Medication Prescribing Patterns Research Articles

Prescription and Dispensation of QT-Prolonging Medications in Individuals Receiving Hemodialysis

Individuals with dialysis-dependent kidney failure have numerous risk factors for medication-related adverse events, including receipt of care by multiple clinicians and initiation of some QT-prolonging medications with known risk of torsades de pointes (TdP), which is associated with higher risk of sudden cardiac death. Little is known about the prescription and dispensation patterns of QT-prolonging medications among people receiving dialysis, hindering efforts to reduce drug-related harm from these and other medications in this high-risk population. To examine prescription and dispensation patterns of QT-prolonging medications with known TdP risk and selected interacting medications prescribed to individuals receiving hemodialysis. This cross-sectional study included patients 60 years or older who were enrolled in Medicare Parts A, B, and D receiving in-center hemodialysis from January 1 to December 31, 2019. Analyses were conducted from October 20, 2022, to June 16, 2023. New-user prescriptions for the 7 most frequently filled QT-prolonging medications characterized by the timing of the new prescription relative to acute care encounters, the type of prescribing clinician and pharmacy that dispensed the medication, and concomitant use of selected medications known to interact with the 7 most frequently filled QT-prolonging medications with known TdP risk. The main outcomes were the frequencies of the most commonly filled and new-use episodes of QT-prolonging medications; the timing of medication fills relative to acute care events; prescribers and dispensing pharmacy characteristics for new use of medications; and the frequency and types of new-use episodes with concurrent use of potentially interacting medications. Of 20 761 individuals receiving hemodialysis in 2019 (mean [SD] age, 74 [7] years; 51.1% male), 10 992 (52.9%) filled a study drug prescription. Approximately 80% (from 78.6% for odansetron to 93.9% for escitalopram) of study drug new-use prescriptions occurred outside of an acute care event. Between 36.8% and 61.0% of individual prescriptions originated from general medicine clinicians. Between 16.4% and 26.2% of these prescriptions occurred with the use of another QT-prolonging medication. Most potentially interacting drugs were prescribed by different clinicians (46.3%-65.5%). In this cross-sectional study, QT-prolonging medications for individuals with dialysis-dependent kidney failure were commonly prescribed by nonnephrology clinicians and from nonacute settings. Prescriptions for potentially interacting medications often originated from different prescribers. Strategies aimed at minimizing high-risk medication-prescribing practices in the population undergoing dialysis are needed.

Prescription Pattern of Cholelithiasis at Surgery Ward in Tertiary Care Hospital

Background: Cholelithiasis is a chronic recurrent disease of the hepatobiliary system. The impaired metabolism of cholesterol, bile acids and bilirubin are characterized by gallstone formation.The number of surgical procedures for cholelithiasis has risen markedly in developed countries since 1950. An estimated 90% of cholecystectomies are now performed by the laparoscopic approach worldwide. Objectives: The aim of the study was to study prescription pattern of Cholelithiasis at surgery ward in B&C medical college teaching hospital and research Centre Pvt. Ltd. Materials and Methods: A Retrospective study was conducted and data of Cholelithiasis cases admitted at Surgery ward from 2077/01/01 BS to 2077/12/31 BS were collected. Coding of data , result and interpretation of data were drawn using SPSS version 16 and MS Excel 2016 . Result: The present study included 137 patients.Among them,80.3% were females and 19.7% were males. The high incidence of cholelithiasis was found in the age group 30-39 years (27%). 98.5% of total hospitalized patient were prescribed with antibiotics followed by Proton Pump inhibitors (93.4%) and NSAIDS(92%) .Among antibiotics, Ceftriaxone (65.7%) were the most prescribed one. During discharge , antibiotics (98.5%) were the most prescribed group of medicine followed by Proton Pump Inhibitors (88.3%) and NSAIDS(67.9%). And among antibiotics, Cefixime (52.6%) were mostly prescribed. While analyzing prescription pattern of discharge medication it was found that percentage of drugs prescribed by generic name was 13.86% and percentage of drugs prescribed from essential drug list was 43.36%. Conclusion: The present study revealed that there was greater incidence of Cholelithiasis in females (80.3%) than in males and in the age group 30-39 years (27%) .The results obtained from this study showed that most commonly prescribed medicines were antibiotics. Prescription through generic name and essential drug list was low. Therefore, prioritization on prescribing drugs by generic name and from essential drug list needs to be encouraged.

