Topical Corticosteroid Prescribing Patterns following Changes in Drug Benefit Status

2003 ◽  
Vol 37 (6) ◽  
pp. 787-793 ◽  
Author(s):  
Chole A Campbell ◽  
Charmaine A Cooke ◽  
Swarna DS Weerasinghe ◽  
Ingrid S Sketris ◽  
Pam R McLean-Veysey ◽  
...  
Keyword(s):  
Nova Scotia ◽  
Elderly Patients ◽  
Topical Corticosteroid ◽  
Patient Outcomes ◽  
Prescribing Patterns ◽  
Drug Benefit ◽  
Topical Product ◽  
Increasing Trend ◽  
Increasing Trends ◽  
Program Benefit

OBJECTIVE: To examine changes in prescribing patterns for topical corticosteroid products dispensed to elderly patients in Nova Scotia, Canada, after all but 2 combination topical corticosteroid products were removed from the Nova Scotia Seniors' Pharmacare Program benefit list. METHODS: Administrative prescription claims from the Nova Scotia Seniors' Pharmacare Program were used to identify the number and costs of topical corticosteroid, antifungal, antibiotic, and combination corticosteroid products dispensed. Time-series analysis was used to compare the periods before (April 1, 1999–March 31, 2000) and after (April 1, 2000–March 31, 2001) the delisting. RESULTS: In 1999–2000, 26 031 of 103 400 eligible elderly patients (25%) and in 2000–2001, 22 837 of 95 550 eligible elderly (24%) received a prescription for a defined topical product. Nova Scotia Seniors' Pharmacare Program expenditures for all topical products decreased from $11.88 to $10.60 (CND) per beneficiary per year (11%) after the policy revision. Topical combination products decreased from 18% of all topical products dispensed to 14%, while the percentage of potent corticosteroid products dispensed increased from 24% to 27% over the study period. Pre- and post-policy time–trend analysis showed statistically significant increasing trends in cost per beneficiary for all topical products and potent corticosteroid products. Combination corticosteroid products showed no change in trends for costs per beneficiary before, and a slight increasing trend after, the policy revision. CONCLUSIONS: Prescribing of topical corticosteroid combination products in Nova Scotia decreased following the formulary revision. There was an increase in potent topical corticosteroid prescribing. Future study involving evaluation of patient outcomes would be useful.

Trends in Periprosthetic Knee Infection and Associated Costs: A Population-Based Study Using National Data

2020 ◽  
Author(s):  
Robert Brochin ◽  
Jashvant Poeran ◽  
Khushdeep S. Vig ◽  
Aakash Keswani ◽  
Nicole Zubizarreta ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Trend Test ◽  
Strong Impact ◽  
Hospitalization Costs ◽  
Teaching Status ◽  
Increasing Trend ◽  
Total Knee ◽  
Increasing Trends

AbstractGiven increasing demand for primary knee arthroplasties, revision surgery is also expected to increase, with periprosthetic joint infection (PJI) a main driver of costs. Recent data on national trends is lacking. We aimed to assess trends in PJI in total knee arthroplasty revisions and hospitalization costs. From the National Inpatient Sample (2003–2016), we extracted data on total knee arthroplasty revisions (n = 782,449). We assessed trends in PJI prevalence and (inflation-adjusted) hospitalization costs (total as well as per-day costs) for all revisions and stratified by hospital teaching status (rural/urban by teaching status), hospital bed size (≤299, 300–499, and ≥500 beds), and hospital region (Northeast, Midwest, South, and West). The Cochran–Armitage trend test (PJI prevalence) and linear regression determined significance of trends. PJI prevalence overall was 25.5% (n = 199,818) with a minor increasing trend: 25.3% (n = 7,828) in 2003 to 28.9% (n = 19,275) in 2016; p < 0.0001. Median total hospitalization costs for PJI decreased slightly ($23,247 in 2003–$20,273 in 2016; p < 0.0001) while median per-day costs slightly increased ($3,452 in 2003–$3,727 in 2016; p < 0.0001), likely as a function of decreasing length of stay. With small differences between hospitals, the lowest and highest PJI prevalences were seen in small (≤299 beds; 22.9%) and urban teaching hospitals (27.3%), respectively. In stratification analyses, an increasing trend in PJI prevalence was particularly seen in larger (≥500 beds) hospitals (24.4% in 2003–30.7% in 2016; p < 0.0001), while a decreasing trend was seen in small-sized hospitals. Overall, PJI in knee arthroplasty revisions appears to be slightly increasing. Moreover, increasing trends in large hospitals and decreasing trends in small-sized hospitals suggest a shift in patients from small to large volume hospitals. Decreasing trends in total costs, alongside increasing trends in per-day costs, suggest a strong impact of length of stay trends and a more efficient approach to PJI over the years (in terms of shorter length of stay).

scholarly journals Inpatient Outcomes and Rates of Venous Thromboembolism and Gastrointestinal Bleeding in Patients with Hepatocellular Carcinoma: Results from Nationwide Inpatient Sample Database 2007-2016

