Prescription Volume Research Articles

Assessment of Local and Regional Control in Atypical (WHO Grade 2) Meningiomas Receiving Fractioned Stereotactic Radiotherapy

The optimal delivery of postoperative radiotherapy to WHO grade 2 or atypical meningiomas (AM) is controversial. The historical standard of care has been high dose fractionated radiation to the resection bed and a 2 cm CTV as in RTOG 0539. Single fraction radiosurgery offers a more conformal alternative with demonstrated local control for smaller AM in less sensitive areas. Though less studied, fractionated stereotactic radiosurgery (FSRT) promises safer treatment of larger AM in more sensitive locations while minimizing the treated volume. This single institution retrospective review examines the hypothesis that local and marginal failure patterns in AM treated with five fraction FSRT remain unacceptably high. Thirty-nine patients received 27.5 - 30 Gy in 5 fractions to their AM from 2009 to 2022 with grading based on the WHO criteria active at the time of treatment. All treatments were frameless VMAT deliveries with no PTV margin. Histological diagnosis of AM, gross disease at time of FSRT, five fraction FSRT, and lack of prior local radiation were required for inclusion. Single fraction treatments were excluded. Local recurrence was defined similar to RECIST criteria as an increase of 20% in the greatest cross-sectional diameter on MRI (or CT if MRI contraindicated) with at least one voxel touching the prescription volume. To examine the role of CTV margin, marginal recurrence was defined as any new lesion outside of the prescription volume but within 2 cm of the resection cavity. High grade toxicity per CTCAE v5 was an irreversible grade 3 or any grade 4 toxicity. Resection for radionecrosis was considered a local failure if any viable tumor was seen on pathology. Median follow up was 32.5 months (range 3.2-147.5 months). The number of AM treated post STR, post GTR recurrence, and definitively were 26, 16, and 5 respectively. 3-year local tumor control was estimated to be 84%. As expected, larger tumors were more likely to fail locally (p >.001). Two (5%) patients experienced high grade toxicity - both symptomatic radionecrosis requiring resection. Three-year marginal control was estimated to be 92.3%. Of the 5 tumors treated to the entire resection cavity, none experienced a marginal failure. Interestingly, recurrent tumors s/p GTR were more likely to recur marginally than tumors treated after STR (p = .009). Only 1 (4%) tumor treated after STR failed marginally while 4 (33%) tumors treated after GTR recurrence failed. The rate of high-grade toxicity in AM receiving FSRT was low. Local control appeared comparable to historical rates which may suggest the need for dose escalation with longer term follow-up. Recurrent tumors appear more prone to marginal failures, however more work is needed to determine which patients may benefit from additional CTV margin and more prolonged fractionated dose schedules. Improved targeting with newer imaging studies (e.g., DOTATATE PET) should be examined to determine if more accurate targeting will improve outcomes.

Understanding data provenance when using electronic medical records for research: Lessons learned from the Deliver Primary Healthcare Information (DELPHI) database.

We set out to assess the impact of Choosing Wisely Canada recommendations (2014) on reducing unnecessary health investigations and interventions in primary care across Southwestern Ontario. We used the Deliver Primary Healthcare Information (DELPHI) database, which stores deidentified electronic medical records (EMR) of nearly 65,000 primary care patients across Southwestern Ontario. When conducting research using EMR data, data provenance (i.e., how the data came to be) should first be established. We first considered DELPHI data provenance in relation to longitudinal analyses, flagging a change in EMR software that occurred during 2012 and 2013. We attempted to link records between EMR databases produced by different software using probabilistic linkage and inspected 10 years of data in the DELPHI database (2009 to 2019) for data quality issues, including comparability over time. We encountered several issues resulting from this change in EMR software. These included limited linkage of records between software without a common identifier; data migration issues that distorted procedure dates; and unusual changes in laboratory test and medication prescription volumes. This study reinforces the necessity of assessing data provenance and quality for new research projects. By understanding data provenance, we can anticipate related data quality issues such as changes in EMR data over time-which represent a growing concern as longitudinal data analyses increase in feasibility and popularity.

