Use Of Medications For Treatment Research Articles

Influenza antiviral treatment in spinal cord injury patients, 2007–2010

ObjectiveThis study assessed antiviral medication use for treatment of influenza-like illness (ILI) in Veterans with spinal cord injury or disorder (SCI/D) and examined whether antiviral prescribing improved over time.DesignRetrospective cohort study of Department of Veterans Affairs (VA) facilities.ParticipantsVeterans with SCI/D and matched non-SCI/D controls (matched by facility and date of visit/admission) who were diagnosed by a clinician with ILI during the period 1 October 2007 to 31 May 2010.Main outcome measuresAntiviral receipt and appropriateness were examined. Appropriate antiviral prescribing was defined as patients who received an antiviral medication within 2 days of collection of a sample for diagnostic testing or within 2 days of symptom onset.ResultsWe identified 101 influenza visits/admissions for veterans with SCI/D and 123 for controls. Antiviral prescribing for Veterans with SCI/D increased from 37.1% in 2007/2008 to 67.6% in 2009/2010 (P = 0.01) and appropriate antiviral prescribing increased from 20.0 to 41.2% (P = 0.05). Predictors of antiviral prescribing included being treated in the 2009/2010 influenza season (vs. 2007/2008) and having a cough. Fever, aches/myalgia, or a positive influenza test was associated with appropriate antiviral treatment. SCI/D was an independent predictor of receiving antiviral treatment (adjusted odds ratio = 1.16, 95% confidence interval 1.04–1.29), but having SCI/D was not associated with receiving appropriate treatment.ConclusionsInfluenza antiviral prescribing increased over time and in a larger proportion in veterans with SCI/D (vs. controls). This suggests that providers treating patients with SCI/D recognize treatment guidelines and their importance in a high-risk population. Continued efforts are needed to improve appropriate influenza antiviral prescribing.

Arabic-speaking religious leaders’ perceptions of the causes of mental illness and the use of medication for treatment

The Arabic-speaking clergy is highly revered and considered the first point of contact for people who suffer from mental illness within their community. The current study aimed to explore the beliefs of Arabic-speaking religious leaders regarding the causes of mental illness and the use of medication for their treatment. Participants consisted of 170 Arabic-speaking clerics of Muslim (n = 85) and Christian (n = 85) denominations residing in Sydney, Australia. A questionnaire was administered during face-to-face interviews and included items regarding the causes of mental illness and beliefs about whether psychiatric medications were viewed as helpful or harmful. Most of the Arabic-speaking clerics viewed drug and alcohol addiction and psychosocial factors as the most important causes of mental illness. Biological causes such as a chemical imbalance in the brain were less frequently endorsed. Although medications were viewed by most religious clerics as helpful in the treatment of mental illness, there were also concerns about the potential harms of medications, particularly among Muslim clerics. Muslim clerics also endorsed the religious causes for mental illness, such as spiritual poverty, as being more important more so than did Christian clerics. The beliefs of Arabic-speaking religious leaders influence how they respond to people with mental illness and may determine whether they refer people to professional mental health services or not. Understanding their perspectives allows opportunities to share information to facilitate collaborative work in the care of Arabic-speaking people with mental illness. Arabic-speaking religious leaders need to be better educated about the mechanisms of action and benefits of medication in the treatment of mental illness.

Adverse Drug Reaction Labelling for Atomoxetine, Methylphenidate and Modafinil: Comparison of Product Information for Oral Formulations in Australia, Denmark and the United States

