Prescribing Research Articles

Determinants of the economic burden of ART on the Italian NHS: insights from the Lombardy region

With the rising spread of Assisted Reproductive Technology (ART), it becomes imperative to understand the determinants of resource utilization in ART versus spontaneous pregnancies to enhance policies directed to pregnancy care. The focus of our study is to examine the costs associated with ART from the perspective of the Italian NHS and to investigate in depth the contributing social and clinical factors.Using the healthcare informative system of Lombardy, a Region of Northern Italy, we gathered individual-level information for a cohort of women who experienced either spontaneous pregnancies or pregnancies following ART from 2007 until 2020. The information covered multiple healthcare services, and we used a propensity score matching technique to match couples of ART/No ART women based on a comprehensive set of confounders. We then applied statistical tests and regression models to identify the impact of ART on the reported cost differences.Our cohort was composed of 44652 women and results revealed significantly higher costs for ART pregnancies, especially in terms of hospital admissions (additional 1611€, 95% CI 1558-1666) and drug prescriptions (additional 216 €, CI 95% 204-228) occurring before delivery. In-depth analysis showed for ART pregnancies, i) a higher likelihood of incurring expenses related to complications and ii) higher costs associated with two established clinical practices that lack scientific evidence supporting their efficacy.Our study sheds light on the complex interplay of clinical and social factors influencing the ART burden, emphasizing the importance of tailored support and evidence-based practices in optimizing outcomes and resource allocation.

Benchmarks for low back pain in general practice in Flanders: electronic audit of INTEGO

BackgroundLow back pain (LBP) is one of the most frequent reasons for encounter in general practice. Yet results from literature show adherence to clinical practice guidelines is low. Audit & feedback is a well-known strategy to improve adherence to guidelines. Benchmarking is an important step in the audit & feedback process. The objective of this study was to develop data-derived benchmarks for low back pain quality indicators.MethodsFour electronic health record extractable quality indicators were selected from an existing indicator set developed by CEBAM, an independent, multidisciplinary and interuniversity medical scientific institute in Belgium. Data from 2021-2022 from INTEGO, a general practice morbidity registry, were used to calculate benchmarks for the four quality indicators. The Achievable Benchmark of Care methodology was used to create benchmarks based on the performance of the 10% best-performing practices.ResultsThe following benchmarks were derived: 4.2% prescription for medical imaging, 12.7% prescription for opioids, 27.2% for prescription for non-steroidal anti-inflammatory drugs or acetaminophen, 37.7% prescription for physical therapy and 11.9% prescription for work absenteeism.ConclusionsBenchmarks for four electronic health record-extractable quality indicators have been established. They can be used for an electronic audit & feedback tool in primary practice in Flanders or other quality improvement initiatives.

The role of osteobiotics in the prevention of osteoporosis and the formation of bone cavities while taking antibacterial drugs

Taking antibacterial drugs can be accompanied by a variety of negative consequences affecting many organs and systems of the body. In particular, disturbances in the nervous system, cellular respiration, and allergic reactions may be observed. However, the most pronounced negative effects occur in the gastrointestinal tract. With the frequent prescription of antibacterial drugs, there is a need for additional therapy aimed at reducing the risk of adverse events that affect the entire body, including the musculoskeletal system. The article discusses the specifics and action of a new class of drugs called “osteobiotics”. The effectiveness of the first domestic product in this category (Osteo-Vit D3) and the possibility of its use in antibacterial therapy were analyzed.

Cytochrome P450 phenotyping using the Geneva cocktail improves metabolic capacity prediction in a hospitalized patient population.

Liver cytochromes (CYPs) play an important role in drug metabolism but display a large interindividual variability resulting both from genetic and environmental factors. Most drug dose adjustment guidelines are based on genetics performed in healthy volunteers. However, hospitalized patients are not only more likely to be the target of new prescriptions and drug treatment modifications than healthy volunteers, but will also be more subject to polypharmacy, drug-drug interactions, or to suffer from disease or inflammation affecting CYP activities. We compared predicted phenotype based on genetic data and measured phenotype using the Geneva cocktail to determine the extent of drug metabolizing enzyme variability in a large population of hospitalized patients (>500) and healthy young volunteers (>300). We aimed to assess the correlation between predicted and measured phenotype in the two populations. We found that, even in cases where the genetically predicted metabolizer group correlates well with measured CYP activity at group level, this prediction lacks accuracy for the determination of individual metabolizer capacities. Drugs can have a profound impact on CYP activity, but even after combining genetic and drug treatment information, the activity of a significant proportion of extreme metabolizers could not be explained. Our results support the use of measured metabolic ratios in addition to genotyping for accurate determination of individual metabolic capacities to guide personalized drug prescription.

