Evaluating Provider and Pharmacy Discordance in Potential Calcium Channel Blocker-Loop Diuretic Prescribing Cascade.

IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY
Drugs & Aging Pub Date : 2024-02-01 Epub Date: 2024-01-22 DOI:10.1007/s40266-023-01091-9
Asinamai M Ndai, Earl J Morris, Almut G Winterstein, Scott M Vouri
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引用次数: 0

Abstract

Background: Prescribing cascades occur when a drug-induced adverse event is treated with a new medication. Identifying clinical scenarios in which prescribing cascades are more likely to occur may help determine ways to prevent prescribing cascades.

Objective: To understand the extent to which discordant providers and discordant pharmacies contribute to the dihydropyridine calcium channel blocker (DH CCB)-loop diuretic prescribing cascade.

Study population and design: A retrospective cohort study using Medicare Fee-For-Service data (2011-2018) of adults aged ≥ 66 years.

Exposures: Patients who initiated DH CCB with subsequent initiation of loop diuretic (DH CCB-loop diuretic dyad) within 90 days or patients who initiated angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) with subsequent initiation of a loop diuretic (ACEI/ARB-loop diuretic dyad; control).

Main outcomes: The primary outcomes were provider and pharmacy discordance for prescribing cascades and control drug pairs. Baseline clinical and socio-demographic characteristics were balanced using inverse probability of treatment weighting with propensity scores.

Results:  Overall, we identified 1987 DH CCB-loop diuretic dyads and 3148 ACEI/ARB-loop diuretic dyads. Discordant providers occurred in 64% of DH CCB-loop diuretic dyads and 55% of ACEI/ARB-loop diuretic dyads, while discordant pharmacies occurred in 19% of DH CCB-loop diuretic dyads and 16% of ACEI/ARB-loop diuretic dyads. After adjustment, the risk of having discordant providers was 20% {Relative Risk (RR) 1.20 [95% confidence interval (CI), 1.14-1.26]} higher in the DH CCB-loop diuretic dyad compared with the ACEI/ARB-loop diuretic dyad. Moreover, pharmacy discordance was 17% (RR 1.17 [95% CI 1.02-1.33]) higher.

Conclusion: Our findings suggest that discordant providers and discordant pharmacies were more commonly involved in the potential prescribing cascade when compared with a similar control dyad of medications. Opportunities for enhanced care coordination and medication reconciliation should be explored to prevent unnecessary polypharmacy.

Abstract Image

评估在潜在的钙通道阻滞剂-环利尿剂处方串联中提供商和药房的不一致。
背景:当使用一种新药治疗由药物引起的不良事件时,就会出现处方连环效应。找出更有可能出现处方连环效应的临床情况有助于确定预防处方连环效应的方法:目的:了解不一致的医疗服务提供者和不一致的药房在多大程度上促成了二氢吡啶类钙通道阻滞剂(DH CCB)-环利尿剂处方连环效应:使用医疗保险收费服务数据(2011-2018 年)对年龄≥ 66 岁的成人进行回顾性队列研究:暴露:90天内开始使用DH CCB并随后开始使用襻利尿剂(DH CCB-襻利尿剂二联用药)的患者,或开始使用血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)并随后开始使用襻利尿剂(ACEI/ARB-襻利尿剂二联用药;对照)的患者:主要结果:主要结果是提供者和药房对处方级联和对照药物对的不一致。基线临床和社会人口学特征采用反概率治疗加权与倾向评分进行平衡: 总体而言,我们发现了 1987 个 DH CCB 循环利尿剂配对和 3148 个 ACEI/ARB 循环利尿剂配对。在 64% 的 DH CCB 环路利尿剂队列和 55% 的 ACEI/ARB 环路利尿剂队列中出现了供应商不一致的情况,而在 19% 的 DH CCB 环路利尿剂队列和 16% 的 ACEI/ARB 环路利尿剂队列中出现了药房不一致的情况。经调整后,与 ACEI/ARB 循环利尿剂二联用药相比,DH CCB 循环利尿剂二联用药中出现供应商不一致的风险高出 20% {相对风险 (RR) 1.20 [95% 置信区间 (CI),1.14-1.26]}。此外,药房不一致的比例也高出 17% (RR 1.17 [95% CI 1.02-1.33]):我们的研究结果表明,与类似的药物对照组相比,不一致的医疗服务提供者和不一致的药房更常参与潜在的处方级联。应探索加强护理协调和药物调节的机会,以防止不必要的多药治疗。
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来源期刊
Drugs & Aging
Drugs & Aging 医学-老年医学
CiteScore
5.50
自引率
7.10%
发文量
68
审稿时长
6-12 weeks
期刊介绍: Drugs & Aging delivers essential information on the most important aspects of drug therapy to professionals involved in the care of the elderly. The journal addresses in a timely way the major issues relating to drug therapy in older adults including: the management of specific diseases, particularly those associated with aging, age-related physiological changes impacting drug therapy, drug utilization and prescribing in the elderly, polypharmacy and drug interactions.
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