Objective Hyponatraemia is a serious adverse event commonly reported in elderly people treated with serotonergic antidepressants. The mechanism, incidence and risk factors for antidepressant induced hyponatraemia are not fully understood. Method In a retrospective chart analysis, depressed patients aged >63 years were investigated for change in serum sodium levels between two time points, separated by a median period of 45.5 days, with the first specimen taken prior to treatment. Patients were grouped into three cohorts; treated with an SSRI or SNRI (n=77), treated with an antidepressant other than an SSRI or SNRI (n=54) and not treated with an antidepressant (n=128). Results For change in sodium level between measurements and total number of patients with hyponatraemia, there was no significant difference between cohorts. However, the rate of reduction of serum sodium levels between time points was significantly greater for SSRI and SNRI treated patients (p<0.001) and patients treated with other antidepressants (p=0.03) compared to patients not treated with antidepressants. Moreover, the distribution of values of change in serum sodium was skewed towards reduced serum sodium in patients treated with SSRI or SNRIs (skew -0.43) and patients treated with other antidepressants (skew -0.09) but not for patients without antidepressants (skew 0.25). Conclusions These data suggest that antidepressant treatment is associated with hyponatraemia affecting a subgroup of individuals only. Generalised linear modelling showed that the risk of hyponatraemia increases with increased age, female gender, and particularly the antidepressant agents sertraline and escitalopram. The findings are of clinical significance as they demonstrate that hyponatraemia can occur rapidly with antidepressants, and SSRI/SNRI medications induce more rapid changes. They support the use of electrolyte monitoring early in antidepressant treatment in patients receiving antidepressants.

Retrospective database analysis of the impact of prior authorization for type 2 diabetes medications on health care costs in a Medicare Advantage Prescription Drug Plan population.

Health plans and pharmacy benefit managers have implemented utilization management strategies for newer type 2 diabetes mellitus (T2DM) medications to control pharmacy expenditures. Little is known about the impact of utilization management strategies on overall health care costs and subsequent use of T2DM medications among members who request, but do not receive, a T2DM medication requiring prior authorization (PA). To examine the relationship between the receipt of a T2DM medication requiring PA, health care costs, and subsequent treatment for T2DM. A retrospective cohort study using pharmacy, medical, and laboratory claims data was conducted among Medicare Advantage Prescription Drug plan members with a denied claim for a T2DM medication requiring PA (sitagliptin, a dipeptidyl peptidase-4 inhibitor [DPP-4i], and exenatide, an incretin mimetic) between January 1, 2008, and June 30, 2009. Subjects were required to have 12 months of continuous enrollment both before and after the index date. The entire study period was 24 months in duration, including a 12-month pre-index and 12-month post-index period. Three cohorts were identified: 1 that received a medication requiring PA (denied claim, subsequent fill) and 2 nonfilling control groups. Both control groups requested a medication requiring PA, as evidenced by the denied claim, but neither received the medication, either because the medication was not authorized or the member chose not to fill. Claims-based estimates were used to infer whether the individual likely met the criteria for PA, with 1 control group designated as having met the claims-based criteria (qualifying nonfilling cohort) and the other not having done so (nonqualifying nonfilling cohort.) The primary endpoint evaluated was the relationship between PA medication fill status and plan-paid costs (medical [including laboratory] and pharmacy) over the 12-month post-denial period, with generalized linear models adjusting for key covariates including demographics, concomitant medications, pre-index costs, pre-index adherence, and comorbidities. The secondary endpoint of T2DM medication use (post-denial) among the 2 nonfilling control groups was also evaluated. There were 1,728 members identified who received medication for T2DM requiring PA (the received authorization cohort) and 2,373 who did not (606 qualifying nonfilling cohort; 1,767 nonqualifying nonfilling cohort.) Cohorts were similar with regard to age and gender, but the nonfilling cohort had more comorbidities. Total unadjusted plan-paid 12-month costs were lowest among the received authorization cohort ($11,739), slightly higher ($11,980) for the qualifying nonfilling cohort, and notably higher for the nonqualifying nonfilling cohort ($12,962), although no differences were statistically significant. After adjusting for key covariates, the difference between the nonqualifying nonfilling cohort ($11,980) and the received authorization cohort ($11,729) was statistically significant (P = 0.034). Large differences in plan-paid medical costs ($10,127 for the nonqualifying nonfilling cohort vs. $8,192 for the received authorization cohort) appeared to drive the overall cost totals and were significant in both the unadjusted (P = 0.005) and adjusted models (P less than 0.001). Pharmacy costs were significantly lower for the nonqualifying nonfilling cohort in the adjusted model and for the qualifying nonfilling cohort in both models (all P less than 0.001), but the lower pharmacy costs were not offset by the higher medical costs. In examining the use of medication for treatment of T2DM following the denied claim, 10.6% of the qualifying nonfilling cohort and 13.4% of the nonqualifying nonfilling cohort added another oral therapy, 10.2% and 5.8% added insulin, and 11.9% and 7.1% had treatment intensification, respectively. More than half (56.1%) of the qualifying nonfilling cohort, but only 32.1% of the nonqualifying nonfilling cohort, maintained current therapy. This study found higher plan-paid health care costs (overall and medical alone) among members who requested a type 2 diabetes medication requiring PA, but never received it, compared with those who qualified for and received the requested medication. A notable number of individuals who were assumed to have met the criteria based on a claims-based equivalent, but who never received the medication, made no change to their current therapy. Failure of a member to take medication deemed necessary by his or her physician could translate to inadequate control of the diabetic condition and result in an excess of resource utilization and costs for treating the disease and associated comorbidities. In light of the present findings, health plans should consider not only the impact of utilization management strategies on reducing pharmacy costs, but the broader implication for overall health care costs and subsequent treatment patterns among members.

