Prescription Volume Research Articles

Implementation of a Synergistic, Complementary Pharmacy Practice Model for an Advanced Heart Failure/Heart Transplant Program

Study Objective: A pharmacy practice model for an Advanced Heart Failure (HF)/Transplant program was designed to address gaps in medication access, medication education and transitions of care (ToC). Activities specific to these initiatives performed by a four-member pharmacy team (3 pharmacists, 1 specialty technician) are described. Methods: Data were prospectively collected in 2020 for 284 admissions involving a high-risk cohort of advanced HF/transplant patients and a similar cohort seen in an ambulatory HF clinic. Interventions including medication reconciliation, e-prescribing, patient consultation and telephone call backs were performed daily to ensure medication access on discharge and as outpatients, comprehensive medication education on a continuum, and improved ToC. Metrics specific to these interventions and revenue reflecting outpatient prescription volume were quantified. Results: Standardized discharge medication education was provided to 97% of the cohort (n = 275). Of the 51 patients newly transplanted or receiving a left ventricular assist device, 100% had medication access on discharge and received follow-up telephone consultation within 48 hours. ToC was performed on admission (97%), pre-operatively (n = 51; 100%), post-operatively (n = 51; 100%) and on discharge (97%). Outpatient prescription volume increased 42% with net revenue increasing 157%. Conclusion: A pharmacy practice model involving an integrated 4-member team improved medication access and education and allowed for ToC at multiple points in the care process thereby improving medication safety. Collaboration between pharmacists and technicians working in inpatient, outpatient and specialty pharmacy settings is encouraged to provide complementary care to high-risk patients.

Exploration of Trends in Antimicrobial Use and Their Determinants Based on Dispensing Information Collected from Pharmacies throughout Japan: A First Report

The purpose of this study was to evaluate the defined daily doses (DDD)/1000 prescriptions/month (DPM) as a new indicator that can be used in pharmacies, and to describe antimicrobial use patterns in pharmacies nationwide in Japan. Dispensing volumes, number of prescriptions received, and facility information were obtained from 2638 pharmacies that participated in a survey. DPM was calculated based on the dispensing volume and number of prescriptions, which are routinely collected data that are simple to use. Use of third-generation cephalosporins, quinolones, and macrolides in pharmacies that received prescriptions primarily from hospitals or clinics decreased from January 2019 to January 2021. In particular, the antimicrobial use was higher in otorhinolaryngology departments than in other departments, despite a decrease in the antimicrobial use. In the linear multiple regression analysis, otorhinolaryngology department was independently associated with the third-generation cephalosporin, quinolone, and macrolide prescription in all periods. This study reveals for the first-time trends in antimicrobial use through a new indicator using the volume of drugs dispensed in pharmacies throughout Japan. Antimicrobial use differed by the medical department, suggesting the need to target interventions according to the department type.

Opioid Discharge Prescriptions After Inpatient Surgery: Risks of Rebound Refills by Length of Stay

IntroductionAs inpatient stays become shorter, one concern with standardizing discharge opioid prescriptions is the potential risk of “rebound refills.” We sought to compare opioid prescription refill rates and volumes for surgical patients discharged on postoperative day (POD) 2-3, 4-7, and 8+. MethodsIn a prospective quality improvement protocol, faculty volunteered to use either a 5x-multiplier (5x) or usual care (UC) for discharge prescriptions after inpatient (≥48 h stay) surgery from Sep-Dec 2019. The 5x-multiplier is 5-times the patient's last 24-h opioid use (by oral morphine equivalents, OME). Cohorts were compared by POD of discharge: POD 2-3 (“SHORT”), POD 4-7 (“INTERMEDIATE”), and POD 8+ (“LONG”). The primary endpoint was 30-d refill rates. Secondary endpoints included 30-d refill OME and inpatient opioid weaning/discharge metrics. ResultsFrom 22 faculty, 409 patients were included. When stratified by POD, 154 (37.7%) were discharged SHORT, 176 (43.0%) INTERMEDIATE, and 79 (19.3%) LONG. SHORT stay patients had a median last 24-h OME of 10 mg (versus 5 mg INTERMEDIATE, 5 mg LONG; P = 0.268), and a median discharge OME of 55 mg (versus 75 mg INTERMEDIATE, 100 mg LONG; P = 0.221). Patients with SHORT stays did not have higher refill rates (11.7% versus 18.2% INTERMEDIATE, 19.0% LONG; P = 0.193) or higher median refill OME (150 mg versus 300 mg INTERMEDAITE, 339 mg LONG; P = 0.154). ConclusionsDespite concerns of increased refills, patients discharged by POD 2-3 were not associated with “rebound refills.” A patient-centered 5x-multiplier standardization of discharge opioid prescriptions is feasible in all inpatient surgery patients, even those discharged following a short inpatient stay.