NATO DEFENSE STANDARDS: LEGAL NATURE AND IMPLEMENTATION IN NATIONAL LEGISLATION

An integration of Ukraine in the Euro-Atlantic defence system and achievement the compatibility of the Armed Forces of Ukraine with the relevant structures of the NATO member states comprise the implementation NATO military (administrative, operational and technical) standards into the national legislation. That is why understanding of legal meaning of NATO standards is so important for the determination of most effective ways of implementation of NATO standards and relevant procedures because it quite a large volume of technical prescriptions and rules that are complex and unusual for legal system of Ukraine. Military standardization and certification of weapons and military equipment in Ukraine according to NATO standards should take into account specific international law processes like adoption, ratification, implementation, change and cancellation of regulatory requirements. The purpose of the military standardization is to achieve, maintain and improve the interoperability of the Armed Forces of Ukraine with the armed forces of NATO and NATO member states on the base of interchangeability and uniformity of harmonized terminology in the field security and defense. In its legal nature the NATO standard is an international agreement that regulates and defines common rules in the field of defense joint procedures and establishes the unification of technical processes, weapons and military techniques. Therefore, the concept of “NATO standard” should consider precisely in the extended meaning, not in y narrow understanding, as it defined be Ukrainian legislation. National legislation provides definition of NATO standard as document that developed, adopted and published Organization of the North Atlantic Treaty. Such definition too narrowly reflects the complex nature of that international legal phenomenon and our country faces the necessity to review normative definition of multilevel system of NATO standardization. Solving the problem of interoperability of the security and defense sector of Ukraine with NATO is required through the creation of common conceptual and categorical conditions of standardization. Application of direct translation of the text of the standards NATO is not always correctly reflects content of the standard through essential difference in interpretation terms adopted in Ukraine from one side, and in NATO states on the other. The purpose of the article is to analyses the legal nature NATO standard and its impact on processes of adoption national military standards and to propose effective ways of implementation of the norms of international law in the sphere of defense and security into national legislation of Ukraine. General scientific and special methods of research were applied, in particular methods of system analysis and synthesis, comparative legal method, etc. Thorough analysis of organizational and legal standardization mechanism of NATO was done; it is determined that the system is military standardization in Ukraine should take into account the substance of international legal processes such as adoption, ratification, implementation, change and cancellation of NATO regulatory documents. It is established that new extended meaning regulatory and legal concept of NATO standard should be included in the national legislation. The need to develop a common Ukraine – NATO glossary was proposed. That glossary should contain an agreed terminological base in the field of security and defense, which would greatly simplify the activities of personnel not only in the sphere of military standardization, but also during the performance of their functional tasks.

Patterns of GP and nurse independent prescriber prescriptions for antibiotics dispensed in the community in England: a retrospective analysis.

Physician-nurse task shifting, a process of delegation whereby tasks are moved to other specialized healthcare workers, is used in primary care in many countries to improve access, efficiency and quality of care. One such task is the prescription of medicines. To identify nurse independent prescriber (NIP) and GP numbers in England, the proportions and types of NIP and GP antibiotic prescriptions dispensed in the community, and the impact of COVID-19 on the volume, rate and types of antibiotic prescriptions dispensed. Descriptive population-based retrospective cohort study using routinely collected data on prescriptions for antibiotics dispensed in the community in England between January 2014 and October 2021. Between 2014 and 2021, numbers (headcount) of NIPs whose prescriptions were dispensed in the community rose by 146% to 34 997. GP numbers (headcount) rose by 10% to 44 681. Of the 25.373 million antibiotic prescriptions dispensed between 2014 and 2021, NIPs were responsible for 8.6%. The rate of dispensed antibiotic prescriptions per prescriber per calendar year decreased (by 50% for NIPs and by 21% for GPs) between 2014 and 2020. This decreasing trend continued following the onset of the COVID-19 pandemic across both groups. Narrow-spectrum antibiotics (penicillins, macrolides, tetracyclines) were the most frequently dispensed across both NIPs and GPs. NIPs are an increasing contributory influence on total antibiotic prescribing and should be included in antimicrobial stewardship efforts. Interventions for this group need to be tailored to the population and context in which they work.

Antimicrobial resistance landscape and COVID-19 impact in Egypt, Iraq, Jordan, and Lebanon: A survey-based study and expert opinion.

