Prescription Redemption Research Articles

Non‐steroidal anti‐inflammatory drug use and risk of venous thromboembolism

The association between the use of non-selective non-steroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase-2-selective inhibitors (COX2Is) and the risk of venous thromboembolism (VTE) remains unclear. To examine this association. We conducted a population-based case-control study in northern Denmark (population of 1.7 million). Using the National Patient Registry, we identified patients with a first hospital VTE diagnosis during 1999-2006 (n = 8368) and their comorbidities. For each case, we selected 10 controls (n = 82, 218) matched by age and sex. From the prescription database, we ascertained the use of NSAIDs at the time of diagnosis (current use) or before (recent use), and comedications. Current use was further classified as new use (first-ever prescription redemption within 60 days before diagnosis date) or long-term use. We used odds ratios from a logistic regression model to estimate incidence rate ratios (IRRs) with 95% confidence intervals (CIs). As compared with no use, the adjusted IRR associating current non-selective NSAID use with VTE was 2.51 (95% CI 2.29-2.76), and that for current COX2I use was 2.19 (95% CI 1.99-2.41). Recent users had substantially smaller increases than current users. The adjusted IRRs among long-term users were 2.06 for non-selective NSAIDs (95% CI 1.85-2.29) and 1.92 for COX2Is (95% CI 1.72-2.15). Similarly increased risks were found for unprovoked VTE (occurrence in the absence of pregnancy, cancer, major trauma, fracture or surgery within 3 months preceding the VTE), deep vein thrombosis, pulmonary embolism, and individual NSAIDs. The use of non-selective NSAIDs or COX2Is was associated with a two-fold or more increased risk of VTE.

Adherence to guidelines in people with screen-detected type 2 diabetes, ADDITION, Denmark

Objective. In people with screen-detected type 2 diabetes in primary care, (1) to assess adherence to guidelines, recommending consultation with the GP every three months and treatment initiation with an ACE inhibitor or an angiotensin-II receptor antagonist when systolic BP was > 120 mmHg and/or diastolic BP was > 80 mmHg, and (2) to identify predictors for adherence. Design. Prospective follow-up of a fixed cohort of patients. Setting. Fifty-four Danish general practices. Subjects and main outcome measures. A total of 361 people with screen-detected type 2 diabetes were followed up for 410 days to assess planned consultations with their GP and recording of BP. Some 226 people, with BP recorded above guideline threshold(s) and where treatment was not already initiated, were followed for up to 410 days to monitor prescription redemption. Results. At 3, 6, 9 and 12 months 80%, 77%, 74%, and 73% of the cohort attended a consultation. A total of 89% of the cohort attended two of the four planned consultations. The probability of redeemed prescriptions for an ACE inhibitor or an angiotensin-II receptor antagonist according to the guideline during the first year following diagnosis was 51%. High initial BP was associated with prescription redemption. No other analysed individual or organisational characteristics were found to be associated with treatment initiation. Conclusion. The consultation attendance was reasonably high, and treatment initiation with an ACE inhibitor or an angiotensin-II receptor antagonist according to the guideline was found in half of the cases. High initial BP increased the probability of treatment initiation.

One in 3 prescriptions are never redeemed: Primary nonadherence in an outpatient clinic

Despite being essential to medication adherence, redemption of initial prescriptions (ie, primary adherence) has been investigated only sparsely. The objectives were to determine the frequency and risk factors for primary nonadherence among outpatients with dermatologic conditions. Every 15th day during 2006, all patients receiving a prescription for an initial treatment with a previously untried medication were studied. Redemptions were traced in an electronic register after 4 weeks. Exclusions were a result of identical treatments within the last 6 months or hospitalizations within 4 weeks. In all, 30.7% of the 322 eligible patients did not collect their medication. Patients with psoriasis were least adherent with nearly 50% of the prescriptions being unredeemed. Only initial prescriptions for previously untried medications issued to hospital outpatients were studied. For the clinician, primary nonadherence is an essential differential diagnosis when a given therapy fails.