Design and analysis of a telemonitoring system for high-risk pregnant women in need of special care or attention

BackgroundHigh-risk pregnancies, characterized by underlying health issues or unusual circumstances, pose increased risks to both maternal and neonatal health during pregnancy and childbirth. Global guidelines emphasize the importance of early identification, monitoring, and intervention to mitigate these risks.MethodWe decided to design and implement a telemonitoring system for remotely monitoring and managing pregnancies in women with conditions such as hypertension, diabetes, or high-risk pregnancy. When a high-risk pregnant mom is discharged from the hospital, the Healthcare Center or Integrated Healthcare Services Center in her area is immediately notified via SMS to ensure her condition is monitored remotely. In addition to sending notifications, the patient’s medical record, post-discharge care recommendations, drug prescription, re-visit time, and contact details are also sent to them via the application. The high-risk pregnant mom is followed up and all her information is recorded in the application for further use. To evaluate the usability of the proposed telemonitoring system, we conducted a laboratory study involving 92 participants, including pregnant mothers’ care experts at hospitals, healthcare center experts, midwives at integrated healthcare services centers, and midwifery department experts with varying levels of digital skills. Participants performed activities related to the application’s services, while their satisfaction was measured using the QUIS 7.0 questionnaires covering multiple aspects of usability, including user interface, system capabilities, and online help, with ratings on a Likert scale.ResultThe usability evaluation revealed that the average satisfaction score across all usability dimensions was above 8, demonstrating a satisfactory level of system usage from all user perspectives. Additionally, the close alignment of mean and median scores, along with standard deviations below 1 for several dimensions, indicated consistent positive feedback among users.ConclusionOur telemonitoring system demonstrates promise for enhancing the management of high-risk pregnancies, facilitating better health outcomes for mothers and infants through effective remote monitoring and support. The usability test results underscore the platform’s effectiveness and user satisfaction, contributing valuable insights for future improvements in high-risk pregnancy care.

The role of substance assessment tools in treatment planning and monitoring: a narrative review

Psychoactive drugs including alcohol and tobacco products can be considered as substances that lead to various negative physical and psychological consequences. On the other hand, socioeconomic deterioration also comes along with harmful substance usage. Substance addiction is a complex condition characterised by a compulsive and harmful pattern of substance use despite the adverse consequences it may comprise, and the risk of developing substance addiction is influenced by a combination of genetic, environmental, and psychological factors and relapse is the recurrence of substance use after a period of abstinence or successful treatment. Hence, healthcare professionals, educational experts, and legal officers are required to get a broader idea regarding the factors associated with substance use. Assessment tools are the most efficient way of identifying the associated factors of substance use, customising specific treatment plans, and monitoring the progress of addiction intervention. By implementing modifications and enhancements to the pre-existing tools, researchers and clinicians able to improve the accuracy of participant responses and findings, leading to a more precise identification of causal links within the context of substance use disorders. The primary focus of this study lies in the comprehensive review of the Alcohol Use Disorder Identification test, Michigan Alcohol Screening Test, Alcohol Dependency Scale, Self-administered Alcoholism Screening Test, Drug Abuse Screening Test, Tobacco, Alcohol, Prescription Medication, and Other Substance Use Tool, Alcohol, Smoking, and Substance Involvement Screening Test, Substance and Choice Scale, Screening to Brief Intervention, Adolescent Alcohol and Drug Involvement Scale, and Severity of Dependence Scale play crucial roles in identifying substance use disorders, assessing severity, guiding treatment decisions, and facilitating interventions to promote recovery and well-being.

