Long-Term Healthcare Utilization And Prescription Drug Use Of Former Preterm Infants With Respiratory Diseases And Extreme Low Birth Weight

12023 Background: The burden of prescription drug use is higher in cancer survivors than the general population. We examined the prevalence and temporal trends of prescription drug use among cancer survivors, with an emphasis on central nervous system (CNS) active medications used to manage long-term cancer sequelae. Methods: Adult respondents with (n=3207) and without (n=40,440) a prior cancer diagnosis from 8 cycles (2001-2016) of the National Health and Nutritional Examinational Survey (NHANES) were evaluated for prescription drug usage. Cross-sectional analyses and temporal trends across cycles were evaluated and weighted to represent the US adult population. Results: Cancer survivors report higher rates of prescription drug usage (85.1% vs 54.3%, p<0.001, and 75.8%, p<0.001) and polypharmacy (27.8% vs 10.7%, p<0.001, and 22.7%, p<0.001) than both unadjusted and age-adjusted controls. Younger survivors report greater usage of CNS (36.8% vs 13.1%, p<0.001), psychotherapeutic (18.4% vs 7.7%, p<0.001), hormonal agents (19.1% vs 10.1%, p=0.003), and gastrointestinal (10.7% vs 4.7%, p=0.02) than controls, while differences are attenuated in older cohorts. Among broad drug categories, the usage of cardiovascular (p-trend<0.001), metabolic (p-trend<0.001), and immunologic agents (p-trend=0.01) has increased. Among CNS active subclasses, the usage of anticonvulsants (p-trend<0.001), anxiolytics (p-trend =0.02), narcotics (p-trend=0.02) and GABA analogs (p-trend<0.001) has increased. When comparing respondents with and without a history of cancer, the increased usage of anti-depressant prescription medications (18.3% vs 1.5% p<0.001), including SSRIs (11.2% vs 1.0%, p<0.001), SSNRIs (3.5% vs 0.3%, p<0.001), tricyclics (2.8% vs 0.1%, p<0.001), among cancer survivors was disproportionate compared to the increased proportion of positive depression screens (9.2% vs 7.0%, p=0.006). Conclusions: Cancer survivors report higher prescription drug use for both chronic conditions and late effects of cancer. The usage of CNS active medications, many of which are used on and off label for their pain management properties, has increased. The higher rates of pharmaceutical use may result in unanticipated long-term toxicities and financial burdens.

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More than Just a Fad: Building and Maintaining a Small Baby Program

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/11-t-716 ◽

2021 ◽

Vol 40 (4) ◽

pp. 224-232

Author(s):

Ching Ching Tay ◽

Serena de la O ◽

Summer Finn ◽

James Fritzell

Keyword(s):

At Risk ◽

Birth Weight ◽

Survival Rate ◽

Low Birth Weight ◽

Preterm Infants ◽

Continuous Improvement ◽

Extremely Low Birth Weight ◽

Change Model ◽

Model Framework

Survival rate for preterm infants has improved significantly in the last decade because of advancements in care provided by NICUs. Yet, a large proportion of extremely low birth weight (ELBW) infants continue to be at risk of being discharged home from NICUs with long-term co-morbidities. Several centers have introduced and described the concept of a focused program on the care of micro-preemies and demonstrated improved processes as well as outcomes utilizing a continuous improvement approach with adoption of standardized guidelines, checklists, and shared team values. The journey and effort that it takes to develop and sustain such a program have been described less. This article discusses the process of building a Small Baby Program using a change model framework, how the organization and staff bought into the concept, as well as the accomplishments and challenges experienced during the last 3 years as the program continues to evolve and grow.

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Prescription Drug Use, Diagnoses, and Healthcare Utilization among the Elderly

Annals of Pharmacotherapy ◽

10.1345/aph.10351 ◽

2001 ◽

Vol 35 (9) ◽

pp. 1004-1009 ◽

Cited By ~ 167

Author(s):

Tove Jörgensen ◽

Saga Johansson ◽

Anita Kennerfalk ◽

Mari-Ann Wallander ◽

Kurt Svärdsudd

Keyword(s):

Drug Use ◽

Prescription Drug ◽

Healthcare Utilization ◽

The Elderly ◽

Prescription Drug Use

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Comorbidity prevalence, healthcare utilization, and expenditures of Medicaid enrolled adults with autism spectrum disorders

Autism ◽

10.1177/1362361316665222 ◽

2016 ◽

Vol 21 (8) ◽

pp. 995-1009 ◽

Cited By ~ 20

Author(s):

Rini Vohra ◽

Suresh Madhavan ◽

Usha Sambamoorthi

Keyword(s):

