafaxine (AAPC: 55.68 [30.74–85.39]) and bupropion (AAPC: 35.28 [23.68–47.98]) exhibited the sharpest increase in prescription rates over the study period. LimitationsMedication adherence could not be assessed and actual drug use may be overestimated. ConclusionsOur results affirm a significant rising trend of antidepressant prescriptions among Chinese children and adolescents over time. All antidepressant drug-classes, except TCA, demonstrated significantly increased use, with SSRI being the most frequently-prescribed drug class. Future investigation should clarify indications, hence off-label use, of antidepressant initiation in this vulnerable population.

Comparison of Sodium-Glucose Cotransporter-2 Inhibitor and Glucagon-Like Peptide-1 Receptor Agonist Prescribing in Patients With Diabetes Mellitus With and Without Cardiovascular Disease

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1-RAs) reduce cardiovascular events and mortality in patients with type 2 diabetes mellitus (T2DM). We sought to describe trends in prescribing for SGLT2is and GLP1-RAs in diverse care settings, including (1) the outpatient clinics of a midwestern integrated health system and (2) small- and medium-sized community-based primary care practices and health centers in 3 midwestern states. We included adults with T2DM and ≥1 outpatient clinic visit. The outcomes of interest were annual active prescription rates for SGLT2is and GLP1-RAs (separately). In the integrated health system, 22,672 patients met the case definition of T2DM. From 2013 to 2019, the overall prescription rate for SGLT2is increased from 1% to 15% (absolute difference [AD] 14%, 95% confidence interval [CI] 13% to 15%, p <0.01). The GLP1-RA prescription rate was stable at 10% (AD 0%, 95% CI -1% to 1%, p=0.9). In community-based primary care practices, 43,340 patients met the case definition of T2DM. From 2013 to 2017, the SGLT2i prescription rate increased from 3% to 7% (AD4%, 95% CI 3% to 6%, p <0.01), whereas the GLP1-RA prescription rate was stable at 2% to 3% (AD1%, 95% CI -1 to 1%, p=0.40). In a fully adjusted regression model, non-Hispanic Black patients had lower odds of SGLT2i or GLP1-RA prescription (odds ratio 0.56, 95% CI 0.34 to 0.89, p=0.016). In conclusion, the increase in prescription rates was greater for SGLT2is than for GLP1-RAs in patients with T2DM in a large integrated medical center and community primary care practices. Overall, prescription rates for eligible patients were low, and racial disparities were observed.

HbA1c-Triggered Endocrinology Electronic Consultation for Type 2 Diabetes Management.

Electronic consultation (eConsultation) offers a potential mechanism to increase access to specialty care, address knowledge gaps, and overcome therapeutic inertia in patients with type 2 diabetes (T2DM) being managed by primary care physicians (PCPs). To develop and implement a system to provide unsolicited endocrinology eConsult for T2DM patients with HbA1c 8.5-10.5% managed by PCPs. Cluster-randomized matched cohort study with implementation evaluation. PCPs affiliated with Massachusetts General Hospital (MGH). Unsolicited endocrinology eConsultation. The primary clinical outcome was mean change in HbA1c at 6 months. Secondary process outcomes included referral completion rate, prescription rates of glucose-lowering medications, differences in rate of other management recommendations, change in all glucose-lowering medications, and number of face-to-face endocrinology visits. 161 PCPs were randomly assigned to intervention (n=81) and control (n=80) arms. eConsultations were triggered on 130 patients from intervention arm PCPs. Intervention arm patients had a 0.89 (SD 1.45) decrease in HbA1c compared to 0.69 (SD 1.32) decrease in the control arm (p=0.28). There were significant differences in prescribing of glucose-lowering medications between arms. There was a 19.3% increase in patients prescribed GLP-1 RA or SGLT2i in the intervention arm compared to a 6.9% increase in control (p=0.003). There were also significant increases in prescription rates of metformin (3.1% vs -3.1%, p=0.03) and sulfonylureas (1.5% vs -6.9%, p=0.03). At 6-month follow-up, the intervention arm had 13 in-person endocrinology visits compared to 29 (p=0.012) in the control arm. PCPs were more likely to accept recommendations regarding adherence to or dose adjustment of current medications than initiation of new medications. The implementation of an unsolicited endocrinology eConsult system for patients with poorly controlled T2DM is feasible. Unsolicited eConsultation was associated with increased prescribing of glucose-lowering medications without significant difference in HbA1c. Clinicaltrials.gov registration: NCT03542084.

