Physician Prescribing Research Articles

Discontinuation of Buprenorphine Treatment for Opioid Use Disorder During the Coronavirus Disease-2019 Pandemic: A Multilevel Framework.

The coronavirus disease-2019 pandemic has been associated with large increases in opioid-related mortality, yet it is unclear whether specific subpopulations were especially likely to discontinue buprenorphine treatment for opioid use disorder as the pandemic ensued. The aim was to assess predictors of buprenorphine discontinuation in the early months of the coronavirus disease-2019 pandemic (April-July 2020) compared with a prepandemic period (April-July 2019). In each time period, we estimated a multilevel regression models to assess risk of discontinuation in April-July for people who started buprenorphine in January-February. Models included person-level, prescriber-level, and area-level covariates. Individuals age 18 years or older in the all-payer IQVIA Longitudinal Prescription Claims. The primary outcome was buprenorphine discontinuation (ie, no filled prescriptions during the follow-up periods). Overall, 13.98% of patients discontinued buprenorphine in April-July 2020, less than the 15.71% in 2019 (P<0.001). In 2020, patient-level factors associated with discontinuation included younger age, male sex, shorter baseline possession ratio, and payment by cash. Compared with patients with a primary care physician prescriber, specialties most associated with discontinuation were pain medicine and physician assistant/nurse practitioner. Compared with the South Atlantic region, discontinuation risk was lowest in New England and highest in the West South Central States. The association between patient, prescriber, and geographic variables to risk of discontinuation was very similar in 2019 and 2020. While clinical and policy interventions may have mitigated opioid use disorder treatment discontinuation following the pandemic, such discontinuation is nevertheless common and varies by identifiable patient, provider and geographic factors.

Pharmaceutical brochures in Lebanon: do they meet WHO recommendations?

BackgroundDrug promoting brochures can influence physicians prescription patterns. The validity of the info presented in these brochures is of major importance. World Health Organization (WHO) issued criteria to guarantee validity, equity and ethical presentation of data in medical brochures. This study aims to evaluate the quality and the validity of information presented in the pharmaceutical brochures distributed among family physicians in Lebanon.MethodsPharmaceutical brochures were randomly collected at the family medicine center in Hôtel Dieu de France hospital in Beirut - Lebanon. These brochures were evaluated in reference to the WHO ethical criteria for medicinal drug promotion and on guidelines for quality assurance of the graphs, references, texts and illustrations.ResultsAmong the 60 brochures collected, only 4 fulfilled all the WHO ethical criteria, and 24 presented less than half the required criteria. Information concerning the drug safety are the least mentioned. Only 11.8% of the presented graphs are based on studies of high methodological level. Half of the brochures presented necessary information to identify studies references which are not always retrievable. Texts present mainly brand names instead of generic names and emphasize on information reflecting the drug efficacy.ConclusionThe pharmaceutical brochures in this study presented incomplete or invalid information. Prescribing physicians should be aware of the claims found in the brochures distributed by pharmaceutical companies and should be familiar with the principles of the evidence-based medicine to be able to critically appraise the validity of the reference studies and avoid the pitfalls in graphs reading.

Physician influence on medication adherence, evidence from a population-based cohort.

The overall impact of physician prescribers on population-level adherence rates are unknown. We aimed to quantify the influence of general practitioner (GP) physician prescribers on the outcome of optimal statin medication adherence. We conducted a retrospective cohort study using health administrative databases from Saskatchewan, Canada. Participants included physician prescribers and their patients beginning a new statin medication between January 1, 2012 and December 31, 2017. We grouped prescribers based on the prevalence of optimal adherence (i.e., proportion of days covered ≥ 80%) within their patient group. Also, we constructed multivariable logistic regression analyses on optimal statin adherence using two-level non-linear mixed-effects models containing patient and prescriber-level characteristics. An intraclass correlation coefficient was used to estimate the physician effect. We identified 1,562 GPs prescribing to 51,874 new statin users. The median percentage of optimal statin adherence across GPs was 52.4% (inter-quartile range: 35.7% to 65.5%). GP prescribers with the highest patient adherence (versus the lowest) had patients who were older (median age 61.0 vs 55.0, p<0.0001) and sicker (prior hospitalization 39.4% vs 16.4%, p<0.001). After accounting for patient-level factors, only 6.4% of the observed variance in optimal adherence between patients could be attributed to GP prescribers (p<0.001). The majority of GP prescriber influence (5.2% out of 6.4%) was attributed to the variance unexplained by patient and prescriber variables. The overall impact of GP prescribers on statin adherence appears to be very limited. Even "high-performing" physicians face significant levels of sub-optimal adherence among their patients.