Leveraging Drug-Gene Interaction Information for Personalized Hypertension Drug Molecule Discovery

Aims: To examine whether novel lead hypertension molecules can be used in the personalized treatment of hypertension. Background: Hypertension is a modifiable condition that affects over 1 billion adults worldwide. Maintaining a healthy blood pressure is vital for overall health, especially given that hypertension is a primary risk factor for developing cardiovascular conditions. However, some individuals have resistant hypertension, which may be due to variations in genetic expression, making standard hypertension treatments ineffective. Objective: The integration of genetic data into the personalized optimization of novel hypertension drugs is demonstrated. Method: This research created coding criteria for drug-gene recommendations based on the genomic profiles of ten pseudo-patients. The genomic data of these patients was created using chromosome and hypertension-implicated gene sequences from the NCBI National Library of Medicine database. Results: This study uses the proposed drug recommendation criteria to recommend novel hypertension lead molecules to each patient based on their gene expression profiles. Conclusion: This study’s patient-centric drug prescription approach integrates patient gene expression data with drug-gene interaction data and recommends novel hypertension drugs most suitable for each patient. Variations in patient gene expression explain the diverse treatment responses inherent across hypertensive patients, thus necessitating a personalized approach to their drug prescription. Future studies can investigate the challenges of ethical, technological, and technical expertise that may affect the clinical implementation of personalized drug prescription recommendation systems.

Individualizing Antiretroviral Therapy in the Older Patient.

Owing to widespread availability of potent and tolerable antiretroviral therapy, life expectancy of people with human immunodeficiency virus (HIV) has significantly increased. Consequently, the population of people with HIV are ageing, with over 50% over the age of 50 years, and it is expected that 25% will be over the age of 65 years by 2030. People diagnosed with HIV at older age tend to have more advanced disease, and may already be experiencing comorbidities that will influence the choice of initial antiretroviral treatment. Despite the well described changes in pharmacokinetics associated with ageing, there are a paucity of pharmacokinetics studies of contemporary antiretroviral drugs to help guide treatment for HIV. Irrespective of this, integrase inhibitor-based regimens have been shown to have similar treatment outcomes in older and young adults and are the preferred regimens for initiation and switching therapy in older adults. Non-acquired immunodeficiency syndrome (AIDS) comorbidities are more common in people with HIV owing to chronic immune activation and inflammation even in the presence of virological suppression on antiretroviral treatment. Screening and risk assessment of comorbidities is crucial as the presence of geriatric syndrome, frailty or neurocognitive impairment may impact medication adherence. Simplification of complex regimens, both antiretroviral and comorbidity treatments, is recommended to improve adherence. Regular medication reviews under the guidance of an experienced HIV pharmacist are recommended to identify adverse drug-drug interactions and inappropriate prescribing of drugs with potential adverse effects, such as falls risk. Antiretroviral stewardship has been shown to improve patient outcomes and quality of life for ageing people with HIV.

Pediatricians at the forefront of child mental health? A Delphi method exploration

BackgroundRising mental health challenges among children and adolescents are a global concern. However, a shortage of professionals, inadequate competence and lack of resources hamper necessary care, presenting a major challenge to health service provision. Community pediatricians, frequently the initial contact for mental health issues, are in a key position to improve access to care. The Delphi method was employed as an initial step toward redefining the role of pediatricians and the re-design of pediatric responses within Israeli primary mental health care.MethodNinety-two experts, including pediatricians, psychiatrists, mental health and child-development professionals, and parents of children with emotional-behavioral challenges participated in a three-round Delphi study. A survey including 6 topics (37 items, 9 demographic questions) was distributed, probing the envisioned role of pediatricians in children’s mental health care.ResultsThere was strong endorsement between experts regarding pediatricians’ potential roles in risk identification, parental guidance, psycho-education, and health policy isuues such as referrals to mental health professionals, and the need for training in this domain. However, discord arose concerning changes in the service framework and pediatricians’ role in psychiatric drug prescription. The majority agreed on the necessity of close support from mental health experts, despite differing in the form it should take.ConclusionsThis study underscores the critical need for mental health training among pediatricians and advocates for a structured, consensus-driven model to bolster early detection and initial treatment of mental health issues in children. The findings highlight the potential for leveraging this model to drive health policy changes and improve service delivery in pediatric mental health care, and might inform other health systems considering extending pediatricians’ roles. By equipping pediatricians with essential competencies, this approach can broaden mental health service delivery and reduce stigma. Aligning the model with expert consensus paves the way for impactful policy reform, enhancing pediatricians’ roles in mental health risk identification and intervention, and advancing child health services.

Prescription drug use in Danish children and adolescents 2005-2023.