Challenges in Implementing Evidence Based Cross-Disciplinary Therapies: Are Cardiovascular Specialists Ready to Claim SGLT-2 Inhibitors and GLP-1 Analogs?

Cardiovascular disease is a leading cause of morbidity, mortality and financial burden to the United States health system. A change in focus towards preventive medicine along with advances in pharmacologic and invasive therapies, has led to improved cardiac death rates. These benefits however, come with increased prevalence of heart failure and soaring readmission rates. Reducing burden of hospitalizations has therefore, been a focus of clinicians and researchers over the years. An improvement in clinical outcomes has been demonstrated in multiple trials investigating HF therapies, however, execution of guideline recommendations has been trailing. Over the past decade, 2 classes of hypoglycemic agents, the glucagon-like peptide-1 (GLP-1) receptor agonists and the sodium-glucose cotransporter 2 (SGLT-2) inhibitors have been recognized for their cardiovascular morbidity and mortality benefits. Studies have shown that there has been a steady increase in prescription rates of these medications, however, overall usage remains quite low. Various patient, physician and system-based factors have been identified that cause barriers to translation of trial data to real-world clinical outcomes. A strategy focused on physician and patient education, quality improvement, multi-disciplinary team approach, and patient centered care is essential to meet treatment goals.

Antidepressant and anticonvulsant prescription rates in patients with osteoarthritis: a population-based cohort study.

ObjectivesThere are signs that antidepressants and anticonvulsants are being prescribed more often for OA patients, despite limited evidence. Our objectives were to examine prescription rates and time trends for antidepressants and anticonvulsants in OA patients, to assess the percentage of long-term prescriptions, and to determine patient characteristics associated with antidepressant or anticonvulsant prescription.MethodsA population-based cohort study was conducted using the Integrated Primary Care Information database. First, episodic and prevalent prescription rates for antidepressants (amitriptyline, nortriptyline and duloxetine) and anticonvulsants (gabapentinoids) in OA patients were calculated for the period 2008–17. Logistic regression was used to assess which patient characteristics were associated with prescriptions.ResultsIn total, 164 292 OA patients were included. The prescription rates of amitriptyline, gabapentin and pregabalin increased over time. The increase in prescription rates for pregabalin was most pronounced. Episodic prescription rate increased from 7.1 to 13.9 per 1000 person-years between 2008 and 2017. Amitriptyline was prescribed most (15.1 episodic prescriptions per 1000 person-years in 2017). Prescription rates of nortriptyline and duloxetine remained stable at 3.0 and 2.0 episodic prescriptions per 1000 person-years, respectively. For ≤3% of patients with incident OA, medication was prescribed long-term (≥3 months). In general, all medication was prescribed more frequently for older patients (except duloxetine), women, patients with OA in ≥2 joints, patients with spinal OA and patients with musculoskeletal disorders.ConclusionPrescription rates of amitriptyline, gabapentin and pregabalin increased over time. Since there is little evidence to support prescription in OA, caution is necessary when prescribing.

Association of Medicaid Expansion With Rates of Utilization of Cardiovascular Therapies Among Medicaid Beneficiaries Between 2011 and 2018.