The objective of this study was to assess the antimicrobial resistance (AMR) landscape and the impact of COVID-19 on AMR in Egypt, Iraq, Jordan, and Lebanon, and to gather expert opinions on the barriers to the implementation of antimicrobial stewardship (AMS) initiatives in the region. A cross-sectional questionnaire survey was used to assess the current AMR landscape, existing AMS initiatives, barriers to implementing AMS initiatives, and the impact of COVID-19 on AMR in the four countries. The survey was completed by 204 physicians from Egypt (n = 82), Lebanon (n = 49), Iraq (n = 43), and Jordan (n = 30). Previous antibiotic use and previous bacterial colonization were perceived as the most common risk factors for an increase in AMR. According to the survey, multidrug-resistant (MDR) gram-negative bacteria were most common in lower respiratory tract infections, and Klebsiella pneumoniae and Escherichia coli were the most commonly identified gram-negative bacteria in hospital-acquired infections. Only 14.8% of pediatric physicians and 28.6% of adult physicians reported that target pathogen genotyping and phenotyping were done in hospitals, and the most commonly reported reasons for the lack of testing were technological and resource constraints. These constraints, coupled with the scarcity and high cost of newer antibiotics, have been identified as the most significant barriers to the successful management of MDR gram-negative bacterial infections in the region. It was reported that the spectrum of activity and safety of the antibiotic, the site of infection, the presence of comorbidities, and published guidelines and local antibiograms determined the choice of empirical antibiotic therapy for patients in the region. The four countries experienced a significant rise in AMR due to several factors during the COVID-19 pandemic, including an increase in hospital occupancy, a shift in priorities away from AMR surveillance, and changes in AMR epidemiology. Additionally, the large volumes of unnecessary and unsubstantiated antibiotic prescriptions during the COVID-19 pandemic has led to subsequent antibiotic shortages and significant increases in AMR in the region. Physicians also noted that the majority of COVID-19 patients were already on antibiotics before visiting the healthcare facility. MDR gram-negative bacteria were found in the majority of COVID-19 patients admitted to the intensive care unit. Despite the fact that various AMS initiatives have been implemented, they are not standardized across the region. Some of the main barriers to AMS implementation in the region are a lack of adequately trained AMS staff, lack of AMS knowledge and training among healthcare professionals, financial constraints, and the lack of AMR surveillance systems. These survey results provide valuable insights into the existing AMR and AMS landscape in the region, as well as the barriers that impede efficient AMS and AMR management. Based on these findings, the authors developed a call to action that suggests ways for each country in the region to address these challenges.

Implementation of a medication delivery service for ambulatory oncology infusion patients.

Patients receiving infusions for the treatment of cancer are commonly prescribed supportive care medications which are filled through retail pharmacies. The initial phase of the COVID-19 pandemic created hurdles for patients to receive supportive care medications due to concerns related to exposure risk. Meds-to-Chemo Chairs (M2CC) was created allowing an onsite retail pharmacy to dispense and hand-deliver supportive care prescriptions to patients in the infusion suite. The purpose of this study was to assess the value of this program. The volume of prescriptions dispensed through the M2CC service, as well as the financial impact, was tracked through the prescription software system used by the onsite retail pharmacy dispensing and delivering the medications. Through the first 2.5 years of the program, M2CC has delivered over 13,000 prescriptions with an estimated gross revenue of $3.5 million. The M2CC medication delivery program has proved to be highly successful and feasible.

The Impact of Prescribing Monitoring Policy on Drug Use and Expenditures in China: A Multi-center Interrupted Time Series Study.