Evaluation of Over-the-Counter Portable Oxygen Concentrators Utilizing a Metabolic Simulator.

Supplemental oxygen is designed to raise alveolar PO2 to facilitate diffusion into arterial blood. Oxygen is generally delivered by nasal cannula either by continuous or pulsatile flow. Battery-powered portable oxygen concentrators (POCs) facilitate ambulation in patients experiencing exertional hypoxemia. In the United States, the Food and Drug Administration (FDA) clears these devices to be sold by physician prescription. Recently, however, lower-cost devices described as POCs have been advertised by online retailers. These devices lack FDA clearance and are obtained over the counter (OTC) without prescription. This study determined whether a selected group of OTC POCs have oxygen delivery characteristics suitable for use by hypoxemic patients. A metabolic simulator, capable of simulating a range of metabolic rates and minute ventilations, determined effects of oxygen supplementation delivered by a variety of devices on alveolar PO2 . Devices tested included 3 OTC POCs, an FDA-cleared POC, and continuous-flow oxygen from a compressed oxygen cylinder. End-tidal PETO2 , a surrogate of alveolar PO2 , was determined at each of each device's flow settings at 3 metabolic rates. Continuous-flow tank oxygen yielded a linear PETO2 increase as flow increased, with progressively lower slope of increase for higher metabolic rate. The prescription POC device yielded similar PETO2 elevations, though with somewhat smaller elevations in pulse-dose operation. One OTC POC was only technically portable (no on-board battery); it provided only modest PETO2 elevation that failed to increase as flow setting was incremented. A second OTC POC produced only minimal PETO2 elevation. A third OTC POC, a pulsed-dose device, produced meaningful PETO2 increases, though not as great as the prescription device. Only one of 3 OTC POCs tested was potentially of use by patients requiring ambulatory oxygen. Physicians and respiratory therapists should inform patients requiring portable oxygen that OTC devices may not meet their oxygenation requirements.

Medications for Opioid Use Disorder in Rural United States: A Critical Review of the Literature, 2004–2021

Background The opioid epidemic continues to be problematic in the United States (US). Medications for opioid use disorder (MOUD) are a commonly used evidence-based approach to treating affected individuals, but little is known about its use in the rural US. We reviewed published literature and summarized access, barriers, and approaches to MOUD delivery in rural areas. Methods We conducted a search using databases in EBSCOhost, such as Academic Search Complete, Medline, and APA PsycArticles, using a priori aims. Articles published after 2004 were included if they were cross-sectional, analyzed secondary data, collected quantitative or qualitative primary data, were longitudinal or reported intervention results. Studies were excluded if they were conducted outside the US or did not present data. Results A total of 13 articles met all criteria. Themes from the articles included increase in rural areas with waivered physicians able to prescribe buprenorphine, barriers to physician prescribing, waivered physicians choosing not to prescribe, and inability to assess quality of MOUD practices in rural US settings. Conclusions Additional studies of MOUD delivery in rural areas are needed to help explicate themes found in this review. Having a stronger understanding of prescribers operating practices and program roll-out in rural areas may help address some identified barriers and deliver a stronger quality treatment practice for individuals with substance-use disorder.