Changes in lymph node surgery in breast cancer and preoperative drug prescription analysis for postoperative pain management: A retrospective, cross-sectional study.

This study aimed to investigate the changes in lymph node surgery types and prescription patterns of postoperative medications for pain management in patients with breast cancer using national health insurance claim data from South Korea. The study population comprised patients with at least one record of a principal diagnosis of breast cancer (ICD-10 code: C50) from the national health insurance claim database between 2010 and 2019. Patients who underwent mastectomy or lumpectomy only once were selected for the analysis. Patients who underwent axillary lymph node dissection (ALND) with mastectomy or lumpectomy on the day of surgery were included in the ALND group, whereas those who underwent sentinel lymph node biopsy (SLNB) were included in the SLNB group. Prescription records of opioids before, after and on the date of breast cancer surgery were collected and categorized according to the opioid type. Multivariate logistic regression modeling was used to compare postoperative opioid prescriptions. The proportion of those undergoing ALND among 3,080 patients decreased consistently after 2014, while the proportion undergoing SLNB increased. Although the rate of pain medication prescription on the day of surgery was similar between the two groups, the rate of prescription of postoperative pain medication and anticancer agents was lower in the SLNB group than in the ALND group. Logistic regression modeling showed that the SLNB group had lower odds of receiving opioids than did the ALND group (Odds ratio (OR) = 0.727, Confidence Interval (CI) = 0.546-0.970). A consistent trend was observed when the model was adjusted for neoadjuvant chemotherapy and the use of preoperative pain medications (OR = 0.718, CI = 0.538-0.959). To manage postoperative pain and prevent chronic pain with minimal side effects, sufficient discussion among clinicians, patients, and other healthcare professionals is imperative, along with adequate treatment planning.

Prescribing Patterns of Psychotropic Medications for Common Psychiatric Disorders in a Mental Health Hospital in Tabuk.

Mental health disorders are often chronic and disabling conditions that impact different populations, irrespective of age, cultural background, or socioeconomic status. This study aimed to describe the prescribing pattern of psychotropic medications in patients with psychiatric disorders. This research was a retrospective investigation of psychotropic medication prescribing patterns and conducted at Eradah Mental Health Hospital at Tabuk City, SaudiArabia. The data were extracted from the electronic medical database of adult patients presenting to the outpatient and inpatient clinics of a mental health hospital between 2020 and 2023. The diagnosis of psychiatric disorders was identified using the International Classification of Diseases 10th Revision (ICD-10) codes version 2019 for mental and behavioral disorders (F00 to F99). The electronic medication records of 526 patients were reviewed, of whom 510 (97%) were Saudi nationals, 368 (69.9%) were males, 235 (44.7%) were between 31 and 40 years of age, and 233 (44.3%) were outpatients. The most common psychiatric diagnoses were schizophrenia (33.3%), followed by bipolar affective disorder (16.9%). A total of 2,153 medication orders for psychotropic medications were quantified. Second-generation antipsychotics (SGAs) and first-generation antipsychotics (FGAs) were the top prescribed medication classes (1,290, 60%), followed by mood stabilizers (324, 15%). More than one-half of the patients (282, 53.6%) received a combination of antipsychotic and mood stabilizers, and 155 (29.5%) received a combination of antipsychotic and antidepressant medications.No significant differences were observed in prescribing for males and females. Schizophrenia was highly prevalent among adult patients who sought mental healthcare. Polypharmacy of psychotropic medication was common depending on the symptoms' severity and comorbid psychiatric diseases.

VISUALIZING HETEROGENEOUS TRAJECTORIES OF SUBJECTS WITH SURGICAL RELAPSE IN INFLAMMATORY BOWEL DISEASE FROM UK BIOBANK GENERAL PRACTICE DATA

