Osteoporosis prophylaxis prescribing patterns in ophthalmology patients treated with long-term corticosteroids

2010 ◽  
Vol 45 (1) ◽  
pp. 81-82 ◽  
Author(s):  
Randy A. Walker ◽  
Riley B. Hall ◽  
Robert D. Pekush ◽  
Regina M. Taylor-Gjevre
Keyword(s):  
Prescribing Patterns ◽  
Osteoporosis Prophylaxis

Disease modifying anti-rheumatic drugs, biologics and corticosteroid use in older patients with rheumatoid arthritis over 20 years

2020 ◽  
pp. jrheum.200310
Author(s):  
John G. Hanly ◽  
Lynn Lethbridge
Keyword(s):  
Rheumatoid Arthritis ◽  
Secondary Analysis ◽  
Case Definition ◽  
Prescribing Patterns ◽  
Annual Dose ◽  
Pharmacological Management ◽  
Health Administrative Data ◽  
Disease Modifying ◽  
Universal Health

Objective To examine changes in prescribing patterns, especially the use of corticosteroids, in patients with rheumatoid arthritis (RA) over two decades. Methods This was a secondary analysis of health administrative data using a previously validated dataset and case definition for RA. Cases were matched 1:4 by age and sex to controls within a population of approximately 1 million inhabitants with access to universal health care. Longitudinal data for incident and prevalent RA cases were studied between 1997 and 2017. Results There were 8240 RA cases (all ≥ 65 years) with a mean (SD) age 72.2 (7.5) years and 70.6% were female. Over 20 years, annual utilization of coxibs in prevalent RA cases fell with a concomitant increase in disease modifying anti-rheumatic drugs (DMARDs) and biologics. Over the same period corticosteroid use was largely unchanged. Approximately one third of patients had at least one annual prescription for corticosteroid, most frequently prednisone. The mean annual dose showed a modest reduction and the duration of utilization in each year shortened. Rheumatologists prescribed corticosteroids less frequently and in lower doses than other physician groups. For incident RA cases there was a significant fall in annual prescribed dose of prednisone by rheumatologists over time. Conclusion In older adults with RA the utilization of DMARDs and biologics has increased over the past 20 years. However, the use of corticosteroids has persisted. Renewed efforts are required to minimize their use in the long-term pharmacological management of RA.

Investigation of gastrointestinal stromal tumor (GIST) care management in GIST patients (pts) receiving short-term versus long-term imatinib (IM) adjuvant therapy: A chart review analysis.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 195-195
Author(s):  
Anthony Paul Conley ◽  
Annie Guérin ◽  
Medha Sasane ◽  
Geneviève Gauthier ◽  
Frances Schwiep ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Profile ◽  
Prescribing Patterns ◽  
Community Practice ◽  
Short Term ◽  
Online Data ◽  
Kit Mutation ◽  
Nccn Guidelines

195 Background: Although optimal duration of adjuvant IM therapy in Kit+ GIST pts is unknown, the NCCN guidelines recommend treatment for ≥36 months in high-risk pts based on clinical trials showing reduced risk of recurrence and mortality in pts receiving long-term adjuvant IM. The objective of this study was to investigate clinicians’ recurrence risk assessment and GIST management in patients receiving adjuvant IM for short- (6-12 months) vs. long-term (≥24 months) in community practice. Methods: GIST-related and treatment characteristic information on adult pts with primary resectable Kit+ GIST initiating IM ≤84 days after surgery (short-term: 411 pts; long-term: 408 pts) was collected from 320 U.S. oncologists using an online data collection form. In addition, physician prescribing patterns and perception of risk assessment and IM duration were collected. Results: Indicators of risk (tumor size, mitotic count, and tumor location) were significantly associated with IM treatment duration. Tumor rupture status did not impact IM duration, except when unknown, in which case pts had longer IM duration. About 50% of pts had not been tested for Kit mutation; 31% of physicians reported that it would not have changed therapy/management or were not aware of how results should have impacted GIST management. Among short-term pts for whom physicians reported a reason for IM discontinuation, main reasons included non-severe adverse events, completion of the 1-year treatment scheduled, economic constraint/health plan coverage change, and pts’ preference. Overall, 77.8% of surveyed physicians reported that pt risk profile drove their decision of continuing IM over an extended period of time. However, in practice 39.9% of the short-term pts and 48.8% of the long-term pts had a high risk profile as assessed by Fletcher classification; suggesting a lack of consistency between treatment related opinions and practice. Conclusions: These observed discrepancies highlight the need for standardization of risk assessment practices and education among community oncologists and pts.