Comparative pharmacoepidemiological analysis of the structure of prescribing antidepressants in the treatment of anxiety and depressive disorders

Introduction. Anxiety-depressive disorders are among the most common psychiatric disorders in the group of borderline conditions, and antidepressants are widely used for their treatment. Around the world, there is an active development of new drugs with thymoanaleptic activity, as well as in-depth study and comparison of the efficacy and safety of existing drugs. Due to this, the approach to psychopharmacotherapy of anxiety-depressive disorders and the very structure of prescribing antidepressants are constantly changing. Thus, the analysis of the structure of prescribing antidepressants, as well as the identification and justification of the changes that this structure inevitably undergoes over time, becomes extremely relevant. Purpose of the study. Conduct a pharmacoepidemiological analysis of the structure of prescribing antidepressants to patients with anxiety-depressive disorders of the neurotic register (F 06.41 — Organic anxiety disorder due to cerebrovascular disease, F 41.0 — Panic disorder (episodic paroxysmal anxiety), F 41.2 — Mixed anxiety and depressive disorder and F 45 — Somatoform disorders according to ICD-10) in two comparable groups of patients treated in the Department of Crisis States of the Clinic of Hematology and Occupational Pathology of the SSMU in 2010–2012 and 2019–2021 respectively. Materials and methods. The volume of antidepressant prescriptions was assessed, taking into account dosages and treatment regimens, using the «Defined Daily Doses» technique in each of the study groups. Differences in the structure of prescribing antidepressants in the study groups were identified and analyzed, as well as the causes and prerequisites for their occurrence were investigated. Results. The conducted comparative pharmacoepidemiological study revealed discrepancies in the structure of antidepressant prescriptions in the 2010–2012 groups. and 2019–2021 Maprotiline was in second place in terms of prevalence in the 2010–2012 group, while in the 2019–2020 group never been appointed. By the end of the decade, the frequency of prescribing clomipramine significantly decreased, which in the 2010–2012 group ranked third in terms of appointments. When comparing groups of 2010–2012 and 2019–2021 it was found that in the first case, the volume of clomipramine prescriptions was almost 6 times higher. There is a trend towards an increase in the volume of prescriptions for almost all drugs of the SSRI group, both individually and for this group as a whole. The structure of prescriptions is significantly influenced by such factors as an in-depth study of the main and side effects of drugs, accessibility for patients and the volume of supplies of individual drugs to the territory of the Russian Federation. Conclusion. Modern pharmacoepidemiological studies make it possible to study in depth the advantages and disadvantages of each specific antidepressant, so that in each clinical case it is possible to choose the most suitable drug or combination thereof. It is necessary to continue and increase the scale of such studies, maintaining their independence from the financing of pharmaceutical companies, as well as to expand the local market for psychopharmacotherapeutic agents so that its limitations do not reduce the effectiveness of the therapy on a large scale.