Abstract BACKGROUND AND AIMS The United Kingdom (UK) Biobank (UKBB) is a large-scale biomedical database and research resource, containing in-depth health information from half a million participants in UK that have been used for detailed analyses of IBD. Using the UKBB, we examined the lab findings and prescription medication use in IBD subjects to identify trajectory patterns of disease with respect to surgical relapse. METHODS Of the 363 subjects in the UKBB with an established IBD diagnosis (UC, CD, or both) and an initial GI surgery, 116 had a subsequent surgery within 5 years of initial surgery and had follow up lab values of urine and serum creatinine, plasma and serum C-reactive protein, urine and serum albumin, urine albumin-creatinine ratio, total white blood count, urine microalbumin, total white cell count, hemoglobin estimation, and erythrocyte sedimentation rate. Additionally, data for the 9 most used IBD prescription medications: budesonide, sulfasalazine, methotrexate, hydrocortisone, balsalazide, olsalazine, prednisolone, azathioprine, and mesalamine was analyzed as well. Hidden Markov Models (HMM) using these variables and open-source packages were incorporated to label observations of each subject-visit until the subsequent surgery. Interactive visualizations using DPVis open-source package were then applied to identify individual trajectories and explore clinical characteristics. RESULTS Five hidden states were observed from HMM. The five states observed are based on differing prescription medication usage for the treatment of IBD and were assigned a color to allow for comparison (Figure 1). The majority of patients fell within the states labeled “blue” (azathioprine, sulfasalazine, and prednisone) “red” (mesalamine only) or “purple” (azathioprine, balsalazide, and prednisolone). The visualizer showed that while some transitions among states were observed, most patients fell into one of three major trajectory patterns as a factor of time to surgical relapse and were largely segregated by state. Based on the trajectories, a comparison of subjects with prescription of mesalamine-only vs. any immunosuppressive medications (azathioprine + sulfasalazine + balsalazide) in combination with prednisolone showed a significant difference in time to surgical relapse (P < 0.005) (Figure 2), with a shorter time to surgical relapse identified in patients who took mesalamine only. CONCLUSIONS We identified three distinct trajectories leading up to surgical relapse. These trajectories show distinctive medication prescription patterns (5-ASA vs. Azathioprine with steroid use), as well as significantly different times to surgical relapse. Furthermore, heterogeneity is shown within each trajectory pattern in terms of progression time and warrant further investigation. Figure 1 Three Trajectories of time to surgical relapse generated from 5-State HMM using lab values and prescription medications. Note that a patient can traverse multiple states so the summation of the observed subjects of those states exceeds the cohort size (N=116). Figure 2 Kaplan-Meier curves for the UC/CD subgroup with surgical relapse considering events from the first documented lab values and/or planned prescription at most 2 years prior to the baseline surgery up to the subsequent 5 years.

The Effect of Telehealth on Patterns of Health Care Utilization and Medication Prescription in Patients with Diabetes or Hypertension During COVID-19: A Nationwide Study.

Background: In response to the coronavirus disease-19 pandemic, audio-based telehealth services for consultation and medication prescription were temporarily introduced in Korea. This study investigated the impact of telehealth services on patterns of health care utilization and medication prescription in patients with hypertension or diabetes. Methods: The 2019 to 2021 Health Insurance Review and Assessment Service claims data were used. The difference-in-difference approach was used to investigate the effect of telehealth services between the case and control group before and after the intervention period. The pre-intervention period was from February 24, 2019, to February 23, 2020, and the post-intervention period from February 24, 2020, to February 23, 2021. The control group included individuals who used in-person outpatient services and the case group those who utilized both telehealth and in-person services. Results: A total of 250,640 patients with hypertension and 154,212 patients with diabetes were included. The use of telehealth services was associated with an increase in outpatient visits in those with hypertension (0.07, p = 0.0027) and diabetes (0.32, p < 0.0001). A decrease in hospitalizations (-0.2%, p = 0.0007) and emergency department visits (-0.11%, p = 0.0016) was found in individuals with hypertension. Policy implementation also resulted in an increase in medication possession ratio (MPR) and the proportion of appropriate prescription in patients with hypertension (MPR: 3.0%, p < 0.0001, prescription: 3.1%, p < 0.0001) and diabetes (MPR: 3.4%, p < 0.0001, prescription: 1.7%, p < 0.0001). Conclusions: The findings confirm a relationship between implementing telehealth services and improved patterns of health care utilization and medication prescription, suggesting the potential benefit of telehealth in managing chronic diseases.