Continuous monitoring of pediatric drug utilization is important for ensuring rational use and prioritizing research. This study provides an overview of pediatric prescription drug use among Danish children and adolescents from 2005-2023. Using Danish nationwide individual-level dispensing data, we identified all redeemed prescriptions for individuals < 18years from January 2005-December 2023. We computed overall annual prevalence proportions of users and mean number of prescriptions per child. For all non-antibiotic drugs, we further determined the quantity of drug use measured in defined daily doses (DDDs) and stratified all analyses by age and Anatomical Therapeutic Chemical classification first and forth level. During the study period, the overall yearly prevalence of prescription drug use decreased due to reductions in antibiotic prescribing. When antibiotic prescriptions were disregarded, the prevalence of children with at least one prescription increased from 38% in 2005 to 42% in 2023, while the mean number of prescriptions and DDDs increased from 1.2 prescriptions per child and 51.2 million DDDs in 2005 to 1.5 prescriptions per child and 76.5 million DDDs in 2023. This increase was primarily driven by prescribing of central nervous system drugs to adolescents 12-17years, with a substantial increase in centrally acting sympathomimetics and melatonin use. Overall pediatric drug prescribing is decreasing due to reduced antibiotic use. Non-antibiotic drug use is, however, rising, especially among adolescents and notably for psychotropic drugs. These findings underscore the importance of ongoing monitoring and call for further research into underlying causes and prescription practices for psychotropics.

The relationship between conference presentations and in-hospital mortality in patients admitted with acute myocardial infarction: A retrospective analysis using a Japanese administrative database.

Clinicians' research activities reportedly improve their healthcare performance. Presenting research at conferences may be related to improved patient care outcomes; however, few studies have investigated this relationship. Thus, we examined the association between presenting at conferences and the mortality of patients hospitalized for acute myocardial infarction. We analyzed an administrative database of acute care hospitals in Japan. The study compared patients admitted to hospitals in which physicians made at least one conference presentation during the patient's admission year (Presentation Group) with those admitted to hospitals with no conference presentations (Control group). We performed multivariable logistic regression analyses to estimate the risk of all-cause in-hospital mortality. Five models were fitted: a Crude model, unadjusted; Model 1, adjusted for personal factors, including sex, age, Killip classification, and so on; Model 2, adjusted for Model 1 plus hospital factors; Model 3 was a multilevel analysis clustered by hospital codes and adjusted for the same variables as Model 1; Model 4 was adjusted for Model 1 plus evidence-based practices through causal mediation analysis. After excluding 3,544 patients with missing Killip classification or ambulance use, data for 56,923 patients in 384 acute care hospitals were analyzed. Drug prescription in accordance with the evidence was significantly greater in the Presentation group than in the Control group. Moreover, conference presentation was significantly associated with lower in-hospital mortality in all models (Odds ratios (OR) = 0.68, 95% Confidence intervals (CIs): 0.65 to 0.72 in the Crude model; OR = 0.73, 95% CIs: 0.68 to 0.79 in Model 1; OR = 0.76, 95% CIs: 0.70 to 0.82 in Model 2; OR = 0.84, 95% CIs: 0.76 to 0.92 in Model 3; OR = 1.00, 95% CIs: 0.92 to 1.09 in Model 4). The promotion of scholarly activities such as conference presentations might improve patient outcomes through increased evidence-based practice.

Trends in Proton Pump Inhibitor Use in Sweden by Sex and Age: A Drug Utilisation Study.

Proton pump inhibitors (PPIs) are among the most popular drugs worldwide. Yet, there are concerns on long-term safety and poor adherence to prescription guidelines. Off-label use in children and increasing maintenance use in older adults may be particularly worrisome. To assess differences in PPI use by age, sex calendar year and PPI type, and to explore potential underlying indications (ulcerogenic drugs, and indications) in Sweden. Proton pump inhibitor drug utilisation study based on the Swedish nationwide prescribed drug (2006-2023) and patient registries (2006-2022). Proton pump inhibitors were used by 14.4% (women) and 10.5% (men) of adults; and 1.0-1.5% of children and adolescents (aged < 20 years). Proton pump inhibitor use was higher in women in all age-groups except small children (aged < 5 years). Proton pump inhibitor use has increased in all age groups, especially in young children (aged < 10 years) and the oldest groups (aged > 65 years). Proton pump inhibitor users aged > 85 years filled most prescriptions with an annual average of 9.5 (men), 11.6 (women) prescriptions. Most prescriptions were for omeprazole and esomeprazole: 63.7% and 23.5% in adults; 23.5% and 44.7% in children (2023). Prescriptions for other drugs for peptic ulcers/reflux became rare, with 99% of prescriptions in this category being PPIs by 2023. Gastro-intestinal diagnoses were predominantly recorded in men, became less prevalent and only explained part of PPI use, while ulcerogenic drugs were common (particularly in women), suggesting PPIs are regularly used for gastroprotection. Proton pump inhibitor use has doubled in children and increased 50% in adults over the study period, in both sexes, while recorded gastrointestinal indications decreased. Alternative therapies were rarely prescribed in Sweden.

