Prescribing and pharmacotherapeutics最新文献

{"title":"Examining opioid dose reductions by sex and race in a cohort of patients in a Family Medicine training practice","authors":"Colleen Fogarty, Jefferson Hunter, Kevin Fiscella, Yasin Mohamed, Mechelle Sanders","doi":"10.1370/afm.22.s1.5176","DOIUrl":"https://doi.org/10.1370/afm.22.s1.5176","url":null,"abstract":"Context The 2022 Centers for Disease Control’s “Clinical Practice Guidelines for Prescribing Opioids for Pain in United States” called for attention and action toward reducing disparities in untreated and undertreated pain among Black and Latino patients. There is growing evidence on the potential for controlled substance safety committees (CSSC) to change prescribing culture, but few have been examined through the lens of health equity. Objective Our study aimed to determine the impact of a primary care based CSSC on opioid prescribing, including by patients’ race and sex. Study Design and Analysis We conducted a retrospective cohort study. Setting or Dataset Large Family Medicine residency practice in the Eastern United States. Population Studied Patients of the practice prescribed opioid medications who remained in the practice between 2017-2021. Intervention/Instrument Patient registry of opioid medications, over four years. Outcome Measures Our primary outcome was a change in morphine milligram equivalents (MME) from baseline to follow-up, over 3 years. We compared the differences in MME by race and sex at baseline and follow-up. We also examined potential intersectional disparities of race and sex. We used paired t-tests to compare changes in mean MME’s from baseline to follow-up and logistic regression to determine associations between patient characteristics and MME changes. Results There were 93 patients in our cohort. The mean opioid dose decreased from nearly 200 MME at baseline to 136.1 MME at follow-up, p<0.0001. Thirty percent of patients had their dose reduced to under 90 MME by follow-up. The reduction rates by race or sex alone were not statistically significant. There was evidence of intersectional disparities at baseline. On average Black women were prescribed 88.5 fewer MME’s at baseline compared to their White men counterparts, p=0.04. Conclusions Our findings add to the previously documented success of CSSCs in reducing opioid doses for chronic nonmalignant pain to safer levels. We highlight an opportunity for primary care based CSSCs to lead the efforts to identify and address chronic pain management inequities.","PeriodicalId":227441,"journal":{"name":"Prescribing and pharmacotherapeutics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139305891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulatory Medication Safety Events Before and After the COVID-19 Shutdown","authors":"Richard A Young, Anna Espinoza, Kimberly Fulda, Yan Xiao","doi":"10.1370/afm.22.s1.5155","DOIUrl":"https://doi.org/10.1370/afm.22.s1.5155","url":null,"abstract":"","PeriodicalId":227441,"journal":{"name":"Prescribing and pharmacotherapeutics","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139299148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and risk factors for prescription medication sharing in the UK general population","authors":"Shoba Dawson, Deborah McCahon","doi":"10.1370/afm.22.s1.5278","DOIUrl":"https://doi.org/10.1370/afm.22.s1.5278","url":null,"abstract":"","PeriodicalId":227441,"journal":{"name":"Prescribing and pharmacotherapeutics","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139294254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription medication sharing for non-recreational purposes: A systematic review of the literature","authors":"Shoba Dawson","doi":"10.1370/afm.22.s1.5269","DOIUrl":"https://doi.org/10.1370/afm.22.s1.5269","url":null,"abstract":"Context Prescription medication sharing is defined as the lending or borrowing of prescription medications where the recipient of those medicines is someone other than the person for whom the prescription is intended. Sharing of prescription medication can cause significant harm to the individuals who engage in these practices. Adverse consequences include increased risk of side effects, delayed health seeking, masking of the symptoms and severity of disease. Prevalence estimates vary across different populations, and peoples’ reasons for sharing and their perceptions of risks from sharing are poorly understood. Objective We conducted a systematic review to investigate types of prescribed medication shared, factors that influence this behaviour, including reasons for sharing and the consequences and impact of these practices, including potential harms and risks. Study design and Analysis Systematic review. Population and Setting People of any age and in any setting. Primary studies that investigated non-recreational","PeriodicalId":227441,"journal":{"name":"Prescribing and pharmacotherapeutics","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139295995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the risk of QT prolongation in primary care","authors":"Vishal Bhella, Divya Garg","doi":"10.1370/afm.22.s1.5351","DOIUrl":"https://doi.org/10.1370/afm.22.s1.5351","url":null,"abstract":"","PeriodicalId":227441,"journal":{"name":"Prescribing and pharmacotherapeutics","volume":"189 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139292026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality risk associated with dose tapering among patients prescribed long-term opioid therapy","authors":"A. Agnoli, Daniel Tancredi, Elizabeth Magnan, Joshua Fenton","doi":"10.1370/afm.22.s1.5300","DOIUrl":"https://doi.org/10.1370/afm.22.s1.5300","url":null,"abstract":"","PeriodicalId":227441,"journal":{"name":"Prescribing and pharmacotherapeutics","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139291232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of dementia associated with bladder