Real world hypertension treatment patterns analysis identifies putative gaps and risk-associated patterns

ABSTRACTObjectiveAlthough treatment patterns’ analyses at scale can provide insights into associated health outcomes, they remain relatively uncharacterized for most chronic diseases, including hypertension (HTN). To address this gap, we analyzed HTN treatment patterns among US health-insured patients.Materials and MethodsNew (n = 200,786) or all (n = 4.1 million) HTN patients were identified from 2015, 2016 enrollments in a nationwide administrative claims’ database and compared for HTN-specific treatment (Rx) choices, Rx count, and distinct rounds of treatment options (ROTO), respectively. Selected treatment patterns were risk-assessed using predictive modeling and/or literature-based recommendations.ResultsFor 2016, ACE inhibitors/ARBs were most frequent choices in new HTN patients’ vs more diverse Rx-choices among all HTN patients. All HTN patients had ∼3-fold and ∼5-fold-higher prevalence of (same-year) polytherapy and Rx interventions, respectively.New HTN patients with ≥2 rounds of treatment options (vs single/initial round) were associated with ∼5-fold or higher predicted HTN complications’ risk (p-value < 0.0001). All HTN patients with ≥3 rounds of treatment options (vs single/initial round) had 3.8-fold higher next-year HTN complications’ risk (p-value < 0.0001). Co-morbidities/persistence of ≥3 rounds of treatment options over 2 years further increased these odds and total medications/chronic disease score correlated with ROTO counts.Discussion∼95% of new HTN patients in 2016 did not start treatment with current literature-recommended first option, Thiazides. Assuming “sticky” prescription patterns, opportunity exists to improve (current) initial HTN treatments. Additionally, ROTO counts can inform HTN complications’ risk/management thereof.ConclusionWe highlight opportunities to improve initial HTN treatments and treatment patterns associated with higher risk among HTN patients.

Risk Factors for Central-Line–Associated Bloodstream Infections: A Focus on Comorbid Conditions

Centers for Disease Control and Prevention (CDC) risk adjustment methods for central-line–associated bloodstream infections (CLABSI) only adjust for type of intensive care unit (ICU). This cohort study explored risk factors for CLABSI using 2 comorbidity classification schemes, the Charlson Comorbidity Index (CCI) and the Chronic Disease Score (CDS). Our study supports the need for additional research into risk factors for CLABSI, including electronically available comorbid conditions.Infect Control Hosp Epidemiol 2014;00(0): 1–3

Description of a systematic pharmaceutical care approach intended to increase the appropriateness of medication use by elderly patients

Background & Aims. The pharmaceutical care practice represents a model of responsible pharmacist involvement in the pharmacotherapy optimization of various population groups, including the elderly, known to be at risk for drug-related problems. Romanian pharmacists could use validated pharmaceutical care experiences to confirm their role as health-care professionals.This descriptive research presents the application in two real and different environments of practice of a structured pharmaceutical care approach conceived as the basis for a medication review activity and aiming at the identification and resolution of the drug related problems in the elderly.Patients and methods. Two patients with similar degree of disease-burden complexity, receiving care in different health-care environments (The Geriatric Ward of the Royal Victoria Hospital from the McGill University Health Centre in Montréal, Québec, Canada, in November 2010, and an urban nursing-home facility in Cluj-Napoca, Romania, in March 2011), were chosen for the analysis. One clinical pharmacist suggested solutions for the management of each of the active drug-related problems identified, using the systematic pharmaceutical care approach and specific published geriatric pharmacotherapy recommendations. The number of the drug-related problems identified and the degree of the care-team acceptance of the pharmacists’ solutions were noted for each patient.Results. The pharmacist found 6 active drug-related problems for the hospitalized patient (72 year-old, Chronic Disease Score 9) and 7 potential ones for the nursing-home resident (79 year-old, Chronic Disease Score 8), involving misuse, underuse and overuse of medications. Each patient had 3 geriatric syndromes at baseline. The therapy changes suggested by the pharmacist were implemented for the hospitalized patient, through collaboration with the health-care team. For the nursing home resident, the pharmacist identified the need for additional 6 medications and safety and efficacy arguments to cease 7 initial therapies, simplifying the therapeutic daily schedule (from 24 daily doses to 15).Conclusion. The pharmacist’s potential contribution to the optimization of the Romanian elderly patients’ pharmacotherapy needs further exploration, as potential drug related problems reported as characteristic for this population were easily identified. The presented structured and validated model of pharmaceutical care approach could be used to this end. Its dissemination and use could be encouraged along with the enhancement of pharmacotherapy information and care team collaboration skills.