Effect of the COVID-19 pandemic on Tennessee hospital antibiotic use

Background: On March 5, 2020, the Tennessee Department of Health (TDH) announced the first case of COVID-19 in the state. Since then, hospitals have been overwhelmed by the spike in respiratory infections. Several studies have attempted to describe the impact of the pandemic on antibiotic prescriptions. The NHSN Antimicrobial Use Option offers a platform for hospitals to report their antibiotic usage. The TDH has established access to hospital antibiotic usage data statewide through an existing NHSN user group. We compared the change in the volume of inpatient antibiotic prescriptions before and during the pandemic. Methods: An ecological study was conducted from January 2019 to December 2021. Aggregated facility-level data from the NHSN Antimicrobial Use Option were used to describe antibacterial use among Tennessee hospitals. Data from facilities that had reported at least 1 month of data during the study period were included in this study. The antimicrobial use rate was calculated by dividing the antimicrobial days of therapy (DOT) by the number of 1,000 days present. Overall antimicrobial use rates as well as specific antimicrobial use rates for azithromycin, ceftriaxone, and piperacillin–tazobactam were compared across years. Results: In total, 55 hospitals reported at least 1 month of data into the NHSN Antimicrobial Use Option during the study period. These hospitals had a median bed size of 140 (range, 12–689). Conclusions: We observed a modest increase in overall antibiotic use during the COVID-19 pandemic in Tennessee facilities. This trend appeared to be primarily attributed to agents used for community-acquired respiratory infections, such as azithromycin and ceftriaxone, earlier in the pandemic. However, both of these agents have fallen to prepandemic use levels during 2021. The fact that overall use increased in 2021 suggests that other agents not analyzed may have contributed to this effect. Further analysis may help determine which agents are responsible for this increase in 2021.Funding: NoneDisclosures: None

Outpatient antibiotic prescribing during the COVID-19 pandemic–United States, January 2019–October 2021

Background: Improving antibiotic use is a key strategy to combat antimicrobial resistance. Here, we have described national outpatient antibiotic prescribing trends during the COVID-19 pandemic. We compared the monthly numbers of prescriptions in 2020–2021 to those from 2019 to describe the impact of the pandemic and to highlight areas for improvement. Methods: We used the IQVIA National Prescription Audit (NPA) data set to identify all antibiotic prescriptions dispensed from US retail pharmacies during January 2019–October 2021. We calculated the percentage change in volume of prescriptions for each month during the pandemic (beginning in March 2020) compared to the baseline (defined as the corresponding month in 2019). Data were characterized by patient age group (0–19 years, 20–64 years, ≥65 years) and antibiotic class and drug, including azithromycin. Results: Antibiotic prescriptions were lower than baseline during March 2020–June 2021. The greatest decrease in antibiotic prescribing volume occurred in May 2020 (40.0% lower than May 2019) (Fig. 1), with the greatest decreases among children 0–19 years of age. However, prescribing was similar to baseline levels in July–August 2021 (Fig. 1). Specifically, azithromycin prescribing exceeded the 2019 baseline by 11.0% in July and further to a 34.5% increase in August 2021 (Fig. 2). Increases in azithromycin prescribing in August 2021 were observed across all age groups: 20–64 years (46.9% above baseline), ≥65 years (25.3% above baseline), and children 0–19 years (7.8% above baseline). Conclusions: Antibiotic prescribing volume was lower during 2020 and the first half of 2021 compared to the corresponding months in 2019. Decreases in outpatient antibiotic prescriptions during the pandemic likely reflect decreased utilization of outpatient healthcare and decreased transmission of non–COVID-19 infections secondary to nonpharmaceutical interventions (eg, masking, social distancing, school closures). However, outpatient antibiotic prescribing levels in general, and azithromycin prescribing in particular, approached or exceeded prepandemic levels in July and August 2021. Ongoing surveillance and sustained outpatient antibiotic stewardship efforts are needed to optimize antibiotic use during the COVID-19 pandemic and beyond.Funding: NoneDisclosures: None

The Effect of Biosimilar Prescription Targets for Erythropoiesis-Stimulating Agents on the Prescribing Behavior of Physicians in Germany

