scholarly journals Evaluating the early impacts of delisting high-strength opioids on patterns of prescribing in Ontario

2018 ◽  
Vol 38 (6) ◽  
pp. 256-262 ◽  
Author(s):  
Qi Guan ◽  
Wayne Khuu ◽  
Diana Martins ◽  
Mina Tadrous ◽  
Maria Chiu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Moving Average ◽  
High Strength ◽  
Population Based ◽  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
Cross Sectional ◽  
The Public ◽  
Long Acting ◽  
Public Drug

Introduction Ontario delisted high-strength fentanyl, hydromorphone and morphine from the public drug formulary for non-palliative care prescribers on 31 January, 2017. Our aim is to assess the early impact of this policy on prescribing patterns and to examine whether this impact varied by prescriber type, opioid type and opioid strength. Methods We conducted a population-based, cross-sectional study on palliative and non-palliative care patients dispensed fentanyl, hydromorphone or morphine through the Ontario public drug program between 1 January, 2014, and 31 July, 2017. For each month during the study period, we reported the total number of high-strength opioid recipients stratified by prescriber type, and the total volume of each drug dispensed, stratified by strength. We used interventional autoregressive integrated moving average (ARIMA) models to assess the policy’s impact on prescribing patterns. Results We observed a 98% decrease in the total number of publicly funded recipients of high-strength opioids between December 2016 and July 2017 (5930 to 133 recipients) for all prescribers. The policy led to a significant decline in the total volume of all three opioids dispensed: hydromorphone from 20 374 621 to 16 952 097 mg (p $lt; .01); morphine from 40 644 190 to 33 555 480 mg (p $lt; .03); and fentanyl from 9 604 913 to 5 842 405 mcg/h (p $lt; .01). For both fentanyl and hydromorphone, this reduction generally corresponded to an increase in the number of low-strength opioids dispensed. Conclusion Delisting high-strength opioids substantially reduced the number of highstrength opioid recipients and reduced the overall volume of long-acting opioids dispensed in Ontario through the public drug program. Future studies should examine its impact on patient outcomes.

scholarly journals Publicly funded overactive bladder drug treatment patterns in Ontario over 15 years: An ecological study

2017 ◽  
Vol 12 (3) ◽  
pp. E142-5 ◽  
Author(s):  
Mina Tadrous ◽  
Dean Elterman ◽  
Wayne Khuu ◽  
Muhammad M. Mamdani ◽  
David N. Juurlink ◽  
...  
Keyword(s):  
Overactive Bladder ◽  
Ecological Study ◽  
Population Based ◽  
Cross Sectional Study ◽  
Publicly Funded ◽  
Cross Sectional ◽  
The Public ◽  
Major Shift ◽  
Public Drug ◽  
Observation Period

Introduction: Medication is an important option for patients with overactive bladder (OAB), with four different drugs approved over the last 10 years, including the first non-anticholinergic treatment, mirabegron. We set out to describe the number and rate of users of medication for the management of OAB over the last 15 years among residents of Ontario, Canada covered by the public drug programs.Methods: We conducted a population-based, repeated cross-sectional study examining quarterly publically funded prescription claims for OAB medications from January 2000 to June 2016 in Ontario, Canada.Results: We report two major changes in prescription patterns for OAB. The first was the rise of newer, more selective anticholinergics (tolterodine, solifenacin, and darifenacin) replacing oxybutynin. This led to a 54.8% reduction in the rate of users of oxybutynin over the study period from 10.4 users/1000 beneficiaries in 2000 to 4.7 users/1000 beneficiaries in 2016. Recently, we saw the emergence of mirabegron as the most commonly prescribed treatment for OAB. By the final quarter of the observation period, mirabegron was the most commonly used OAB treatment with 25.0% (n=19 411) of all OAB medication users in Ontario (n=77 660). Conclusions: Our findings highlight the rapid uptake of novel agents and a major shift in the treatment of OAB over the last three years.