Trends of anti-seizure medication prescribing pattern in traumatic brain injury patients for the prevention of posttraumatic seizure in Taiwan

Traumatic brain injury (TBI) patients are recommended to receive anti-seizure medication (ASM) as posttraumatic seizure (PTS) prophylaxis. However, the utilization of ASM, including the prescription patterns and associated clinical characteristics, is limited in Taiwan. Thus, this study aimed to investigate the ASM trends and clinical characteristics. This retrospective cohort study enrolled TBI patients who received levetiracetam, phenytoin, and valproic acid during hospitalization using the National Health Insurance Research Database between 2012 and 2019. The primary outcome was the trend of the ASMs based on the index year. The duration of levetiracetam prescription was categorized as short-term (seven days or less) or long-term (more than seven days). Logistic regression identified the factors associated with long-term usage. A total of 64,461 TBI patients were included. Levetiracetam usage increased yearly, while phenytoin declined. Among the levetiracetam users, 5681 (30.38%) were short-term users, and 13,016 (69.62%) were long-term users. Diagnoses of contusions, intracranial hemorrhage, other intracranial injuries, receiving operations, and a history of cerebrovascular disease were significantly associated with longer duration. Conclusions This study revealed the rising trend of levetiracetam usage, indicating its potential as an alternative to phenytoin. TBI patients with more severe conditions were more likely to receive longer prescriptions.

Assessment of Medication Prescribing Indicators Using the World Health Organization Standard Indices in a Tertiary Hospital in Ilorin, Nigeria

Background: Drug use is the most common option in treating disease conditions in clinical practice. Irrational prescription and use of medicine have become a major problem in Africa. The patterns of medication prescription in this environment have been under-studied. Evaluating these patterns is essential to provide information that may guide actions towards improving the prescription standards and mitigate the problems associated with irrational prescription and use of medicine. The study aimed to assess medication prescribing patterns by all cadres of doctors in the General Outpatient Department of the University of Ilorin Teaching Hospital (UITH) using the World Health Organization (WHO) prescribing indicators. Methods: It was a six-month retrospective study of medication prescription by all cadres of the doctors attending to outpatients in the General Outpatient Department of UITH between 1st July, 2022 – 31st December, 2022. A validated data capture form was used for the study following the WHO prescribing indicator guidelines. The results were displayed using the arithmetic means, frequencies, and percentages. Results were interpreted by the recommended ideal values by the WHO. Results: 1,650 prescriptions were reviewed, 914 were included in the study. This study found that all the analyzed prescription indices fell short of the WHO-recommended threshold. An average of 2.25 medications were prescribed per patient. The percentages of encounters with injections, antibiotics, and other medications by generic name were 87.2%, 66.9%, and 73.2%, respectively. 53.8% of the medications prescribed came from the essential medicine list. Conclusion: All medication prescribing indicators assessed were found to be below the ideal value recommended by WHO. Therefore, we advocated for the training of prescribers and the formulation of policies that will promote the prescription of medications in line with WHO guidelines.

Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data.

Different medication prescription patterns have been associated with varying course of disease and outcomes in COVID-19. Health claims data is a rich source of information on disease treatment and outcomes. We aimed to investigate drug prescription patterns and their association with mortality and hospitalization via insurance data for a relatively long period of the pandemic in Iran. We retrieved hospitalized patients' data from Iran Health Insurance Organization (IHIO) spanning 26 months (2020-2022) nationwide. Included were patients with ICD-10 codes U07.1/U07.2 for confirmed/suspected COVID-19. A case was defined as a single hospitalization event for an individual patient. Multiple hospitalizations of a patient within a 30-day interval were aggregated into a single case, while hospitalizations with intervals exceeding 30 days were treated as independent cases. The Anatomical Therapeutic Chemical (ATC) was used for medications classification. The two main study outcomes were general and intensive care unit (ICU) hospitalization periods and mortality. Besides, various demographic and clinical associate factors were analyzed to derive the associations with medication prescription patterns and study outcomes using accelerated failure time (AFT) and logistic regression models. During the 26 months of the study period, 1,113,678 admissions with COVID-19 diagnosis at hospitals working in company with IHIO were recorded. 917,198 cases were detected from the database, among which 51.91% were females and 48.09% were males. Among the main groups of medications, antithrombotics (55.84% [95% CI: 55.74-55.94]), corticosteroids (54.14% [54.04-54.24]), and antibiotics (42.22% [42.12-42.32]) were the top used medications among cases with COVID-19. Investigation of the duration of hospitalization based on main medication groups showed antithrombotics (adjusted median ratio = 0.94 [0.94-0.95]) were significantly associated with shorter periods of overall hospitalization. Also, antithrombotics (adjusted odds ratio = 0.74 [95%CI, 0.73-0.76]), corticosteroids (0.97 [0.95-0.99]), antivirals (0.82 [0.80-0.83]), and ACE inhibitor/ARB (0.79 [0.77-0.80]) were significantly associated with lower mortality. Over 2 years of investigation, antithrombotics, corticosteroids, and antibiotics were the top medications for hospitalized patients with COVID-19. Trends in medication prescription varied based on various factors across the country. Medication prescriptions could potentially significantly impact the trends of mortality and hospitalization during epidemics, thereby affecting both health and economic burdens.