A prescribing monitoring policy (PMP) was implemented in November 2015 in Anhui province, China, the first province to pilot this policy to manage the use and costs of select drugs based on their large prescription volumes and/ or costs in hospitals. This study evaluated the impact of PMP on the use and expenditures of different drugs in three tertiary hospitals in Anhui. We obtained monthly drug use and expenditures data from three tertiary hospitals in Anhui (November 2014 through September 2017). An interrupted time series (ITS) design was used to estimate changes in defined daily doses (DDDs per month) and drug expenditures (dollars per month) of policy-targeted and non-targeted drugs after PMP implementation. Drugs were grouped based on whether they were recommended (recommended drugs) by any clinical guidelines or not (non-recommended drugs), or if they were potentially over-used (proton pump inhibitors, PPIs). After PMP, DDDs and costs of the targeted PPIs (omeprazole) declined while use of non-targeted PPIs increased correspondingly with overall sustained declines in total PPIs. The policy impact on recommended drugs varied based on whether the targeted drugs have appropriate alternatives. The DDDs and costs of recommended drugs that have readily accessible appropriate alternatives (atorvastatin) declined, which offset increases in its alternative non-target drugs (rosuvastatin), while there was no significant change in those recommended drugs that did not have appropriate alternative drugs (clopidogrel and ticagrelor). Finally, the DDDs and costs of non-recommended drugs decreased significantly. PMP policy impact was not the same across different drug groups. PMP did help contain the use and costs of potentially over-used drugs and non-recommended drugs. PMP did not seem to reduce the use of first-line therapeutic drugs recommended by clinical treatment guidelines, especially those lacking alternatives; such drugs are unlikely appropriate candidates for PMP.

O02 Patterns of GP and nurse-independent prescriber prescriptions for antibiotics dispensed in the community in England: a retrospective analysis

Abstract Background The substitution of nurses for doctors is a strategy used in primary care to improve access to, and efficiency and quality of, care. Many of these nurses prescribe medicines including antibiotics. Objectives To identify nurse-independent prescriber (NIP) and GP numbers in England, the proportions and types of NIPs and GP antibiotic prescriptions dispensed in the community, and the impact of COVID-19 on the volume, rate and types of antibiotic prescriptions dispensed. Methods A descriptive population-based retrospective cohort study using data obtained from the National Health Service Business Service Authority (under a Freedom of Information request) on GP and nurse-independent prescriber prescriptions for antibiotics dispensed in the community in England between January 2014 and October 2021. Results Between 2014 and 2021, the number of NIPs (headcount) in England almost doubled from 24 457 to 41 649. Of the 41 649 NIPs in 2021, the prescriptions of 34 997 (84%) were dispensed in the community, i.e. a rise of 146% over this 6-year period. By contrast, GP numbers (headcount) rose by 10% to 44 681. Of the 25.373 million antibiotic prescriptions dispensed between 2014 and 2021, NIPs were responsible for 8.6%. The rate of dispensed antibiotic prescriptions decreased (NIPs by 50% and GPs by 21%) between 2014 and 2020 (where data across the full year were available). This decreasing trend continued following the onset of the pandemic across both groups. In line with guidance for the treatment of minor infections, narrow-spectrum antibiotics (penicillins, macrolides and tetracyclines) were the most frequently dispensed across both NIPs and GPs. Trends in prescription of antibiotics during the pandemic were reflected in the use of individual classes of antibiotics prescribed for RTIs. Conclusions Given the rising numbers of nurse prescribers and their increasing contributory influence on total antibiotic prescribing, it is important that this group is included in antimicrobial stewardship efforts. NIPs prescribe fewer antibiotics than GPs but work under different conditions (e.g. longer consultations and less complex patients), and so, interventions should also be tailored to this group and the population and context in which they are delivered.

P36 Using the Australian National Antimicrobial Prescribing Survey portal (NAPS) to benchmark antibiotic prescribing within an Integrated Care Board (ICB): a pilot point prevalence survey (PPS) of two NHS Trusts