Interim Clinical Utility Findings of a Transcriptomic Psoriasis Biologic Test Demonstrate Altered Physician Prescribing Behavior and Improved Patient Outcomes

Objective: This study (MATCH) was designed to assess the clinical utility of a machine-learning based tool (Mind.Px) that predicts patient response to the most common biologic drug classes used in the management of psoriasis patients.&#x0D; Methods: The MATCH study was designed to assess Mind.Px utility in physician decision making and patient outcomes. Psoriasis patients who were biologic naïve or those who were approaching a change due to non-response were enrolled into the study (N=112). At baseline, a dermal biomarker patch was applied to lesional skin and Mind.Px test results were provided to physicians prior to biologic selection. The choice of biologic for each patient was recorded and in the case of physician non-concordance with Mind.Px test results, a questionnaire completed to determine the reason for non-concordance. Patients were evaluated at weeks 4, 8, 12, and 16 after baseline using PASI, PGA, and BSA. Statistical analysis between groups was performed using Fisher’s exact test.&#x0D; Results: Physician prescribing behavior was measured with and without the inclusion of Mind.Px test results in the decision-making process. This data set was compared to a previously obtained data set in which dermal biomarker patches were applied at baseline, but Mind.Px results were not provided to physicians at any point during treatment (N=180). Statistical analysis of concordance between the Mind.Px-informed and Mind.Px-uninformed groups within the MATCH study (84.4% vs 53.8%, respectively) showed that when given access to Mind.Px results, physician behavior was significantly altered (p = 0.0022). Furthermore, analysis of those patients who have completed the study showed improved clinical outcomes in those patients whose physicians were provided Mind.Px test results. Specifically, this cohort reached PASI75 sooner than those who were not provided test results (p = 0.004).&#x0D; Conclusion: These results provide an interim measurement of the clinical utility of Mind.Px by demonstrating that physicians will utilize this test in psoriasis biologic decision making and by doing so, this leads to improved patient outcomes. These improved patient outcomes can also potentially translate into tremendous cost savings for healthcare systems. Mind.Px can effectively minimize the trial-and-error approach to psoriasis treatment, and provide physicians, patients, and payers with a powerful tool for improving psoriasis patient management.

Opioid Systems and Depression: The Relationship Is Strengthening

Prior to the mid-20th century, the acute euphoric effects of opioid drugs and their ability to alleviate depression were primary reasons for physician prescriptions of opioid drugs. This practice was abandoned and discouraged once it was recognized that tolerance, withdrawal, and dependence lead to iatrogenic addiction and opioid use disorder. Nevertheless, the field has far from discarded the connection of the opioid systems with depression [recently reviewed by Jelen et al. (1)], including evidence that nonmedical opioid use may precipitate new-onset depressive episodes (2).

Abstract 11952: Physician Preferences for Treatment of Low-Density Lipoprotein Cholesterol Among Patients With Atherosclerotic Cardiovascular Disease - A Discrete Choice Experiment

Introduction: Around 80% of patients with atherosclerotic cardiovascular disease (ASCVD) do not achieve adequate reduction of low-density lipoprotein cholesterol (LDL-C) in current clinical practice, especially among patients on statin monotherapy. Greater understanding of attributes favored by prescribing physicians may improve treatment outcomes. Methods: To understand attributes of putative statin ‘add-on’ LDL-C lowering therapies, we conducted a discrete choice experiment survey of 200 U.S. cardiologists and 50 primary care physicians (PCPs). The survey presented a series of discrete choices to respondents, systematically varied across 8 treatment attributes: % LDL-C reduction, myalgias, other side effects, route and frequency of administration, time to prior authorization, patient out-of-pocket cost (OOPC) and adherence. Data were analyzed using logistic regression with clustering and heterogeneity adjustments to estimate preference weights for each attribute. Results: Both cardiologists and PCPs most valued efficacy in LDL-C reduction, with odds ratio (OR) for treatment preference of 1.69 per additional 10% reduction in LDL-C, and minimization of monthly OOPC with OR of 0.90 per $10 increase. Cardiologists preferred injectable therapies, with 57.5% of respondents preferring a drug with attributes of a small interfering RNA (siRNA) injectable and 16.4% preferring attributes of a proprotein convertase subtilisin kexin type 9 inhibitor (PCSK9i) biologic over oral ezetimibe therapy, as compared to only 2.8% preference for siRNA injectable among PCPs vs. oral therapy. Across all respondents, preference for injectables was higher for patients with history of nonadherence, with 55.7% preferring a drug with health-care practitioner-based injection every 6 months and 25.4% preferring a drug with properties of monoclonal antibody-based home injections once or twice monthly. Conclusions: Results indicate LDL-C lowering efficacy is a primary driver of physician prescribing preferences, with PCPs placing increasing consideration on OOPC. For patients with suboptimal adherence - the majority of those seen in clinical practice - U.S. physicians are more likely to prefer less-frequent injectable to oral therapies.