Short-acting β2-agonist prescriptions in patients with asthma: findings from the South Korean cohort of SABINA III.

Despite short-acting β2-agonist (SABA) overuse being associated with poor asthma outcomes, data on SABA use in South Korea is scarce. Herein, we describe prescription patterns of SABA and other asthma medications in patients from the South Korean cohort of the SABA use IN Asthma (SABINA) III study. This study included patients with asthma aged ≥ 12 years, who had ≥ 3 consultations with the same healthcare provider, and medical records containing data for ≥ 12 months prior to the study visit. Patients were classified by investigator-defined asthma severity (per 2017 Global Initiative for Asthma recommendations) and practice type (primary or specialist care). Data on disease characteristics, asthma treatments, and clinical outcomes in the 12 months before the study visit were collected using electronic case report forms. Data from 476 patients (mean age, 55.4 years; female, 63.0%) were analyzed. Most patients were treated by specialists (83.7%) and had moderate-to-severe asthma (91.0%). Overall, 7.6% of patients were prescribed ≥ 3 SABA canisters (defined as over-prescription). In patients prescribed SABA in addition to maintenance therapy, 47.4% were over-prescribed SABA. Most patients (95.4%) were prescribed a fixed-dose combination of an inhaled corticosteroid and a long-acting β2-agonist as maintenance therapy. Although asthma was well-controlled/partly-controlled in 91.6% of patients, 29.6% experienced ≥ 1 severe asthma exacerbation. SABA over-prescription was reported in nearly 50% of patients prescribed SABA in addition to maintenance therapy, underscoring the need to align clinical practices with the latest evidence-based recommendations and educate physicians and patients on appropriate SABA use.

Prescription patterns of antidiabetic and cardiovascular preventive medications in community-dwelling older adults with type 2 diabetes mellitus: a cross-sectional study.

To describe trends in antidiabetics drug prescription patterns in community-dwelling older adults with type 2 diabetes mellitus (T2DM) and to evaluate the use of cardiovascular preventive medications among those diagnosed with atherosclerotic cardiovascular disease (ASCVD). This cross-sectional, face-to-face interview study that comprised community-dwelling older adults (≥ 65 years) diagnosed with T2DM. The study questionnaire included the patients' demographics, clinical data, and current medication use. Patients with established ASCVD were further classified into low (i.e., not receiving evidence-based therapy or only one) and high (i.e., receiving at least two evidence-based therapies) composite score groups. Bivariate analysis followed by multivariable logistic regression analysis were performed to evaluate the demographic/clinical characteristics associated with the use of antidiabetic monotherapy/polytherapy and evidence-based pharmacotherapy. A total of 500 older adults were enrolled. The mean age of included participants was 73 ± 7 years, 310 participants (62%) were males, and 385 participants (77.0%) had established ASCVD. Antidiabetic monotherapy was reported in 251 participants (50.2%), with metformin followed by sulfonylureas being the most commonly prescribed drugs as monotherapy. The results of the multivariable analysis showed that age [odds ratio (OR) = 0.89, 95% CI: 0.85-0.94, P < 0.001], obesity (OR = 4.18, 95% CI: 1.63-10.36, P = 0.003), hypertension (OR = 4.2, 95% CI: 1.22-7.66, P = 0.04), and dyslipidemia (OR = 4.1, 95% CI: 1.28-8.30, P = 0.01), were significantly associated with the prescription of cardiovascular preventive medications. Only one in twenty-one participant with T2DM and ASCVD collectively received three guideline-recommended therapies, indicating a deficiency of utilization of cardiovascular preventive drugs.