Abstract Background PPS is useful in evaluating volume and appropriateness of antimicrobial prescribing to guide specific antimicrobial stewardship (AMS) interventions. Integrated care systems enable collaboration within an ICB and benchmarking of antimicrobial prescribing in constituent trusts to identify disparities and learn from sharing best practice. NAPS is a web-based qualitative auditing platform which is used to conduct an annual Australia-wide PPS. To assess the suitability of NAPS in benchmarking antimicrobial prescribing practices, we piloted the NAPS platform in the acute admission ward areas in two NHS Trusts within an ICB. Methods In OUHFT, admissions to 2 acute medicine wards on a single day were extracted using the Cerner electronic prescribing system. Antimicrobial prescriptions were anonymized, reviewed using NAPS protocol and uploaded to the NAPS platform. In BHT, antimicrobial prescriptions on 2 admission wards were collected manually using the NAPS parameters and audit standards and entered directly into Excel®. Ethical approval was not required due to the anonymized nature of this audit. Results A total of 124 patients at OUHFT and 53 patients at BHT were included. The proportion of patients prescribed antimicrobials varied, with a prevalence of 23% (n = 29) at OUHFT and 54% (n = 28) at BHT. The total number of antimicrobial prescriptions was approximately 40 per trust. Compliance with guidelines for OUHFT and BHT (88% versus 83%) and stewardship appropriateness (73% versus 80%) were similar. The main indication for antimicrobials was pneumonia. The most common reasons for inappropriateness were ‘incorrect duration’ and ‘spectrum too broad’. The most prescribed antimicrobials differed, with co-amoxiclav and amoxicillin (43%) at OUHFT and metronidazole and clarithromycin (24%) at BHT. Non-compliance with guidelines was frequently associated with the use of doxycycline and co-amoxiclav (47%) at OUHFT and amoxicillin and piperacillin/tazobactam (72%) at BHT. Conclusions Benchmarking of antimicrobial prescribing was possible as both PPSs were conducted using the NAPS parameters and standards. Focusing efforts on antibiotic prescribing for pneumonia, the use of broad-spectrum antimicrobials and reducing duration of courses will be taken forward as a key focus for AMS efforts. NAPS is a suitable tool for benchmarking, sharing best practice and facilitating discussion of AMS interventions across an ICB. This model should be considered as a template for national benchmarking of antimicrobial prescribing.

Successful Integration of HIV PrEP in Primary Care and Women's Health Clinical Practice: A Model for Implementation.

Ending the HIV Epidemic is contingent upon the increased utilization of pre-exposure prophylaxis (PrEP). The majority of PrEP in the United States is prescribed in specialty care settings; however, to achieve national implementation goals, it is necessary to expand PrEP services in primary care and women's health clinics. To this end, a prospective cohort study was conducted of health care providers participating in one of three rounds of a virtual program aimed at increasing the number of PrEP prescribers in primary care and women's health clinics within the NYC Health and Hospitals network, the public healthcare system of New York City. Provider prescribing behavior was compared at pre-intervention (August 2018-September 2019) and post-intervention (October 2019-February 2021). Among 104 providers, the number prescribing PrEP increased from 12 (11.5%) to 51 (49%) and the number of individual patients on PrEP increased from 19 to 128. The program utilized clinical integration models centering on existing STI management workflows and was associated with increased numbers of PrEP prescribers and volume of prescriptions in primary care and women's health clinics. The dissemination of similar programs could support national scale-up of PrEP.

Evolving adjuvant estrogen therapy prescribing among breast oncology workforce.

1546 Background: An oncologist shortage and rising number of breast cancer survivors has created a strained workforce. Care models that incorporate advanced practice providers (APPs) are recommended to meet this rising demand, particularly during survivorship. The objective of this study is to describe the evolving oncology workforce using anti-estrogen prescribing as a surrogate for breast cancer survivorship care. Methods: We used Medicare Part D Public Use Files to identify prescribers of anti-estrogen therapy from 2013 to 2020. We included medications primarily prescribed in the adjuvant setting for estrogen receptor positive breast cancer, including anastrozole, letrozole, exemestane, tamoxifen, raloxifene, fulvestrant, and toremifene. We assessed the volume of physician and APP prescribers and claims by provider type using descriptive statistics and logistic regression. Individual prescribers were included if they had more than 10 claims. Results: The overall number of anti-estrogen claims did not change significantly from 2013 to 2020, with an average of 3,224,361 annually. There was a significant increase in APP prescribers from 7,815 (8.6%) in 2013 to 12,961 (18.3%) in 2020. There was a reduction in physician prescribers by 24,815 (9.7%) over the same period with an overall net decrease of total prescribers of 19,669 (21.7%). The average annual claims per individual prescriber rose from 2013 to 2020 (Physicians: 2013: 37.5 to 2020: 45.2, p < 0.001; APP: 2013: 28.2 to 2020: 37.0, p < 0.001). The percentage of claims attributed to APP prescribers rose substantially from 6.6% in 2013 to 15.5% in 2020. This represents an increase from 220,000 prescriptions in 2013 to over 480,000 in 2020. Conclusions: Our results indicate an ongoing shift in the provider composition responsible for delivering breast cancer survivorship care. Over the time frame analyzed, there was no significant change in number of prescription claims annually, but an overall decrease in providers. Thus, the rise in APP prescribers is not driven by an increased prescribing volume, but rather seems to reflect an evolving surgical oncology workforce. This has significant implications for the future access to and delivery of timely high-quality cancer care.[Table: see text]