Trends and variation in issuance of high-cost narcolepsy drugs by NHS England organisations and regions from 2019 to 2022.

Clinicians and people with narcolepsy report varied access to higher-cost narcolepsy treatments in England associated with variations in national and local commissioning. There are no publicly available data quantifying use of these drugs to support policy decisions. We therefore aimed to describe national, regional and local prescribing trends for higher-cost narcolepsy drugs using new national databases. We used the English prescribing dataset and secondary care medicines data to quantify volumes of high-cost narcolepsy drugs issued between 01 January 2019 and 31 December 2022. Volumes were converted to World Health Organisation defined daily doses, to estimate the monthly number of defined daily doses of sodium oxybate, pitolisant and solriamfetol issued by each integrated care board and region. We compared national, integrated care board, and regional level issuance of each drug over time. Analysis of almost 6000 primary care prescriptions and 2000 cumulative months of secondary care pharmacy stock data, issued across 41/42 integrated care boards in England, revealed a 49.1% increase in issuance of high-cost narcolepsy drugs between 2019 and 2022. In 2022, sodium oxybate accounted for 52.66% of issuance, pitolisant 43.09% and solriamfetol 4.25%, with 22.31% of defined daily doses issued in primary care. Three integrated care boards (NHS Southeast London, NHS Cumbria and North-East, NHS Cheshire and Merseyside) predominate, issuing 56.33% of all defined daily doses. Variations between integrated care boards and regions differ substantially by drug and route of issuance. Our findings describe substantial variation in the use of specialist narcolepsy drugs in England, and highlight the untapped potential of using large, public domain datasets to publicly review higher-cost drug prescribing.

CYP3A4 drug metabolism considerations in pediatric pharmacotherapy

AbstractCytochrome P450 3A4 (CYP3A4) is a crucial enzyme involved in the Phase I metabolism of numerous medications used in clinical practice. Its potential significance in pediatric pharmacotherapy is underscored by the unique metabolic profile of children, which differs markedly from adults, especially in neonates, infants, and young children due to developmental changes in enzyme activity. This review explores the critical role of CYP3A4 in the metabolism of drugs used in the pediatric population, with a particular focus on combination drug therapies. Given the high potential for drug-drug interactions in combination therapies, understanding the modulation of CYP3A4 activity is essential for optimizing therapeutic outcomes and minimizing adverse effects. This paper further examines the structural similarities between these medications and bergamottin, a known CYP3A4 inhibitor found in citric fruits such as grapefruit. Variability in CYP3A4 activity, influenced by genetic polymorphisms, developmental stage, and external factors, necessitates careful consideration in the prescribing and management of drugs in children. This review corroborates the need for personalized medicine approaches and enhanced pharmacovigilance to ensure the safe and effective use of CYP3A4-metabolized drugs in the pediatric population. Graphical Abstract

Functional Dyspepsia and Gastroesophageal Reflux Disease: From Pathogenesis to Current Treatment Strategies

Aim: to present a modern view on the combination of functional dyspepsia (FD) and gastroesophageal reflux disease (GERD) and to evaluate the effectiveness of acotiamide in patients with FD and GERD.Key points. The high frequency of the combination of FD and GERD is caused by common pathogenetic mechanisms and presents an urgent problem in clinical practice. The concurrent occurrence of these diseases alters the clinical picture, complicates differential diagnostics, and leads to inadequate prescription of drugs. Medical treatment for patients with FD and GERD includes the use of proton pump inhibitors (PPIs) and prokinetics. Currently, acotiamide is recognized as an effective drug that affects the motility of the upper gastrointestinal tract. Acotiamide is an antagonist of muscarinic M1 and M2 receptors and a reversible inhibitor of acetylcholinesterase. The clinical efficacy of this drug has been demonstrated not only in patients with FD but also in those with a combination of FD and GERD.Conclusion. Administration of acotiamide is pathogenetically justified in patients with the combination of GERD and FD.