scholarly journals Impact of a Multidisciplinary Long-Term Opioid Therapy Safety Program at a Military Tertiary Academic Medical Center

2021 ◽  
Author(s):  
Jennifer L Jaskiewicz ◽  
Conor B Garry ◽  
Andrew J Ernst ◽  
Jacob H Cole ◽  
Miranda L Allen ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Opioid Therapy ◽  
Prescribing Patterns ◽  
Therapy Outcomes ◽  
Academic Medical ◽  
Anonymized Data ◽  
Systematic Education ◽  
Safety Metrics

ABSTRACT Objective In light of the ongoing opioid crisis, Naval Medical Center Portsmouth (NMCP) created the Long-Term Opioid Therapy Safety (LOTS) program to reduce risks and improve long-term opioid therapy outcomes. Our primary outcome was change in compliance with the recommended safety metrics. Design This is a retrospective cohort study performed at NMCP, a large military academic medical center providing comprehensive medical care to DoD beneficiaries. The NMCP LOTS program provides both patient and provider narcotic education as well as medical record auditing. The NMCP LOTS program promotes adherence to published CDC, the DVA, and DoD guidelines. Methods Anonymized data were compiled each fiscal quarter and were analyzed retrospectively. Adult patients prescribed opioids for at least 90 days without a gap of 30 days between prescriptions were included in this study. The investigators recorded and reported provider compliance with LOTS metrics over the same period. Results Compliance with the recommended safety metrics improved. We noted a decrease in the number of long-term opioid patients, concurrent benzodiazepine prescriptions, and patients prescribed greater than 90 morphine equivalents per day during the observation period. The number of naloxone prescriptions for LOTS patients also increased, reflecting improved guideline adherence. Conclusion Systematic education and feedback to providers are effective in creating a system and culture of opioid reduction, safe opioid prescribing, and system accountability. This article presents a comprehensive approach to modifying prescribing patterns of long-term opioids in a large healthcare system.

Characteristics of gastrointestinal stromal tumor (GIST) patients receiving short-term versus long-term imatinib (IM) adjuvant therapy: A chart review analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10094-10094
Author(s):  
Annie Guerin ◽  
Anthony Paul Conley ◽  
Medha Sasane ◽  
Genevieve Gauthier ◽  
Frances Schwiep ◽  
...  
Keyword(s):  
Heart Diseases ◽  
Clinical Information ◽  
Extended Period ◽  
Risk Profile ◽  
Prescribing Patterns ◽  
Short Term ◽  
Online Data ◽  
Chi Square ◽  
Post Surgery

10094 Background: In clinical practice, significant variability is seen in duration of adjuvant IM use. The objective of this study is to compare characteristics of GIST pts receiving adjuvant IM for a short (6-12 months) vs extended period (≥24 months) to better understand factors that may influence treatment (trt) duration decisions. Methods: Physician prescribing patterns and clinical information on adult pts with primary resectable Kit positive GIST initiating IM ≤84 days post-surgery was collected from 248 U.S. oncologists using online data collection forms. In addition to physicians’ perception of short- vs long-term use, pts’ risk assessment, trt, demographics, and comorbidities were collected for 246 short-term and 395 long-term IM pts. Characteristics were compared using Wilcoxon and Chi-square tests. Results: While pts were similar in age [59.0 vs. 58.1, P =.23], ethnicity, and region of residence, the short-term group included fewer males (57.7% vs 69.6%, P <.01) and had a higher prevalence of cardiovascular (11.4% vs 5.8%, P = .01) and ischemic heart diseases (5.3% vs 1.5%, P<.01). Differences were also observed in indicators of pre-treatment risk profile (tumor size, location, and rupture during surgery, mitotic count, and Miettinen score) (Table). Findings were consistent with main reasons reported by physicians for prescribing adjuvant IM over longer duration; in addition to pt risk profile (76.6%), tolerability (70.6%), younger pts (59.7%), safety (39.1%), trt response (29.8%), and economic reasons (26.2%) were other reasons impacting trt decisions. Conclusions: Pt risk is an important factor in physicians’ decisions to prescribe adjuvant IM for extended duration. However, age, tolerability, and comorbidities, also play an important role. [Table: see text]