Prescribing pattern of antipsychotics for patients with schizophrenia using the total daily dose online tool

This study aimed to investigate the prescribing pattern of antipsychotic medications for schizophrenia using the British National Formulary total daily dose (TDD) online tool. We analysed data from the electronic medical records at King Khalid University Hospital (KKUH) of 272 patients diagnosed with schizophrenia who were prescribed both typical and atypical antipsychotic medications. The results showed that aripiprazole was the most commonly prescribed antipsychotic drug, followed by haloperidol then risperidone. The TDD online tool was used to calculate the TDD of each prescribed antipsychotic medication. Most patients were prescribed doses within the recommended range for each medication, although some were prescribed doses above or below the recommended range. Moreover, a high recommended TDD was associated with the combined use of antipsychotics rather than monotherapy. Additionally, high TDD levels were associated with the following antipsychotics: haloperidol, olanzapine, paliperidone, and quetiapine. Our findings highlight the importance of using evidence-based tools such as the TDD online tool to guide prescribing practices and ensure optimal dosing of antipsychotic medications for patients with schizophrenia.

Patterns of psychotropic medication prescribing and potential drug-hormone interactions among transgender and gender-diverse adults within 2 years of hormone therapy

BackgroundTransgender and gender-diverse (TGD) people have a high prevalence of psychotropic medication use, yet knowledge about the patient-level psychotropic medication burden is limited. TGD patients may take hormone therapy to meet their gender expression goals. Potential drug-hormone interactions exist between psychotropic medications and hormone therapy, requiring increased knowledge about psychotropic medication use for TGD adults undergoing hormone therapy. ObjectivesThe objective of this study was to examine the extent of psychotropic medication polypharmacy in a cohort of TGD adults within 2 years of starting hormone therapy. We also characterized potential drug-hormone interactions and the association with psychotropic polypharmacy. MethodsRetrospective cross-sectional analysis of patients with ≥1 transgender health-related visit (2007−2017) in the University of Washington Medical System (Seattle, WA). Eligible patients had ≥1 psychotropic medication including antidepressants, antipsychotics, mood stabilizers, and sedative-hypnotics ordered within 2 years of starting hormone therapy (testosterone or estradiol with or without spironolactone, progesterone, finasteride, or dutasteride). We defined psychotropic polypharmacy as ≥2 psychotropic medication orders with overlapping treatment durations for at least 90 days and characterized potential drug-hormone interactions (Lexicomp, Hudson, OH). We descriptively summarized patients with and without polypharmacy (frequencies and percentages) and compared drug-hormone interactions using chi-square or Fishers exact tests (P < 0.05 considered significant). ResultsA total of 184 patients had ≥1 psychotropic medication order within 2 years of hormone therapy; 68 patients (37.0%) had psychotropic polypharmacy. The most frequent type of psychotropic polypharmacy was antidepressant+sedative-hypnotic (18 of 68, 26.5%). More patients had a potential drug-hormone interaction among those with psychotropic polypharmacy (23 of 68, 33.8%) versus those without (8 of 116, 6.9%, P < 0.001). ConclusionAmong TGD patients on psychotropic medications within 2 years of hormone therapy, one-third had psychotropic polypharmacy. Most polypharmacy types appeared to align with mental health treatment guidelines. The number of patients with a potential drug-hormone interaction was significantly higher among those with polypharmacy. Prospective studies are needed to characterize drug-hormone interactions.

Patterns of Cough Medication Prescribing among Patients with Chronic Cough in Florida: 2012-2021.

Among patients with chronic cough (CC) in the 2012-2021 statewide OneFlorida Clinical Research Consortium database, we examined trends in cough medication (CM) prescribing prevalence over time in repeated cross-sectional analyses and identified distinct CM utilization trajectories using group-based trajectory modeling (GBTM) in a retrospective cohort study. Among eligible adults (≥18 years) without cancer/benign respiratory tumor diagnoses, we identified CC patients and non-CC patients with any cough-related diagnosis. In the GBTM analysis, we calculated the number of monthly prescriptions for any CMs (excluding gabapentinoids) during the 12 months from the first qualifying cough event to identify distinct utilization trajectories. From 2012 to 2021, benzonatate (9.6% to 26.1%), dextromethorphan (5.2% to 8.6%), and gabapentinoid (5.3% to 14.4%) use increased among CC patients, while opioid antitussive use increased from 2012 to 2015 and decreased thereafter (8.4% in 2012, 14.7% in 2015, 6.7% in 2021; all p < 0.001). Of 15,566 CC patients and 655,250 non-CC patients identified in the GBTM analysis, CC patients had substantial burdens of respiratory/non-respiratory comorbidities and healthcare service and concomitant medication use compared to non-CC patients. Among CC patients, GBTM identified three distinct CM utilization trajectories: (1) no CM use (n = 11,222; 72.1%); (2) declining CM use (n = 4105; 26.4%); and (3) chronic CM use (n = 239; 1.5%). CC patients in Florida had limited CM use with increasing trends in use of benzonatate, dextromethorphan, and gabapentinoids and a decreasing trend in opioid antitussive use. CC patients, particularly with chronic prescription CM use, experienced substantial disease burden.

