Prevalence Of Medication Use Research Articles

Inappropriate Medication in Home Health Care.

The Authors Reply: —We are pleased to respond to Dr. Lau and Ms. Dwyer’s letter. Dr. Lau and Ms. Dwyer point out that the validity of using the Beers list to evaluate prescribing quality among patients receiving end-of-life (EOL) care is questionable. They raise concerns about our examination of potentially inappropriate medication (PIM) without distinguishing between patients receiving and not receiving EOL care in the home health setting. We agree with Dr. Lau and Ms. Dwyer that, given the different needs and treatment goals between the two patient populations, medication appropriateness should be examined by EOL status. In response, we conducted the same analysis as reported in our article, but stratified by EOL status. To define EOL status, we used a variable in the survey indicating that the patient had a life expectancy of 6 months or less or was receiving palliative/EOL care. Consistent with Lau and Dwyer, we estimated that a weighted 15.7% of our original study population were EOL patients. Estimated rate of PIM use was similar between EOL patients (36.6%, 95% CI: 29.2–44.8%) and non-EOL patients (39.0%, 95% CI: 36.0–42.1%). Lau and Dwyer mentioned several classes of medications on the Beers list that may be clinically appropriate for EOL patients. Our estimates indicate that prevalence of medication use in these classes were also comparable by EOL status. For example, 6.5% (CI: 3.6–11.4%) of EOL patients vs. 6.5% (CI: 5.1–8.2%) of non-EOL patients used antihistamines included in the Beers list. The rate of long-acting benzodiazepines use was 2.9% (CI: 1.5–5.4%) among the EOL patients vs. 2.2% (CI: 1.5–3.2%) among the non-EOL patients. Use of anticholinergic agents (including gastrointestinal antispasmodics and other anticholinergics on the Beers list) was low (1–2%) for both populations, with confidence intervals overlapping. These results indicate that our original estimate of close to 40% PIM use among older home health care patients was not driven by the potentially greater (and appropriate) use of these medications by patients with limited life expectancy or receiving EOL care. Lau and Dwyer make a legitimate point of the need to take into account EOL status when examining medication appropriateness. The policy and practice implications of our original findings, however, remain highly relevant to the vast majority of home health patients who receive active treatment.

Prevalence and predictors of self-medication in a selected urban and rural district of Sri Lanka.

Self-medication is widely practised in many developing countries. The determinants of self-medication need to be understood to design adequate medicine information policies and patient-dispenser education strategies. Hence, the prevalence of medicine use and predictors of self-medication were determined in Sri Lanka. In a community-based cross- sectional study, data were collected from 1800 adults selected from Gampaha and Polonnaruwa districts respectively. Study participants were sampled using a multistage cluster sampling technique. Trained public health midwives administered the questionnaire. Two Likert scales provided information on access to medical care and satisfaction with available pharmacy services. About 95% of the sampled population participated in the study. Overall, prevalence of medication use (allopathic, traditional, home remedies) in urban and rural population was 33.9% and 35.3%, respectively. Self-medication prevalence of allopathic drugs in the urban sector (12.2%) was significantly higher than in the rural (7.9%) sector(p<0.05). In the urban sector, small household size and preference to have medicines from outside the pharmacies predisposed to self-medication. The higher acceptability of medical services and regularity of medical care decreased the likelihood of self-medication. In the rural sector, lower satisfaction about the healthcare providers' concern for clients, lower satisfaction about affordability of medical care and higher satisfaction with technical competence of the pharmacy staff increased the likelihood of self-medication. In both urban and rural sectors, when symptom count increased, tendency to self-medicate decreased. Self-medication prevalence was higher in urban compared to rural areas in Sri Lanka. Some aspects of access to medical care, satisfaction with pharmacy services and perceived severity of the disease were found to be important determinants of self-medication.

Prevalence and correlates of psychotropic medication use in adolescents with an autism spectrum disorder with and without caregiver-reported attention-deficit/hyperactivity disorder.