scholarly journals Long-Term Antithrombotic Therapy after Venous Stent Placement

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1249-1249
Author(s):  
Chenyu Lin ◽  
Karlyn A. Martin ◽  
Mei Wang ◽  
Brady L. Stein ◽  
Kush R. Desai
Keyword(s):  
Antiplatelet Therapy ◽  
Major Bleeding ◽  
Stent Placement ◽  
Antithrombotic Therapy ◽  
Dual Antiplatelet Therapy ◽  
Antiplatelet Agent ◽  
Prescribing Patterns ◽  
Stent Restenosis ◽  
Extrinsic Compression

Abstract Introduction Chronic deep venous insufficiency (CVI) is a common disorder of the venous valves which can cause many debilitating symptoms including edema, pain, and skin changes. CVI may result from a primary non-thrombotic cause, such as May-Thurner syndrome (MTS) or extrinsic compression from a pelvic mass, or as the sequelae of an acute deep vein thrombosis (DVT). Endovascular interventions, including percutaneous transluminal angioplasty and venous stent placement, have been increasingly utilized as a minimally-invasive treatment option for CVI. In patients treated via endovascular therapy, stent restenosis is a significant area of clinical concern. However, there is a paucity of data on the optimal preventative long-term antithrombotic strategy. Current practice is highly variable and employs a combination of anticoagulation and antiplatelet agents, which borrows heavily from experience with venous thromboembolism and arterial stent management, respectively. This study examines the prescribing patterns and outcomes of various antithrombotic regimens after venous stent placement at a large academic medical center. Methods Patients who received venous stents at our institution between January 1st, 2010 and December 31st, 2015 were eligible for the study. A retrospective review was performed to determine the antithrombotic regimens and the rates of stent restenosis and major bleeding within two years of stent placement. The relationship between these outcomes and antithrombotic regimens was analyzed via logistic regression. Additional logistic regression and linear regression models were used to evaluate the impact of indications and hypercoagulable risk factors on the selection of antithrombotic agents. Results A total of 151 patients were included in the study (Table 1). Antithrombotic regimens were variable: 58 patients (38%) received triple therapy (i.e., anticoagulation plus dual antiplatelet therapy), 25 (17%) received anticoagulation only, 21 (14%) received anticoagulation plus a single antiplatelet agent, 15 (10%) received dual antiplatelet therapy only, 10 (7%) received a single antiplatelet, and 22 (15%) received no antithrombotic therapy (Figure 1). Patients with acute DVTs with or without MTS were more frequently given multiple antithrombotic agents compared to those with extrinsic compression. The duration of antithrombotic therapy was also variable. When anticoagulation was prescribed (n = 104), 31% received indefinite therapy, followed by 22% for 6 months and 12% for 3 months. Patients with a history of prior DVTs or thrombophilia were more likely to be prescribed indefinite anticoagulation. Aspirin was most commonly prescribed for an indefinite duration (62 of 88 patients) while clopidogrel was most commonly prescribed for just 3 months (60 of 89 patients). Twenty-three patients (15%) developed stent restenosis. Triple antithrombotic therapy had significantly lower rates of stent restenosis compared to no antithrombotic therapy (OR = 0.05, p < 0.01), and was associated with lower rates of restenosis compared to anticoagulation alone (OR = 0.19, p = 0.07) and dual antiplatelet therapy (OR = 0.25, p = 0.09). Anticoagulation with a single antiplatelet agent also led to lower rates of stent restenosis when compared to no antithrombotic therapy (OR = 0.08, p = 0.04). Medication non-compliance and antiphospholipid antibody syndrome were identified as independent predictors of stent restenosis (OR = 8.84, p = 0.01 and OR = 7.11, p = 0.03, respectively). Major bleeding was observed in 11 patients (7%). Of note, there were no major bleeding events observed in the dual antiplatelet or single antiplatelet groups, which were thus excluded from the regression model. Among the remaining treatment groups, there was no significant difference in major bleeding rates. Conclusions This study emphasizes the considerable variability in the prescribing patterns of long-term antithrombotic therapy after venous stent placement. There appears to be benefit to antithrombotic therapy in preventing stent restenosis, particularly when anticoagulation is combined with antiplatelet agents. However, this may be counterbalanced by an increased risk of bleeding. Larger prospective trials are needed to evaluate the relative risks and benefits of each antithrombotic regimen, and ultimately determine the optimal management strategy, following venous stent placement. Disclosures Desai: Philips/Spectranetics: Other: consulting; Cook Medical: Other: consulting, Speakers Bureau; Boston Scientific: Other: consulting, Speakers Bureau; AngioDynamics: Other: consulting, Speakers Bureau; OptiMed: Other: consulting.