scholarly journals Socioeconomic, hygienic, and sanitation factors in reducing diarrhea in the Amazon

2016 ◽  
Vol 50 (0) ◽  
Author(s):  
Katiuscia Shirota Imada ◽  
Thiago Santos de Araújo ◽  
Pascoal Torres Muniz ◽  
Valter Lúcio de Pádua
Keyword(s):  
Family Health ◽  
Population Based ◽  
Cross Sectional Study ◽  
Cow’S Milk ◽  
Cross Sectional ◽  
Public Network ◽  
Cow's Milk ◽  
The Public ◽  
Family Health Program ◽  
The City

ABSTRACT OBJECTIVE To analyze the contributions of the socioeconomic, hygienic, and sanitation improvements in reducing the prevalence of diarrhea in a city of the Amazon. METHODS In this population-based cross-sectional study, we analyzed data from surveys conducted in the city of Jordão, Acre. In 2005 and 2012, these surveys evaluated, respectively, 466 and 826 children under five years old. Questionnaires were applied on the socioeconomic conditions, construction of houses, food and hygienic habits, and environmental sanitation. We applied Pearson’s Chi-squared test and Poisson regression to verify the relationship between origin of water, construction of homes, age of introduction of cow’s milk in the diet, place of birth and the prevalence of diarrhea. RESULTS The prevalence of diarrhea was reduced from 45.1% to 35.4%. We identified higher probability of diarrhea in children who did not use water from the public network, in those receiving cow’s milk in the first month after birth, and in those living in houses made of paxiúba. Children born at home presented lower risk of diarrhea when compared to those who were born in hospital, with this difference reversing for the 2012 survey. CONCLUSIONS Sanitation conditions improved with the increase of bathrooms with toilets, implementation of the Programa de Saúde da Família (PSF – Family Health Program), and water treatment in the city. The multivariate regression model identified a statistically significant association between use of water from the public network, construction of houses, late introduction of cow’s milk, and access to health service with occurrence of diarrhea.

Opioid prescribing patterns among generalists & oncologists for Medicare Part D beneficiaries from 2013-2017.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2070-2070
Author(s):  
Trevor Joseph Royce ◽  
Andrew Roberts ◽  
Stacie Dusetzina ◽  
Ankit Agarwal
Keyword(s):  
Medicare Part D ◽  
Opioid Therapy ◽  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
Medicare Part ◽  
Cross Sectional ◽  
Part D ◽  
Opioid Prescribing ◽  
Poisson Models ◽  
Long Acting

2070 Background: In response to the opioid crisis, recent policies aiming to reduce opioid prescribing, misuse, & abuse have generated concern that patients with cancer pain may unintentionally experience reduced access to necessary opioid therapy. It is unknown how opioid prescribing patterns have changed between generalists and oncologists during this era. Methods: We conducted a longitudinal repeated cross-sectional study estimating adjusted annual national trends in opioid prescribing among generalists & oncologists using the Medicare Part D Prescriber Public Use Files 2013-2017. Poisson models estimated annual adjusted predicted mean rates of opioid prescribing-per-1,000 total prescriptions & long-acting opioid prescribing per-1,000 opioid prescriptions. Poisson models estimated adjusted incidence rate ratios (aIRRs) to quantify annual changes in prescribing rates. Results: From 2013-2017 the annual adjusted predicted mean rate of opioid prescriptions per 1,000 total prescriptions decreased from 53.4 to 41.3 among generalists (aIRR = 0.78; p < 0.01) and from 133.2 to 105.9 among oncologists (aIRR = 0.83; p < 0.01). The rate of long-acting opioid fills per 1,000 opioid prescriptions decreased from 96.0 to 87.0 (aIRR = 0.87; p < 0.01) and 235.1 to 222.5 (aIRR = 0.95; p < 0.01) for generalists & oncologists, respectively (Table). Conclusions: We found large declines in overall opioid prescribing rates among generalists (-22%) and oncologists (-17%) from 2013-2017. Long-acting opioid prescribing rates decreased over 2.5-times more among generalists than oncologists. Opioid policy & advocacy have been effective in reducing the extent of opioid prescribing in the Medicare population but how much of the decrease in prescribing by oncologists is ‘appropriate’ versus ‘inappropriate’ deserves further investigation. [Table: see text]

scholarly journals Impact of 2017 ACC/AHA Guideline on Prevalence, Awareness, Treatment, Control and Risk Factors of Hypertension: a Population-based, Cross-sectional Study in Iran