Cardiovascular risk following cannabinoid treatment for patients with chronic pain

Abstract Background Treatment with medical cannabis for chronic pain is in popular demand, and a rising number of countries allow physicians to prescribe medical cannabis for pain management. However, data on drug-safety is scarce. Studies have showed a risk of cardiovascular side effects following use of recreational cannabis warranting further investigations into the safety of prescribing medical cannabis. Purpose We investigated risk of new-onset arrhythmias (tachy- or bradyarrhythmia and conduction disorders), acute coronary syndrome (ACS) and heart failure (HF) following use of prescribed medical cannabis compared with no use in a nationwide cohort of patients with chronic pain. Methods Using nationwide Danish registers, a cohort of patients with chronic pain and without prior history of arrhythmias, ACS, HF or prescribed medical cannabis (cannabinoid, cannabidiol or dronabinol) use were followed from 2018–2021. Any patient from the cohort initiating first-time treatment with medical cannabis was identified and matched 1:10 to corresponding controls within the cohort using incidence density sampling. Matching parameters were age group, sex, and chronic pain diagnosis. Follow-up was initiated at the date of the first claimed prescription of medical cannabis or the corresponding date among controls. We reported 180-day standardized absolute risks (AR) with 95% confidence intervals (CI) and risk ratios (RR) from fitted multivariable logistic regression models comparing patients exposed to medical cannabis with patients not exposed. Separate analyses for each chronic pain group were conducted as well. Results Among 1.6 million patients with chronic pain, 4,562 patients claimed at least one prescription of medical cannabis (exposed) and were each matched to 10 controls (non-exposed). Exposed and non-exposed patients were identical in relation to matching parameters; however, exposed patients were slightly more comorbid, and a larger proportion was concomitantly treated with other pain medication (Table). The risk of new-onset arrhythmia was elevated among exposed patients with 180-day AR of 0.71% (95% CI 0.47%–0.94%) compared with 0.43% (95% CI 0.37%–0.49%) yielding a RR of 1.64 (95% CI 1.04–2.23). The risk of new-onset ACS and HF was not increased comparing exposed to non-exposed with corresponding 180-day ARs of 0.13% (95% CI 0.03%-0.23%) vs 0.11% (95% CI 0.08%–0.14% and 0.13% (95% CI 0.03%–0.24%) vs 0.14% (95% CI 0.11%–0.17% (corresponding RRs of 1.2 [95% CI 0.3–2.1] and 0.9 [95% CI 0.2–1.7]) (Figure). Subgroup analyses of each chronic pain group yielded similar results. Conclusion In a nationwide cohort of patients with chronic pain, use of medical cannabis was associated with a 64% risk increase of arrhythmias compared with no use. This poses a potential health concern and is vital knowledge for any physician prescribing medical cannabis. Use of medical cannabis was not associated with an elevated risk of ACS or HF. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Ib Mogens Kristiansens Almene FondHelsefonden

Sustained usage of an app-based clinical-decision making aid for the management of atherosclerotic cardiovascular disease

