Drugs, Pharmaceuticals, and Therapeutics

Research Findings

Research Activities, February 2013:
Prescription of antidepressants for children and adolescents by office-based physicians is typically done off-label
Patients with coronary artery disease who get ongoing support from their community pharmacy may adhere better to medications
Bevacizumab, when added to chemotherapy regimen for elderly patients with lung cancer, does not increase survival rates
More research needed to compare therapies for colorectal cancer metastases is to the liver
Some assessment tools and medications are effective for chronic cough
Using a terbutaline pump to prevent preterm birth may be beneficial, but evidence suggests caution

Research Activities, January 2013:
High rates of paper-based prescribing errors found among community-based primary care providers
Including FDA hotline in print drug ads has small effect on adverse event reporting by consumers
Intravenous fentanyl can be given safely to trauma patients for pain in the prehospital setting
Aldosterone antagonist therapy at hospital discharge linked to modest reduced risk of rehospitalization for heart failure
Headache and nausea most common side effects among adults and adolescents taking antidepressants
Computerized clinical decision support may promote contraceptive counseling for women prescribed teratogenic medications
Elderly colon cancer patients receiving chemotherapy after surgery are at risk for various toxicities
Antipsychotic choices in nursing homes partly influenced by nursing home's prescribing culture
Electronic health record-based medication monitoring improves patient compliance in primary care clinics
Provision of personal digital assistants alone does not help providers avoid drug-drug interactions
Four drugs to treat chronic heart failure found similarly effective
Dual therapy may be slightly less effective than triple therapy for chronic infection with hepatitis C virus
Many non-oral medications appear to effectively treat acute migraines in emergency department patients
New review evaluates treatment options for plaque psoriasis
AHRQ Stats: Adult asthma rates nearly doubled in past decade

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Research Activities, December 2012:
Continuing beta blockers after noncardiac surgery improves patient outcomes and lowers mortality
Stroke education program improves medication knowledge and satisfaction among stroke patients after hospital discharge
Antipsychotic medications linked to occurrence of diabetes in children
Quality improvement collaborative improves outcomes in children with inflammatory bowel disease
Medicare Part D coverage gap reduces antidepressant use in the elderly
Adding another medication rather than switching medications may benefit patients partially responding to initial antidepressant
When cancer drug went generic, its use declined
Review supports use of metformin as first-line therapy for patients with type 2 diabetes
Limited evidence of benefit of interventions during early stages of chronic kidney disease
New AHRQ tool assesses patient safety culture in pharmacies

Research Activities, November 2012:
Many hospitalized children receive numerous medications, raising potential safety concerns
Seniors learn some things from prescription drug advertisements, but can also be misled
Physicians optimistic about potential for electronic prescribing but barriers to adoption still exist
Procalcitonin guidance may lead to decreased antibiotic usage
Progestogens effective for preventing preterm births in single pregnancies

Research Activities, October 2012:
Many Federal drug risk alerts fail to achieve the recommended changes in prescribing
Label changes, manufacturer's warning letter did not reduce use of propofol for conscious sedation in children
Drug discontinuation effects are not limited to psychoactive drugs, but may be important for cardiovascular drugs as well
Diabetes treatment involves more multidrug regimens and high financial burden
Survival rates for colon cancer patients on chemotherapy improve with addition of oxaliplatin
Certain antibiotics increase the risk of treatment failure in children with MRSA-related skin and soft-tissue infections
Hospitals vary widely in their use of dopamine and dobutamine in preterm/low birthweight neonates
Insulin pump and glucose monitoring improve blood-sugar control for patients with type 1 diabetes
Extending use of anti-clotting medication following major orthopedic surgery may help prevent post-operative blood clots
New research examines use of nitrous oxide for labor pain
Tactics to improve medication adherence in short-term shown effective
Physicians' implicit racial attitudes influence prescribing of opioids for black children
Blacks treated at community health centers are less likely than Hispanics or whites to have controlled blood pressure
Number of Americans prescribed anticonvulsant drugs has nearly doubled
More safeguards needed to prevent adverse drug events caused by medication administration errors

