Mebeverine Prescribing in the Outpatient Setting in Riyadh Region

Aim: The present study aimed to explore mebeverine prescribing in the outpatient setting in Riyadh Region. Methodology: This was a retrospective study that included reviewing the outpatient prescriptions of mebeverine in a governmental hospital in Riyadh Region. The study excluded the prescriptions that were prescribed by other settings and the outpatient prescriptions that didn’t contain an mebeverine. Results: During the study period between January 2018 to June 2018, mebeverine was prescribed to 113 patients. most of them were females (62.83%). The age of 29.20% of the patients was between 50 and 59 years. Most of the prescriptions that contained mebeverine were written by residents (86.73%) and most of the prescriptions that contained mebeverine were prescribed by internal medicine (34.51%), gastroenterology (23.89%), and emergency (21.24%) departments. Conclusion: The present study showed that mebeverine was prescribed commonly in the outpatient setting. More studies are needed to explore the frequency of prescribing mebeverine and the frequency of prescribing other antispasmodic medications in different settings.

Budesonide Use in the Outpatient Department in a Public Hospital in Al-Kharj

Aim: This study aimed to describe the prescribing pattern of budesonide nebulizer and budesonide nasal spray in a public hospital in Alkharj. Methodology: This retrospective study was conducted in a public hospital in Alkharj city. The outpatient prescriptions were reviewed to describe the use of budesonide in the period between 01-01- 2018 and 31-06-2018. The study included budesonide forms that are delivered directly to the respiratory system, so budesonide nebulizer and budesonide nasal spray were included in the study and other dosage forms were excluded. Results: About 53.12% of the prescribed budesonide was in the form of nebulizer and 46.88% was in the form of nasal spray. Most of them were males (62.50%) and about 43.75% of them were less than 10 years. More than 53% of the prescriptions were written by residents and 40.62% were written by consultants. The most commonly prescribed department was pediatrics department (43.75%) followed by Ear-Nose-Throat (E.N.T) department (18.75%) and emergency (18.75%). Conclusion: The present study showed that the use of budesonide was uncommon in the outpatient setting. More studies are needed to explore the frequency of prescribing other dosage forms of budesonide and to explore the frequency of prescribing other alternative agents.

Profile of Pain Medication Use in Hemophilia and Hemarthrosis: An Analysis of a Pharmacy Claims Database

Introduction: Chronic joint pain associated with bleeding disorders (particularly Hemophilia A and Hemophilia B) is well characterized. The most common treatments reported by patients with bleeding disorders include acetaminophen, traditional nonsteroidal anti-inflammatory drugs (tNSAIDs; cyclooxygenase 1/2 inhibitors, COX-1/2), COX-2 selective NSAIDs, and opioids (Witkop, et al. Haemophilia . 2017;23:556). Up to 50% of patients have reported opioid use to manage both acute and chronic pain(Witkop, et al. Haemophilia . 2017;23:556). The aim of this study was to compare and analyze different types of prescription pain medications in patients with a diagnosis of hemophilia A, B, and hemarthrosis using a pharmacy claims database. Methods: A cross-sectional analysis was conducted on a retrospective cohort of patients with bleeding disorders receiving pain medications in the Truven Health MarketScan Commercial Claims and Encounters database, for which IRB approval was not required. Index encounters were reported from April 1, 2017 to March 30, 2018, with one year of follow up. Patients were outpatients, inpatients, or both. Patient-level demographics were not collected. Results: Unique patients totaling 876 received 5,702 prescriptions. Patient diagnosis codes included Hemophilia A (D66), Hemophilia B (D67), and hemarthrosis (M362), each of which contributed 79.2%, 11.9%, and 8.8%, respectively, to the total prescriptions. Outpatient prescriptions comprised 81.0% of total prescriptions. Scheduled prescriptions comprised 70.8% of all prescriptions, 81.7% of inpatient prescriptions, and 68.2% of outpatient prescriptions (see Table). Schedule II drugs comprised 82.6% and 77.3% of all scheduled inpatient and outpatient prescriptions, respectively (see Table). Schedule IV prescriptions were the next most common, followed by schedule III. Prescription NSAIDs were more common in the outpatient than in the inpatient setting (see Table). Among NSAIDs, celecoxib comprised approximately half of the outpatient NSAID prescriptions and 15.1% of all outpatient prescriptions. Discussion: Regardless of setting, schedule II drugs are the most common form of pain management prescription in patients with hemophilia or hemarthrosis. Prescriptions for scheduled medications appear similar to what might be inferred in previous studies of patient reported use (Witkop, et al. Haemophilia . 2017;23:556). Consistent with self-reports (Witkop, et al. Haemophilia . 2017;23:556), hydrocodone or oxycodone with acetaminophen were confirmed to be the most frequently prescribed schedule II opioids. tNSAIDs, such as those reported in this analysis share gastrointestinal (GI) bleeding risk which may be heightened in persons with hemophilia compared with those who have no bleeding disorders. Celecoxib represents approximately 50% of outpatient NSAID prescriptions in this analysis despite data showing its clinically significant GI event risk is similar to both ibuprofen and naproxen (Nissen, et al. N Engl J Med. 2016:2519). Over-the counter acetaminophen is commonly used to treat chronic joint pain in hemophilia (Witkop, et al. Haemophilia. 2017;23:556) presumably to avoid GI bleeding, yet is reported to be less efficacious than celecoxib (Rodriguez-Merchan, et al. Blood Rev. 2018: 116). The broad use of opioids with their attendant risk of misuse, addiction, and diversion; as well as tNSAIDs, with their attendant GI risks, underscores the limited pain management options available for persons with hemophilia. This cross-sectional prescription claims data analysis highlights the need to identify and develop alternate forms of chronic pain medications for this population who have unique unmet needs (Humphries, et al. Haemophilia. 2015:41). Figure 1 Figure 1. Disclosures Helm: Tremeau Pharmaceuticals Inc.: Current Employment, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company. Buckner: Genetech: Honoraria; Spark: Honoraria; Sanofi: Honoraria; Bayer: Honoraria; Pfizer: Honoraria; Takeda: Honoraria; American Thrombosis: Membership on an entity's Board of Directors or advisory committees; Hemostasis Network: Membership on an entity's Board of Directors or advisory committees; Novo Nordisk: Honoraria; CSL Behring: Honoraria; Tremeau Pharmaceuticals: Consultancy, Honoraria; uniQure: Consultancy, Honoraria; BioMarin: Consultancy, Honoraria. Macgregor: Tremeau Pharmaceuticals Inc.: Current Employment, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company. Boice: Tremeau Pharmaceuticals Inc.: Current Employment, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company. Cerasoli: RX Medical Dynamics LLC: Consultancy, Current Employment, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company. Khan: Rx Medical Dynamics, LLC: Current Employment. Argoff: Tremeau Pharmaceuticals,Inc: Consultancy.