Trends in stroke incidence rates and stroke risk factors in Rotterdam, the Netherlands from 1990 to 2008

Stroke incidence rates have decreased in developed countries over the past 40 years, but trends vary across populations. We investigated whether age-and-sex-specific stroke incidence rates and associated risk factors as well as preventive medication use have changed in Rotterdam in the Netherlands during the last two decades. The study was part of the Rotterdam Study, a large population-based cohort study among elderly people. Participants were 10,994 men and women aged 55–94 years who were stroke-free at baseline. Trends were calculated by comparing the 1990 subcohort (n = 7516; baseline 1990–1993) with the 2000 subcohort (n = 2883; baseline 2000–2001). Poisson regression was used to calculate incidence rates and incidence rate ratios in age-and-sex-specific strata. We further compared the prevalence of stroke risk factors and preventive medication use in the two subcohorts. In the 1990 subcohort 467 strokes occurred during 45,428 person years; in the 2000 subcohort 115 strokes occurred in 18,356 person years. Comparing the subcohorts, incidence rates decreased by 34% in men, but remained unchanged in women. Blood pressure levels increased between 1990 and 2000, whereas the proportion of current cigarette smokers decreased in men, but not in women. There was a strong increase in medication use for treatment of stroke risk factors across all age categories in both sexes. Our findings suggest that in Rotterdam between 1990 and 2008 stroke incidence rates have decreased in men but not in women.

PMH73 Increasing Use of Medication for Treatment of Attention-Deficcit/Hyperactivity Disorder (ADHD) in Germany between 2003 and 2009

PMH73 Increasing Use of Medication for Treatment of Attention-Deficcit/Hyperactivity Disorder (ADHD) in Germany between 2003 and 2009

Use of Medications and Resources for Treatment of Nausea, Vomiting, or Constipation in Hospitalized Patients Treated With Analgesics

Hospitalized patients often experience adverse events of the gastrointestinal tract due to analgesic treatment. The objectives of this study were to estimate use of medications for treatment of nausea, vomiting, or constipation (NVC medications) after initiation of analgesic treatment, and to compare differences in length of stay and treatment costs between patients who received NVC medications and those who did not. This retrospective cohort study used the Premier Perspective data from January 1, 2005 to December 31, 2007 and stratified inpatients into 4 groups based on the first analgesic agent they were given. Patients were observed for 14 days after the first analgesic use until a regimen change, first use of NVC medication, or hospital discharge, whichever occurred first. Data were analyzed using a Cox proportional hazards model and a generalized linear model. This study found that 239,183 (55.1%) of 434,304 patients received NVC medications after analgesic administration. Compared with oral nonopioid analgesics, the risk of using NVC medication was 4.8 times higher for injectable opioid analgesics after controlling for confounders. Patients who received NVC medications were hospitalized 0.26 days longer (P < 0.0001) at an additional cost of $756 per patient compared with patients who did not receive NVC medications (P < 0.0001). Use of an analgesic with improved gastrointestinal tolerability may potentially reduce use of NVC medications and hospital resources.