Research Activities, September 2012:
Opioid prescriptions for treating chronic abdominal pain doubled between 1997 and 2008
Response to etanercept for rheumatoid arthritis can be predicted by 12 weeks
The financial burden from prescription drugs has declined for the nonelderly, but remains a problem for some groups
Differences in the costs of drugs prescribed lead to regional variation in Medicare Part D drug spending
Studies link adverse drug interactions to elevated risk for hospitalization among the elderly
Conventional and atypical antipsychotic drugs show differing safety risks among older nursing home residents
Several factors influence completion of chemotherapy in elderly patients with stage-III colon cancer
No link found between stimulant treatment of youth with ADHD and cardiovascular problems
Pediatric visits for ADHD have risen and the condition is increasingly being managed by psychiatrists
Drug interaction decision support software has limitations and pharmacists' knowledge of support features is limited
Despite more widespread prescribing of antiretroviral therapy for HIV infection, disparities remain
Increased fluid and supplemental treatments may reduce recurrence of kidney stones
Clinician and patient resources now available on ADHD treatment options

Research Activities, August 2012:
Liver transplant patients who taper off or do not take corticosteroids after transplantation have better quality of life
More patients with anxiety disorders are being prescribed antipsychotic medications by office-based psychiatrists
Effects of antidepressants on suicidal thoughts and behavior differ by age group
Insulin pump and glucose monitoring improve blood-sugar control for diabetes patients
Newer antidepressants equally effective in treating major depressive disorder
JAMA special issue focuses on comparative effectiveness research
Provider-patient dialogue could be improved to foster medication adherence in HIV care
Adverse drug reactions a major cause of unplanned hospitalizations of elderly veterans
Certain medications are associated with functional decline in the elderly
Treatment guideline reduces hypoglycemic events in critically ill children

Research Activities, July 2012:
Tumor necrosis factor-antagonists in patients with autoimmune diseases showed no overall increased risk of hospitalizations for serious infections than non-biologic drugs
Depressed patients with anxiety who fail initial antidepressant therapy may benefit from adding a second drug
Study looks at impact of FDA suicide risk advisory on antidepressant prescribing in children
Implementing a clinical practice guideline helps children with pneumonia get proper antibiotics
Key treatments for high blood pressure and high blood lipids do not reduce elderly patients' risk of limited mobility
Rise in prescription copays puts different patients at risk for nonadherence to medications
Limited evidence prevents firm conclusions on rheumatoid arthritis drug therapies
Consumer and clinician summaries now available on chronic pelvic pain treatment options

Research Activities, June 2012:
1 in 10 computer-generated prescriptions include at least one error
Clinicians find triggers and algorithms in e-prescribing software helpful in avoiding inappropriate medications in older adults
No evidence of serious cardiovascular events in children and young adults using medications for ADHD
Evidence lacking on effectiveness of antipsychotics for children
Limited evidence prevents firm conclusions on psoriatic arthritis drug therapies
Glaucoma treatments can lower eye pressure
Several risk factors point to the use of high-risk medications in older veterans
Drug industry-sponsored patient assistance programs are seldom used by older adults
Study of Medicare beneficiaries validates Medical Expenditure Panel Survey's prescription drug data
Patients recovering from stroke tend to continue using secondary preventive medications

Research Activities, May 2012:
Curricular modules teach budding pharmacists how to engage patients with low health literacy
Extended use of medications to prevent blood clots may benefit patients after major orthopedic surgery
Research review finds support for some off-label uses of atypical antipsychotic medications
Medications for low bone density prevent fractures in women with osteoporosis
Dissemination and implementation of clinical trial results are needed to encourage recommended practices