ObjectivesThis study aimed to aid decision makers by analyzing the impact of introducing biosimilar prescription targets on physician prescribing behavior in the prescription of biologic erythropoiesis-stimulating agents in Germany. MethodsWe combined secondary data of regional level biosimilar prescription targets and secondary data of routinely collected claims data of dispensed prescriptions by physicians operating within the statutory health insurance system in ambulatory care across 7 German regions from 2009 to 2015. Two-way fixed-effects regression analysis was used to identify the average treatment effect of introducing biosimilar prescription targets at the physician level. The main outcome of interest was the share of biosimilar prescriptions on all prescriptions within the substance group. We compared 6 regions that introduced biosimilar prescription targets with 1 region without any prescription target policy. ResultsIntroducing biosimilar prescription targets increased the average share of biosimilars between 6 percentage points (P < .05) in Hamburg and up to 20 percentage points (P < .001) in Saxony-Anhalt. Stratification of specialists by prescription volume and adoption status indicated heterogeneous effects. We identified similar but higher effects for high-volume prescribers. Disentangling of effects with regard to the composition of biosimilar share suggested that the increase in biosimilar share was driven by increased biosimilar use accompanied by a nonsignificant decrease in original biologics prescriptions. ConclusionsPrescription targets to alter physician prescribing behavior meet their intended goals by increasing biosimilar share. Physicians partly responded to the policy by decreasing overall prescriptions of the target substance. Prescription targets might be a useful tool, but decision makers need to consider all aspects of potential responses.

Effects of Low Level Laser Therapy on Tendinopathies: A Systematic Literature Review

BackgroundActive individuals may become afflicted by degeneration of tendon protein collagen. This phenomenon, termed tendinopathy, manifests with pain, swelling, and loss of function. Low Level Laser Therapy (LLLT) is a proposed modality for the management of pain and inflammation associated with tendinopathies.PurposeThis literature review aims to look at the state of evidence among previously conducted randomized controlled trials (RCT) examining the effects of LLLT on tendinopathies in humans.Methods and Data ExtractionSystematic literature searches for randomized controlled trials between 2011‐2021 were performed in the databases of PubMed, PEDro, CINAHL, Cochrane, and Medline between July 7 to 23, 2021. A total of three randomized controlled trials (full text available, PEDro score &gt; 6, met search criteria, and conducted in the past 10 years) with a total of 132 subjects met quality guidelines using the PEDro scale.ResultsA total of 171 articles were screened, and three studies with a total population of n=132 were included. With heterogeneity in frequency, dosage, and volume of treatment prescription, no meta‐analysis was conducted. Majority of the RCT’s did not meet PEDro quality guidelines (6 of 10 total points). Of the three studies that met criteria, there were statistically significant improvements reported in terms of pain and function in 2 of the 3 studies (n=92). On the other hand, no notable clinically significant effects were found in 1 of the studies (n=40). The results suggest that in the management of tendinopathies, the use of LLLT has some clinically significant effect on pain and functional outcomes.Conclusion and RecommendationsThis review of current randomized controlled trials and systematic reviews presented limited evidence for LLLT for tendinopathies. While the use of LLLT may improve pain and functional outcome, improving the quality of RCT’s, their methodology, and dosing and prescription guidelines are suggested.

Military Health System Opioid, Tramadol, and Gabapentinoid Prescription Volumes Before and After a Defense Health Agency Policy Release