Trends and determinants of prescription medication use for treatment of osteoporosis

Trends in the use of different treatments for osteoporosis among the civilian, ambulatory U.S. population are described. Data from the Medical Expenditure Panel Survey (MEPS) were used to estimate osteoporosis prevalence and treatment rates among individuals ages 50 years and older who self-reported having osteoporosis. Specific pharmacologic treatments analyzed included oral and transdermal estrogen and estrogen and progesterone combination products in women, injectable and transdermal testosterone products in men, oral bisphosphonate medications, raloxifene, and nasal calcitonin. Predisposing characteristics included sex, age, education, income, and race. Required characteristics included the use of an oral corticosteroid medication, having a fracture in the current MEPS year, presently smoking, and self-report of fair or poor health status. Self-report of osteoporosis increased steadily from approximately 3.2 million patients in 1999 to 7.2 million patients in 2005. This was associated with an increase of the number of patients who used medication for the treatment of osteoporosis from 2.3 million in 1999 to 5.6 million in 2005. Although medication use increased over time, only 77% of people with osteoporosis reported using medication for the treatment of osteoporosis in the previous year. Only 25.4% of men, 55.6% of blacks, 64.2% of patients without a usual source of health care, and 66.8% of patients who reported their health as fair or poor used medication for the treatment of osteoporosis in the previous year. Although the MEPS data are based on patient self-report, the results from our study suggest that approximately one in four patients with osteoporosis did not receive prescription management for this condition.

Migraine in Pregnancy

Migraine is the headache disorder that most commonly complicates pregnancy. Migraine often, but not always, improves during pregnancy. Postdelivery migraine flares are common, and it can be difficult to distinguish these from dangerous causes of postpartum headache. Many pregnant or lactating migraineurs require intermittent use of medication for treatment of individual headache attacks, and some also need preventive treatment aimed at decreasing the number or severity of headache attacks. In general, medication use should be limited and nonpharmacologic approaches are preferred. Appropriate treatment choices also vary with the stage of pregnancy, and may differ for pregnancy and lactation. Risk rating systems are available that help guide decisions. Women with migraine have an increased risk for several serious pregnancy complications, but there is little convincing evidence of an increase in neonatal complications. Migraine is not a contraindication to breast-feeding.

ADHD drugs: Values that drive the debates and decisions

Use of medication for treatment of ADHD (or its historical precursors) has been debated for more than forty years. Reasons for the ongoing differences of opinion are analyzed by exploring some of the arguments for and against considering ADHD a mental disorder. Relative to two important DSM criteria - that a mental disorder causes some sort of harm to the individual and that a mental disorder is the manifestation of a dysfunction in the individual - ADHD's classification as a mental disorder is found to be contentiously value-laden. The disagreements spill over to reasoning regarding appropriate management, because justification for a drug prescription is in part predicated on the idea that the drugs manage mental disorders. These debates do not appear to be nearing resolution, so individuals offering advice, or trying to decide whether ADHD drugs are appropriate for themselves or their children, may find it helpful to compare the values underlying various perspectives with their own.

