Medication Use In Persons Research Articles

Anticholinergic and sedative medication use in persons with HIV: defining the evidence for risks on cognition.

Anticholinergic and sedative medication use in persons with HIV: defining the evidence for risks on cognition.

Brief Report: Self-Reported Medication Use in Individuals Diagnosed with Autism Spectrum Disorder in Adulthood: A U.S. Clinic Sample from 2012 to 2022.

As the understanding of autism spectrum disorder (ASD) across the lifespan has increased, so has the number of individuals being identified with ASD for the first time in adulthood. Understanding co-occurring psychiatric conditions in this subset of the ASD population is a growing focus of research; however, little is known about the rate at which psychiatric medications are prescribed to adults with a first-time diagnosis of ASD. The purpose of this study was to examine self-reported medication use in persons diagnosed with ASD in adulthood in a clinic sample (2012-2022) in the United States. The present study was a retrospective record review. Participants (n = 281) were drawn from an outpatient clinic specializing in the diagnosis of ASD in adults. Participants self-reported previous and current psychiatric medication prescription using a medication checklist. Approximately 50% of participants self-reported being prescribed at least one psychiatric medication at the time of their initial evaluation appointment. The most commonly prescribed psychiatric medications were antidepressants (23.8%), followed by stimulants (16.7%). Similar to individuals diagnosed with ASD in childhood, those identified with ASD for the first time in adulthood are prescribed psychiatric medication at a much higher rate than their same-age non-autistic peers. These results can inform future research and practice for improving outcomes for autistic adults, particularly those who were undiagnosed for much of their lives.

Medication-Related Outcomes and Health Equity: Evidence for Pharmaceutical Care

Marginalised people experience diminished access to pharmaceutical care and worse medication-related outcomes than the general population. Health equity is a global priority. This article explores the key evidence of health inequity and medication use, structures the causes and contributory factors and suggests opportunities that can be taken to advance the pharmaceutical care agenda so as to achieve health equity. The causes of, and contributors to, this inequity are multi-fold, with patient- and person-related factors being the most commonly reported. Limited evidence is available to identify risk factors related to other aspects of a personal medication use system, such as technology, tasks, tools and the internal and the external environments. Multiple opportunities exist to enhance equity in medication-related outcomes through pharmaceutical care research and practice. To optimise the effects and the sustainable implementation of these opportunities, it is important to (1) ensure the meaningful inclusion and engagement of members of marginalised groups, (2) use a person-centred approach and (3) apply a systems-based approach to address all of the necessary components of a system that interact and form a network as work processes that produce system outcomes.

Quality of Life and Pain Medication Use in Persons With Advanced Dementia Living in Long-Term Care Facilities

ObjectivesIn residents with dementia living in a long-term care facility (LTCF), un(der)treated pain may trigger behavioral disturbances, mood syndromes, and deterioration of physical functioning and self-maintenance. Because these factors can have considerable impact on the quality of life (QoL), this study aimed to (1) compare characteristics of persons with advanced dementia living in LTCFs with and without pain medication; (2) compare QoL in these persons with and without pain, stratified by type of pain medication use; and (3) explore associations between the use of paracetamol and QoL in persons with advanced dementia living in LTCFs. Design and settingThis study analyzed baseline data from the Communication, Systematic Assessment and Treatment of Pain, Medication Review, Occupational Therapy, and Safety Study; a multicenter, cluster-randomized effectiveness-implementation clinical hybrid trial in 67 Norwegian LTCF clusters. ParticipantsIn total, 407 LTCF residents (rural and urban areas) aged ≥65 years, with Functional Assessment Staging scores of 5–7 (ie, moderate to advanced dementia). Main outcome measureQoL as assessed by the 6 QUALIDEM (validated questionnaire to measure QoL in persons with dementia living in LTCF) domains applicable to persons with moderate to severe dementia. The association between QoL and paracetamol was estimated using linear mixed-effect models, adjusting for confounding variables. Results62.0% used pain medication (paracetamol, opioids, or both). QoL was lower in residents using pain medication, compared with those without pain medication [mean QUALIDEM score 68.8 (standard deviation 17.4 vs) 75.5 (standard deviation 14.6), respectively, P < .001). Multilevel analysis showed that paracetamol use was not associated with QoL. Conclusions and ImplicationsPersons with advanced dementia living in LTCF using pain medication have a lower QoL compared with those not using pain medication. These results are of key importance for the clinician because they stress the need for regular medication review and pain management. When measured cross-sectionally, use of paracetamol is not associated with increased QoL.