Clinical practice guidelines (CPGs) and health system policies to mitigate inappropriate opioid prescribing practices may have an extended impact on low-dose opioid (e.g., tramadol) and non-opioid (e.g., gabapentinoid) pain medication prescribing practices. To evaluate changes in opioid, tramadol, and gabapentinoid prescribing rates from January 2016 to February 2020 within the Military Health System, including the degree to which prescribing rates changed after release of a US Defense Health Agency Procedural Instruction. In this observational health services research study, opioid, tramadol, and gabapentin prescription dispense events of US Military Health System beneficiaries enrolled in care at military treatment facilities prior to US Defense Health Agency Procedural Instruction release (January 2016-May 2018) were used to forecast values from the post-intervention period (June 2018-February 2020). The median opioid and tramadol prescribing rates decreased from January 2016 to February 2020, aside from tramadol prescribing in Surgery Clinics, which increased. Gabapentinoid prescribing rate changes were mixed. In Bayesian time series models, the forecasted proportion of patients receiving each of the three medications, regardless of age group or clinic type, did not significantly vary from the actual prescribing rates in the post-intervention period. Overall, CPGs and policies targeting opioid prescribing practices may have provided the maximal impetus for providers to re-evaluate their prescribing practices, as the policy did not appear to change the slope in prescribing rates. However, it is unclear whether the policies mitigated the likelihood of plateaus in prescribing rates. Further work is needed to assess the degree to which providers simultaneously altered other non-opioid pain medication prescribing practices, self-management recommendations, and non-pharmacological therapy referrals.

Uptake of biosimilar drugs in Canada: analysis of provincial policies and usage data.

KEY POINTS Biologics represent a large segment of drug spending in Canada: although they constituted just 1.5% of prescription volumes, biologics accounted for 27.3% of expenditures in 2018.[1][1] As of 2018, the price of biologics in Canada, including spending per capita, was second only to that in

Recreational cannabis legalizations associated with reductions in prescription drug utilization among Medicaid enrollees.

The potential substitution of cannabis for prescription medication has attracted a substantial amount of attention within the context of medical cannabis laws (MCLs). However, much less is known about the association between recreational cannabis laws (RCLs) and prescription drug use. With recent evidence supporting substitution of cannabis for prescription drugs following MCLs, it is reasonable to ask what effect RCLs may have on those outcomes. We use quarterly data for all Medicaid prescriptions from 2011 to 2019 to investigate the effect of state-level RCLs on prescription drug utilization. We estimate this effect with a series of two-way fixed effects event study models. We find significant reductions in the volume of prescriptions within the drug classes that align with the medical indications for pain, depression, anxiety, sleep, psychosis, and seizures. Our results suggest substitution away from prescription drugs and potential cost savings for state Medicaid programs.

Estimate the Spectrum and Prescription Pattern in Patients with Myocardial Infarction, Angina, Congestive Cardiac Failure at a Tertiary Care Hospital- Retrospective Study

Introduction: Analysis of the prescription patterns is essential to improve rational prescribing in cardiac patients to decrease the risk associated with cardiovascular drugs &amp; also to reduce morbidity and mortality. However, this type of study is progressively more important because of a boost in marketing of new medicines, variations in the prescribing and consumption of drugs, growing concern about delayed adverse effects, cost of drugs, and volume of prescription provokes us to carry out this study. &#x0D; Objectives: To evaluate cardiovascular disease (Myocardial Infarction (MI), ANGINA, and Congestive Cardiac Failure (CCF) drugs prescribing pattern &amp; its cost.&#x0D; Methods: This study is a Retrospective case study carried out for a period of 6months at Sagar Hospitals, Bangalore, by collecting the required data in a structured questionnaire.&#x0D; Results: Out of 250 patient cases observed, patients aged 60-69 were 31.6%, followed by 50-59 (26.8%) are more prone to CAD &amp; males were more when compared to females. The study showed the highest number of patients suffering from Angina and the second highest in MI, and few patients have been diagnosed with CCF.&#x0D; Conclusion: This study showed that Coronary artery disease was managed by antiplatelets, antihypertensives, statins, and diuretics;&#x0D; Angina has the highest diagnosis rate under this study. However, the antianginal drug class does not practice well. However, these studies also show the path for the pharmacist's role in promoting rational drug promotion in cardiac disease management.

Prospective Implementation of Standardized Post-Hepatectomy Care Pathways to Reduce Opioid Prescription Volume after Inpatient Surgery.