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2162-2162
Author(s):  
Kamelah Abushalha ◽  
Sawsan Abulaimoun ◽  
Ryan Walters ◽  
Sara Albagoush ◽  
Hussain I Rangoonwala ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Venous Thromboembolism ◽  
Gastrointestinal Bleeding ◽  
Hospital Mortality ◽  
Hospital Cost ◽  
Clinical Decision Making ◽  
Conflicts Of Interest ◽  
Increased Risk ◽  
Increasing Trend ◽  
Increasing Trends

Background: Patients with hepatocellular carcinoma (HCC) are at an increased risk for developing venous thromboembolism (VTE)- mainly portal venous thrombosis (PVT). Malignancy and liver cirrhosis ( 80%-90% of HCC cases are related to cirrhosis) are conditions that can perturb the hemostatic balance towards a prothrombotic state. Also, these patients with HCC are at high risk for gastrointestinal bleeding (GIB), making thromboprophylaxis and anticoagulation a treatment challenge. Additional information regarding the outcomes and severity of both VTE and GIB in patients with HCC would be useful to guide clinical decision-making Aim: To determine the rates, inpatient mortality, length of stay (LOS) and hospital cost of VTE and GIB-related admissions in patients with hepatocellular carcinoma. Method: We used ICD-9-CM and ICD-10-CM codes to identify hospitalizations from 2007 to 2016 that included HCC with primary discharge diagnoses of GIB or VTE. Linear trends in the rate of GIB and VTE, as well as in-hospital mortality, LOS, and inflation-adjusted hospital cost (in 2016 US dollars), were evaluated using Daniel's test; piecewise slopes were used as needed. All analyses accounted for the NIS sampling design with updated hospital trend weights used as appropriate. SAS v. 9.4 was used for all analyses. Results: Between 2007 and 2016, we identified 6,527,871 hospitalizations with HCC and a primary discharge diagnosis of GIB (3,517,059; 53.9%) or VTE (3,010,812; 46.1%). From 2007 to 2010, a decreasing trend was observed in the rate of GIB diagnoses (55.5% to 51.6%, ptrend < .001), whereas an increasing trend was observed for VTE diagnoses (44.5% to 48.4%, ptrend < .001). By contrast, from 2010 to 2016, an increasing trend was observed in GIB (51.6% to 55.2%, ptrend < .001), whereas a decreasing trend was observed in VTE (48.4% to 44.8%, ptrend < .001). For in-hospital mortality, a decreasing trend was observed for GIB (2.3% to 1.9%, ptrend < .001), whereas a decreasing trend was observed in VTE until 2012 (1.8% to 1.5%, ptrend < .001), after which no trend was indicated (1.5% to 1.6%, ptrend = .337). Although decreasing trends in LOS were observed for GIB (3.4 days to 3.2 days, ptrend < .001) and VTE (4.3 days to 3.3 days, ptrend < .001), increasing trends were observed for inflation-adjusted hospital cost for both GIB ($6,996 to $7,707, ptrend < .001) and VTE ($7,283 to $7,584, ptrend = .048). Conclusion: In this NIS cohort of hospitalized patients with HCC, GIB was more frequently observed than VTE. Trends observed in the rates of GIB and VTE went in opposite directions. In general decreasing trends were observed in in-hospital mortality and LOS for both VTE and GIB. By contrast, increasing trends were observed in the hospital cost for both diagnoses. Clinicians should balance benefits against risks when deciding VTE prophylaxis and treatment in patients with HCC. Future studies are needed to determine the ideal agent and specific dosages to treat HCC-associated VTE. Disclosures No relevant conflicts of interest to declare.

scholarly journals The Prescribing Patterns of Antipsychotic Drugs and Antiparkinsonian Drugs in Elderly Patients with Dementia

2020 ◽  
Vol 30 (2) ◽  
pp. 81-86
Author(s):  
Soo Mi Yoon ◽  
Sungwon Lee ◽  
Ji-Eun Chang ◽  
Young Sook Lee ◽  
Kiyon Rhew
Keyword(s):  
Elderly Patients ◽  
Antipsychotic Drugs ◽  
Prescribing Patterns ◽  
Antiparkinsonian Drugs

scholarly journals Roles of Climate Variability on the Rapid Increase of Winter Haze Pollution in North China after 2010

2020 ◽  
Author(s):  
Yijia Zhang ◽  
Zhicong Yin ◽  
Huijun Wang
Keyword(s):  
North China ◽  
Economic Losses ◽  
Early Winter ◽  
Premature Deaths ◽  
The Pacific ◽  
Haze Pollution ◽  
Increasing Trend ◽  
Before And After ◽  
Increasing Trends ◽  
Trend Reversal