The Affordable Care Act expanded Medicaid eligibility allowing low-income individuals greater access to health care. However, the uptake of state Medicaid expansion has been variable. It remains unclear how the Medicaid expansion was associated with the temporal trends in use of evidence-based cardiovascular drugs. We used the publicly available Medicaid Drug Utilization and Current Population Survey to extract filled prescription rates per 1000 Medicaid beneficiaries of statins, antihypertensives, P2Y12 inhibitors, and direct oral anticoagulants. We defined expander states as those who expanded Medicaid on or before January 1, 2014, and nonexpander states as those who had not expanded by December 31, 2018. Difference-in-differences (DID) analyses were performed to compare the association of the Medicaid expansion with per-capita cardiovascular drug prescription rates in expander versus nonexpander states. Between 2011 and 2018, the total number of prescriptions among all Medicaid beneficiaries increased, with gains of 89.7% in statins (11.0 to 20.8 million), 76% in antihypertensives (35.3 to 62.2 million), and 37% in P2Y12 inhibitors (1.7 to 2.3 million). Medicaid expansion was associated with significantly greater increases in quarterly prescriptions (per 1000 Medicaid beneficiaries) of statins (DID estimate [95% CI]: 22.5 [16.5-28.6], P<0.001), antihypertensives (DID estimate [95% CI]: 63.2 [47.3-79.1], P<0.001), and P2Y12 inhibitors (DID estimate [95% CI]: 1.7 [1.2-2.2], P<0.001). Between 2013 and 2018, >75% of the expander states had increases in prescription rates of both statins and antihypertensives. In contrast, 44% of nonexpander states saw declines in statins and antihypertensives. The Medicaid expansion was not associated with higher direct oral anticoagulants prescription rates (DID estimate [95% CI] 0.9 [-0.3 to 2.1], P=0.142). The 2014 Medicaid expansion was associated with a significant increase in per-capita utilization of cardiovascular prescription drugs among Medicaid beneficiaries. These gains in utilization may contribute to long-term cardiovascular benefits to lower-income and previously underinsured populations.

Impact of the antidepressant citalopram on the behaviour of two different life stages of brown trout.

BackgroundOver the last two decades, there has been a constant increase in prescription rates of antidepressants. In parallel, neuroactive pharmaceuticals are making their way into aquatic environments at increasing concentrations. Among the antidepressants detected in the environment citalopram, a selective serotonin reuptake inhibitor, is one of the most commonly found. Given citalopram is specifically designed to alter mood and behaviour in humans, there is growing concern it can adversely affect the behaviour on non-target wildlifeMethodsIn our study, brown trout were exposed to citalopram (nominal concentrations: 1, 10, 100, 1000 µg/L) in two different life stages. Larvae were exposed at 7 and 11 °C from the eyed ova stage until 8 weeks post yolk sac consumption, and juvenile brown trout were exposed for 4 weeks at 7 °C. At both stages we measured mortality, weight, length, tissue citalopram concentration, behaviour during exposure and behaviour in a stressfull environment. For brown trout larvae additionally hatching rate and heart rate, and for juvenile brown trout the tissue cortisol concentration were assessed.ResultsDuring the exposure, both larvae and juvenile fish exposed to the highest test concentration of citalopram (1 mg/L) had higher swimming activity and spent longer in the upper part of the aquaria compared to control fish, which is an indicator for decreased anxiety. Most probably due to the higher swimming activity during the exposure, the juveniles and larvae exposed to 1 mg/L citalopram showed decreased weight and length. Additionally, in a stressful artificial swimming measurement device, brown trout larvae displayed the anxiolytic effect of the antidepressant by reduced swimming activity during this stress situation, already at concentrations of 100 µg/L citalopram. Chemical analysis of the tissue revealed rising citalopram tissue concentrations with rising exposure concentrations. Tissue concentrations were 10 times higher in juvenile fish compared to brown trout larvae. Fish plasma concentrations were calculated, which exceeded human therapeutic levels for the highest exposure concentration, matching the behavioural results. Developmental parameters like hatching rate and heart rate, as well as mortality and tissue cortisol content were unaffected by the antidepressant. Overall, we could trace the pharmacological mode of action of the antidepressant citalopram in the non-target organism brown trout in two different life stages.

Trends in Drug Prescription Rates for Dementia: An Observational Population-Based Study in France, 2006-2014.

Since the 2011 French guidance updates, cholinesterase inhibitors and memantine are considered optional in the management of dementia and leave physicians free to prescribe based on their clinical expertise. The aims of this study were to analyze the influence of these recent guidance updates on the prescription rates of these drugs and to quantify the impact of potential changes on healthcare expenditures. Patients over 65years old from a representative sample of a national administrative claims database, the French national health insurance database, were retrospectively included from 2006 to 2014. Trends of annual prescription rates were tested using adjusted segmented regression analysis. Drug costs with and without prescribers' behavioral changes were estimated. A total of 119,731 individuals were included and followed during the study period. Among them, 5514 individuals were treated for dementia. According to the unadjusted segmented regression model, there was a significant increase in prescription rates between 2006 and 2010, from 2.23% (95% confidence interval 2.13-2.34) to 2.73% (95% confidence interval 2.62-2.84) of the study population. Since 2011, the trend has reversed with a significant decrease until 2014, from 2.64% (95% confidence interval 2.54-2.75) to 1.92% (95% confidence interval 1.84-2.01). In the multivariate analysis, we also found a gradual decline since 2011, particularly for patients aged 65-69years and with one or more other chronic diseases. Cost savings associated with prescribers' behavioral changes were estimated at €108million. Drugs prescribed for dementia are on a declining trend with important cost savings, and this was concomitant with guidance updates that left physicians to rely on their clinical expertise while managing dementia.