Research Activities, April 2012:
Primary care providers who provide contraceptive counseling increase patients' contraceptive use
Injection of hyaluronic acid, a natural joint lubricant, appears effective in reducing pain from wear and tear on the knee
C-reactive protein testing is not more effective than an educational intervention to decrease antibiotic prescriptions for patients seen for acute cough
Clinical algorithm can identify and locate serious internal bleeding related to oral anticoagulant use

Research Activities, March 2012:
Guideline management of inpatient cellulitis and cutaneous abscess reduces antibiotic use
Patients with hepatitis C virus infection who adhere to their drug regimen are more likely to show long-term benefit
Nine percent of adults with hypertension have resistant hypertension
Routinely collecting clinical data can improve pneumococcal vaccination of rheumatology patients on immunosuppressant drugs
Pharmacists have limited awareness of the capabilities of their pharmacy information systems
Some diabetes practice guidelines do not reflect all available evidence
Diagnosis and treatment rates for depression in older adults have grown over time, with medication edging out therapy
More patients are being prescribed antidepressants by non-psychiatrists and without a psychiatric diagnosis
Adherence to bipolar medications may also promote adherence to antiretroviral therapy
AHRQ releases pharmacy health literacy modules for faculty

Research Activities, February 2012:
E-prescribing systems within electronic health records reduce ambulatory prescribing errors in community-based practices
The effects of direct-to-consumer drug advertising on statin use depends on the person's experience with the statin
Educational intervention helps doctors and patients split statin tablets to save money for patients and payers
Newer antidepressants equally effective in treating major depressive disorder
Older medications for epilepsy obtain better control but have more adverse effects
Evidence lacking on devices used with percutaneous coronary interventions
Benefits of active surveillance therapy for localized prostate cancer not yet demonstrated
HIV outcomes and medication use are similar between rural and urban HIV patients
Recommendations on rounding pediatric doses may improve e-prescribing while reducing risk of adverse drug events
Study finds potentially suboptimal use of antidepressants for residents in Veterans Affairs nursing homes

Research Activities, January 2012:
Clinical informatics monitoring tool helps reduce adverse drug events in nursing home settings
Duplicate medication order errors increase after computerized provider order entry is implemented
Measuring quality of care for middle ear infection has many pitfalls
A large proportion of hospitalized children receive numerous medications during their hospitalization
ADHD medications don't increase serious heart risks in children or adults
New study finds e-prescribing is safe and efficient, but barriers remain

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Research Activities, December 2011:
Transitioning to new electronic health records can result in potential safety problems
Pharmacy, medical, and nurse practitioner students need more education on drug-drug interactions
For-profit dialysis chains have higher mortality rates than non-profit dialysis chain
The increase in pediatric stimulant use since 1996 mostly linked to treatment of ADHD in adolescents
Birth defects may be linked to high blood pressure, not use of ACE inhibitors in early pregnancy
Children's use of asthma controller drugs doubles

Research Activities, November 2011:
Nearly 1 in 10 outpatient computerized prescriptions contains errors
Off-label use of atypical antipsychotics not supported by evidence for some conditions
Uncertainty surrounds use of terbutaline to prevent preterm birth

Research Activities, October 2011:
Less than half of pharmacy computer systems studied correctly identified drug-drug interactions
Simpler drug warning labels are easier to understand
Medical students, interns, and residents need training to disclose medical errors
Certain factors increase risk of medication errors in the neonatal intensive care unit (NICU)
Going "smooth" can help relieve weekday crowding at children's hospitals
Medicare Part D reduces out-of-pocket costs and modestly boosts prescription volume
A small number of drugs are used most commonly during pediatric hospitalizations

Research Activities, September 2011:
Metformin just as effective as other medications for treating type 2 diabetes
Administrative data alone are insufficient to understand equivalence of two common blood pressure drugs
HIV/AIDS drugs have varied effects on lipid levels
A program for laboratory monitoring of renin-angiotensin system drugs is cost-effective for certain high-risk patients
Clinicians cautioned about use of antihypertensive in children receiving kidney transplants who take tacrolimus
Providers perceive e-prescribing as being very efficient
Drug expenses for children with asthma more than doubled in 10 years