ABS004: The concept, prevalence and consequences of low tolerance to ICS in asthma

Introduction:The concept of low tolerance to ICS can be extended beyond the experience of side effects to include conceptual barriers such as doubts about personal need for ICS, and concerns about ICS.Aims and objectives:To assess the prevalence of low tolerance to ICS and consequences in terms of ICS adherence and asthma control.Subjects and methods:2372 patients managed in primary care at steps 2 and 3 of the asthma guidelines who participated in the Asthma Control, Concordance and Tolerance (ACCT) initiative and completed the Minimum Asthma Assessment Tool (MAAT) [1] and Asthma Control Questionnaire (ACQ) [2]. ICS adherence was measured by validated self-report [1], cross-checked against prescription redemption data.Results:Prevalence of low tolerance to ICS Experiential – Patients attributed bothersome symptoms to ICS: cough (31.5%), hoarse voice (20.6%), sore mouth (17.3%), weight gain (12%), bruising (9.4%), dental decay (9.3%), and oral thrush (8.8%). Conceptual- 21.4% reported concerns about ICS (e.g. long term effects, dependency, difficult to use and inconvenient) and 17.8% had doubts about their need for ICS.Consequences of low tolerance Low adherence to ICS (38.3%) was associated with the attribution of bothersome symptoms to ICS (t = 3.06; p< 0.005), doubts about personal need for ICS (t = 20.83; p< 0.001) and ICS concerns (t = 7.10; p < 0.001). ICS non-adherence was related to poor asthma control (ACQ t = 3.83; p< 0.001).Conclusions:Experiential and conceptual indicators of low tolerance to ICS were prevalent and associated with low adherence to ICS and hence asthma control. Conflict of interest and funding ACCT is supported by an unrestricted educational grant from ALTANA Pharma.

Do maternal characteristics influence the relationship between obstetric complications and schizophrenia?

Early onset schizophrenia (EOS) begins in childhood or adolescence. EOS is associated with poor treatment response and may benefit from timely use of clozapine. This study aimed to identify the predictors of clozapine use in EOS and characterize the clinical profile and outcome of clozapine-treated youths with schizophrenia. We conducted a nationwide population-based study using linked data from Danish medical registries. We examined all incident cases of EOS (i.e., cases diagnosed prior to their 18th birthday) between December 31st 1994 and December 31st 2006 and characterized their demographic, clinical and treatment profiles. We then used multivariable cox proportional hazard models to identify predictors of clozapine treatment in this patient population. We identified 662 EOS cases (1.9% of all schizophrenia cases), of whom 108 (17.6%) had commenced clozapine by December 31st 2008. Patients had on average 3 antipsychotic trials prior to clozapine initiation. The mean interval between first antipsychotic treatment and clozapine initiation was 3.2 (2.9) years. Older age at diagnosis of schizophrenia [HR=1.2, 95% CI (1.05–1.4), p=0.01], family history of schizophrenia [HR=2.1, 95% CI (1.1–3.04), p=0.02] and attempted suicide [HR=1.8, 95% CI (1.1–3.04), p=0.02] emerged as significant predictors of clozapine use. The majority of patients (n=96, 88.8%) prescribed clozapine appeared to have a favorable clinical response as indicated by continued prescription redemption and improved occupational outcomes. Our findings support current recommendations for the timely use of clozapine in EOS.

Obstetric complications in schizophrenia

Early onset schizophrenia (EOS) begins in childhood or adolescence. EOS is associated with poor treatment response and may benefit from timely use of clozapine. This study aimed to identify the predictors of clozapine use in EOS and characterize the clinical profile and outcome of clozapine-treated youths with schizophrenia. We conducted a nationwide population-based study using linked data from Danish medical registries. We examined all incident cases of EOS (i.e., cases diagnosed prior to their 18th birthday) between December 31st 1994 and December 31st 2006 and characterized their demographic, clinical and treatment profiles. We then used multivariable cox proportional hazard models to identify predictors of clozapine treatment in this patient population. We identified 662 EOS cases (1.9% of all schizophrenia cases), of whom 108 (17.6%) had commenced clozapine by December 31st 2008. Patients had on average 3 antipsychotic trials prior to clozapine initiation. The mean interval between first antipsychotic treatment and clozapine initiation was 3.2 (2.9) years. Older age at diagnosis of schizophrenia [HR=1.2, 95% CI (1.05–1.4), p=0.01], family history of schizophrenia [HR=2.1, 95% CI (1.1–3.04), p=0.02] and attempted suicide [HR=1.8, 95% CI (1.1–3.04), p=0.02] emerged as significant predictors of clozapine use. The majority of patients (n=96, 88.8%) prescribed clozapine appeared to have a favorable clinical response as indicated by continued prescription redemption and improved occupational outcomes. Our findings support current recommendations for the timely use of clozapine in EOS.