Abstract Background Complexity of therapies for atherosclerotic cardiovascular disease (ASCVD) risk reduction represents a challenge for clinicians and may lead to poor uptake of these therapies. Purpose The goal of this project was to design an easy-to-use, point-of-care tool to risk stratify ASCVD patients and provide individualized guidance for clinicians to incorporate these agents. Methods Based on the REACH registry trial and predictive modeling (including 49,689 patients with ASCVD in 44 countries), we designed and implemented an app for secondary risk assessment. Using demographic and comorbidity profiles, this tool was used to calculate an individual's 20-month risk of cardiovascular events and mortality. It also provided graphical comparison to an age-matched control with optimized cardiovascular risk profile to illustrate the modifiable residual risk. The app then utilized the patient's risk profile to provide specific guidance for possible therapeutic interventions SGLT2-inhibitors, GLP1-agonists, PCSK9-inhibitors, Vascular-dose Rivaroxaban, and Icosapent Ethyl. Additionally, it identified individuals who qualified for cardiac rehabilitation or may benefit from smoking cessation interventions, including counselling or pharmacological therapies. We launched a pilot test of the “Residual Cardiovascular Risk: Assessment and Management Guide” app at a regional cardiac center. 240 referring physicians (including family doctors, emergency physicians, internists, and cardiologists) were invited by email or fax to utilize the app. Feedback was solicited from all users three months into the test period. Following this, no further marketing of the app was performed for all users. Usage data was recorded using Google Analytics over a 12-month period and analyzed in 4-month increments. Results From January to December 2021, our app was used to risk stratify 1576 patients. A total of 47 individual users utilized the app over this period. From January to April, the app was used on average 160 times monthly. From May to August, it was used 115 times monthly. From September to December, it was used 118 times monthly. Twenty-four physicians provided feedback; 100% affirmed the functionality, ease of use, and utility of the tool. The app was described as “useful for discussions with patients”, “helpful to optimize patients” and “similar to a mini-cardiology consult”. User suggestions resulted in further improvements to the app, including integration of reports into Electronic Medical Records. Conclusions The early success of this app demonstrates a need for simple, accessible, and individualized guidance for management of ASCVD patients to improve uptake of guideline-based medical therapies. This tool demonstrates sustained usage among clinicians, as well as subjective utility in aiding therapeutic decision making. Future clinical research will focus on the ability of this tool to impact physician prescribing patterns and clinical outcomes. Funding Acknowledgement Type of funding sources: None.

A new approach for optimizing empirical prescriptions of famous physicians based on network target: taking Qingluo Decoction as an example

Based on the network target approach and technology, this study proposed for the first time a novel optimization method for Chinese medicine formulae. Moreover, with Qingluo Decoction as an example, a method for the research and development of Chinese medicine, which combines scientific methodology and experience of famous doctors, was developed. Specifically, based on the composition of Qingluo Decoction, this study used the using network target for intelligent and quantitative analysis on drug actions(UNIQ) to predict the medicinals that targeted the key pathways of rheumatoid arthritis(RA) such as angiogenesis. Then, combining the experience of the first national Chinese medical master LI Ji-ren and Aihui famous Chinese medicine doctor LI Yan and Chinese medicine theory, this study developed a novel angiogenesis-targeted prescription modified Qingluo Decoction(MQLD). Afterward, the clinical efficacy and mechanism of MQLD were verified. The results showed that 27 medicinals with significant regulatory effect on angiogenesis-related key signaling pathways were identified by UNIQ, among which 6 were selected by the Chinese medicine physicians to develop the MQLD. Clinical trials demonstrated that the clinical efficacy of MQLD, in terms of either American College of Rheumatology 20% improvement and 50% improvement criteria(ACR20, ACR50) or TCM syndrome evaluation, was better than that of Qingluo Decoction. Experimental study revealed that MQLD can inhibit RA angiogenesis by acting on the vascular endothelial growth factor(VEGF) pathway, nuclear factor κB(NF-κB) pathway, inflammatory cytokine release, and immune cell regulation. Taken together, this study developed a new formula MQLD with improved clinical efficacy, precise applicable clinical settings, and authorized patent through the network target technology, thus providing a new way for the precise development of Chinese medicine and preservation of the experience of famous physicians.

The factors influencing customer choice of pharmaceutical brands in Sulaimani

The pharmaceutical industry is an important component of health care systems throughout the world; it is comprised of many public and private organizations that discover, develop, manufacture and market medicines for human and animal health, as Physicians play major role in the selection of medicine to consume, this study aims to determine the most important factors influencing physician prescription behavior (medicine brand choice).&#x0D; In order to achieve this objective, a self-administered questionnaire designed, it was completed by 77 physicians in Sulaimani city. Iraq. Data were analyzed applying various statistical methods, such as descriptive statistics, and ANOVA.&#x0D; The results show that, the most important factors influence physician’s prescription behavior are patient compliance, medicine efficacy, patient buying power, and medicine availability respectively.&#x0D; this research suggests that future research may explore the factors influencing patient’s choice for over the counter medicine (OTC).