2020 ◽  
Author(s):  
Fatemeh Sadeghi ◽  
Bahman Cheraghian ◽  
Zahra Mohammadi ◽  
Sadaf G Sepanlou ◽  
Sahar Masoudi ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Population Based ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Public Health Burden ◽  
The Public ◽  
And Control ◽  
Number Of Individuals

Abstract Background: In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) provided a new guideline for hypertension prevention and management. We aimed to update the prevalence, awareness, control and risk factors of hypertension based on this guideline and to estimate the number of people who are eligible for non-pharmacologic and pharmacologic intervention. Methods: This population-based, cross-sectional study was conducted in Khuzestan, a large province in the southwest of Iran. Comprehensive information about the potential risk factors of hypertension was collected and blood pressure, blood biomarkers, and anthropometric were measured. Moreover, the dietary pattern was evaluated in 10% of the participants, using a qualitative food frequency questionnaire.Results: A total number of 30,506 individuals aged 20-65 years was included in this study. In comparison to previous guideline (JNC8), the prevalence of hypertension in Khuzestan dramatically increased by 27.04% after implementation of ACC/AHA (15.81% vs 42.85%), which was more dominant in the male population and the 50-59 age group. The sex and age adjustment of the hypertension prevalence was estimated to be 39.40%. The number of individuals required antihypertensive treatment was slightly increased from 15.53% to 21.18%; however, the level of awareness and control dramatically dropped by 23.17% & 31.78%, respectively. All hypertension-related risk factors remained significant after applying the new guideline; however, the strength of the association was reduced in the risk factors like age, waist-hip ratio, body mass index, alcohol consumption, water pipe usage, and physical activity. Similarity, the association between hypertension and history of diabetes, and cardiovascular diseases were decreased by 38%, and 62%, respectively.Conclusions: In the ACC/AHA guideline, a higher number of individuals with the pre-hypertension condition had been shifted into the hypertension category and the level of awareness, treatment, and control was dramatically fallen, which highlight a great need to expand the public health infrastructure for further managing the substantial increase in the public health burden of hypertension.

scholarly journals Awareness and Misperceptions of Hospice and Palliative Care: A Population-Based Survey Study

2017 ◽  
Vol 35 (3) ◽  
pp. 431-439 ◽  
Author(s):  
Ariel Shalev ◽  
Veerawat Phongtankuel ◽  
Elissa Kozlov ◽  
Megan Johnson Shen ◽  
Ronald D. Adelman ◽  
...  
Keyword(s):  
New York ◽  
Palliative Care ◽  
Hospice Care ◽  
New York State ◽  
Population Based ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Survey Study ◽  
Cross Sectional ◽  
Comfort Care

Background: Despite the documented benefits of palliative and hospice care on improving patients’ quality of life, these services remain underutilized. Multiple factors limit the utilization of these services, including patients’ and caregivers’ lack of knowledge and misperceptions. Objectives: To examine palliative and hospice care awareness, misperceptions, and receptivity among community-dwelling adults. Design: Cross-sectional study. Subjects: New York State residents ≥18 years old who participated in the 2016 Empire State Poll. Outcomes Measured: Palliative and hospice care awareness, misperceptions, and receptivity. Results: Of the 800 participants, 664 (83%) and 216 (27%) provided a definition of hospice care and palliative care, respectively. Of those who defined hospice care, 399 (60%) associated it with end-of-life care, 89 (13.4%) mentioned it was comfort care, and 35 (5.3%) reported hospice care provides care to patients and families. Of those who defined palliative care (n = 216), 57 (26.4%) mentioned it provided symptom management to patients, 47 (21.9%) stated it was comfort care, and 19 (8.8%) reported it was applicable in any course of an illness. Of those who defined hospice or palliative care, 248 (37.3%) had a misperception about hospice care and 115 (53.2%) had a misperception about palliative care. Conclusions: Most community-dwelling adults did not mention the major components of palliative and hospice care in their definitions, implying a low level of awareness of these services, and misinformation is common among community-dwelling adults. Palliative and hospice care education initiatives are needed to both increase awareness of and reduce misperceptions about these services.