Many youths with an autism spectrum disorder (ASD) benefit from psychotropic medication treatment of co-morbid symptom patterns consistent with attention-deficit/hyperactivity disorder (ADHD). The lack of clear indications and algorithms to direct clinical practice has led to a very poor understanding of overall medication use for these youths. The present study examined the prevalence of psychotropic medication use compared across individuals with an ASD without a caregiver-reported ADHD diagnosis (ASD-only), ADHD without ASD (ADHD-only), and an ASD with co-morbid ADHD (ASD+ADHD). Correlates of medication use were also examined. Data on psychotropic medication from the first wave of the National Longitudinal Transition Study 2, a nationally representative study of adolescents ages 13-17 in special education, were used to compare the prevalence of medication use across the three groups, overall and by class. Separate logistic regression models were constructed for each group to examine the correlates of psychotropic medication use. Poisson regression models were used to examine correlates of the number of medications. Youths with ASD+ADHD had the highest rates of use (58.2%), followed by youths with ADHD-only (49.0%) and youths with ASD-only (34.3%). Youths with an ASD, both ASD-only and ASD+ADHD, used medications across a variety of medication classes, whereas stimulants were dominant among youths with ADHD-only. African American youths with ASD-only and with ASD+ADHD were less likely to receive medication than white youths, whereas race was not associated with medication use in the ADHD-only group. Clearer practice parameters for ADHD have likely contributed to more consistency in treatment, whereas treatment for ASD reflects a trial and error approach based on associated symptom patterns. Additional studies examining the treatment of core and associated ASD symptoms are needed to guide pharmacologic treatment of these youths. Interventions targeting African American youths with ASD and the physicians who serve them are also warranted.

Vísbendingar um gæði lyfjameðferða aldraðra við innlögn á Landspítala

Increased morbidity and higher prevalence of medication use commonly coexists among the elderly. When managed appropriately, older patients can benefit from drug therapy. However, drug related problems are more frequent and more serious in the elderly. The aim of the study was to assess the quality of medication use in older people at hospital admission. A retrospective medical record review was performed for patients 70 years and older who had an unplanned admission to the internal medicine and geriatric units at Landspitali University Hospital in 2007. Among the sampled medical records, 913 met inclusion criteria. Assessment was carried out using 15 drug-specific quality indicators. Mean age was 80.9 years and 54.5% were women. Mean number of drugs at admission was 7.0 for women and 6.5 for men (p=0.047). The prevalence of having one or more quality indicators on admission was 48.4%. Women were more likely to have a quality indicator than men (women 56.2%, men 39.9%). The probability also increased with increasing age and number of drugs. The quality of drug therapy among older patients at hospital admission appears to be suboptimal. A more accurate estimate of the problem could be obtained through a prospective study where drug regimens are correlated with symptoms and reason for admission. Additional studies are also needed in the outpatient setting. Such studies could provide more accurate evidence and assist policy making towards improved quality of drug prescribing for a growing number of older patients. elderly, quality indicators, hospitalization, drugs, inappropriate prescribing.

Exploring Medication Risk among Older Residents in Supported Residential Services: A Cross‐Sectional Study

ABSTRACTBackgroundOlder residents in supported residential services (SRS) are often on multiple medications and may be at risk of medication misadventure. Their medication risk and uptake of medication reviews by pharmacists has not been investigated.AimTo investigate medication use, risk factors for medication misadventure and uptake of home medicines review (HMR) among older residents in SRS.MethodA pre‐piloted postal survey was distributed to 361 residents from 14 SRS in Victoria. The questionnaire included validated items on medication risk, medication use, health information and uptake of HMR. The questionnaire was completed by residents, SRS care staff or family members.ResultsOf the 77 respondents (21% response rate) aged 53 to 98 years, 73 (95%, 95%CI 90–100) reported taking prescribed medications. Risk factors for medication‐related problems were present in 56 respondents (73%; 95%CI 63–83) and included: ≥ 5 regular medications (n = 41; 53%; 95%CI 42–64), ≥ 3 comorbidities (n = 31; 40%; 95%CI 29–51), medications with low therapeutic index (n = 15; 20%; 95%CI 11–28), recent hospitalisations (n = 12; 16%; 95%CI 7.5–24), recent changes to medication regimens (n = 10; 13%; 95%CI 5.5–21) and ≥ 12 tablets/capsules a day (n = 9; 12%; 95%CI 4.5–19). Of these at‐risk respondents, only 3 (5.4%; 95%CI 0.4–11) reported receiving an HMR in the previous 12 months.ConclusionHigh prevalence of medication use and medication‐related risk factors, but low awareness and uptake of HMR were identified among SRS residents.