Research Activities, August 2011:
Electronic order sets can help treatment conform to guidelines for antibiotic use after surgery
Patients with heart failure are older, have more illnesses, and take more medications than earlier
Drugs to treat hepatitis B may not prevent patients from liver disease later
Caregivers for advanced cystic fibrosis patients want to discuss intensive treatments and symptom relief

Research Activities, July 2011:
Foreign-born patients are more likely to have a form of tuberculosis that resists a common drug used in treatment
Studies examine safety of pain killers among older adults
Guideline familiarity does not equal guideline adherence
Metformin remains the medication of first choice in treating type 2 diabetes
Trends in treating depression favor psychotropic medications over psychotherapy
Some patients hospitalized for stroke more likely to keep taking drugs to prevent another stroke
No link found between chemotherapy in older women with breast cancer and later cognitive impairment
Antibiotics are modestly more effective than no treatment for middle ear infections in children
Over 3 million look to hospitals for headache relief
Connecting local providers to academic medical centers using video improved hepatitis C outcomes

Research Activities, June 2011:
Treatment by physicians with same race and language as the patient may improve medication adherence
Patients with chronic diseases who pay coinsurance less likely to refill their medication than those with fixed copayments
Half of all annual medical expenditures are for chronic diseases
Chemotherapy and radiation therapy for lung cancer linked to cardiac disorders
Combination diuretic therapy for heart failure appears useful, but needs a stronger evidence base
Patients with sickle cell disease employ various strategies to control their pain
Doctor's comments during a child's physical exam can affect whether parents push for antibiotics
Physicians weigh the costs and benefits of integrating e-prescribing systems with electronic health records
Medication side effects, injuries up dramatically

Research Activities, May 2011:
Genotype information can make the predicted therapeutic dose of warfarin more accurate
Systems to detect adverse drug events need buy-in from leaders and staff to become part of hospital routine
Laboratory monitoring of high-risk medications varies greatly
Specific primary care strategies may improve medication safety
Inhaler costs contribute to medication nonadherence for Medicare patients with chronic pulmonary disease
Care for patients with HIV remains expensive
Treatments show promise in reducing autism-related behaviors, but some have significant side effects

Research Activities, April 2011:
Blacks less likely than whites to use either statins or aspirin in the prevention of cardiovascular disease
Medication safety indicators can guide improvement in primary care drug selection, dosing, and monitoring
Medications differ in their effect on risk of foot ulcers and limb amputations in patients with diabetes
Diet and medication adherence can reduce cardiovascular disease for patients with type 2 diabetes
Medicare Part D enrollees have higher cost-sharing amounts for brand name prescription drugs than those in employer plans
Many patients with diabetes who reach the Medicare Part D drug coverage gap don't talk about drug costs with their doctors
Adverse drug event surveillance tailored to hospitalized children
Spending for prescriptions to control diabetes, cholesterol, and other metabolic conditions exceeds $52 billion

Research Activities, March 2011:
Automated screening of patient electronic medical records is only the first step to identifying a medication problem
Better adherence to diabetes medications means fewer hospitalizations and emergency department visits
Colony-stimulating factor is effective in reducing infection for elderly patients with non-Hodgkin's lymphoma on chemotherapy
Antipsychotic use doubles for very young children, while mental health visits are few
HIV treatment costs much more when patients start treatment later in the disease
AHRQ report finds unclear value of pretesting autoimmune disorder patients before prescribing thiopurine drugs

Research Activities, February 2011:
Research comparing diabetes medications helps patients and clinicians choose the right one
Pilot study finds a low level of medication errors for look-alike, sound-alike drugs prescribed for children
Ketorolac, a pain medication, is underused in children operated on for bladder reflux
Use of physician extenders associated with increase in antidepressant prescribing in nursing homes
Pre-existing cardiovascular conditions linked to lower stimulant prescribing rates for adults with ADHD
Clinicians' adoption and use of electronic prescribing is likely linked to their views on technology
The number of U.S. adults treated for diabetes more than doubled between 1996 and 2007