The Effect of Minimum Unit Pricing for Alcohol on Prescriptions for Treatment of Alcohol Dependence: A Controlled Interrupted Time Series Analysis.

The online version contains supplementary material available at 10.1007/s11469-023-01070-6.

Effects of state opioid prescribing cap laws on providers' opioid prescribing patterns among patients with chronic non-cancer pain

Prior work suggests opioid prescribing cap laws are not associated with changes in opioid prescribing among patients with chronic pain. It is unknown how these effects differ by provider specialty, provider opioid prescribing volume, or patient insurer. This study assessed effects of state opioid prescribing cap laws on opioid prescribing among providers of patients with chronic non-cancer pain, by high volume prescribing, provider specialty, and patient insurer. We identified 224,290 providers of patients with low back pain, fibromyalgia, or headache from the IQVIA administrative database. Using a difference-in-differences approach, we examined impacts of opioid prescribing cap laws implemented between 2016 and 2018 on the annual proportion of a provider's patient panel who received any opioid prescription, as well as on dose and duration of opioid prescriptions. For providers overall, high volume prescribers, all specialties, and patient insurance categories, prescribing cap laws were associated with non-significant changes of <1.0, 1.5, and 3.5 percentage points in the proportion of chronic non-cancer patients receiving any opioid prescription, a prescription with 7 days' supply, or with >50 morphine milligram equivalents (MME)/day, per year, respectively. There were two exceptions with high dose prescribing: prescribing cap laws were associated with a 1.5 percentage point increase in the proportion of high-volume prescribers' patient panel receiving an opioid prescription with ≥50 MME/day, and a 3.0 percentage point decrease in the same measure among surgeons. Among nearly all measured subgroups of providers and patient insurers, opioid prescribing cap laws were not associated with changes in opioid prescribing.

Web Search Query Volume Correlates With Prescription Volumes of Antidepressants and Antipsychotics in the Netherlands and United Kingdom: An Explorative Study.

The significant increase in Internet availability has resulted in a rise in search queries on health-related topics. Previous research has demonstrated the potential for analyzing web search query volume for nonpsychotropic prescription drugs, while studies on psychotropic drugs remain scarce. The aims of this study were to expand upon this scarce knowledge by investigating the relationship between web search query volumes and prescription volumes of antidepressants and antipsychotics in the United Kingdom and the Netherlands and to gain insight in topics of concern, such as withdrawal symptoms and discontinuation. Data were obtained for the United Kingdom and the Netherlands from January 2010 until January 2021. Prescription volume data for 5 antidepressants (paroxetine, fluoxetine, sertraline, citalopram, venlafaxine) and 5 antipsychotics (quetiapine, olanzapine, clozapine, aripiprazole, and risperidone) were obtained. Web search query volumes and data on related search queries of these substances were acquired from Google Trends. Descriptive statistics and Pearson correlation analyses were performed. A strong, positive, and statistically significant correlation between web search query volume and prescription volume was observed for most included substances in both the Netherlands and the United Kingdom. The search queries related to the included antidepressants and antipsychotics indicate important topics of concern for specific substances, such as withdrawal symptoms and discontinuation. Web search data from Google Trends could potentially be used as a proxy for prescribing trends of antidepressants and antipsychotics and to gain insight in topics of concern of users of these substances. These findings highlight the importance of providing reliable patient information, particularly regarding adverse effects, withdrawal, and discontinuation.

The Association Between Opioid Prescribing and Opioid-Related Mortality Within Neighborhoods in Ontario, Canada: A Case-Control Study.