Among the goals of prospectively implemented post-hepatectomy care pathways was a focus on patient-centric opioid reduction. We sought to evaluate the impact of pathway implementation on opioid volumes in the last 24-hour period and discharge prescriptions. This is a retrospective cohort study comparing a prospective cohort ("POST," September 2019 through February 2020) treated after pathway implementation to a historical cohort of hepatectomy patients ("PRE," March 2016 through December 2017) before our 2018 departmental opioid reduction efforts. Opioid volumes in the last 24 hours and prescribed at discharge were converted to oral morphine equivalents (OME) and compared between cohorts. There were 276 PRE and 100 POST patients. There was a similar proportion of major (PRE-34.1% vs POST-40%) and minimally invasive hepatectomies (PRE-19.9% vs POST-11%, p = 0.122). Implementation was associated with a shorter length of stay (median 5 d PRE vs 4 d POST, p < 0.001). Standardized opioid weaning was associated with a lower median last 24-hour OME (20 mg PRE vs 10 mg POST, p = 0.001). Using a standardized discharge calculation, median discharge OME were lower (200 mg PRE vs 50 mg POST, p < 0.001). More POST patients were discharged opioid-free (6.9% PRE vs 21% POST, p < 0.001). Implementation of post-hepatectomy care pathways was associated with a 50% reduction in last 24-hour OME, which, combined with a standardized discharge calculation, was associated with an overall 75% reduction in discharge opioid volumes and tripled opioid-free discharges. These data suggest that no-cost, reproducible pathways can be considered in abdominal operations with similar incisions/length of stay to decrease variation in opioid dosing while prioritizing patient-centric opioid needs.

Drug Utilization and Medical Cost Study Focusing on Moisturizers in Cancer Patients Treated with Molecular Targeted Therapy: A Retrospective Observational Study Using Data from a Japanese Claims Database.

IntroductionMolecular targeted therapies (MTTs) cause skin disorders in patients with cancer, and moisturizers are useful treatments; however, their actual use and costs are unknown. Our purpose was to examine the use and costs of moisturizers prescribed for xerosis (asteatosis) in patients with cancer treated with MTTs.MethodsWe used data from a Japanese hospital-based claims database. The index date was the first date of MTT prescription from October 2011 to April 2018 (selection period), and the follow-up period was 1 year from the index date. Patients treated with MTTs during the selection period and who were not prescribed moisturizers in the 6 months before the index date were included as the study cohort. Timing, duration, amount, and costs of the prescribed moisturizers and total medical costs were analyzed.ResultsAmong the 78,190 patients in the study cohort, 27,906 patients (35.7%) were prescribed moisturizers during follow-up. Moisturizer prescription timing, duration, and volume were inconsistent. The average annual total medical costs for treating patients with MTT who were prescribed moisturizers was JPY 6.165 million (USD 53,797) per patient, and the moisturizer costs were JPY 6033 (USD 53). The number of patients who used moisturizers showed an increasing trend.ConclusionNo consistent patterns were observed for the timing or duration of moisturizer use, which suggests various developmental patterns of skin disorders. Furthermore, medical costs for moisturizers accounted for only a small proportion of the total medical costs required for cancer treatment.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-022-00712-2.

Evaluation of the Correspondence between the Concentration of Antimicrobials Entering Sewage Treatment Plant Influent and the Predicted Concentration of Antimicrobials Using Annual Sales, Shipping, and Prescriptions Data.

The accuracy and correspondence between the measured concentrations from the survey and predicted concentrations on the basis of the three types of statistical antimicrobial use in Japan was evaluated. A monitoring survey of ten representative antimicrobials: ampicillin (APL), cefdinir (CDN), cefpodoxime proxetil (CPXP), ciprofloxacin (CFX), clarithromycin (CTM), doxycycline (DCL), levofloxacin (LFX), minocycline (MCL), tetracycline (TCL), and vancomycin (VMC), in the influent of sewage treatment plant (STP) located in urban areas of Japan, was conducted. Then, the measured values were verified in comparison with the predicted values estimated from the shipping volumes, sales volumes, and prescription volumes based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). The results indicate that the correspondence ratios between the predicted concentrations calculated on the basis of shipping and NDB volumes and the measured concentrations (predicted concentration/measured concentration) generally agreed for the detected concentration of antimicrobials in the STP influent. The correspondence ratio on the basis of shipping volume was, for CFX, 0.1; CTM, 2.9; LFX, 0.5; MCL, 1.9; and VMC, 1.7, and on the basis of NDB volume the measured concentration was CFX, 0.1; CTM, 3.7; DCL, 0.4; LFX, 0.7; MCL, 1.9; TCL, 0.6; and VMC, 1.6. To our knowledge, this is the first report to evaluate the accuracy of predicted concentrations based on sales, shipping, NDB statistics and measured concentrations for antimicrobials in the STP influent.