Outpatient Antibiotic Prescribing Patterns and Appropriateness for Children in Primary Healthcare Settings in Beijing City, China, 2017–2019

(1) Background: Few studies have focused on antibiotic use and appropriateness in children in primary health institutions (PHIs). This study aimed to identify the patterns and appropriateness of antibiotic use for children in PHIs in Beijing, China. (2) Methods: Outpatient prescriptions of 327 PHIs from 2017 to 2019 for patients < 18 years old were collected. Prescriptions were described using quantity indicators. Antibiotics were categorized according to ATC classification J01 and Access, Watch, Reserve grouping. Appropriateness was reviewed by experts using three subtypes of irrational prescriptions (irregular, inappropriate, and abnormal). (3) Results: 20,618 prescriptions were collected in total. The antibiotic prescription rate (APR) was 15.1% (N = 3113). Among antibiotic prescriptions, J01FA Macrolides were the most used (N = 1068, 34.9%). The Watch group constituted 89.0% (N = 2818) of total antibiotic use. Bronchitis (N = 1059, 35.2%) was the most common diagnosis. A total of 292 instances of irrational antibiotic use were identified, with inappropriate prescriptions being the most prevalent subtype (N = 233, 79.8%). (4) Conclusion: Although APR for children in PHIs in Beijing was relatively low, the pattern of antibiotic use differed from other countries. Further studies are needed to optimize antibiotic use for children in PHIs under different levels of economic development.

INITIALLY BUILDING AND APPLYING A LIST OF DRUG INTERACTIONS AT VINH LONG GENERAL HOSPITAL, IN 2020

Background: Drug interactions are the main causes of adverse drug events. In order to promptly detect, and handle drug interactions, medical staff often have to look up information in different databases. However, in practice this is still difficult. Stemming from practical needs, we conducted the study "Initially building and applying a list of drug interactions at Vinh Long General Hospital, in 2020". Methods: The study built a list of drug interactions appearing in the list of outpatient drugs at Vinh Long General Hospital. Then, the above list was used to examine the drug interaction on 260 outpatient prescriptions at the hospital. Results: The main findings show that 23 pairs of interactions appearing in the outpatient drug list applied at Vinh Long General Hospital; The rate of prescriptions with interactions is still quite high (44.2%). Among prescriptions with interactions: the rate of prescriptions with 1 interaction was 58.2%; 13% of prescriptions have 3 types of interactions and 4.5% of prescriptions have more than 3 types of interactions. The proportion of prescriptions with interactions at level 1 – "need to be monitored" accounted for 72.2%. The rate of prescriptions with serious interactions requiring replacement of other drugs was 11.3% and contraindications was 2.6%.