Agreement between self‐reported and pharmacy data on medication use in the Northern Finland 1966 Birth Cohort

To compare self-reported (SR) medication use and pharmacy data for major psychoactive medications and three classes of medications used for different indications, and to determine the socio-economic factors associated with the congruence. Postal questionnaire data collected in 1997 were compared with the register of the Social Insurance Institution of Finland on the reimbursed prescriptions purchased during 1997. Altogether 7625 subjects were included in this study. Drugs were categorized according to the Anatomical Therapeutic Chemical (ATC) system. Kappa values were 0.77, 0.68, 0.84, 0.92 and 0.55 for antipsychotics, antidepressants, antiepileptics, antidiabetics and beta-blocking agents, respectively. Prevalence-adjusted and bias-adjusted kappa values were almost perfect (0.98-1.00). Reliability of antipsychotics use was better for married subjects than for those who were not married; and of antidepressants use for highly educated and married subjects than for those who were less educated and were not married. Altogether 414 (5.4%) responders and 285 (7.1%) non-responders had used at least one of the selected medications. Agreement between the SR and pharmacy data was moderate for psychoactive medication use. Even though data collected by postal questionnaire may underestimate the prevalence of medication use due to non-participation it can be assumed accurate enough for study purposes.

Use of dietary supplements and medication among postmenopausal women with vasomotor symptoms

Objectives To assess how postmenopausal women with severe vasomotor symptoms who volunteer for an acupuncture trial (ACUFLASH) differ from the general population (the Norwegian Women and Cancer study, NOWAC); and to describe the use of dietary supplements and medication during trial intervention and follow-up.Methods Questionnaire data on postmenopausal women regarding demography and use of dietary supplements and medication were compared between the ACUFLASH trial (baseline, 2006–2007, n = 267) and the NOWAC study (2004–2005, n = 331). Additionally, the trial intervention groups, acupuncture and self-care (n = 134) or self-care alone (n = 133), were compared regarding supplements and medication use.Results The prevalence of dietary supplement use was higher among women with severe vasomotor symptoms (83.9%) than in the population-based sample (74.3%), with particularly extensive use of cod liver oil. The prevalence of medication use was 46.4% in ACUFLASH and 55.0% in NOWAC. Trial participants reported poorer self-reported health, higher education level and tended to be former oral contraceptive users and smokers. At trial baseline, 48.5% of the acupuncture group and 60.3% of the self-care group used dietary supplements (p > 0.05), while 48.5% in the acupuncture group and 45.0% in the self-care group used medication (p > 0.05). Use of supplements for vasomotor symptoms increased significantly in the self-care group at 12 weeks, while it remained unchanged in the acupuncture group. Hormone therapy use increased significantly in both groups after intervention.Conclusion Postmenopausal women suffering severe vasomotor symptoms used more dietary supplements than the general population. They also had poorer self-reported health, but their medication use was similar to that of the general population. Acupuncture did not influence use of dietary supplements in the randomized intervention.

Lung function and indicators of exposure to indoor and outdoor particulate matter among asthma and COPD patients

Objectives:Misclassification of exposure related to the use of central sites may be larger for ultrafine particles than for particulate matter ⩽2.5 μm and ⩽10 μm (PM2.5 and PM10) and may...

Medication Overdoses Leading to Emergency Department Visits Among Children

The high prevalence of medication use increases the potential for medication overdoses, especially among children. This paper describes the burden of unintentional pediatric medication overdoses in order to target new prevention efforts. Data were analyzed in 2007 and 2008 from the National Electronic Injury Surveillance System, collected January 1, 2004, through December 31, 2005, to estimate the number of emergency department visits resulting from unintentional medication overdoses among children aged <or=18 years in the U.S. These data were analyzed by patient demographics, overdose cause, and implicated products, and compared to visits for nonpharmaceutical consumer product poisonings. Based on 3034 cases, an estimated 71,224 emergency department visits for medication overdoses were made annually by children aged <or=18 years, representing 68.9% of emergency department visits for unintentional pediatric poisonings. The rate of unintentional poisonings from medications was twice the rate of those from nonpharmaceutical consumer products (9.2 visits per 10,000 individuals per year [95% CI=7.3, 11.0] vs 4.2 per 10,000 individuals per year [95% CI=3.3, 5.0]). Four fifths (82.2%) of visits for medication overdoses were from unsupervised ingestions (children accessing medications on their own); medication errors and misuse resulted in 14.3% of visits. Most visits (81.3%) involved children aged <or=5 years, and commonly available over-the-counter medications were implicated in one third (33.9%) of visits. Medication overdoses among children, notably unsupervised ingestions, represent a substantial burden in terms of emergency department visits and hospitalizations. New efforts to prevent pediatric medication overdoses are needed.

