Protecting the identity of doctors in drug prescription analysis

Abstract:Currently, there is no widely accepted structured representation of drug prescription. Nevertheless, a structured representation is required for entering and storing drug prescriptions avoiding free text in computerized systems, and for drug prescription reviews. Derived from part of the work of the European OPADE project, we describe an object-oriented model of drug prescription which incorporates important concepts such as the phase and triggering event concepts. This model can be used to record all drug prescriptions, including infusions, in a structured way avoiding free text. The phase concept allows the storage of sequentially ordered dosage regimens for a drug within the same prescription. The prescription triggering event concept allows recording of the administration of a drug conditional to dates, symptoms and clinical signs, medical procedures, and everyday life events. This model has been implemented within the OPADE project; the corresponding aspects of the user interface are presented to show how this model can be used in practice. Even if other new attributes may be added to the described objects, the structure of this model is suitable for general use in software which requires the entry, storage and processing of drug prescriptions.

Download Full-text

Pharmacotherapy in the Elderly. Notice and Contrivance on Multiple Drug Prescription for Elderly Patients.

Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics ◽

10.3143/geriatrics.36.176 ◽

1999 ◽

Vol 36 (3) ◽

pp. 176-180 ◽

Cited By ~ 1

Author(s):

Yasufumi Sawada

Keyword(s):

Elderly Patients ◽

Drug Prescription ◽

The Elderly ◽

Multiple Drug

Download Full-text

POLYPHARMACY IN ELDERLY OUT PATIENTS

Ulyanovsk Medico-biological Journal ◽

10.34014/2227-1848-2019-2-16-22 ◽

2019 ◽

pp. 16-22

Author(s):

E.A. Panova ◽

V.A. Serov ◽

A.M. Shutov ◽

N.N. Bakumtseva ◽

M.Yu. Kuzovenkova

Keyword(s):

Drug Therapy ◽

Elderly Patients ◽

Drug Prescription ◽

Daily Practice ◽

Drug Prescriptions ◽

Ulcer Disease ◽

Start Criteria ◽

Therapeutic Value ◽

Elderly Outpatients ◽

Oncological Diseases

The aim of the work is to study the daily practice of prescribing drugs at the outpatient stage of medical care and to analyze the data obtained based Beers 2012 criteria and STOPP / START version 1. Materials and Methods. The authors analyzed drug prescriptions for 150 outpatients, who were over 65 years old. Results. Cardiovascular diseases, diseases of the osteo-articular system and type 2 diabetes mellitus prevailed in the morbidity structure of patients. Oncological diseases, thyroid diseases, bronchial asthma, cataracts, pancreatitis, anemia, peptic ulcer disease were diagnosed in some patients. All drug prescriptions during the year were taken into account. Simultaneous prescription of more than 4 drugs was considered polypharmacy. All the patients were monitored for a year since drug prescriptions had been made. Death was taken as the end point. The authors considered drug therapy to be irrational according to Beers and STOPP / START criteria. The therapeutic value of drug prescription audit based on restrictive lists was evaluated. Conclusions. Polypharmacy is observed in more than half of elderly outpatients. According to Beers 2012 criteria, irrational drug therapy was detected in 20 % of elderly patients, according to STOPP and START lists – in 43.3 % and 66.6 %, respectively. The lack of drug prescriptions in accordance with START criteria is associated with increased mortality of elderly patients. Keywords: polypharmacy, pharmacotherapy, drug therapy, geriatrics, restrictive lists, Beers criteria, STOPP / START criteria. Цель работы – изучение ежедневной практики назначения лекарственных препаратов на амбулаторном этапе медицинской помощи и анализ полученных данных на основе критериев ограничительных перечней Бирса 2012 г. и STOPP/START версии 1. Материалы и методы. Проанализированы лекарственные назначения 150 пациентам старше 65 лет, находившимся на амбулаторном лечении. Результаты. В структуре заболеваемости пациентов преобладали сердечно-сосудистые заболевания, а также болезни костно-суставной системы и сахарный диабет 2-го типа. Онкологические заболевания, заболевания щитовидной железы, бронхиальная астма, катаракта, панкреатит, анемия, язвенная болезнь диагностированы у единичных больных. Учитывались все лекарственные назначения в течение года. За полипрагмазию принималось одновременное назначение более 4 препаратов. В течение последующего года отслеживалось состояние пациентов, за конечную точку принята смерть. Выявлена нерациональная лекарственная терапия на основе критериев Бирса и STOPP/START. Оценена терапевтическая значимость аудита лекарственных назначений по ограничительным перечням. Выводы. Полипрагмазия наблюдается более чем у половины амбулаторных пациентов пожилого возраста. На основе критериев ограничительных перечней Бирса 2012 г. нерациональная лекарственная терапия выявлена у 20 % пациентов пожилого возраста, на основе критериев STOPP и START – у 43,3 и 66,6 % соответственно. Отсутствие назначений лекарств в соответствии с критериями START ассоциировано с увеличением смертности пациентов пожилого возраста. Ключевые слова: полипрагмазия, фармакотерапия, лекарственная терапия, гериатрия, ограничительные перечни, критерии Бирса, критерии STOPP/START.