Trends in prescribing rate of statins at discharge and modifiable factors in patients with atherosclerotic cardiovascular disease.

Tremendous effort has been invested in reducing the prevalence of atherosclerotic cardiovascular disease (ASCVD) in China. Meanwhile, accumulating evidence has emerged to show the benefits of statins in the prevention of cardiovascular disease. The present study investigated the change trends of statins prescription at discharge among patients with ASCVD in recent years, differences across subtypes of ASCVD, and associated factors. The study included 51,972 patients with a discharge diagnosis of ASCVD who were hospitalized in West China Hospital from 2008 to 2014. Trends of statins prescription rates between subtypes of ASCVD were compared and potential influential factors were explored. The overall statins prescription rate in patients with ASCVD was 58.8%. Adjusted odds ratios (ORs) of increase in prescription rate per year were 1.15 (95% CI 1.13-1.17, p<0.001), 1.14 (95% CI 1.10-1.17, p<0.001), 1.19 (95% CI 1.16-1.23; p<0.001), 1.14 (95% CI 1.09-1.19; p<0.001), and 1.13 (95% CI 1.09-1.17; p<0.001) for ASCVD, coronary artery disease, cerebrovascular disease, peripheral arterial disease (PAD), and polyvascular disease, respectively; no significant differences in trends were detected among ASCVD subtypes. However, statins prescription rates were persistently lower in cerebrovascular disease and PAD than the other two subtypes. Discharge departments, together with other physician-related and patient-related characteristics were associated with statins utilization. In conclusion, between 2008 and 2014, statins prescription rate in patients with ASCVD was not optimal. The increasing trends in statins prescription among patients with ASCVD subtypes were similar but the differences did not decrease. Consciousness of integrated and successive medical care should be strengthened in China.

Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis.

Opioid use in chronic pain treatment is complex, as patients may derive both benefit and harm. Identification of individuals currently using opioids in a problematic way is important given the substantial recent increases in prescription rates and consequent increases in morbidity and mortality. The present review provides updated and expanded information regarding rates of problematic opioid use in chronic pain. Because previous reviews have indicated substantial variability in this literature, several steps were taken to enhance precision and utility. First, problematic use was coded using explicitly defined terms, referring to different patterns of use (ie, misuse, abuse, and addiction). Second, average prevalence rates were calculated and weighted by sample size and study quality. Third, the influence of differences in study methodology was examined. In total, data from 38 studies were included. Rates of problematic use were quite broad, ranging from <1% to 81% across studies. Across most calculations, rates of misuse averaged between 21% and 29% (range, 95% confidence interval [CI]: 13%-38%). Rates of addiction averaged between 8% and 12% (range, 95% CI: 3%-17%). Abuse was reported in only a single study. Only 1 difference emerged when study methods were examined, where rates of addiction were lower in studies that identified prevalence assessment as a primary, rather than secondary, objective. Although significant variability remains in this literature, this review provides guidance regarding possible average rates of opioid misuse and addiction and also highlights areas in need of further clarification.

Is bipolar always bipolar? Understanding the controversy on bipolar disorder in children.

Dramatically increasing prevalence rates of bipolar disorder in children and adolescents in the United States have provoked controversy regarding the boundaries of manic symptoms in child and adolescent psychiatry. The serious impact of this ongoing debate on the treatment of affected children is reflected in the concomitant increase in prescription rates for antipsychotic medication.A key question in the debate is whether this increase in bipolar disorder in children and adolescents is based on a better detection of early-onset bipolar disorder—which can present differently in children and adolescents—or whether it is caused by an incorrect assignment of symptoms which overlap with other widely known disorders.So far, most findings suggest that the suspected symptoms, in particular chronic, non-episodic irritability (a mood symptom presenting with easy annoyance, temper tantrums and anger) do not constitute a developmental presentation of childhood bipolar disorder. Additional research based on prospective, longitudinal studies is needed to further clarify the developmental trajectories of bipolar disorder and the diagnostic status of chronic, non-episodic irritability.