Impact of TimeSlips Creative Expression Program on Behavioral Symptoms and Psychotropic Medication Use in Persons with Dementia in Long-term Care: A Cluster-randomized Pilot Study

To evaluate whether involvement in TimeSlips, a creative storytelling program, reduced mood and behavioral symptoms as well as psychotropic medication use in persons with dementia. A cluster-randomized pilot study compared two discrete dementia care units in one nursing home. The control cohort (N= 10) received standard-of-care activity programming, and the intervention cohort (N= 10) received standard-of-care plus two one-hour TimeSlips sessions per week for six weeks. Data on mood and behavioral symptoms and psychotropic drug prescriptions were collected, and within-group and between-group comparisons were performed. Between-group comparisons did not reveal statistically significant differences in mood and behavioral symptoms. No differences in psychotropic drug prescriptions were found. Larger trials of longer duration are needed to determine whether involvement in TimeSlips reduces mood and behavioral symptoms that compromise quality of life for persons with dementia.

Patterns of Use and Reasons for Discontinuation of Prophylactic Medications for Episodic Migraine and Chronic Migraine: Results From the Second International Burden of Migraine Study (IBMS‐II)

Our objective was to characterize patterns of preventive medication use in persons with episodic migraine (EM) and chronic migraine (CM). Several classes of medications are used both on- and off-label for the prevention of migraine, including β-blockers (eg, propranolol, timolol), tricyclic antidepressants (eg, amitriptyline), anti-epileptic drugs (eg, topiramate, valproic acid), and neurotoxins (eg, onabotulinumtoxinA). Preventive medication use and reasons for discontinuation were collected in an international, Web-based, cross-sectional survey of adults with migraine during 2010. Descriptive analyses were conducted on demographics and headache-related disability as measured by the Migraine Disability Assessment Scale, stratified by use of preventive medication, and EM or CM. Univariate and multivariate logistic regression models were constructed to assess predictors of preventive medication use. One thousand one hundred and sixty-five respondents completed the survey. Only 28.3% of EM and 44.8% of CM respondents were currently using preventive medication; any use of prophylaxis (prior or current) was reported by 43.4% of those with EM and 65.9% with CM. The mean number of prophylactic medications ever used was 2.92 for EM and 3.94 for CM. Antidepressants were used most frequently (EM 60.9%; CM 54.7%), followed by β-blockers (EM 35.4%; CM 36.8%) and anti-epileptics (EM 28.6%; CM 36.3%). Odds of preventive medication use were higher among CM than EM, adjusting for age, gender, race, years of daily headache, and country (odds ratio 2.72; 95% confidence interval 2.15 to 3.57). Greater headache-related disability and older age were also associated with greater odds of ever having used prophylaxis, regardless of headache frequency. Less than half the persons with EM and CM were currently using preventive medication for migraine, with treatment rates being higher for CM, as expected. Those with CM tried more medications than those with EM, possibly reflecting higher levels of treatment need.

Pregnant Women's Beliefs About Medications—A Study Among 866 Norwegian Women

Beliefs about medication may impact a woman's decision to take a needed medication during pregnancy. While many women will be faced with decisions regarding medication use during pregnancy, there is a paucity of research on this topic in the literature. To study pregnant women's beliefs about medication and factors that determine those beliefs. A questionnaire was posted at the University of Oslo's Web site for Internet surveys for 5 weeks from mid-September 2008 through October 2008. Seven general statements from the "Beliefs about Medicines" questionnaire and 9 pregnancy-specific statements were used to assess pregnant women's attitudes toward medication use during pregnancy. Other information, such as sociodemographic background and personal medication use during pregnancy, was also collected. A total of 866 pregnant women completed the questionnaire. Most women had a positive attitude toward medication in general, but believed pregnant women should be more restrictive regarding use than nonpregnant women. There was a significant association between women's education, occupation, and attitudes, with less educated women believing that medications in general were harmful and herbal remedies were safe, while women with a higher education were more reluctant to use any medication in pregnancy. Women with health-related occupations were more knowledgeable about the possible risks of untreated illness during pregnancy. There was also an association between pregnant women's attitudes and their use of prescribed penicillins and herbal remedies. Most pregnant women believe that medicines in general are helpful and safe to use. However, they are much more restrictive and unsure about use during pregnancy. Health-care professionals should be aware of such attitudes when advising a woman to take a needed medication during pregnancy.