Long-term road traffic noise exposure is associated with an increase in morning tiredness

This study investigates the association between night time road traffic noise exposure (L(night)) and self-reported sleep problems. Logistic regression was performed in a large population based cohort study (GLOBE), including over 18 000 subjects, to study the association between exposure at the dwelling facade and sleep problems. Measures of sleep problems were collected by questionnaire with two questions: "Do you in general get up tired and not well rested in the morning?" and "Do you often use sleep medication or tranquilizers?" After adjustment for potential confounders, a significant association was found between noise exposure and the risk of getting up tired and not rested in the morning. Although prevalence of medication use was higher at higher noise levels compared to the reference category (L(night)<35 dB), after adjustment for covariates this association was not significant. Long-term road traffic noise exposure is associated with increased risk of getting up tired and not rested in the morning in the general population. This result extends the earlier established relationship between long-term noise exposure and self-reported sleep disturbance assessed with questions that explicitly referred to noise and indicates that road traffic noise exposure during the night may have day-after effects.

Effects of Prior Authorization on Medication Discontinuation Among Medicaid Beneficiaries With Bipolar Disorder

Few data exist on the cost and quality effects of increased use of prior-authorization policies to control psychoactive drug spending among persons with serious mental illness. This study examined the impact of a prior-authorization policy in Maine on second-generation antipsychotic and anticonvulsant utilization, discontinuations in therapy, and pharmacy costs among Medicaid beneficiaries with bipolar disorder. Using Medicaid and Medicare utilization data for 2001-2004, the authors identified 5,336 patients with bipolar disorder in Maine (study state) and 1,376 in New Hampshire (comparison state). With an interrupted time-series and comparison group design, longitudinal changes were measured in second-generation antipsychotic and anticonvulsant use; survival analysis was used to examine treatment discontinuations and rates of switching medications. The prior-authorization policy resulted in an 8-percentage point reduction in the prevalence of use of nonpreferred second-generation antipsychotic and anticonvulsant medications (those requiring prior authorization) but did not increase use of preferred agents (no prior authorization) or rates of switching. The prior-authorization policy reduced total pharmacy reimbursements for bipolar disorder by $27 per patient during the eight-month policy period. However, the hazard rate of treatment discontinuation (all bipolar drugs) while the policy was in effect was 2.28 (95% confidence interval=1.36-4.33) higher than during the prepolicy period, with adjustment for trends in the comparison state. The small reduction in pharmacy spending for bipolar treatment after the policy was implemented may have resulted from higher rates of medication discontinuation rather than switching. The findings indicate that the prior-authorization policy in Maine may have increased patient risk without appreciable cost savings to the state.

Medication Use by Athletes at the Athens 2004 Summer Olympic Games

To gather data and examine the use by elite Olympic athletes of food supplements and pharmaceutical preparations in total and per sport, country, and gender. Survey study. Athens 2004 Olympic Games (OG). Data from 2 sources were collected: athletes' declaration of medications/supplements intake recorded on the Doping Control Official Record during sample collection for doping control, and athletes' application forms for granting of a therapeutic use exemption (TUE) and through the abbreviated TUE process (aTUE). Classification of declared food supplements according to the active ingredient and medications according to therapeutic actions and active compounds. 24.3% of the athletes tested for doping control declared no use of medications or food supplements. Food supplements (45.3%) continue to be popular, with vitamins (43.2%) and proteins/aminoacids (13.9%) in power sports being most widely used. Nonsteroidal antiinflammatory agents and analgesics were also commonly used by athletes (11.1% and 3.7%, respectively). The use of the hemoderivative actovegin and several nonprohibited anabolic preparations are discussed. The prevalence of medication use for asthma and the dangers of drug interactions are also presented.Laboratory analysis data reveal that of the aTUEs received for inhaled glucocorticosteroids, only budesonide was detectable in significant percentage (10.0%). Only 6.5% of the 445 athletes approved to inhale beta2-agonists led to an adverse analytical finding. This review demonstrates that overuse of food supplements was slightly reduced compared to previous OGs and a more rational approach to the use of medication is being adopted.