Client and counselor attitudes toward the use of medications for treatment of opioid dependence

Attitudes, perceived social norms, and intentions were assessed for 376 counselors and 1,083 clients from outpatient, methadone, and residential drug treatment programs regarding four medications used to treat opiate dependence: methadone, buprenorphine, clonidine, and ibogaine. Attitudes, social norms, and intentions to use varied by treatment modality. Methadone clients and counselors had more positive attitudes toward the use of methadone, whereas their counterparts in residential and outpatient settings had neutral or negative assessments. Across modalities, attitudes, perceived social norms, and intentions toward the use of buprenorphine were relatively neutral. Assessments of clonidine and ibogaine were negative for clients and counselors in all settings. Social normative influences were dominant across settings and medications in determining counselor and client intentions to use medications, suggesting that perceptions about beliefs of peers may play a critical role in use of medications to treat opiate dependence.

Psychiatry in Chronic Pain: A Review and Update

As the field of pain management nears the halfway point of the Congressionally declared “Decade of Pain Control and Research,” the prevalence of chronic pain and disability related thereto continue to escalate. In the context of rising costs and suffering associated with persistent pain worldwide, the chronic pain research community has increasingly recognized and investigated the role of the cognitive and affective dimensions of pain. In this paper, the authors review psychologic aspects of pain, psychopathology in chronic pain syndromes, suicidality in this population, and the use of psychotropic medications for treatment in these patients. Where possible, the authors have outlined limitations of previous research in these areas, and have highlighted and described recent studies that have addressed these perceived shortcomings. The role of the psychiatrist in the treatment of patients with chronic pain is reviewed.

The Unchanging Incidence and Case-Fatality of Stroke in the 1990s

Many advances were made in stroke prevention strategies during the 1990s, and yet temporal trends in stroke incidence and case-fatality have not been reported in the United States. Blacks have a 2-fold higher risk of stroke; however, there are no data over time showing if any progress has been made in reducing racial disparity in stroke incidence. The objective of this study was to examine temporal trends in stroke incidence and case-fatality within a large, biracial population during the 1990s. Within a biracial population of 1.3 million, all strokes were ascertained at all local hospitals using International Classification of Diseases, 9th Revision codes during July 1993 to June 1994 and again in 1999. A sampling scheme was used to ascertain cases in the out-of-hospital setting. Race-specific incidence and case-fatality rates were calculated and standardized to the 2000 US Census population. A population-based telephone survey regarding stroke risk factor prevalence and medication use was performed in 1995 and 2000. There were 1954 first-ever strokes in 1993-1994 and 2063 first-ever strokes in 1999. The annual incidence of first-ever hospitalized stroke did not significantly change between study periods: 158 per 100,000 in both 1993-1994 and 1999 (P=0.97). Blacks continue to have higher stroke incidence than whites, especially in the young; however, case-fatality rates continue to be similar between races and are not changing over time. Medication use for treatment of stroke risk factors significantly increased in the general population between study periods. Despite advances in stroke prevention treatments during the 1990s, the incidence of hospitalized stroke did not decrease within our population. Case-fatality also did not change between study periods. Excess stroke mortality rates seen in blacks nationally are likely the result of excess stroke incidence and not case-fatality, and the racial disparity in stroke incidence did not change over time.

Neuroleptic treatment of late-life schizophrenia.

There is a paucity of studies on the use of neuroleptic medication for treatment of the core symptoms of schizophrenia in elderly patients. The studies that are available have significant methodologic problems, including the mixing of early- and late-onset patients, inadequate outcome criteria, and the lack of control groups. Studies of conventional neuroleptics suggest that older patients have a moderate therapeutic response but are likely to develop side effects. The few studies of atypical antipsychotics now available suggest efficacy for treatment of behavioral disturbance in the elderly and a more favorable side-effect profile. The usefulness of all neuroleptics for the treatment of the core symptoms of late-life schizophrenia may depend on the duration and severity of the symptoms, with a poor response associated with greater severity and duration. It appears that patients with later-onset symptoms may respond better to all neuroleptics.