Association between clinician specialty and prescription of preventive medication for young adults with migraine: A retrospective cohort study.

We aimed to compare the prescribing patterns of preventive medications between pediatric and adult neurologists for young adults with migraine. Although preventive medications are effective for adults with migraine, studies in children have failed to demonstrate similar efficacy. As a result, lifestyle modifications and non-pharmacological interventions are often emphasized in children. It is not known whether young adults are prescribed preventive medications at different rates according to whether they are cared for by an adult or pediatric neurologist. We performed a multicenter retrospective cohort analysis of patients with migraine aged 18-25 years who were seen by a pediatric or adult neurologist at Mass General Brigham Hospital between 2017 and 2021. The primary outcome was whether the patient received a prescription for any preventive medication during the study period. Among the 767 included patients, 290 (37.8%) were seen by a pediatric neurologist. Preventive medications were prescribed for 131/290 (45.2%; 95% confidence interval [CI]: 39.5%, 51.0%) patients seen by a pediatric neurologist and 206/477 (43.2%; 95% CI: 39.0%, 47.7%) patients seen by an adult neurologist (p = 0.591). In the mixed effects logistic regression model, clinician specialty was not associated with preventive medication use (adjusted odds ratio [AOR] 1.20, 95% CI: 0.62, 2.31). Female sex (AOR 1.69, 95% CI: 1.07, 2.66) and number of visits during the study period (AOR 1.64, 95% CI: 1.49, 1.80) were associated with receiving preventive medication. Approximately two fifths of young adults with migraine were prescribed preventive medications, and this proportion did not differ according to clinician specialty. Although these findings suggest that pediatric and adult neurologists provide comparable care, both specialties may be underusing preventive medications in this patient population.

Medication clusters at hospital discharge and risk of adverse drug events at 30 days postdischarge: A population-based cohort study of older adults.

Certain combinations of medications can be harmful and may lead to serious adverse drug events (ADEs). Identifying potentially problematic medication clusters could help guide prescribing and/or deprescribing decisions in hospital. The aim of this study is to characterize medication prescribing patterns at hospital discharge and determine which medication clusters were associated with an increased risk of ADEs in the 30-day posthospital discharge. All residents of the province of Ontario in Canada aged 66 years or older admitted to hospital between March 2016 and February 2017 were included. Identification of medication clusters prescribed at hospital discharge was conducted using latent class analysis. Cluster identification and categorization were based on medications dispensed up to 30-day posthospitalization. Multivariable logistic regression was used to assess the potential association between membership to a particular medication cluster and ADEs postdischarge, while also evaluating other patient characteristics. In total, 188 354 patients were included in the study cohort. Median age (interquartile range) was 77 (71-84) years, and patients had a median (IQR) (interquartile range [IQR]) of 9 (6-13) medications dispensed prior to admission. Within the study population, 6 separate clusters of dispensing patterns were identified: cardiovascular (14%), respiratory (26%), complex care needs (12%), cardiovascular and metabolic (15%), infection (10%), and surgical (24%). Overall, 12680 (7%) patients had an ADE in the 30 days following discharge. After considering other patient characteristics, those belonging to the respiratory cluster had the highest risk of ADEs (adjusted odds ratio: 1.12, 95% confidence interval: 1.08-1.17) compared with all the other clusters, while those in the complex care needs cluster had the lowest risk (adjusted odds ratio: 0.82, 95% confidence interval: 0.77-0.87). This study suggests that ADEs post hospital discharge can be linked with identifiable medication clusters. This information may help clinicians and researchers better understand patient populations that are more or less likely to benefit from peri-hospital discharge interventions aimed at reducing ADEs.