Benzodiazepine use disorder: A cross-sectional study at a tertiary care center in Lebanon.

Benzodiazepines are medications used for the treatment of multiple conditions including anxiety disorders, insomnia, agitation, and seizures. They are the most prescribed psychiatric medications and the third most misused drugs among adults and adolescents in the US. This study aims to assess the patient utilization patterns and benzodiazepine use disorder among Lebanese patients. A cross-sectional study was performed on Lebanese patients presenting to the Emergency Department of the American University of Beirut Medical Center (AUBMC), between November 11th, 2019, and May 30th, 2020. Institutional review board approved the study, and an informed consent was obtained from patients. A total of 244 patients were included in the final analysis. A total of 154 (63.1%) patients were found to have benzodiazepine use disorder as per the DSM-V criteria with the majority (64%) being females and young adults aged 18 to 40 years. The most common medication was alprazolam, and anxiety was the most common reason for benzodiazepine use. The majority (88%) of patients obtained their medications using a physician’s prescription. More than half of users were not satisfied with the physician’s instructions and lacked knowledge about side effects and abuse potential. The high rate of benzodiazepine misuse among our young adults highlights an important public health concern that requires interventions and policy implementation.

Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study

BackgroundFor the two-thirds of patients with epilepsy who achieve seizure remission on antiseizure medications (ASMs), patients and clinicians must weigh the pros and cons of long-term ASM treatment. However, little work has evaluated how often ASM discontinuation occurs in practice. We describe the incidence of and predictors for sustained ASM fill gaps to measure discontinuation in individuals potentially eligible for ASM withdrawal.MethodsThis was a retrospective cohort of Medicare beneficiaries. We included patients with epilepsy by requiring International Classification of Diseases codes for epilepsy/convulsions plus at least one ASM prescription each year 2014–2016, and no acute visit for epilepsy 2014–2015 (i.e., potentially eligible for ASM discontinuation). The main outcome was the first day of a gap in ASM supply (30, 90, 180, or 360 days with no pills) in 2016–2018. We displayed cumulative incidence functions and identified predictors using Cox regressions.ResultsAmong 21,819 beneficiaries, 5191 (24%) had a 30-day gap, 1753 (8%) had a 90-day gap, 803 (4%) had a 180-day gap, and 381 (2%) had a 360-day gap. Predictors increasing the chance of a 180-day gap included number of unique medications in 2015 (hazard ratio [HR] 1.03 per medication, 95% confidence interval [CI] 1.01–1.05) and epileptologist prescribing physician (≥25% of that physician’s visits for epilepsy; HR 2.37, 95% CI 1.39–4.03). Predictors decreasing the chance of a 180-day gap included Medicaid dual eligibility (HR 0.75, 95% CI 0.60–0.95), number of unique ASMs in 2015 (e.g., 2 versus 1: HR 0.37, 95% CI 0.30–0.45), and greater baseline adherence (> 80% versus ≤80% of days in 2015 with ASM pill supply: HR 0.38, 95% CI 0.32–0.44).ConclusionsSustained ASM gaps were rarer than current guidelines may suggest. Future work should further explore barriers and enablers of ASM discontinuation to understand the optimal discontinuation rate.

The Rise and Rise of Medicinal Cannabis, What Now? Medicinal Cannabis Prescribing in Australia 2017-2022.

Medicinal cannabis was legalised in Australia in November 2016. By August 2022, there were 5284 specialist physician and general practitioner (GP) prescribers who submitted Special Access Scheme (SAS) applications to the Therapeutic Goods Administration (TGA) for the provision of medicinal cannabis prescriptions their patients. In this article we examine the impact of the delivery of publicly available clinical guidance documents, provision of education to prescribers, establishment of the TGA online portal, and launching of cannabis clinics on the number of applications approved by the TGA over time. We considered these findings in the context of the need to align the interventions facilitating the prescribing of medicinal cannabis with the establishment of processes to enable the systematic monitoring of patient outcomes. The cumulative number of medicinal cannabis Special Access Scheme-B (SAS-B) prescription approvals from January 2017 to June 2022 was 258,926. SAS-B approvals increased at an average rate of 208.55% p < 0.000, (95% CI 187.25–229.85) per month. Conclusion: There has been a rapid growth in prescribing since the legalisation of medicinal cannabis in Australia and this expansion has not been accompanied by parallel processes for the monitoring of medicinal cannabis. The capture of more highly granulated data, as found in the electronic medical record (EMR), patient smartphone applications, and social media provide an opportunity to monitor medicinal cannabis effectiveness and safety across multiple prescribing indications.