The severity of dependence score correlates with medication overuse in persons with secondary chronic headaches. The Akershus study of chronic headache

The objective was to compare the Severity of Dependence Scale (SDS) score and pattern of medication use in persons with secondary chronic headache (⩾15days/month for at least 3months) in a cross-sectional epidemiological survey. A posted questionnaire screened for chronic headache. Neurological residents interviewed those with self-reported chronic headache. The International Classification of Headache Disorders was used. Split file methodology was employed for data analysis. People with secondary chronic headaches were identified in an age and gender stratified sample of 30,000 30–44year olds from the general population. The interviews and examinations were conducted at the Akershus University Hospital, Oslo, Norway. The main outcome measure was the SDS score in those with and without medication overuse. Fifty-five (49%) of the 113 persons with secondary chronic headaches were found to have medication overuse. Fifty-eight percent overused simple analgesics and 31% overused combination analgesics. The SDS score was significantly higher among those with than without medication overuse (5.5 vs. 1.9). The sensitivity, specificity, positive and negative predictive values were 0.82, 0.82, 0.82 and 0.83, respectively. Thus the SDS score correlates with medication overuse, and a high SDS score suggests dependency-like behaviour in persons with secondary chronic headache. The use of SDS score in subjects with frequent pain episodes may contribute to the detection of medication overuse and better management of this group of patients.

Management of Depression in Ambulatory Care for Patients with Medical Co-Morbidities: A Study from a National Electronic Health Record (EHR) Network

Since co-morbid depression can complicate medical conditions such as cardiovascular disease and cancer, physicians may treat depression more aggressively in patients with these conditions. This study compared antidepressant medication use in persons with and without medical co-morbidities. This cross-sectional study was conducted in a national network of outpatient electronic medical record users. Participants included active adult patients with an active diagnosis of depression as of 11/30/05 (the "prevalent" population, 185,029 patients) or a new episode of depression during the one-year period 12/1/03-11/30/04 (the "incident" population, 29,768 patients). For each population, four co-morbid conditions were defined--diabetes, coronary heart disease (CHD), stroke, and cancer. Prescription of antidepressant medication was compared for persons with and without each medical condition. The most common medical condition was diabetes, with cancer being the least common (7.6% and 2.4% of the prevalent population). Overall, 69.6% of the prevalent population and 76.1% of the incident population were treated with antidepressant medications. For the prevalent population, treatment was significantly more likely for patients with diabetes (OR 1.07, 95% CI 1.03-1.11) but significantly less likely for patients with CHD (OR 0.94 95% CI 0.90-0.99), after controlling for differences in age and gender. For the incident population, treatment was significantly more likely for persons with diabetes (OR 1.14, 95% CI 1.04-1.26), CHD (OR 1.23 95% CI 1.08-1.39), and stroke (OR 1.21, 95% CI 1.04-1.42). Antidepressant medication use was somewhat higher in persons with medical co-morbidities, although these differences were small and inconsistent.

Survey of Psychiatric Treatment Among Psychiatric Residents in Manhattan

Psychiatric trainees seek personal psychiatric treatment for a variety of reasons including educational objectives, symptoms relief, or functional impairment. Data on the rate of psychiatric treatment among residents and the attitudes of residents toward personal treatment are limited. The purpose of this study was to determine the frequency and types of psychiatric treatment among residents and to assess residents' attitudes toward treatment. A 51-item questionnaire was mailed to all postgraduate year (PGY)-2 through PGY-4 psychiatric residents training in Manhattan in the spring of 2002 (N = 288). Questionnaires were anonymous. Significance was tested using McNemar test of symmetry, dependent-groups t tests, or 2-way contingency table analysis where appropriate. The study was conducted from March 2002 through June 2002. Forty-eight percent of residents returned the questionnaire. Among respondents, 57% were in individual psychiatric treatment, predominantly individual psychotherapy or psychoanalysis. The rate of medication treatment was 18%, corresponding to a 31% rate of medication use among those in psychotherapy. Residents felt that their training programs explicitly encouraged psychotherapeutic treatment but not medication treatment, and they were more likely to tell other residents and faculty about personal psychotherapy as compared with personal medication use. Residents felt that the use of medication carried "significant" stigma, while personal psychotherapy did not. In this sample, residents believe there is "significant" stigma associated with the use of psychotropic medication, while psychotherapy is seen as a respected and valued educational and therapeutic experience. These findings deserve the attention of educators and emphasize the need for further research in this area.