Improving outpatient care in chronic heart failure

Despite advances in pharma and high-technology medicine, the rate of burdensome hospital admissions and mortality in patients with chronic heart failure (CHF) remains high. Over half of all admission-entailing decompensations have been repeatedly shown to emerge from non-compliance with outpatient prescriptions. Poor adherence to medication and non-medication treatment can only be broken by improving the patient’s awareness of the disease and his closer monitoring by healthcare professionals. The power of clinical and laboratory illness monitoring in line with the recommended quality criteria of medical aid in heart failure (HF) is strongly limited today by time resources available in outpatient and midwifery clinics. Meanwhile, an international and certain domestic experience has been built up to run CHF outpatient centres with involvement of specially-trained nursing and senior medical staff. Analytic evidence on such centres suggests a reduction in mortality and hospitalisation rate among the visiting patients. To combat existing drawbacks of CHF outpatient care, the National Medical Research Center of Cardiology in alliance with the Specialist Society of Heart Failure have developed the nurses’ guidelines for CHF rooms and are launching a medical staff training programme to manage CHF rooms, registry and data analysis. Furthermore, a procedure has been developed for patient routing to regional CHF outpatient cabinets that is being actively deployed in the Tyumen Region.

Outpatient Psychotropic Drug Interactions in a Public Psychiatry Hospital in Bahrain: An Audit Study

Background: Psychotropic polypharmacy is particularly common which puts psychiatric patients at high risk for developing drug-drug interactions. Objective: We aimed to study potential interactions between psychotropic medications prescribed within the outpatient psychiatry setting. Method: This was an audit study, which targeted a sample of outpatient prescriptions ordered within the outpatient clinics of the main psychiatry hospital in Bahrain over 2017. We studied the degree and correlation between psychotropic drugs. Results: The total number of prescriptions in our sample was 992 (56.1% males, 43.9% females). Psychotropic polypharmacy was detected in 842 prescriptions (84.9%). Potential interactions between psychotropic drugs were observed in 550 prescriptions (56.4%). The degree of interaction was minor in 43 prescriptions (7.8%), significant in 419 prescriptions (76.2%), and serious in 88 prescriptions (16%). Schizoaffective disorder subjects were the most likely to suffer from interactions (64.6%), whereas prescriptions issued for those who had schizophrenia contained the least number of interactions (51.6%). The total number of interactions was strongly associated with polypharmacy (p < .001), and gender (p < .01), but not with age (p > .05) or diagnosis (p > .05). Conclusion: High prevalence of polypharmacy and interactions between psychotropic medications were observed in our sample, particularly of the significant grade.

Impact of Postoperative Dexamethasone on Survival, Steroid Dependency, and Infections in Newly Diagnosed Glioblastoma Patients

Background We examine the effect of dexamethasone prescribed in the initial 3 postoperative weeks on survival, steroid dependency, and infection in glioblastoma patients. Methods In this single-center retrospective cohort analysis, we electronically retrieved inpatient administration and outpatient prescriptions of dexamethasone and laboratory values from the medical record of 360 glioblastoma patients. We correlated total dexamethasone prescribed from postoperative day (POD) 0 to 21 with survival, dexamethasone prescription from POD30 to POD90, and diagnosis of an infection by POD90. These analyses were adjusted for age, KPS, tumor volume, extent of resection, IDH1/2 tumor mutation, tumor MGMT promoter methylation, temozolomide and radiotherapy initiation, and maximum blood glucose level. Results Patients were prescribed a median of 159 mg [109-190] of dexamethasone cumulatively by POD21. Every 16mg increment (4mg every 6 hours/day) of total dexamethasone associated with a 4% increase in mortality (95% confidence interval, CI, 1–7%, P&lt;0.01), 12% increase in the odds of being prescribed dexamethasone from POD30-POD90 (95% CI 6–19%, P&lt;0.01), and a 10% increase in the odds of being diagnosed with an infection (95% CI, 4–17%, P&lt;0.01). Of the 175 patients who had their absolute lymphocyte count measured in the preoperative week, 80 (45.7%) had a value indicative of lymphopenia. In the POD1-POD28 period, this proportion was 82/167 (49.1%). Conclusions Lower survival, steroid dependency, and higher infection rate in glioblastoma patients associated with higher dexamethasone administration in the initial 3 postoperative weeks. Nearly half of the glioblastoma patients are lymphopenic preoperatively and up to one month postoperatively.