Use of Prescription and Over-the-counter Medications and Dietary Supplements Among Older Adults in the United States

Despite concerns about drug safety, current information on older adults' use of prescription and over-the-counter medications and dietary supplements is limited. To estimate the prevalence and patterns of medication use among older adults (including concurrent use), and potential major drug-drug interactions. Three thousand five community-residing individuals, aged 57 through 85 years, were drawn from a cross-sectional, nationally representative probability sample of the United States. In-home interviews, including medication logs, were administered between June 2005 and March 2006. Medication use was defined as prescription, over-the-counter, and dietary supplements used "on a regular schedule, like every day or every week." Concurrent use was defined as the regular use of at least 2 medications. Population estimates of the prevalence of medication use, concurrent use, and potential major drug-drug interactions, stratified by age group and gender. The unweighted survey response rate was 74.8% (weighted response rate, 75.5%). Eighty-one percent (95% confidence interval [CI], 79.4%-83.5%) used at least 1 prescription medication, 42% (95% CI, 39.7%-44.8%) used at least 1 over-the-counter medication, and 49% (95% CI, 46.2%-52.7%) used a dietary supplement. Twenty-nine percent (95% CI, 26.6%-30.6%) used at least 5 prescription medications concurrently; this was highest among men (37.1%; 95% CI, 31.7%-42.4%) and women (36.0%; 95% CI, 30.2%-41.9%) aged 75 to 85 years. Among prescription medication users, concurrent use of over-the-counter medications was 46% (95% CI, 43.4%-49.1%) and concurrent use of dietary supplements was 52% (95% CI, 48.8%-55.5%). Overall, 4% of individuals were potentially at risk of having a major drug-drug interaction; half of these involved the use of nonprescription medications. These regimens were most prevalent among men in the oldest age group (10%; 95% CI, 6.4%-13.7%) and nearly half involved anticoagulants. No contraindicated concurrent drug use was identified. In this sample of community-dwelling older adults, prescription and nonprescription medications were commonly used together, with nearly 1 in 25 individuals potentially at risk for a major drug-drug interaction.

Parent-Reported Medication Use in a Head Start Population

This study investigates the prevalence of medication use within a Head Start population. Parent-reported data (N = 1,397) from initial enrollment information indicated 6.8% of children were taking 34 different types of medication. More than two thirds (69%) of those on medication were prescribed more than one medication, and more than one third (37%) were taking three or more medications. The majority of children were reported to be taking medications that were asthma (88%) or allergy (17%) related. Psychotropic medications accounted for 4% of the medications, indicating a prevalence of less than 0.3%. African American and Hispanic children were overrepresented in those taking medicines. School nurses can work with parents and caregivers of Head Start children by raising awareness of (1) the benefits and side effects of medications commonly taken within this population, (2) the significant role that asthma medications play in low-income areas, and (3) the issues and challenges associated with polypharmacy practices.

Prescribers??? Knowledge of and Sources of Information for Potential??Drug-Drug Interactions