Psychostimulant Use for Children with ADHD in Australia

There has been rapid growth in the use of medication for treatment of attention-deficit/hyperactivity disorder in the last decade. This growth has often been explained as the recognition of a condition that affects up to 5% of all young people. The purpose of this study is to compare past medication trends and current usage in Australia with that in the United States. We present country-wide data from Australia on psychostimulant production and prescription rates. We also analyze data from one city on the number of children receiving medication. Results suggest that medication use in Australia is increasing at a rate similar to that found in the United States and that in one city a relatively small proportion of practitioners accounted for the majority of prescriptions. Results also suggest that, in Australia, there may be differences in prescription rates by income and unemployment.

The Progression From Hypertension to Congestive Heart Failure

- To study the relative and population-attributable risks of hypertension for the development of congestive heart failure (CHF), to assess the time course of progression from hypertension to CHF, and to identify risk factors that contribute to the development of overt heart failure in hypertensive subjects. - Inception cohort study. - General community. - Original Framingham Heart Study and Framingham Offspring Study participants aged 40 to 89 years and free of CHF. To reflect more contemporary experience, the starting point of this study was January 1, 1970. - Hypertension (blood pressure of at least 140 mm Hg systolic or 90 mm Hg diastolic or current use of medications for treatment of high blood pressure) and other potential CHF risk factors were assessed at periodic clinic examinations. - The development of CHF. - A total of 5143 eligible subjects contributed 72422 person-years of observation. During up to 20.1 years of follow-up (mean, 14.1 years), there were 392 new cases of heart failure; in 91% (357/392), hypertension antedated the development of heart failure. Adjusting for age and heart failure risk factors in proportional hazards regression models, the hazard for developing heart failure in hypertensive compared with normotensive subjects was about 2-fold in men and 3-fold in women. Multivariable analyses revealed that hypertension had a high population-attributable risk for CHF, accounting for 39% of cases in men and 59% in women. Among hypertensive subjects, myocardial infarction, diabetes, left ventricular hypertrophy, and valvular heart disease were predictive of increased risk for CHF in both sexes. Survival following the onset of hypertensive CHF was bleak; only 24% of men and 31% of women survived 5 years. - Hypertension was the most common risk factor for CHF, and it contributed a large proportion of heart failure cases in this population-based sample. Preventive strategies directed toward earlier and more aggressive blood pressure control are likely to offer the greatest promise for reducing the incidence of CHF and its associated mortality.

Participation in and outcome of treatment for major depression among low income Asian-Americans

This study examined the relationship of four aspects of psychiatric treatment (use of medication, client-therapist ethnic match, treatment in an Asian-specific clinic, and professional therapist) to participation in treatment and outcome of treatment in low income Asian-American clients ( n = 273) of the Los Angeles County mental health system who were diagnosed with major depression. Based on cultural responsiveness theory, the study tested the hypothesis that use of medication in treatment would have the greatest effect on participation and outcome followed, in order, by client-therapist ethnic match, treatment in an Asian-specific clinic, and treatment by a professional therapist. The hypotheses were largely supported: treatment with medication had a significant relationship to total number of treatment sessions (participation) and improvement in the admission-discharge Global Assessment Scale (GAS) score (outcome). Treatment by a therapist of the same ethnicity as the client and treatment in an agency designated to provide services to Asian clients both had significant relationships to the number of treatment sessions but not to GAS score improvement. Four covariates included in the analysis and treatment by a professional therapist had no relationship to either of the dependent variables.

The training and use of an artificial neural network to monitor use of medication in treatment of complex patients.

An artificial-neural-network-based drug interaction warning system was developed for use with a computerized real-time entry medical records system. The goal of the study was to provide physicians and nurses with timely warnings of potential drug interactions as therapies were prescribed. In a dialysis unit, physicians and clinical pharmacists defined rules of proper drug therapy, then trained a neural network with those rules. When the network was used to review the therapies of this patient population, a number of inconsistencies were discovered, and medication orders were changed on several patients. Real-time implementation of this monitoring system could provide messages to assure that drug therapy is consistent and proper, according to rules created by the providers of healthcare, thus preventing occasional mistakes in drug therapy.