Download Full-text

Equity in Telemedicine for Older Adults During the Covid-19 Pandemic (Preprint)

10.2196/preprints.22486 ◽

2020 ◽

Author(s):

Weihong Kuang ◽

Guojun Zeng ◽

Yunbo Nie ◽

Yan Cai ◽

Jin Li ◽

...

Keyword(s):

Older Adults ◽

Paradigm Shift ◽

Drug Prescription ◽

Rapid Change ◽

Policy Makers ◽

West China Hospital ◽

West China ◽

Effective Strategies ◽

Online Treatment ◽

Treatment Disparities

UNSTRUCTURED The COVID-19 pandemic spurred unprecedented progress on a paradigm shift to telemedicine to limit exposure to the virus. Telemedicine has many benefits. In the West China Hospital of Sichuan University, we use it to do COVID-19 related tele-educations to health professionals and general population, tele-diagnosis, online treatment and internet-based drug prescription and delivery. However, at our practices, we are noticing that many older adults could not make appointment with doctors due to their difficulty using the internet-based platform. We worried that older adults who need healthcare the most are not well prepared for this rapid change. We need to pay attention to avoid causing treatment disparities for vulnerable older adults 60 years of age and over. Researchers and policy makers should work together to study effective strategies and make proper policies to mitigate barriers older adults face when using telemedicine.

Download Full-text

Drug Prescription Profiles in Patients with Polypharmacy in Spain: A Large-Scale Pharmacoepidemiologic Study Using Real-World Data

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094754 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4754

Author(s):

Miguel Ángel Hernández-Rodríguez ◽

Ermengol Sempere-Verdú ◽

Caterina Vicens-Caldentey ◽

Francisca González-Rubio ◽

Félix Miguel-García ◽

...

Keyword(s):

Psychotropic Drugs ◽

Large Scale ◽

Anatomical Therapeutic Chemical ◽

Drug Prescription ◽

Age Groups ◽

System Level ◽

Real World Data ◽

Converting Enzyme Inhibitors ◽

Cross Sectional ◽

Β Blockers

We aimed to identify and compare medication profiles in populations with polypharmacy between 2005 and 2015. We conducted a cross-sectional study using information from the Computerized Database for Pharmacoepidemiologic Studies in Primary Care (BIFAP, Spain). We estimated the prevalence of therapeutic subgroups in all individuals 15 years of age and older with polypharmacy (≥5 drugs during ≥6 months) using the Anatomical Therapeutic Chemical classification system level 4, by sex and age group, for both calendar years. The most prescribed drugs were proton-pump inhibitors (PPIs), statins, antiplatelet agents, benzodiazepine derivatives, and angiotensin-converting enzyme inhibitors. The greatest increases between 2005 and 2015 were observed in PPIs, statins, other antidepressants, and β-blockers, while the prevalence of antiepileptics was almost tripled. We observed increases in psychotropic drugs in women and cardiovascular medications in men. By patient´s age groups, there were notable increases in antipsychotics, antidepressants, and antiepileptics (15–44 years); antidepressants, PPIs, and selective β-blockers (45–64 years); selective β-blockers, biguanides, PPIs, and statins (65–79 years); and in statins, selective β-blockers, and PPIs (80 years and older). Our results revealed important increases in the use of specific therapeutic subgroups, like PPIs, statins, and psychotropic drugs, highlighting opportunities to design and implement strategies to analyze such prescriptions’ appropriateness.

Download Full-text

In Silico Drug Prescription for Targeting Cancer Patient Heterogeneity and Prediction of Clinical Outcome

Cancers ◽

10.3390/cancers11091361 ◽

2019 ◽

Vol 11 (9) ◽

pp. 1361

Author(s):

Elena Piñeiro-Yáñez ◽

María José Jiménez-Santos ◽

Gonzalo Gómez-López ◽

Fátima Al-Shahrour

Keyword(s):