Profil peresepan dan analisis risiko racikan antidepresan di sebuah apotek di Yogyakarta

In Yogyakarta, the number of patients suffering from depression reached 5.5%. To enhance the therapeutic benefit, psychiatrists frequently prescribe a combination of antidepressants to their patients. To identify the risk for incompatibility, the prescription profile of antidepressant medicines that are compounded together must be examined. The purpose of this study is to examine the prescribing patterns of compounded medications designated as antidepressants in a Yogyakarta pharmacy. The prescription is the research subject in this descriptive exploratory study. Prescriptions that satisfied the inclusion criteria were gathered, and the frequency of prescriptions was calculated. Two medications with the greatest prescribing frequency were then examined for potential interactions and incompatibility. Folic acid is the most commonly prescribed medicine when combined with another. It was formerly used with sertraline HCl, maprotiline HCl, trifluoperazine HCl, and diazepam. The psychiatrist was used to mixing three to four active drugs administered in capsules. The drug combination has various interactions that must be properly monitored. These findings can be used by the doctor to choose the best medicine combination.

P57. Anti-osteoporotic medication prescription patterns in patients with vertebral compression fractures

P57. Anti-osteoporotic medication prescription patterns in patients with vertebral compression fractures

Pre-diagnostic prescribing patterns in dyspnoea patients with as-yet-undiagnosed lung cancer: A longitudinal study of linked primary care and cancer registry data

IntroductionPatients with as-yet undiagnosed lung cancer (LC) can present to primary care with non-specific symptoms such as dyspnoea, often in the context of pre-existing chronic obstructive pulmonary disease (COPD). Related medication prescriptions pre-diagnosis might represent opportunities for earlier diagnosis, but UK evidence is limited. Consequently, we explored prescribing patterns of relevant medications in patients who presented with dyspnoea in primary care and were subsequently diagnosed with LC. MethodLinked primary care (Clinical Practice Research Datalink) and National Cancer Registry data were used to identify 5434 patients with incident LC within a year of a dyspnoea presentation in primary care between 2006 and 2016. Primary care prescriptions relevant to dyspnoea management were examined: antibiotics, inhaled medications, oral steroids, and opioid analgesics. Poisson regression models estimated monthly prescribing rates during the year pre-diagnosis. Variation by COPD status (52 % pre-existing, 36 % COPD-free, 12 % new-onset) was examined. Inflection points were identified indicating when prescribing rates changed from the background rate. Results63 % of patients received 1 or more relevant prescriptions 1–12 months pre-diagnosis. Pre-existing COPD patients were most prescribed inhaled medications. COPD-free and new-onset COPD patients were most prescribed antibiotics. Most patients received 2 or more relevant prescriptions. Monthly prescribing rates of all medications increased towards time of diagnosis in all patient groups and were highest in pre-existing COPD patients. Increases in prescribing activity were observed earliest in pre-existing COPD patients 5 months pre-diagnosis for inhaled medications, antibiotics, and steroids, ConclusionResults indicate that a diagnostic window of appreciable length exists for potential earlier LC diagnosis in some patients. Lung cancer diagnosis may be delayed if early symptoms are misattributed to COPD or other benign conditions.

Patterns and Trends in the Use of Medications for COPD Control in a Cohort of 9476 Colombian Patients, 2017-2019.

Chronic obstructive pulmonary disease (COPD) affects approximately 174 million people worldwide. The objective was to determine the trends of COPD medication use in a group of Colombian patients. This was a retrospective study on prescription patterns of bronchodilators and other medications used in COPD from a population database with follow-up at 12 and 24 months. Patients older than 18 years of age of any sex with a COPD diagnostic code between 2017 and 2019 were included. Sociodemographic variables, medications, treatment schedules for COPD, comorbidities, comedications, and the specialty of the prescriber were considered. Data from 9476 people with COPD was evaluated. The mean age was 75.9 ± 10.7 years, 50.1% were male, and 86.8% were prescribed by a general practitioner. A total of 57.9% had comorbidities, most often hypertension (44.4%). At the baseline measurement, on average, they received 1.6 medications/patient, mainly short-acting antimuscarinics (3784; 39.9%), followed by short-acting β-agonists (2997, 31.6%) and inhaled corticosteroids (ICS) (2239, 23.6%); more than half (5083, 53.6%) received a long-acting bronchodilator. Prescription of triple therapy (antimuscarinic, β-agonist, and ICS) went from 645 (6.8%) at baseline to 1388 (20.6%) at the 12-month mark. This group of patients with COPD treated in Colombia frequently received short-acting bronchodilators and ICS, but a growing proportion are undergoing controlled therapy with long-acting bronchodilators, a situation that can improve the indicators of morbidity, exacerbations, and hospitalization.