scholarly journals Trends in acid suppressant drug prescriptions in primary care in the UK: a population-based cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041529
Author(s):  
Devin Abrahami ◽  
Emily Gibson McDonald ◽  
Mireille Schnitzer ◽  
Laurent Azoulay
Keyword(s):  
Population Based ◽  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
Secondary Outcome ◽  
Clinical Practice Research Datalink ◽  
Sectional Study ◽  
Cross Sectional ◽  
Number Of Patients ◽  
The Uk ◽  
Over Time

ObjectiveTo examine proton pump inhibitor (PPI) and histamine-2 receptor antagonist (H2RA) prescribing patterns over a 29-year period by quantifying annual prevalence and prescribing intensity over time.DesignPopulation-based cross-sectional study.SettingMore than 700 general practices contributing data to the UK Clinical Practice Research Datalink (CPRD).ParticipantsWithin a cohort of 14 242 329 patients registered in the CPRD, 3 027 383 patients were prescribed at least one PPI or H2RA from 1 January 1990 to 31 December 2018.Primary and secondary outcome measuresAnnual prescription rates were estimated by dividing the number of patients prescribed a PPI or H2RA by the total CPRD population. Change in prescribing intensity (number of prescriptions per year divided by person-years of follow-up) was calculated using negative binomial regression.ResultsFrom 1990 to 2018, 21.3% of the CPRD population was exposed to at least one acid suppressant drug. During that period, PPI prevalence increased from 0.2% to 14.2%, while H2RA prevalence remained low (range: 1.2%–3.4%). Yearly prescribing intensity to PPIs increased during the first 15 years of the study period but remained relatively constant for the remainder of the study period. In contrast, yearly prescribing intensity of H2RAs decreased from 1990 to 2009 but has begun to slightly increase over the past 5 years.ConclusionsWhile PPI prevalence has been increasing over time, its prescribing intensity has recently plateaued. Notwithstanding their efficacy, PPIs are associated with a number of adverse effects not attributed to H2RAs, whose prescribing intensity has begun to increase. Thus, H2RAs remain a valuable treatment option for individuals with gastric conditions.

scholarly journals Changes in dispensing of medicines proposed for re-purposing in the first year of the COVID-19 pandemic in Australia

2021 ◽  
Author(s):  
Andrea L Schaffer ◽  
David Henry ◽  
Helga Zoega ◽  
Julian H Elliott ◽  
Sallie-Anne Pearson
Keyword(s):  
General Practitioners ◽  
Moving Average ◽  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
List Type ◽  
Quick Response ◽  
Interrupted Time Series Analysis ◽  
Cross Sectional ◽  
The Impact ◽  
Medicine Supply