Scenario modeling of the drug prescriрtion process for children: application of machine learning methods

Objective: determining the most appropriate machine learning method to solve the problem of drug prescribtion for children, evaluating its performance and potential for implementation into scenario modeling systems of the pharmaceutical care structure.Material and methods. The study was based on data on drug prescription for children from medical information systems of Moscow clinics for the period from January to December 2023 including information about patients, the date of treatment, diagnoses, prescribed medications and the doctor's specialty. Preliminary data processing enabled to extract additional features and define the process as a multi-label classification task. The following model architectures were developed and validated: fully connected neural network (FCNN), convolutional neural network (CNN), One-vs-Rest (OvR) classifier, eXtreme gradient boosting classifier (XGBC), and random forest classifier (RFC). The models were evaluated using area under curve (AUC) of receiver operating characteristic (ROC), F1-measure metrics and Custom Accuracy metrics.Results. The XGBC model showed the best results for all tasks and metrics. After optimizing the model and dataset, the AUC ROC reached 0.9993, the F1-measure was 0.8318, and its own accuracy metric was 0.8548. The model effectively predicted the prescription of drugs with similar pharmacological effects, allowing us to evaluate the structure of pharmaceutical care within a specific scenario. Optimization of the data and model has increased the accuracy of predictions up to 85%.Conclusion. The XGBC model proved ti be the most appropriate for solving the problem of scenario modeling of drug prescribtion. The identified problems with predicting similar drugs validate the demand for further improvement of the model and data. Concurrently, the results obtained attest the potential of integrating machine learning methods into scenario modeling systems for pharmaceutical care.

A Preliminary Numerical Thermal Analysis of an Endometrial Ablation Procedure Based on Foley’s Catheter

Dysfunctional uterine bleeding (DUB) is an ailment affecting a substantial number of women during a significant part of their reproductive years. This condition usually leads to discomfort, mild or severe pain, or, in some extreme cases, anemia. It may be caused by diverse factors such as hormonal issues, structural abnormalities, or even cancer in a woman’s reproductive tract. A typical DUB treatment requires a pharmacological approach through the prescription of drugs. Nonetheless, some patients require a more involved treatment calling for surgical procedures. In order to avoid hysterectomy, which is the complete removal of the uterus, the medical community has devised, over the years, alternative surgical schemes to handle DUB issues. One such treatment is the “endometrial ablation technique” where the inner lining of the uterus is subjected to a controlled destruction by using a hot, approximately constant-temperature fluid inside a balloon, which is placed in contact with the uterine wall of the patient. As a means to avoid the high costs associated with such devices, the medical community has proposed a similar treatment in which the fluid inside the balloon is no longer held at a high constant temperature but rather diminishes as the treatment progresses. The main purpose of this contribution is to critically assess the effectiveness of this second, low-cost endometrial ablation treatment. Consequently, a mathematical model is devised in which Pennes’ bioheat equation is employed to predict the transient temperature field of the uterine wall together with an energy balance that yields the temperature of the saline solution inside the thermal balloon, throughout the duration of the treatment. These equations aresolved by utilizing the finite volume method and the numerical predictions are verified by comparing the present results with similar cases from the literature. Once the verification phase is authenticated, the uterine wall and fluid balloon transient temperature fields are obtained for typical situations reported in the medical literature. On general grounds, the simulations indicate that the extent of the affected tissue is strongly dependent on the volume,on the type of fluid inside the thermal balloon, and on the magnitude of the perfusion of the uterus. Moreover, it was found that the proposed low-cost treatment can indeed be a successful alternative to the standard endometrial ablation process under some viable circumstances that are described in the contribution.