Five-fold increase in national prevalence rates of attention-deficit/hyperactivity disorder medications for children and adolescents with autism spectrum disorder, attention-deficit/hyperactivity disorder, and other psychiatric disorders: a Danish register-based study.

The purpose of this study was to estimate the prevalence and time trends in prescriptions of methylphenidate, dexamphetamine, and atomoxetine in children and adolescents, within three diagnostic groups: 1) autism spectrum disorder (ASD), 2) attention-deficit/hyperactivity disorder (ADHD), and 3) other psychiatric disorders. Data from six different national registers were used and merged to identify a cohort of all children and adolescents born in Denmark between 1990 and 2001 (n=852,711). Sociodemographic covariates on cohort members and their parents and lifetime prescriptions of methylphenidate, dexamphetamine, and atomoxetine were extracted from the registers. Prescriptions were also stratified by duration (<6 months. vs.≥ 6 months). Sixteen percent of 9698 children and adolescents with ASD (n=1577), 61% of 11,553 children and adolescents with ADHD (n=7021) and 3% of 48,468 children and adolescents with other psychiatric disorders (n=1537) were treated with one or more ADHD medications. There was a significant increase in prescription rates of these medications for all three groups. From 2003 to 2010, youth 6-13 years of age with ASD, ADHD, and other psychiatric disorders had 4.7-fold (4.4-4.9), 6.3-fold (6.0-6.4), and 5.5-fold (5.0-5.9) increases, respectively, in prescription rates of ADHD medications. This is the largest study to date assessing stimulant treatment in children and adolescents with ASD, and is the first prospective study quantifying the change over time in the prevalence of treatment with ADHD medications in a population-based national cohort of children and adolescents with ASD. The prevalence of stimulant treatment in youth with ASD of 16% is consistent with earlier studies. The past decade has witnessed a clear and progressive increase in the prescription rates of medications typically used to treat ADHD in children and adolescents in Denmark. This increase is not limited to only those with ADHD, but includes others with neuropsychiatric disorders, including ASD. The risks and benefits of this practice await further study.

Nationwide time trends in dispensed prescriptions of psychotropic medication for children and adolescents in Denmark

The analysis of time trends in dispensed prescriptions of psychotropic medications for children and adolescents in Denmark. The entire data set of the Danish prescription register covering stimulants, antidepressants, antipsychotics, and anxiolytics used in children and adolescents over a 15-year time span from 1996 to 2010 was analyzed. Both non-adjusted age-standardized prevalence rates and adjusted age-standardized prevalence rates considering the increase in patient numbers over time were calculated, and time trends were assessed based on 105908 patient-years. For stimulants, antidepressants, and antipsychotics, the non-adjusted prevalence rates increased significantly. These trends were strongest for the stimulants. However, all adjusted prevalence rates were much lower with the anxiolytics even declining significantly. The prevalence rates of stimulants and antipsychotics were significantly higher among males than females, whereas females received significantly more antidepressants. The increase in prescription rates for both antidepressants and antipsychotics was mainly due to increased use among the 14- to 17-year-olds. Stratification by diagnoses revealed significantly increasing prevalence rates of dispensed antidepressants and antipsychotics in six major diagnostic indications. Although increasing, the unadjusted Danish prevalence rates of dispensed prescriptions of psychotropics for children and adolescents are still lower than in many other Western countries.