Cancer Patients ◽

In Silico ◽

Tumour Progression ◽

Drug Prescription ◽

A Priori ◽

Growth Factor Receptor ◽

Clonal Diversity ◽

Molecular Alterations ◽

Patient Heterogeneity ◽

Epidermal Growth

In silico drug prescription tools for precision cancer medicine can match molecular alterations with tailored candidate treatments. These methodologies require large and well-annotated datasets to systematically evaluate their performance, but this is currently constrained by the lack of complete patient clinicopathological data. Moreover, in silico drug prescription performance could be improved by integrating additional tumour information layers like intra-tumour heterogeneity (ITH) which has been related to drug response and tumour progression. PanDrugs is an in silico drug prescription method which prioritizes anticancer drugs combining both biological and clinical evidence. We have systematically evaluated PanDrugs in the Genomic Data Commons repository (GDC). Our results showed that PanDrugs is able to establish an a priori stratification of cancer patients treated with Epidermal Growth Factor Receptor (EGFR) inhibitors. Patients labelled as responders according to PanDrugs predictions showed a significantly increased overall survival (OS) compared to non-responders. PanDrugs was also able to suggest alternative tailored treatments for non-responder patients. Additionally, PanDrugs usefulness was assessed considering spatial and temporal ITH in cancer patients and showed that ITH can be approached therapeutically proposing drugs or combinations potentially capable of targeting the clonal diversity. In summary, this study is a proof of concept where PanDrugs predictions have been correlated to OS and can be useful to manage ITH in patients while increasing therapeutic options and demonstrating its clinical utility.

Download Full-text

POS1203 EFFECT OF THE COVID19 PANDEMIC ON RHEUMATOLOGIST PRESCRIPTION BEHAVIOUR OF NEW ADVANCED THERAPY: DATA OF THE TARDIS-RA REGISTRY, A NATIONWIDE BELGIAN BIOLOGIC REGISTRY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2049 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 884.1-884

Author(s):

D. De Cock ◽

P. Durez ◽

V. Badot ◽

R. Westhovens ◽

P. Verschueren

Keyword(s):

T Cell ◽

Cell Therapy ◽

Drug Prescription ◽

Monthly Basis ◽

T Cell Therapy ◽

Drug Classes ◽

Advanced Therapy ◽

Advanced Therapies ◽

Catch Up ◽

Second Wave

Background:Belgium suffered considerably from the COVID19 pandemic with high hospitalisation rates during 2 periods: a first wave in March and April 2020, and a second starting from October until the end of 2020. Measures of lowering social interaction were taken throughout 2020 and intensified during the first and second wave when needed. This pandemic could have influenced the access to care and advanced therapies for patients with Rheumatoid Arthritis (RA). In the electronic platform “Tool for Administrative Reimbursement Drug Information Sharing” (TARDIS), data from all Belgian RA patients on biologic and targeted therapy are collected during the submission of a request for initiation and prolongation of reimbursement for these drugs.Objectives:to investigate the effect of the COVID19 pandemic on the monthly prescription behaviour of a new advanced therapy in 2020 by comparing it to 2019.Methods:Patients were selected for this analysis if they started a new TNFi, B/T cell therapy, IL6 inhibitors or tsDMARD therapy in the TARDIS registry in 2019 or in 2020. Rheumatologists request reimbursement via the online TARDIS tool, which is considered here as a new drug prescription. Prescription behaviour was compared between 2019 and 2020, between bionaive and bioexperienced patients, and between the different drug classesResults:In 2019, 2949 patients were prescribed any new advanced therapy, including 1153 TNFi, 469 B/T cell therapy, 436 IL6 inhibitors and 891 tsDMARDs. In 2020, 2998 patients were prescribed any new advanced therapy including 1233 TNFi, 382 B/T cell therapy, 496 IL6 inhibitors and 887 tsDMARDs.On a monthly basis, on average 246 and 250 new advanced therapies were prescribed in 2019 and 2020 respectively. Monthly deviations from this average in 2019 ranged from -19% to +16%. Monthly deviations from this average in 2020 ranged from -50% to +30%. Figure 1A shows the monthly prescription of new advanced therapies in 2019 and 2020.For bionaive and bioexperienced patients, the same trend can be noted. Monthly deviations in bionaive patients in 2020 ranged from -60% to +38%, compared to -18% to +21% in 2019. Monthly deviations in bioexperienced patients ranged from -40% to +25%, compared to -19% to +17% in 2019.Comparison per drug class in 2020 show similar trends. IL6 inhibitors show a slightly different timeline than other drugs classes with other periods of less or more prescriptions changes compared to the other drugs classes. See Figure 1B.Conclusion:The COVID19 pandemic did affect reimbursement requests for patients starting new advanced therapies in March and April 2020, especially for bionaive patients. The latter half of 2020 was apparently used to catch up with reimbursement requests for patients in need for advanced therapies resulting in similar total numbers of patients treated with advanced therapy in 2019 and 2020. The choice for a particular drug type was not clearly influenced by the pandemic. IL6 inhibitor use did seem to be affected differently by the pandemic, yet caution is warranted as these relatively large differences in proportional changes parallel small differences in actual drug numbers.In sum, the observed effect of the pandemic on initiating advanced therapy during the first wave corresponds with Belgian governmental measures that restricted non-essential care which was less observed in the latter half of 2020.Disclosure of Interests:None declared.

Download Full-text