An efficient modular framework for automatic LIONC classification of MedIMG using unified medical language.

Handwritten prescriptions and radiological reports: doctors use handwritten prescriptions and radiological reports to give drugs to patients who have illnesses, injuries, or other problems. Clinical text data, like physician prescription visuals and radiology reports, should be labelled with specific information such as disease type, features, and anatomical location for more effective use. The semantic annotation of vast collections of biological and biomedical texts, like scientific papers, medical reports, and general practitioner observations, has lately been examined by doctors and scientists. By identifying and disambiguating references to biomedical concepts in texts, medical semantics annotators could generate such annotations automatically. For Medical Images (MedIMG), we provide a methodology for learning an effective holistic representation (handwritten word pictures as well as radiology reports). Deep Learning (DL) methods have recently gained much interest for their capacity to achieve expert-level accuracy in automated MedIMG analysis. We discovered that tasks requiring significant responsive fields are ideal for downscaled input images that are qualitatively verified by examining functional, responsive areas and class activating maps for training models. This article focuses on the following contributions: (a) Information Extraction from Narrative MedImages, (b) Automatic categorisation on image resolution with an impact on MedIMG, and (c) Hybrid Model to Predictions of Named Entity Recognition utilising RNN + LSTM + GRM that perform admirably in every trainee for every input purpose. At the same time, supplying understandable scale weight implies that such multi-scale structures are also crucial for extracting information from high-resolution MedIMG. A portion of the reports (30%) are manually evaluated by trained physicians, while the rest were automatically categorised using deep supervised training models based on attention mechanisms and supplied with test reports. MetaMapLite proved recall and precision, but also an F1-score equivalent for primary biomedicine text search techniques and medical text examination on many databases of MedIMG. In addition to implementing as well as getting the requirements for MedIMG, the article explores the quality of medical data by using DL techniques for reaching large-scale labelled clinical data and also the significance of their real-time efforts in the biomedical study that have played an instrumental role in its extramural diffusion and global appeal.

The value of incorporating patient-consulted medication reconciliation in influencing drug-related actions in the outpatient rheumatology setting

BackgroundUnintentional changes to patients’ medicine regimens and drug non-adherence are discovered by medication reconciliation. High numbers of outpatient visits and medication reconciliation being time-consuming, make it challenging to perform medication reconciliation for all outpatients. Therefore, we aimed to get insight into the proportion of outpatient visits in which information obtained with medication reconciliation led to additional drug-related actions.MethodsIn October and November 2018, we performed a cross-sectional observational study at the rheumatology outpatient clinic. Based on a standardized data collection form, outpatient visits were observed by a pharmacy technician trained to observe and report all drug-related actions made by the rheumatologist. Afterwards, the nine observed rheumatologists and an expert panel, consisting of two rheumatologists and two pharmacists, were individually asked which drug information reported on the drug list composed by medication reconciliation was required to perform the drug-related actions. The four members of the expert panel discussed until consensus was reached about their assessment of the required information. Subsequently, a researcher determined if the required information was available in digital sources: electronic medical record (electronic prescribing system plus physician’s medical notes) or Dutch Nationwide Medication Record System.ResultsOf the 114 selected patients, 83 (73%) patients were included. If both digital drug sources were available, patient’s input during medication reconciliation resulted in additional information to perform drug-related actions according to the rheumatologist in 0% of the visits and according to the expert panel in 14%. If there was only access to the electronic medical record, the proportions were 8 and 29%, respectively. Patient’s input was especially required for starting a new drug and discussing drug-related problems.ConclusionsIf rheumatologists only had access to the electronic medical record, in 1 out of 3 visits the patient provided additional information during medication reconciliation which was required to perform a drug-related action. When rheumatologists had access to two digital sources, patient’s additional input during medication reconciliation was at most 14%. As the added value of patient’s input was highest when rheumatologists prescribe a new drug and/or discuss a drug-related problem, it may be considered that rheumatologists only perform medication reconciliation during the visit when performing one of these actions.