Autism Spectrum Disorders ◽

Drug Use ◽

Prescription Drug ◽

Healthcare Utilization ◽

Psychiatric Comorbidity ◽

Autism Spectrum ◽

Office Visits ◽

Adults With Autism ◽

Prescription Drug Use ◽

Spectrum Disorders

A retrospective data analysis using 2000–2008 three state Medicaid Analytic eXtract was conducted to examine the prevalence and association of comorbidities (psychiatric and non-psychiatric) with healthcare utilization and expenditures of fee-for-service enrolled adults (22–64 years) with and without autism spectrum disorders (International Classification of Diseases, Ninth Revision–clinical modification code: 299.xx). Autism spectrum disorder cases were 1:3 matched to no autism spectrum disorder controls by age, gender, and race using propensity scores. Study outcomes were all-cause healthcare utilization (outpatient office visits, inpatient hospitalizations, emergency room, and prescription drug use) and associated healthcare expenditures. Bivariate analyses (chi-square tests and t-tests), multinomial logistic regressions (healthcare utilization), and generalized linear models with gamma distribution (expenditures) were used. Adults with autism spectrum disorders (n = 1772) had significantly higher rates of psychiatric comorbidity (81%), epilepsy (22%), infections (22%), skin disorders (21%), and hearing impairments (18%). Adults with autism spectrum disorders had higher mean annual outpatient office visits (32ASD vs 8noASD) and prescription drug use claims (51ASD vs 24noASD) as well as higher mean annual outpatient office visits (US$4375ASD vs US$824noASD), emergency room (US$15,929ASD vs US$2598noASD), prescription drug use (US$6067ASD vs US$3144noASD), and total expenditures (US$13,700ASD vs US$8560noASD). The presence of a psychiatric and a non-psychiatric comorbidity among adults with autism spectrum disorders increased the annual total expenditures by US$4952 and US$5084, respectively.

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Neonatal hyperglycemia and diminished long-term growth in very low birth weight preterm infants

Journal of Perinatology ◽

10.1038/jp.2013.77 ◽

2013 ◽

Vol 33 (11) ◽

pp. 882-886 ◽

Cited By ~ 14

Author(s):

S E Ramel ◽

J D Long ◽

H Gray ◽

K Durrwachter-Erno ◽

E W Demerath ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Very Low Birth Weight ◽

Neonatal Hyperglycemia

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Az extrém kis születési súlyú koraszülöttek fejlődésének követése az óvodáskor végéig a perinatalis szövődmények tükrében

Orvosi Hetilap ◽

10.1556/650.2018.31199 ◽

2018 ◽

Vol 159 (41) ◽

pp. 1672-1679

Author(s):

Anett Nagy ◽

Anna Mária Beke ◽

Renáta Cserjési ◽

Rózsa Gráf ◽

Magda Kalmár

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Developmental Outcomes ◽

Extremely Low Birth Weight ◽

Psychomotor Development ◽

Preterm Children ◽

Extremely Preterm ◽

The Mean

Abstract: Introduction: Owing to the rapid progress of the medical science and technology, the chances of survival of the extremely low birth weight (<1000 g) preterm babies have dramatically improved. Nevertheless, the research findings on their long-term developmental outcome are inconsistent. Aim: Our study has attempted to contribute to the understanding of the developmental mechanisms in the extremely low birth weight preterm infants and to the prediction of the developmental outcomes taking into account of the risk factors of development. Method: 34 preterm children who were free of any major central nervous system injury were followed up from one to 5–6 years of age. The psychomotor development of the infants was assessed at 1 and 2 years of age and, at 5–6 years of age, intelligence tests were administered to the children. Perinatal and environmental factors were included in the data analysis. Results: The extremely low birth weight preterm children as a group displayed no developmental delay at any of the measurement points. The mean developmental quotients were 98.6 and 106.6 at ages 1 and 2 years, respectively. At 5–6 years of age, the mean verbal IQ was 101.4, while the mean performance IQ was 92.9. Behind the group means there was a wide range of individual variations. The most powerful contributors to the developmental outcomes were birth weight, bronchopulmonary dysplasia, intra-uterine growth retardation, gender, and maternal education. The girls had a significant advantage over the boys in language development. Verbal intelligence was hampered by intracranial hemorrhage, while intrauterine growth restriction had a similar effect on the performance IQ. Conclusions: Our results suggest that even the extremely preterm infants may have rather good chances of satisfactory mental development. However, the individual developmental prospects are influenced by a great number of domain-specific risk- and protective factors. Although at a group-level, infant psychomotor development is a significant predictor of later intelligence quotient, the rate of development may change at any age. The phenomenon of “moving risk” underscores the importance of the long-term follow-up of preterm infants. Orv Hetil. 2018; 159(41): 1672–1679.

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