Recent Canadian data show that the prescribing of opioids has declined while the number of opioid deaths continues to rise. This study aimed to assess the relationship between neighborhood-level opioid prescription rates and opioid-related mortality among individuals without an opioid prescription. This was a nested case-control study using data in Ontario from 2013 to 2019. Neighborhood-level data were analyzed by using dissemination areas that consist of 400-700 people. Cases were defined as individuals who had an opioid-related death without an opioid prescription filled in the year prior. Cases and controls were matched using a disease risk score. After matching, there were 2,401 cases and 8,813 controls. The primary exposure was the total volume of opioids dispensed within the individual's dissemination area in the 90 days before the index date. Conditional logistic regression was used to examine the association between opioid prescriptions and the risk of overdose. There was no significant association between the total volume of opioid prescriptions dispensed in a dissemination area and opioid-related mortality. In subgroup analyses stratifying the cohort into prescription and nonprescription opioid-related mortality, the number of prescriptions dispensed was positively associated with prescription opioid-related mortality. There was also a significant inverse association between the increased total volume of opioids dispensed and nonprescription opioid mortality. Our results suggest that prescription opioids dispensed within a neighborhood can have both potential benefits and harms. The opioid epidemic requires a nuanced approach that ensures appropriate pain care for patients while also creating a safer environment for opioid use through harm-reduction strategies.

Changes in Waivered Clinicians Prescribing Buprenorphine and Prescription Volume by Patient Limit

This study uses data from a Drug Enforcement Administration list of Drug Addiction Treatment Act (DATA)–waivered clinicians to examine trends in DATA-waivered clinicians’ active participation in prescribing buprenorphine overall and by patient limits between January 2017 and May 2021.

Trends in estimated total retail dispensed prescriptions of purported COVID-19 treatments and preventions in Canada

Abstract Objectives Several medications were proposed for the treatment and prophylaxis of COVID-19 but with limited supporting evidence. Herein, we assessed trends in the volume of projected total retail dispensed prescriptions for 12 agents proposed for treatment and prevention of COVID-19 before and after March 2020 in Canada. Methods We conducted a cross-sectional study using monthly prescription volumes obtained from IQVIA’s CompuScript database. We used joinpoint regression to identify significant inflection points and calculate the monthly percent change (MPC). Key findings Dispensations peaked after March 2020 for several medications, including hydroxychloroquine, fluvoxamine, ivermectin, colchicine, tocilizumab, sarilumab and famotidine. Although most peaks were short lived, large increases were observed for ivermectin (MPC from September 2020 to January 2021 = 28%) and famotidine (MPC from June 2021 to October 2021 = 14%). Conclusions Overall, Canadian prescribing patterns were mostly consistent with recommendations from guidelines and health regulatory bodies. Nonetheless, active monitoring of trends should continue.

The Impact of Opioid Prescribing Limits on Drug Usage in South Carolina: A Novel Geospatial and Time Series Data Analysis.

The opioid crisis in the United States has had devastating effects on communities across the country, leading many states to pass legislation that limits the prescription of opioid medications in an effort to reduce the number of overdose deaths. This study investigates the impact of South Carolina's prescription limit law (S.C. Code Ann. 44-53-360), which aims to reduce opioid overdose deaths, on opioid prescription rates. The study utilizes South Carolina Reporting and Identification Prescription Tracking System (SCRIPTS) data and proposes a distance classification system to group records based on proximity and evaluates prescription volumes in each distance class. Prescription volumes were found to be highest in classes with pharmacies located further away from the patient. An Interrupted Time Series (ITS) model is utilized to assess the policy impact, with benzodiazepine prescriptions as a control group. The ITS models indicate an overall decrease in prescription volume, but with varying impacts across the different distance classes. While the policy effectively reduced opioid prescription volumes overall, an unintended consequence was observed as prescription volume increased in areas where prescribers were located at far distances from patients, highlighting the limitations of state-level policies on doctors. These findings contribute to the understanding of the effects of prescription limit laws on opioid prescription rates and the importance of considering location and distance in policy design and implementation.