The Impact of Point-of-Care Polymerase Chain Reaction Testing on Prescribing Practices in Primary Care for Management of Strep A: A Retrospective Before-After Study.

BackgroundRapid antigen detection tests (RADTs) are the standard of care (SOC) for testing in patients with suspected group A β-hemolytic Streptococcus (Strep A) infection. Due to lower sensitivity, guidelines recommend confirmatory microbiological culture following negative RADT results. This process is time-consuming, and adherence is often poor, resulting in high rates of inappropriate antibiotic prescribing. We sought to evaluate the impact of switching from RADTs to point-of-care (POC) polymerase chain reaction (PCR) testing on use of antibiotics in primary care, when used as part of an antibiotic stewardship initiative.MethodsIn this retrospective before–after study, electronic medical records of any patients presenting with suspected acute pharyngitis (June 2018–May 2019) across 15 outpatient primary care clinics were evaluated. Strep A was detected using the cobas Strep A assay (cobas Liat system).ResultsAnalysis of 10 081 eligible patient records showed that POC PCR testing resulted in a 44.1% reduction in antibiotic prescribing for patients with a negative POC PCR test result (10.1% PCR vs 18.0% RADT; P < .0001). Rates of antibiotic prescription varied across clinical sites, ranging between 10.7% and 33.8% and 12.4% and 34.4% during the use of PCR tests and RADTs, respectively. POC PCR had no impact on prescription rates in patients with positive POC test results compared to RADTs (76.2% vs 76.5%, respectively). More than 99% of antibiotics were prescribed during the initial primary care encounter.ConclusionsAs part of a broader antibiotic stewardship initiative, implementation of POC PCR as SOC in outpatients with acute pharyngitis symptoms reduced the volume of inappropriate antibiotic prescriptions.

Prescription Market Share and Treatment Patterns in Atopic Dermatitis: A Retrospective Observational Study Using US Insurance Claims.

IntroductionThere is limited real-world evidence on the treatments for atopic dermatitis (AD) since dupilumab was approved in 2017. The objective of this study was to assess market share of drugs commonly prescribed for the treatment of AD and describe treatment patterns in patients diagnosed with AD.MethodsThis was a retrospective, observational study in adult patients with an ICD-10 diagnosis of AD between 2017 and 2019 using insurance claims data in the US population.ResultsMarket share cohorts consisted of 75,794 (2017) and 89,618 (2018) patients. Treatment patterns cohort had 68,588 patients with 63.56% female, mean (SD) age 43.54 (15.96) years, and mean (SD) Quan CCI 0.31 (0.85). Topicals had two-thirds market share by prescription volume (2017 = 65.56%; 2018 = 63.63%). Corticosteroids were the most prescribed topical (2017 = 71.94%; 2018 = 72.04%) and systemic (2017 = 30.59%; 2018 = 30.23%) drug class. Dupilumab had the highest medication adherence (proportion of days covered [PDC] ≥ 80%; 60.74%) and persistence (17.39%), lowest discontinuation rate (23.32%), and longest mean (SD) days on therapy 148.20 (101.77).ConclusionTopicals are the primary treatment for patients with AD, even though systemic users have higher medication adherence (PDC). Systemics provide a treatment alternative to topicals.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02071-y.