anticholinergic drugs: a case-control study of older adults in UK primary care","authors":"Barbara Iyen, Delia Bishara, Tom Dening, Carol Coupland, Anthony Avery","doi":"10.1370/afm.22.s1.5573","DOIUrl":"https://doi.org/10.1370/afm.22.s1.5573","url":null,"abstract":"","PeriodicalId":227441,"journal":{"name":"Prescribing and pharmacotherapeutics","volume":"193 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139299330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inappropriate antivertiginous drug prescribing for patients with vestibular symptoms in primary care","authors":"Hà Ngo, Otto R. Maarsingh, Pauline Slottje, Marco H. Blanker, F. Groenhof, J. Bont, Vincent A. van Vugt","doi":"10.1370/afm.22.s1.5004","DOIUrl":"https://doi.org/10.1370/afm.22.s1.5004","url":null,"abstract":"","PeriodicalId":227441,"journal":{"name":"Prescribing and pharmacotherapeutics","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139293407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulatory medication safety in primary care – A systematic review of its measurements and outcomes","authors":"Richard A Young, Timothy Kenny, Noah Hendrix, Anna M. Espinoza, Kimberly G. Fulda, Yan Xiao, Ayse P Gurses","doi":"10.1370/afm.20.s1.2821","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2821","url":null,"abstract":"Context: Medication safety is a concern in primary care, but its measurement may be complex and implications uncertain. Objective: To review of the literature of medication safety in primary care in the electronic health record era, examining the definitions and instruments used, and the primary outcomes. Study Design and Analysis: Systematic Review Dataset: Medline, EMBASE, and SCOPUS from January 1999 to December 2020, supplemented with hand searches. Included Studies: Studies measuring rates and outcomes of medication errors in primary care clinics with electronic prescribing managed by primary care physicians/teams. 4 investigators independently reviewed titles and analyzed abstracts with dual-reviewer review for eligibility, characteristics, and risk of bias. All identified observational studies were determined to be at low risk of bias, there were some biases in the intervention studies. Results: Of 1,464 articles identified, 56 met the inclusion criteria. 42 studies were observational and 14 included an intervention. The majority of the studies (29) used their own definition of error. Others used Beers list (1 4), Screening Tool of Older Persons’ Prescriptions (STOPP) (13), and other definitions (including 10 studies that used more than one method). The most common outcomes were potentially inappropriate prescribing/medications (PIP) (42), adverse drug events (ADEs) (12), and potential prescribing omissions (PPO) (5). Most of the studies only included high-risk sub-populations (38), usually older adults taking > 4 medications. The rate of PIPs varied widely (0.19% to 98.2%). High-risk populations with measurements of multiple clinic visits yielded the highest PIP rates. The rate of ADEs was lower (0.47% to 14.7%). Less commonly measured outcomes were ED visits and hospitalization associated with ADEs (6). No studies adjusted results for","PeriodicalId":227441,"journal":{"name":"Prescribing and pharmacotherapeutics","volume":"279 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127285581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of using pharmacogenetic testing with clinical decision support system in private GP clinics in singapore","authors":"M. Dawes, Xin Hui Sam, Helen Smith, Michael Winther","doi":"10.1370/afm.20.s1.2912","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2912","url":null,"abstract":"Primary care provides patients with immediate care at the first line of treatment. There are about 1,700 private general practitioner (GP) clinics providing 80% of the primary care services in Singapore. These GPs prescribe medications based on standard therapy and dosing guidelines. Medication change or dose modification will take place if the patient is unresponsive or experiences side effects. This conventional “trial -and- error” process of drug optimization is associated with increased cost, and subjects patients to risk of adverse drug reactions (ADRs). Pharmacogenetics offers personalized medicine based on genetic profile for optimal medication choice, reducing unnecessary healthcare utilization, ADRs and polypharmacy. We conducted a feasibility study in private GP practices of the utilization of pharmacogenetic testing and clinical decision support software (CDSS) in the management of patients with ≥1 common chronic diseases. The primary outcomes were adequacy of DNA in the samples collected by GPs and the number of clinically actionable variants among participants. The pharmacogenetic test panel was selected based on accuracy, speed of delivery and cost. Testing of the DNA was provided by the Genome Institute of Singapore using an Illumina array. Data on the selected single nucleotide polymorphisms were incorporated into the CDSS. Seven GPs from six private practices took part in the study. The buccal samples were taken by GPs within the GP consultation. GPs successfully identified, consented and obtained buccal samples from 189 patients. Of the 189 samples, 188 (99.5%) were successfully genotyped with sufficient DNA yield from first sample collection attempt. For the sample yielding insufficient DNA, a second sample was successfully genotyped. Two thirds of the participants had two or more morbidities requiring pharmacological treatment. Half of all participants had three or more clinically actionable pharmacogenetic variants as defined by Clinical Pharmacogenetics Implementation Consortium, Dutch Pharmacogenetics","PeriodicalId":227441,"journal":{"name":"Prescribing and pharmacotherapeutics","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121002050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}