处方层面对2018-2019年缬沙坦、厄贝沙坦和氯沙坦召回和药物短缺的反应:一项全国性研究

IF 2.8 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Katherine Callaway Kim, Julie M Donohue, Eric T Roberts, Chester B Good, Lindsay M Sabik, Katie J Suda
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引用次数: 0

摘要

背景:2018-2019年,缬沙坦、氯沙坦和厄贝沙坦三种血管紧张素受体- ii阻滞剂(arb)在因成分杂质召回后出现全球短缺。提供者对美国ARB短缺的反应以及对其他抗高血压药物类别的溢出效应尚不清楚。目的:评估2018-2019年召回和短缺后18个月内arb和非arb抗高血压药物处方的变化。研究设计:使用全付款药房索赔的处方者的国家队列研究。混合中断时间序列模型量化了处方短缺后的变化和按专科、地区、医学院毕业队列、性别和召回前处方水平的异质性变化。患者和方法:2018-2019年缬沙坦、厄贝沙坦和氯沙坦短缺的活跃供应商(定义为2017年这些药物的前25百分位)。措施:类内arb处方的变化(召回和未召回)。非arb抗高血压药物(ACE-Is, α -和β -肾上腺素阻滞剂,钙通道阻滞剂,利尿剂和其他药物)的类间替代。结果:在符合纳入标准的138032名处方者中,缬沙坦在2018年7月被召回后,处方者的处方填充量减少了57%-59%。我们观察到氯沙坦和厄贝沙坦填充剂同时增加,ARB的总体处方没有变化。ACE-Is或其他抗高血压药物的充盈量无明显变化。缬沙坦填充的绝对减少在基线水平较高的提供者中最大。然而,相对变化没有因处方者特征而异。结论:在这一处方水平的全国性研究中,缬沙坦被召回后,其他arb的替代缓解了缬沙坦填充剂的减少。对非arb抗高血压患者没有溢出效应。在药物短缺期间,接近替代品的可用性可以减轻处方者及其患者在获取方面的差距。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prescriber-Level Responses to the 2018-2019 Valsartan, Irbesartan, and Losartan Recalls and Drug Shortages: A National Study.

Background: Global shortages for 3 angiotensin receptor-II blockers (ARBs)-valsartan, losartan, and irbesartan-occurred in 2018-2019 after recalls due to ingredient impurities. Provider-level responses to the ARB shortages in the United States and spillovers to other antihypertensive classes are unknown.

Objective: To estimate changes in provider-level prescribing for ARBs and non-ARB antihypertensives up to 18 months after the 2018-2019 recalls and shortages.

Research design: National cohort study of prescribers using all-payer pharmacy claims. Mixed interrupted time series models quantified changes in prescribing postshortages and heterogeneous changes by specialty, region, medical school graduation cohort, sex, and level of prerecall prescribing.

Patients and methods: Active providers exposed to the 2018-2019 valsartan, irbesartan, and losartan shortages (defined as top-25th percentile for these drugs in 2017).

Measures: Within-class changes in prescribing for ARBs (recalled and nonrecalled). Between-class substitutions to non-ARB antihypertensives (ACE-Is, alpha- and beta-adrenergic blockers, calcium channel blockers, diuretics, and other agents).

Results: Among 138,032 prescribers who met the inclusion criteria, per-prescriber fills for valsartan decreased by 57%-59% after it was recalled in July 2018. We observed concurrent increases for losartan and irbesartan fills and no change in overall ARB prescribing. There were no significant changes in fills for ACE-Is or for other antihypertensives. Absolute decreases in valsartan fills were greatest among providers with higher levels of prescribing at baseline. However, relative changes did not differ by prescriber characteristics.

Conclusions: In this prescriber level, national study, substitutions to other ARBs mitigated decreases in valsartan fills after it was recalled. There were no spillovers to non-ARB anti-hypertensives. The availability of close substitutes during drug shortages may mitigate gaps in access for prescribers and their patients.

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来源期刊
Medical Care
Medical Care 医学-公共卫生、环境卫生与职业卫生
CiteScore
5.20
自引率
3.30%
发文量
228
审稿时长
3-8 weeks
期刊介绍: Rated as one of the top ten journals in healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of healthcare. This timely journal reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services.
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