Given the high prevalence of medication use in the US, the risk of drug-drug interactions (DDIs) and potential for patient harm is of concern. Despite the rise in technologies to identify potential DDIs, the ability of physicians and other prescribers to recognize potential DDIs is essential to reduce their occurrence. The objectives of this study were to assess prescribers' ability to recognize potential clinically significant DDIs and to examine the sources of information they use to identify potential DDIs and prescribers' opinions on the usefulness of various DDI information sources. A postal questionnaire was developed to assess prescriber knowledge of medications that may interact and prescribers' usual sources of DDI information. Recipients were asked to classify 14 drug pairs as 'contraindicated', 'may be used together but with monitoring' or 'no interaction'. A response option of 'not sure' was also provided. The questionnaires were sent to a national sample of 12 500 prescribers based on past history of prescribing drugs associated with known potential for DDI, who were identified using data from a pharmacy benefit manager covering over 50 million individuals. Usable questionnaires were obtained from 950 prescribers. The percentage of prescribers who correctly classified specific drug pairs ranged from 18.2% for warfarin and cimetidine to 81.2% for paracetamol (acetaminophen) with codeine and amoxicillin, with 42.7% of all combinations classified correctly. The number of drug pairs correctly classified by the prescribers ranged from 0 to 13. For half of the drug pairs over one-third of the respondents answered 'not sure'; among those drug pairs, two were contraindicated. When asked what source was used to learn more about a potential DDI, a quarter of the prescribers reported using personal digital assistants and another quarter used printed material. The majority of the prescribers (68.4%) reported that they were usually informed by pharmacists about their patients' potential exposure to DDIs. Compared with the prescribers who used other sources, those who used computerized DDI alerts as their usual source of DDI information consistently gave a lower rating score to the five statements that assessed the usefulness of the information. This study suggests that prescribers' knowledge of potential clinically significant DDIs is generally poor. These findings are supported by other research and emphasize the need to develop systems that alert prescribers about potential interactions that are clinically relevant. Physicians most commonly reported learning about potential DDIs from pharmacists, suggesting further work is needed to improve the drug-prescribing process to identify potential safety issues earlier in the medication use process.

Clinical Efficacy of Probiotic Bifidobacterium longum for the Treatment of Symptoms of Japanese Cedar Pollen Allergy in Subjects Evaluated in an Environmental Exposure Unit

Japanese cedar pollinosis (JCPsis) affects nearly one in six Japanese. Oral administration of Bifidobacterium longum BB536 has been shown to be effective in relieving JCPsis symptoms during the pollen season. This double- two-way crossover study was designed to evaluate the efficacy of BB536 on reducing symptoms in JCPsis patients exposed to Japanese cedar pollen (JCP) in an environmental exposure unit (EEU) outside of the normal JCP season. After a 1-week run-in period, subjects (n=24) were randomly allocated to receive BB536 powder (approximately 5x1010) or placebo twice a day for 4 weeks. After a 2-week washout period, subjects were crossed over to another 4 weeks of intake. At the end of each intake period, subjects received controlled JCP exposure for 4 hours in the EEU. Symptoms were self-rated 30 minutes before and every 30 minutes during the exposures. From the first day of exposure through the next 5 successive days, participants self-rated their delayed symptoms and medication uses. Blood samples were taken before the exposures. The mean JCP levels for exposures were 6500 to 7000 grains/m3 air. In comparison with placebo, BB536 intake significantly reduced the ocular symptom scores during JCP exposures. Evaluating delayed symptoms after exposures indicated that scores for disruption of normal activities were significantly lower in the BB536 group compared with the placebo group. Prevalence of medication use was markedly reduced by BB536 intake. These results suggest the potential beneficial effect of BB536 in relieving symptoms of JCP allergy.

Prevalência e fatores determinantes do consumo de medicamentos no Município de Fortaleza, Ceará, Brasil

The objective of this work was to investigate the prevalence and determinants of medicines consumption in Fortaleza, Ceará, Brazil. A population-based cross-sectional study was carried out in a representative sample of 331 households. A total of 1,370 persons living in Fortaleza were interviewed from October 2002 to January 2003, and 1,366 were selected for this study. Consumers were defined as all persons having used one or more drugs during the preceding 15 days. The prevalence of medicine consumption was 49.7%. The following were the predictive factors for medicines consumption according to the multivariate logistic regression analysis: family income > 3 minimum wages, older age ( > or = 50), female gender, > or = 3 persons living in household, chronic disease, having a health insurance plan, and one or more visits to the doctor in the last three months. Prevalence of medication use was high in Fortaleza but was similar to that found elsewhere in Brazil and in other countries. Inequality in the access of medications was identified.

Secondary prevention of coronary heart disease in older British men: extent of inequalities before and after implementation of the National Service Framework.