scholarly journals Creating opioid dependence in the emergency department

CJEM ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 100-103 ◽  
Author(s):  
Suneel Upadhye
Keyword(s):  
Emergency Department ◽  
Opioid Dependence ◽  
Prescribing Patterns ◽  
Clinical Question ◽  
Emergency Physicians ◽  
Naive Patient ◽  
Opioid Prescription ◽  
Opioid Prescribing

Clinical questionWhat is the risk of creating opioid dependence from an ED opioid prescription?Article chosenBarnett ML, Olenski AR, Jena AB. Opioid-prescribing patterns of emergency physicians and risk of long-term use. N Engl J Med 2017;376:663-73, doi:10.1056/NEJMsa1610524.ObjectiveThis study examined the risk of creating long-term opioid dependence from a prescription written in an opioid-naive patient in the ED.

scholarly journals Local Nursing Home Prescribing Patterns and Psychoactive Prescribing in Assisted Living

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 707-707
Author(s):  
Kali Thomas ◽  
Christopher Wretman ◽  
Philip Sloane ◽  
Anna Beeber ◽  
Paula Carder ◽  
...  
Keyword(s):  
Nursing Home ◽  
Assisted Living ◽  
Fixed Effects ◽  
Linear Models ◽  
Prescribing Patterns ◽  
Prescribing Practices ◽  
Term Care ◽  
Separate Model ◽  
Medication Prescribing

Abstract Because prescribing practices in long-term care settings may reflect regional influences, we examined how potentially inappropriate antipsychotic and antianxiety medication prescribing in assisted living (AL) compared to prescribing in nursing homes (NHs) based on their proximity, using generalized linear models adjusting for facility characteristics and state fixed effects. Data were derived from a seven state sample of AL communities and data for the same seven states drawn from publicly available data reported on the Nursing Home Compare website. In adjusted analyses, AL rates of antipsychotic use were not associated with the rates in the nearest or farthest NHs. However, AL communities that were affiliated with a NH had lower rates of potentially inappropriate antipsychotic use (b=−0.27[95%CI=−0.50,−0.04]). In a separate model, antianxiety medication prescribing rates in AL were significantly associated with neighboring NHs’ rates of prescribing (b=2.65[95%CI=1.00,4.29]). Findings suggest efforts to change prescribing in NHs may influence prescribing in AL.

Which Drug Next? Sequential Therapy for Osteoporosis

2020 ◽  
Vol 105 (3) ◽  
pp. e879-e881
Author(s):  
Barbara P Lukert
Keyword(s):  
Bone Resorption ◽  
Sequential Therapy ◽  
Prescribing Patterns ◽  
Modes Of Action ◽  
Antiresorptive Agent ◽  
New Challenges ◽  
Rebound Increase

Abstract The proliferation of drugs with unique modes of action for treating osteoporosis has been most welcome. Fear of complications, even though rare, associated with long-term bisphosphonates (BPs) changed prescribing patterns. The BPs are stored in bone for years. Drugs not stored in bone; for example, abaloparatide, teriparatide, denosumab, and romosozumab have expanded our armamentarium for treating osteoporosis but have brought new challenges. Bone accrued during treatment with the last 3 drugs, and perhaps abaloparatide, is lost rapidly after their withdrawal due to rebound increase in bone resorption. Treatment with these drugs must be followed by administration of an antiresorptive agent. The article by Kendler et al. (1) in this issue of JCEM reports alendronate preserves bone accrued during administration of denosumab.

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