The Over-prescription of Ritalin for Suspected Cases of ADHD

Methylphenidate (Ritalin), the current leading form of treatment for Attention Deficit Hyperactivity Disorder (ADHD), has seen a dramatic increase in prescription rate over the past ten years. No contemporary biological basis for ADHD diagnosis results in physicians making their diagnoses based on behavioural symptoms such as hyperactivity and inability to focus. Considering that these symptoms are behaviours that anyone may express at one point in their life, the risk of over-diagnosis of the disease increases. This may subsequently lead to over-prescription of Ritalin. This paper aims to evaluate and identify the causes and effects of Ritalin over-prescription. Key literature on ADHD reveals that the diagnostic criteria for ADHD has undergone various modifications since the disease was first identified; therefore, different experts may have different opinions on what are regarded as symptoms of the disorder. Furthermore, recent research has demonstrated that Ritalin can increase cognitive performance in both healthy individuals and in ADHD patients. Such data indicates that Ritalin has the potential to be abused by healthy individuals looking to increase their cognitive performance. Correspondingly, Ritalin has been reported to be used by college students to boost their academic performance. In addition, the over-prescription of Ritalin raises several ethical issues: as children are the most common age group to be diagnosed with the disease, critics question whether prescribing a drug for a behaviourally based diagnosed disease is appropriate; also it is thought that the drug may affect the originality and creativity of the children which may hinder their personal development. While alternative behavioural therapy is available for the disorder, it tends to be more expensive and time-consuming than a drug prescription; this may explain why Ritalin remains the dominant form of treatment. This paper concludes that the prescription of drugs for ADHD should be cautioned and that more time and resources should be invested on developing consistent diagnostic criteria as well as potential alternative treatments to drugs for the disorder.

Determinantes de la prescripción de antibióticos en atención primaria

To determine patient and physician-related factors associated with variability in antibiotic prescription. Observational study of the prevalence of antibacterial medication prescription >14 years old. official prescriptions, clinical histories and individual health cards. Patient-related variables were: age, sex, number of medical visits-year, comorbidity, antibacterials dispensed with prescription. Physician-related variables were age, sex, number of patients assigned, place of work and rurality. Variables associated with prescription were studied by estimating the odds ratio (OR) from the fit of the multilevel logistic regression models. The rate of antibiotic prescription-year in the population was 31.4%. Factors associated with prescription were high rate of visits (users with more than 5 annual visits multiply the probability of receiving antibiotics, compared to those who madeno visits: OR=10.8), age (non-linearly, with a greater likelihood in the young and the elderly) and sex, with a higher rate in women (OR=1.5). No association was found between prescription and age and sex of the physician, but an association was found with workload: the higher the physician's workload, the higher the likelihood of antibiotic prescription. The most important factor associated with the increase in prescription rate was the frequency of visits. In addition, women, the young and the elderly receive more antibiotics. A multi-factor intervention focusing on demand, patients, and physicians should be carried out to reduce prescription rates.

056 Mutli-dimensional prevention program after acute coronary syndrome (ELIPS)

Guidelines recommend pharmacologic and lifestyle interventions to reduce recurrence of events in patients with coronary and other atherosclerotic vascular disease. Based on our systematic review of tested interventions, we developed the ELIPS program, a multidimensional secondary prevention program targeting multiple cardiovascular risk factors for patients after an acute coronary syndrome (ACS). This programme targets an increase in prescription rates by physicians and/or long term medication adherence by patients. To demonstrate the effectiveness of the ELIPS programme (Multi-dim E nsiona L prevent I on P rogram after Acute coronary S yndrome), which aims at improving quality of care of patients admitted to hospital with ACS in the Swiss setting. A total of 2400 patients will be prospectively included in a multicenter study before and after the implementation of the ELIPS program with a follow-up of 12 months. The primary outcome is a composite of death from any cause, myocardial infarction, documented unstable angina requiring rehospitalization, revascularization (performed at least 30 days after randomization), and stroke. The secondary endpoints are the isolated endpoints of the primary endpoint as well as cardiovascular mortality, and surrogate outcomes such as cardiovascular risk factor control at follow-up. To demonstrate the benefits of the ELIPS program on recurrence rate of cardiovascular events. These results will certainly lead to a generalization of such programs in the field of atherosclerosis.

The relationship between elderly suicide rates and the affordability of psychotropic drugs

A recent cross-national study of 62 developing and developed countries reported an increase in suicide rates with aging in males and females in 25 and 27 countries respectively (Shah, 2007). Longitudinal studies over time have reported a decline in elderly suicide rates in England and Wales (Gunnell et al., 2003; Lodhi and Shah, 2004), Sweden (Carlsten et al., 1999) and Australia (Hall et al., 2003) with an increase in prescription rates of antidepressants, particularly selective serotonin reuptake inhibitors. The vast majority of elderly suicide victims have depressive illness (Shah and De, 1998). The pathway to elderly depressed individuals acquiring a prescription of antidepressants includes the following sequential steps: recognition by individuals or their carers that there is problem and consulting a healthcare professional; recognition of depression by the healthcare professional; prescription of antidepressants by the healthcare professional; and, purchasing of the antidepressants by the patient. Different methods of acquiring the prescribed antidepressants exist in different countries including: healthcare professionals dispensing the antidepressant free or at a cost; and obtaining the prescribed antidepressant from a pharmacist free (either through state welfare system or insurance schemes) or at a cost. We have examined the relationship between elderly suicide rates and the affordability of psychotropic medication in a cross-national study.