Ökonomische Aspekte bei der Versorgung von Patient*innen mit neuen oralen Tumortherapeutika: Erkenntnisse aus der AMBORA-Studie

IntroductionThe number of prescriptions and costs of oral anticancer drugs are increasing. Therapy discontinuation due to, for example, side effects, progression, or death, often lead to medication wastage. While evidence exists for the economic value of wasted injectable chemotherapeutics, there is a lack of data for oral anticancer drugs in Germany. MethodsThe multicenter AMBORA trial investigated 202 patients, who had been newly started on new oral anticancer drugs, over 12 weeks and analyzed the outpatient prescription data of patients who discontinued treatment. The amount of medicines wasted and their costs were determined using the pharmacy retail price. Defined daily doses and prescription data from the AOK Bayern, a German statutory health care insurance company, were used to extrapolate these costs. ResultsWithin 12 weeks, 24.8 % of the AMBORA patients discontinued oral anticancer treatment (50 of 202). Prescription data of 34 patients were evaluable. In total, 1,693 tablets/capsules with a value of 112,212 euros were wasted. The approximate extrapolation to the prescription volume of the AOK Bayern resulted in an estimated wastage of 3.49 million euros in 12 weeks. DiscussionMedication wastage due to discontinuation of new oral anticancer drug therapy leads to a considerable financial burden. Regarding rising prescription numbers and therapy costs in oncology, measures to reduce wastage of oral anticancer drugs should be initiated. ConclusionClinical pharmacological / pharmaceutical care including medication reconciliation and review, side effect management and patient counseling to optimize adherence and medication intake behavior, contributes to a reduction of therapy discontinuations, thereby reducing drug wastage. To further reduce drug wastage small (initiation) packages, which are currently not always available for an economic prescription, play an important role. The practice of partial prescription fills, which is already practiced internationally, should also be further discussed in Germany.

Pharmacist’s time spent: Space for Pharmacy-based Interventions and Consultation TimE (SPICE)—an observational time and motion study

ObjectiveTo describe the pharmacists’ workflow, including tasks and time spent, to better understand their work capacity.DesignCross-sectional, observational, time and motion study.SettingCommunity pharmacies in Western Australia and New South Wales, Australia.ParticipantsCurrently...

Identifying Higher-Volume Antibiotic Outpatient Prescribers Using Publicly Available Medicare Part D Data - United States, 2019.

Antibiotic prescribing can lead to adverse drug events and antibiotic resistance, which pose ongoing urgent public health threats (1). Adults aged ≥65 years (older adults) are recipients of the highest rates of outpatient antibiotic prescribing and are at increased risk for antibiotic-related adverse events, including Clostridioides difficile and antibiotic-resistant infections and related deaths (1). Variation in antibiotic prescribing quality is primarily driven by prescribing patterns of individual health care providers, independent of patients' underlying comorbidities and diagnoses (2). Engaging higher-volume prescribers (the top 10% of prescribers by antibiotic volume) in antibiotic stewardship interventions, such as peer comparison audit and feedback in which health care providers receive data on their prescribing performance compared with that of other health care providers, has been effective in reducing antibiotic prescribing in outpatient settings and can be implemented on a large scale (3-5). This study analyzed data from the Centers for Medicare & Medicaid Services (CMS) Part D Prescriber Public Use Files (PUFs)* to describe higher-volume antibiotic prescribers in outpatient settings compared with lower-volume prescribers (the lower 90% of prescribers by antibiotic volume). Among the 59.4 million antibiotic prescriptions during 2019, 41% (24.4 million) were prescribed by the top 10% of prescribers (69,835). The antibiotic prescribing rate of these higher-volume prescribers (680 prescriptions per 1,000 beneficiaries) was 60% higher than that of lower-volume prescribers (426 prescriptions per 1,000 beneficiaries). Identifying health care providers responsible for a higher volume of antibiotic prescribing could provide a basis for additional assessment of appropriateness and outreach. Public health organizations and health care systems can use publicly available data to guide focused interventions to optimize antibiotic prescribing to limit the emergence of antibiotic resistance and improve patient outcomes.