AbstractPurposeWe quantified changes in dispensing of common medicines proposed for “re-purposing” due to their perceived benefits as therapeutic or preventive treatments for COVID-19 in Australia, a country with relatively low COVID-19 incidence in 2020.MethodsWe performed an interrupted time series analysis and cross-sectional study using nationwide dispensing claims data (January 2017-November 2020). We focused on six subsidised medicines proposed for re-purposing: hydroxychloroquine, azithromycin, ivermectin, colchicine, corticosteroids, and calcitriol (Vitamin D analogue). We quantified changes in monthly dispensing and initiation trends during COVID-19 (March-November 2020) using autoregressive integrated moving average models (ARIMA) and compared characteristics of initiators in 2020 and 2019.ResultIn March 2020, we observed a 99% (95%CI 96%-103%) increase in hydroxychloroquine dispensing (of which approximately 30% attributable to new use), and a 201% increase (95%CI 186%-215%) in initiation, with a shift towards prescribing by general practitioners (42% in 2020 vs 25% in 2019) rather than specialists. These increases subsidised following regulatory restrictions on prescribing to relevant specialties. There was also a small but sustained increase in ivermectin dispensing over multiple months, with a 80% (95%CI 42%-119%) increase in initiation in May 2020 following its first identification as potentially disease-modifying in April 2020. Other than increases in March related to stockpiling among existing users, we observed no increases in initiation of calcitriol or colchicine during COVID-19. Dispensing of corticosteroids and azithromycin remained low after March 2020.ConclusionsMost increases in dispensing observed early on during COVID-19 were temporary and appear to be related to stockpiling among existing users. However, we observed increases in initiation of hydroxychloroquine and ivermectin and a shift in prescribing patterns, indicating that a small proportion may be COVID-19 related. A quick response by regulators can help limit inappropriate repurposing to lessen the impact on medicine supply and patient harms.Key pointsIn Australia, a country with low incidence of COVID-19 in 2020, most increases in dispensing of medicines proposed for re-purposing for treatment or prevention of COVID-19 were temporary and appeared to be related to stockpiling among existing usersWe observed a dramatic increase in new users of hydroxychloroquine in March and April 2020, with a shift toward prescribing by general practitioners instead of rheumatologists which subsided after the introduction of restrictions on its prescribing by non-specialistsDispensing of ivermectin also increased during COVID-19, but occurred later and was spread out over several monthsWhen such situations arise, a quick response by regulators can help limit inappropriate repurposing to reduce the potential for medicine supply shortages and patient harms

Minerals Intake Distributions in a Large Sample of Iranian at-Risk Population Using the National Cancer Institute Method: Do They Meet Their Requirements?

2015 ◽  
Vol 85 (3-4) ◽  
pp. 129-144 ◽  
Author(s):  
Zahra Heidari ◽  
Awat Feizi ◽  
Leila Azadbakht ◽  
Nizal Sarrafzadegan
Keyword(s):  
At Risk ◽  
National Cancer Institute ◽  
Population Based ◽  
Cross Sectional Study ◽  
Normal Function ◽  
Dietary Intakes ◽  
Middle Aged ◽  
Cross Sectional ◽  
Nutritional Interventions ◽  
High Prevalence

Abstract. Background: Minerals are required for the body’s normal function. Aim: The current study assessed the intake distribution of minerals and estimated the prevalence of inadequacy and excess among a representative sample of healthy middle aged and elderly Iranian people. Methods: In this cross-sectional study, the second follow up to the Isfahan Cohort Study (ICS), 1922 generally healthy people aged 40 and older were investigated. Dietary intakes were collected using 24 hour recalls and two or more consecutive food records. Distribution of minerals intake was estimated using traditional (averaging dietary intake days) and National Cancer Institute (NCI) methods, and the results obtained from the two methods, were compared. The prevalence of minerals intake inadequacy or excess was estimated using the estimated average requirement (EAR) cut-point method, the probability approach and the tolerable upper intake levels (UL). Results: There were remarkable differences between values obtained using traditional and NCI methods, particularly in the lower and upper percentiles of the estimated intake distributions. A high prevalence of inadequacy of magnesium (50 - 100 %), calcium (21 - 93 %) and zinc (30 - 55 % for males > 50 years) was observed. Significant gender differences were found regarding inadequate intakes of calcium (21 - 76 % for males vs. 45 - 93 % for females), magnesium (92 % vs. 100 %), iron (0 vs. 15 % for age group 40 - 50 years) and zinc (29 - 55 % vs. 0 %) (all; p < 0.05). Conclusion: Severely imbalanced intakes of magnesium, calcium and zinc were observed among the middle-aged and elderly Iranian population. Nutritional interventions and population-based education to improve healthy diets among the studied population at risk are needed.