500 General practitioners’ views on the electronic transfer of prescriptions to pharmacies in Ireland: a qualitative interview study

Abstract Introduction The use of electronic systems to transfer prescriptions continues to grow in healthcare systems worldwide. In response to the COVID-19 pandemic, legislation was implemented in Ireland in April 2020 to permit the electronic transfer of prescriptions (ETP) from prescribers to pharmacies using a national secure email system (Healthmail). This has resulted in a significant increase in the volume of prescriptions transmitted via Healthmail from general practitioners (GPs) to pharmacies in Ireland. Aim With a clear need to evaluate how stakeholders have been affected by this initiative and to guide the future delivery of patient care, the primary aim of this study was to investigate GPs’ views on the ETP to pharmacies in Ireland via Healthmail and how it has affected their practice. Methods Semi-structured interviews were conducted via video-conference with GPs in Ireland. GPs were identified using convenience and snowball sampling, purposively ensuring variety in age/years of experience, gender, and practice location. Interviews were audio-recorded and transcribed verbatim. Interview transcripts underwent thematic analysis (1). Results Twelve audio-recorded interviews were conducted with GPs between May 2021 and July 2021. The participants had a median of 16 years’ experience as a GP. Four main themes were generated: 1)Efficiencies with prescribing and easing GP workload: even with limited training, GPs felt that Healthmail’s ETP has been easy to use and seamlessly integrated into their practice. Time has been saved and overall workload decreased due to less prescription printing and delegating more to administrative staff with prescription ordering. 2) New GP-pharmacist communication pathways: GPs found asynchronous communication regarding prescription queries less disruptive to their workflow, and particularly useful for less urgent matters. Some GPs were not aware of some Healthmail functions that facilitated additional notes between GPs and pharmacists, whilst others were concerned they had no evidence if pharmacists saw these notes. 3) Security, transparency, and documentation: whilst acknowledging their lack of technological expertise, GPs perceived that Healthmail prescriptions had security advantages over physical ones overall; the increased transparency of the prescription journey minimises the risk of prescriptions being mislaid, damaged, or fraudulently altered, as well as creating an audit trail. 4) Implications for patients: ETP via Healthmail has reduced footfall to practices, reduces multiple pharmacy use, and most patients have adapted well to it. GPs were mostly reluctant to engage routinely in any hypothetical bidirectional communication with patients via Healthmail. Conclusion This study provides strong evidence for continuing the ETP to pharmacies in Ireland as GPs found this initiative easy to use, time-saving, and enhancing both GP-pharmacist communication and GP workflow. However, this study has highlighted stakeholders’ lack of awareness with some functions of Healthmail, so any future systems utilised for the ETP should come with best-practice guidance for all users. While the purposive sampling facilitated GP heterogeneity, snowball sampling may have somewhat reduced the diversity in views; a future survey would be useful in identifying if any GPs characteristics significantly influencing GPs’ views, as well as identifying other issues experienced and novel ideas to improve the ETP process going forward.

Trends in antibiotic selection pressure generated in primary care and their association with sentinel antimicrobial resistance patterns in Europe.

We studied trends in antibiotic prescribing by primary care and assessed the associations between generated antibiotic selection pressure (ASP) and the prevalence of sentinel drug-resistant microorganisms (SDRMs). The volume of antibiotic prescribing in primary and hospital care expressed in DDD/1000 inhabitants per day and the prevalences of SDRMs in European countries where GPs act as gatekeepers were obtained from the European Centre for Disease Control ESAC-NET. Associations were tested between (i) DDD and (ii) the Antibiotic Spectrum Index (ASI) as a proxy indicator for ASP, and the prevalences of three SDRMs: MRSA, MDR Escherichia coli and Streptococcus pneumoniae resistant to macrolides. Fourteen European countries were included. Italy, Poland and Spain had the highest prevalence of SDRMs and prescribed the highest volume of antibiotics in primary care (average 17 DDD per 1000 inhabitants per day), approximately twice that of countries with the lowest volumes. Moreover, the ASIs of these high antibiotic volume countries were approximately three times higher than those of the low-volume countries. Cumulative ASI showed the strongest association with a country's prevalence of SDRMs. The cumulative ASI generated from primary care was about four to five times higher than the cumulative ASI generated by hospital care. Prevalences of SDRMs are associated with the volume of antimicrobial prescribing and in particular broad-spectrum antibiotics in European countries where GPs act as gatekeepers. The impact of ASP generated from primary care on increasing antimicrobial resistance may be much larger than currently assumed.