Use of guideline-recommended medical therapy in patients with heart failure and chronic kidney disease: from physician's prescriptions to patient's dispensations, medication adherence and persistence.

Half of heart failure (HF) patients have chronic kidney disease (CKD) complicating their pharmacological management. We evaluated physicians' and patients' patterns of use of evidence-based medical therapies in HF across CKD stages. We studied HF patients with reduced (HFrEF) and mildly reduced (HFmrEF) ejection fraction enrolled in the Swedish Heart Failure Registry in 2009-2018. We investigated the likelihood of physicians to prescribe guideline-recommended therapies to patients with CKD, and of patients to fill the prescriptions within 90 days of incident HF (initiating therapy), to adhere (proportion of days covered ≥80%) and persist (continued use) on these treatments during the first year of therapy. We identified 31 668 patients with HFrEF (median age 74 years, 46% CKD). The proportions receiving a prescription for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEi/ARB/ARNi) were 96%, 92%, 86%, and 68%, for estimated glomerular filtration rate (eGFR) ≥60, 45-59, 30-44, and<30 ml/min/1.73 m2 , respectively; for beta-blockers 94%, 93%, 92%, and 92%, for mineralocorticoid receptor antagonists (MRAs) 45%, 44%, 37%, 24%; and for triple therapy (combination of ACEi/ARB/ARNi + beta-blockers + MRA) 38%, 35%, 28%, and 15%. Patients with CKD were less likely to initiate these medications, and less likely to adhere to and persist on ACEi/ARB/ARNi, MRA, and triple therapy. Among stoppers, CKD patients were less likely to restart these medications. Results were consistent after multivariable adjustment and in patients with HFmrEF (n=15 114). Patients with HF and CKD are less likely to be prescribed and to fill prescriptions for evidence-based therapies, showing lower adherence and persistence, even at eGFR categories where these therapies are recommended and have shown efficacy in clinical trials.

Prescribing Nirmatrelvir/Ritonavir for COVID-19 in Advanced CKD.

Prescribing Nirmatrelvir/Ritonavir for COVID-19 in Advanced CKD.

Patient Satisfaction and Comprehension of Physician and Pharmacist Prescription in Saudi Arabia: A Cross-Sectional Study.

Background and objectivesPatient satisfaction is a measure of patient quality of life, and the perspective and experience of patients would further improve different aspects of healthcare services of both the health plan and health care. This study aims to assess patient satisfaction with both physicians and pharmacists, as well as how well patients comprehended their prescriptions.MethodsThis was a cross-sectional, survey-based study conducted from January to April 2022 in Saudi Arabia. An online survey was spread through social media and was filled out over two months. The survey received 575 responses and it included participants' demographics and general satisfaction toward both physicians and pharmacists and healthcare services. Two modified tools, i.e., the Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ 2.0) and the Patient Satisfaction Questionnaire (PSQ-18), were used for this study.ResultsThe participants were very satisfied (overall satisfaction: 82.5%) with their education on how to take medicine (87.1%), and the information was easy to understand (89.9%), they were able to ask for more information (67.7%), and the explanations were very clear (84.0%). The level of satisfaction toward healthcare services with both the physician and pharmacist was high (78% with a mean score of 50.7 ± 9.8). The self-perceived general satisfaction toward participant capacity and comprehension by bio-demographic data was higher in females than in males (3.34 ± 1.0 vs. 3.13 ± 1.14, respectively), with a statistically significant difference (p = 0.032). The satisfaction toward healthcare services with both physicians and pharmacists was higher in participants with low education levels compared with those with higher education levels (54.7 ± 8.3 vs. 50.3 ± 10.0; p = 0.049), respectively.ConclusionsThe current study demonstrated a high level of satisfaction among participants with healthcare services and both physicians and pharmacists in general. The majority of the participants were satisfied with the education they received, and they considered the information on how to take the drug to be simple to comprehend.