Modeling of the intelligent interface of interaction between a pharmacy and a children's clinic

Introduction. Economic barriers, uneven territorial distribution of pharmacy organizations, and insufficient efficiency of drugs supply chains hinder the accessibility of drugs and the timely receipt of pharmaceutical care (PC) by patients worldwide. The digital transformation in healthcare, accelerated by the COVID-19 crisis, necessitates the adaptation of PC practices to meet modern patient needs. Objective of the study. To develop and validate a procedure for the interaction between a clinic and a pharmacy to facilitate data exchange through an interface, enabling the pharmacy to receive data for forming an assortment of drugs adapted to the characteristics and behavioral trends of the main target audience. Material and methods. The study utilized anonymized data on drugs prescriptions by physicians from the medical information system of a network of medical organizations in Moscow for the period from January 2018 to December 2023. Data preprocessing was conducted, followed by the training of a machine learning model using the LightGBM algorithm. The predictive performance of the model was assessed using MAE and RMSE metrics. Results. An analytical interface for the interaction between the clinic and the pharmacy was developed, incorporating a predictive model for forming the drugs assortment. The model effectively accounts for seasonal trends, patient demographic characteristics, and other key factors influencing drugs demand. The average MAE and RMSE values were 1.27 and 1.68, respectively, indicating high model accuracy. Conclusion. Implementing the developed interface allows the pharmacy to form drugs assortment tailored to the real needs of patients, contributing to optimized inventory management, reduced risk of shortages and overstocking, enhanced accessibility of PC for children, and increased economic efficiency of the pharmacy. The integration of big data technologies and machine learning opens new prospects for the personalization of medical and pharmaceutical care.

Analyses of Osteogenesis Imperfecta in South Korea Using the Nationwide Health Insurance Service Claim Data: A Propensity Score-Matched Study.

Osteogenesis imperfecta (OI) is the most common inherited form of bone fragility and includes a heterogeneous group of genetic disorders that most commonly result from defects associated with type I collagen. Although genetic analyses have been developed, nationwide research on the incidence and associated fractures in OI is lacking. This study aimed to investigate the patterns of OI prevalence, incidence, fracture rate, etc. in South Korea using National Health Insurance Service (NHIS) claims data. We found 1596 patients newly diagnosed with OI between March 2002 and February 2020. We evaluated the incidence, prevalence, and history of fractures, fracture site, prescription of anti-osteoporosis drugs, etc. To compare medical costs, fracture rates, and scoliosis rates, we created a control group comprising patients without OI using 1:1 propensity score matching. The prevalence of OI increased slightly each year, with an annual incidence of 20.20 per 100,000 live births. Mean fracture frequency in OI patients was 17 (2-32) times per patient and the most frequent fracture site was the lower leg. A total of 21.4% patients were prescribed anti-osteoporosis drugs, and the most popular drug was pamidronate. After 1:1 propensity score matching, in terms of scoliosis, OI patients had a 3.91 times higher prevalence of scoliosis than in healthy patients which was statistically significant. The sum of medical care expenses for patients with OI was 3.5 times higher than that for patients without OI. We identified nationwide trends in OI occurrence, fractures, and medication use. This study also highlighted the real-world data of scoliosis and medical costs compared to the control group.

Prescriptions of anti-reflux drugs in neonatology and neonatal intensive care units: A large multicentre observational study (2014-2022).

Gastro-oesophageal reflux is common in newborns, especially in premature infants. Treatment by medication is controversial as the drugs prescribed have not been consistently proven to be effective and are known to have adverse effects. This study sought to identify trends in the prescription of anti-reflux medication in a large group of French neonatal units. Data on prescriptions of anti-reflux treatments-proton pump inhibitors (PPIs), antacids, histamine-2 receptor antagonists (H2RAs), and prokinetics-from 2014 to 2022 for infants with a corrected gestational age <45 weeks, were extracted from a prescription database (Logipren®) used by 63 French neonatal units, and then analysed. Of all infants recorded in the database during the study period (n =152 743), 10.2% (n = 15 650) were prescribed anti-reflux medication (95% confidence interval [CI] 10.0-10.4%), mainly as monotherapy (77.5%). The rate was higher in the subgroup of preterm infants born before 28 weeks of gestation (n = 9493) (20.6%, 95% CI 19.8-21.4%; n = 1956). PPIs were the most commonly prescribed anti-reflux medications (6.9% of infants, 95% CI 6.8-7.0), followed by antacids (5.2%, 95% CI 5.1-5.3%), while H2RAs and prokinetics were rarely prescribed. Over the period, the prescription rate remained stable for PPIs, decreased for H2RAs (τ = -0.86, P = .02), and, among preterm infants born at gestational ages of 28-31 or 32-36 weeks, increased for antacids. Anti-reflux medications were frequently prescribed by neonatal units, especially for extremely premature infants. Most of these prescriptions were for PPIs and antacids.