Deficiencies in implementation of secondary prevention of coronary heart disease (CHD) have been identified. We explored the extent of medication use for secondary prevention of CHD since the introduction of the National Service Framework (NSF) for CHD and the influence of patient age, social class, region and time since diagnosis in older British men. Prospective study in 24 British towns using patient information on medication use in 1998-2000 and 2003. Subjects were men with medically recorded diagnosis of myocardial infarction or angina, aged 62-85 years in 2003. Prevalence of medication use (aspirin, statins, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers) in 1998-2000 and 2003 was ascertained. Prevalence of use of all drugs increased in 2003 and was markedly higher in patients with a history of myocardial infarction than angina. Older age was related to lower prevalence of drug use, particularly statins. In 2000, older subjects (74-85 years) were 60% [95% confidence interval (CI) = 41-72 per cent] less likely to receive statins compared with younger subjects (62-73 years); this pattern changed very little between 2000 and 2003. Although social class appeared to have little relation to drug use, the prevalence of use of all medications decreased with increasing time since diagnosis. Although the uptake of medications for secondary prevention in CHD patients increased since the NSF in 2000, marked age inequalities in statin use were present both in 1998-2000 and 2003. Further action is needed to reduce these inequalities, because older patients are at particularly high risk of recurrent and fatal CHD.

Reliability of Group Health Cooperative automated pharmacy data by drug benefit status

Evaluate the reliability of health plan pharmacy records in determining medication use among seniors with and without a drug benefit. Subjects included 3610 seniors, enrolled in Group Health Cooperative's Medicare (GHC) + Choice program during 1998-1999, receiving care in an integrated group practice (IGP), and diagnosed with one or more of four chronic conditions (hypertension, diabetes, congestive heart failure, and coronary artery disease). We compared pharmacy records to self-reported medication use for antidepressant, antihypertensive, acid suppressant, cardiac, diabetic, hormone, and lipid lowering drugs. Agreement between pharmacy records and self-report was substantial to almost perfect (prevalence-adjusted and bias-adjusted kappa (PABAK) range: 0.69 for antihypertensives to 0.95 for cardiac agents) among seniors with a drug benefit. Agreement was slightly less for seniors without a drug benefit (PABAK range: 0.51 for antihypertensives to 0.92 for cardiac agents) and differences varied by drug class. Among seniors without a benefit, the prevalence of medication use was lower when based on pharmacy records than when based on self-report for all medication classes of interest. While GHC may not be representative of all health plans, our study indicates that health plan pharmacy records are a reliable source of data for seniors receiving care within an IGP. However, the reliability of pharmacy records appears better among seniors with a drug benefit. Researchers should consider factors such as drug benefit status when conducting studies using pharmacy data. More studies are needed in different populations and delivery systems, as well as over varied types of drug benefits.

The Effects of Exercise on Markers of Lipid Peroxidation in Renal Dialysis Patients Compared with Control Subjects

The purpose of this study was to compare the susceptibility to exercise-induced lipid peroxidation of patients on chronic maintenance dialysis (CMD) and non-CMD control subjects. Cross-sectional comparison of exercise-induced changes in breath ethane and pentane flux between patients on CMD (group A) and an age-, gender-, medical diagnosis-, smoking-, and ethanol consumption-matched comparison group (group B). Breath ethane and pentane were measured at rest before exercise, during cardiopulmonary exercise stress testing (CPX) at lactic acidosis threshold (Vo2lat), and 5 minutes after CPX. Group comparisons of clinical characteristics reveal that the groups were similar in terms of age, ethnicity, comorbid diagnoses, prevalence of medication use, BMI, measurements of aerobic exercise capacity, cigarette smoking and ethanol consumption behaviors. All subjects successfully completed the CPX protocol achieving Vo2lat. There were significant differences in breath ethane flux between group A and B subjects, with greater pre-exercise, Vo2lat, and postexercise ethane levels in group A compared with group B subjects, and significant group differences, with lower breath ethane/pentane flux ratios at rest, Vo2lat, and recovery with lower ratios in group B than group A subjects. This study shows that patients on CMD have greater lipid peroxidation compared with control subjects at rest and during and after physical exercise. In addition, compared with control subjects, patients on CMD preferentially peroxidize n-3 polyunsaturated fatty acids at rest and during physical exercise and recovery. The lipid peroxidation profile may result in an unfavorable endoperoxide shift and should be evaluated further, along with modalities to reduce oxidative stress among patients on CMD.