Abstract. North China experiences severe haze pollution in early winter, resulting in many premature deaths and considerable economic losses. The number of haze days in early winter in North China (HDNC) increased rapidly after 2010 but declined slowly before 2010, reflecting a trend reversal. Global warming and emissions were two fundamental drivers of the long-term increasing trend of haze, but no studies have focused on this trend reversal. The autumn SST in the Pacific and Atlantic, Eurasian snow cover and central Siberian soil moisture, which exhibited completely opposite trends before and after 2010, were proven to stimulate identical trends of meteorological conditions related to haze pollution in North China. Numerical experiments with a fixed emission level confirmed the physical relationships between the climate drivers and HDNC during both decreasing and increasing periods. These external drivers induced a larger decreasing trend of HDNC than the observations, and combined with the persistently increasing trend of anthropogenic emissions, resulted in a realistic slowly decreasing trend. However, after 2010, the increasing trends driven by these climate divers and human emissions jointly led to a rapid increase in HDNC.

scholarly journals Nonmedicinal Ingredients in Topical Corticosteroids Available in Canada

2019 ◽  
Vol 24 (1) ◽  
pp. 60-63
Author(s):  
Elisabeth A. Labadie ◽  
Marie-Claude Houle
Keyword(s):  
Topical Corticosteroid ◽  
Propylene Glycol ◽  
High Potency ◽  
Optimal Care ◽  
Topical Product ◽  
Topical Corticosteroids ◽  
Allergenic Potential

Background Nonmedicinal ingredients in topical corticosteroids might exacerbate pre-existing conditions in patients with contact allergies. In Canada, no database exists to help the clinician identify rapidly the ingredients in a topical product. Thus, prescribing topical corticosteroids to patients with contact allergies represents a challenge. Objectives This study aimed to identify potential allergens contained in topical corticosteroids available in Canada. Methods Ingredients from 140 topical corticosteroids available in Canada were compiled. Ingredients with stronger allergenic potential were identified. Results The most frequent potential allergens found in topical corticosteroids were propylene glycol (42.9%) and parabens (27.9%). Chlorocresol was listed in 11.4% of topical corticosteroids, mostly in high potency products. Formaldehyde releasers were also found in 7.1% of topical products. Conclusions This study confirms that ingredients in topical corticosteroids may be the cause of recalcitrant dermatitis in certain patients with contact allergies. Prescribing an adapted topical corticosteroid to patients with allergies is primordial in order to ensure optimal care.

scholarly journals Persistence With Lipid-Lowering Therapy: Influence of the Type of Lipid-Lowering Agent and Drug Benefit Plan Option in Elderly Patients

2004 ◽  
Vol 10 (5) ◽  
pp. 404-411 ◽  
Author(s):  
Susan M. Abughosh ◽  
Stephen J. Kogut ◽  
Susan E. Andrade ◽  
E. Paul Larrat ◽  
Jerrry H. Gurwitz
Keyword(s):  
Elderly Patients ◽  
Drug Benefit ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Benefit Plan ◽  
Lowering Therapy ◽  
Lipid Lowering Agent

Antimicrobial Stewardship Programs in Inpatient Hospital Settings: A Systematic Review

2014 ◽  
Vol 35 (10) ◽  
pp. 1209-1228 ◽  
Author(s):  
Brittin Wagner ◽  
Gregory A. Filice ◽  
Dimitri Drekonja ◽  
Nancy Greer ◽  
Roderick MacDonald ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Antimicrobial Stewardship ◽  
English Language ◽  
Guideline Implementation ◽  
Hospital Setting ◽  
The United States ◽  
Prescribing Patterns ◽  
Audit And Feedback ◽  
Cochrane Library

ObjectiveEvaluate the evidence for effects of inpatient antimicrobial stewardship programs (ASPs) on patient, prescribing, and microbial outcomes.DesignSystematic review.MethodsSearch of MEDLINE (2000 through November 2013), Cochrane Library, and reference lists of relevant studies. We included English language studies with patient populations relevant to the United States (ie, infectious conditions and prescriptions required for antimicrobials) that evaluated ASP interventions and reported outcomes of interest. Study characteristics and outcomes data were extracted and reviewed by investigators and trained research personnel.ResultsFew intervention types (eg, audit and feedback, guideline implementation, and decision support) substantially impacted patient outcomes, including mortality, length of stay, readmission, or incidence of Clostridium difficile infection. However, most interventions were not powered adequately to demonstrate impacts on patient outcomes. Most interventions were associated with improved prescribing patterns as measured by decreased antimicrobial use or increased appropriate use. Where reported, ASPs were generally associated with improvements in microbial outcomes, including institutional resistance patterns or resistance in the study population. Few data were provided on harms, sustainability, or key intervention components. Studies were typically of short duration, low in methodological quality, and varied in study design, populations enrolled, hospital setting, ASP intent, intervention composition and implementation, comparison group, and outcomes assessed.ConclusionsNumerous studies suggest that ASPs can improve prescribing and microbial outcomes. Strength of evidence was low, and most studies were not designed adequately to detect improvements in mortality or other patient outcomes, but obvious adverse effects on patient outcomes were not reported.

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