Antibiotic Treatment of Wheezing in Children With Asthma: What Is the Practice?

Kozyrskyj AL, Dahl ME, Ungar WJ, Becker AB, Law BJ. Pediatrics. 2006;117(6). Available at: www.pediatrics.org/cgi/content/full/117/6/e1104 PURPOSE OF THE STUDY. To evaluate time trends and determinants of antibiotic use in children with wheezing episodes. STUDY POPULATION. Children with asthma were identified from population-based health care and prescription databases in Manitoba, Canada, during fiscal years 1995–2001. Asthma was defined as at least 1 physician or hospital visit for asthma or at least 1 prescription for an asthma drug. METHODS. In this descriptive study, using general estimating equations, annual population-based rates of antibiotic prescriptions for wheezing episodes were modeled by age and antibiotic class. Population-based rates for antibiotic use for wheezing were defined as the annual number of antibiotic prescriptions dispensed per 1000 children with asthma. Linear hierarchical rankings were used to calculate odds ratios for receiving an antibiotic prescription according to child demographics and physician factors. RESULTS. Antibiotic prescription rates for wheezing decreased 28% from 708 prescriptions per 1000 children with asthma in 1995 to 511 prescriptions per 1000 children with asthma in 2001. However, an increase in prescriptions was observed for broader-spectrum macrolides (azithromycin and clarithromycin) in preschool-aged children (a 15-fold increase) and in all children (an eightfold increase). Immediate prescriptions (defined as within 2 days of the visit) were given in 23% of physician encounters for wheezing. Sixty-four percent of the visits resulted in an antibiotic prescription within 7 days of the visit. General practitioners prescribed antibiotics for wheezing more often than pediatricians, as did older compared with younger physicians. Physicians trained outside Canada and the United States were 40% more likely to prescribe antibiotics. Visits for younger children and visits during winter months more frequently resulted in antibiotic prescriptions. CONCLUSIONS. Antibiotic prescription rates for wheezing episodes declined in the late 1990s, but broader-spectrum antibiotic prescription rates increased. REVIEWER COMMENTS. Antibiotic use in asthma has gained renewed interest because of the antiinflammatory properties of certain antibiotic classes such as the macrolides. Coupled with the better-tolerated and more-convenient dosing of newer antibiotics (primarily azithromycin), they may provide a future therapeutic option in the treatment of asthma. Nonetheless, little is published about the prescribing patterns of antibiotics for wheezing and asthma. Coexisting maladies such as otitis or pneumonia are not specifically addressed in this publication but may account for the increase in prescription rates at 7 days postvisit. In addition, the possible contribution of antibiotics in the inception of asthma by participating in the “hygiene hypothesis” provides additional interest in these data. Finally, the perceived dangers of resistance with antibiotic use continue to make their use controversial in the treatment of asthma exacerbations.

Antipsychotic-Related Abnormal Involuntary Movements and Metabolic and Endocrine Side Effects in Children and Adolescents

There has been a remarkable increase in prescription rates of antipsychotics in children and adolescents in recent years. Their side effects are a neglected area of research in this population, despite its vulnerability. In this cross-sectional study, we compared the presence of side effects in 60 children and adolescents who had taken antipsychotic medication for less than 1 month and 66 who had been receiving treatment with antipsychotics for more than 12 months. Mean age for the total sample was 15.62 years (SD 1.85). Groups did not differ in age, gender, or diagnosis. A total of 21.7% of short-term treatment group patients and 37.9% of longer-term treatment group patients presented mild dyskinetic movements (p = 0.004). Hyperprolactinemia was present in 78.6% and 48.5% in the short-term and longer-term treatment groups, respectively. Body mass index (p < 0.001), cholesterol levels (p < 0.001), and low-density lipoprotein-cholesterol (LDL-C) (p = 0.018) were higher in the longer-term treatment group. The use of these drugs in these populations merits careful scrutiny.