CONSUMO DE ALIMENTOS PROCESSADOS E ULTRAPROCESSADOS POR ESCOLARES DE ARROIO DO TIGRE, RS

2018 ◽  
Vol 7 (1) ◽  
pp. 157-164
Author(s):  
Rubiane Inara Wagner ◽  
Patrícia Molz ◽  
Camila Schreiner Pereira
Keyword(s):  
Public School ◽  
Nutritional Status ◽  
Private School ◽  
Food Habits ◽  
Cross Sectional Study ◽  
School Students ◽  
Cross Sectional ◽  
Public And Private ◽  
The Public ◽  
Cereal Bars

O objetivo deste estudo foi comparar a frequência do consumo de alimentos processados e ultraprocessados e verificar a associação entre estado nutricional por adolescentes do ensino público e privado do município de Arroio do Tigre, RS. Trata-se de um estudo transversal realizado com adolescentes, com idade entre 10 e 15 anos, de uma escola pública e uma privada de Arroio do Tigre, RS. O estado nutricional foi avaliado pelo índice de massa corporal. Aplicou-se um questionário de frequência alimentar contendo alimentos processados e ultraprocessados. A amostra foi composta por 64 adolescentes com idade média de 12,03±1,15 anos, sendo 53,1% da escola pública. A maioria dos adolescentes encontravam-se eutróficos (p=0,343), e quando comparado com o consumo de alimentos processados e ultraprocessados, a maioria dos escolares eutróficos relataram maior frequência no consumo de balas e chicletes (50,0%) e barra de cereais (51,0%), de 1 a 3 vezes por semana (p=0,004; p=0,029, respectivamente). Houve também uma maior frequência de consumo de alimentos processados e ultraprocessados como pizza (73,5%; p0,001), refrigerante (58,8%; p=0,036) e biscoito recheado (58,8%; p=0,008) entre 1 a 3 vezes por semana na escola pública em comparação a escola privada. O consumo de suco de pacote (p=0,013) foi relatado não ser consumido pela maioria dos alunos da escola particular em comparação a escola pública. Os dados encontrados evidenciam um consumo expressivo de alimentos processados e ultraprocessados pelos adolescentes de ambas as escolas, destacando alimentos com alto teor de açúcar e sódio.Palavras-chave: Hábitos alimentares. Adolescentes. Alimentos industrializados. ABSTRACT: The objective of this study was to compare the frequency of consumption of processed and ultraprocessed foods and to verify the association between nutritional status by adolescents from public and private schools in the municipality of Arroio do Tigre, RS. This was a cross-sectional study conducted with adolescents, aged 10 to 15 years, from a public school and a private school in Arroio do Tigre, RS. Nutritional status was assessed by body mass index. A food frequency questionnaire containing processed and ultraprocessed foods was applied. The sample consisted of 64 adolescents with a mean age of 12.03±1.15 years, 53.1% of the public school. Most of the adolescents were eutrophic (p=0.343), and when compared to the consumption of processed and ultraprocessed foods, most eutrophic schoolchildren reported a higher frequency of bullets and chewing gum (50.0%) and cereal bars (51.0%), 1 to 3 times per week (p=0.004, p=0.029, respectively). There was also a higher frequency of consumption of processed and ultraprocessed foods such as pizza (73.5%, p0.001), refrigerant (58.8%, p=0.036) and stuffed biscuit (58.8%, p=0.008) between 1 to 3 times a week in public school compared to private school. Consumption of packet juice (p=0.013) was reported not to be consumed by the majority of private school students compared to public school. Conclusion: The data found evidenced an expressive consumption of processed and ultraprocessed foods by the adolescents of both schools, highlighting foods with high sugar and sodium content.Keywords: Food Habits. Adolescents. Industrialized Foods.

Sign in / Sign up

Export Citation Format

Share Document