Research Activities, January 2011:
Acceptance of "smart" intravenous infusion pumps is growing among nurses, but challenges remain
E-prescribing for managing medication refills has not reached its full potential
A customized computer drug alert requiring active provider response is no more effective than a passive alert
Compliance is low for computer alerts recommending conversion from intravenous to oral medications
Patients taking only salmeterol seen in the emergency department for asthma more likely to be hospitalized
Black Medicare patients less likely than whites to follow their doctor's instructions on taking medicines
Review looks at approaches to improve drug prescribing in nursing homes

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Research Activities, December 2010:
Brand-name drugs not better than generics for controlling epilepsy
Uncontrolled asthma events among Massachusetts patients declined between 2002 and 2007
Antiretroviral switching strategies to treat HIV improve survival and are cost-effective in resource-limited countries
Hospitalizations for medication and illicit drug-related conditions on the rise among Americans aged 45 and older

Research Activities, November 2010:
Oral chemotherapy drugs not immune to medication errors
Whistleblowers in pharmaceutical fraud cases pursue Federal lawsuits for moral reasons, not money
Various factors affect providers' ability to identify spoken drug names
Clopidogrel increases bleeding risk in cardiac patients with drug-eluting stents
Higher risk of death or heart attack in first 90 days after cardiac patients stop taking clopidogrel
Pharmacy intervention for patients with limited literacy evokes positive responses from patients and pharmacists
One-fifth of mothers do not receive recommended antenatal corticosteroids before delivery of premature infants
Use of diabetes pills up, insulin use down
Human growth hormone shows promise in treating cystic fibrosis symptoms

Research Activities, October 2010:
For elderly patients with depression, cost-sharing insurance policies reduce drug use without increasing use of care
Delay in filling a blood-thinner prescription after procedures to implant a drug-eluting stent is risky
More than a quarter of patients do not fill prescriptions for new medications
Acamprosate safe and efficacious in treating alcohol dependence
How community pharmacies decide how and whether to provide immunization services

Research Activities, September 2010:
Assessment of hospital computerized physician order entry systems finds many medication errors are missed
Detailed, up-to-date medication lists help prevent errors
Physician champions key to successful quality improvement projects
Impact of anti-arthritis drug on lipid levels in patients with rheumatoid arthritis remains unclear
Hydroxychloroquine still underused by patients with lupus, but use more likely if treated by rheumatologists
Patients more likely to follow medication regimens if they share their doctor's beliefs about causes of health outcomes
Electronic prescribing with clinical decision support reduces medication errors in community-based practices
Electronic prescribing improves safety, but with a small increase in physician time
Benefits of chemotherapy for elderly patients with lung cancer must be weighed against risk of long-term toxicities
Measure of inappropriate prescribing predicts risk of adverse drug events in older adults

Research Activities, August 2010:
Women want clinicians to talk about the risk medications pose to an unborn child
Care setting affects likelihood that children with persistent asthma will receive inhaled steroids
Remote supervision of stroke therapy is safe and effective at smaller hospitals
Coronary risk information may improve prescribing practices
Simple tool to measure health literacy in patients with HIV successfully predicts medication adherence

Research Activities, July 2010:
Simplified drug warnings improve patients' understanding of what to do or avoid when given a particular prescription
Health plans vary widely in the prescribing of antibiotics
Unlike the United Kingdom, the United States has boosted its use of broad-spectrum antibiotics for respiratory infections
Extended use of antiviral drugs found to be safe and effective in preventing symptomatic influenza
Epilepsy drugs do not appear to increase suicide risk in patients with bipolar disorder
HIV patients are at risk for being prescribed wrong drug combinations
Elderly lung cancer patients experience more adverse events during chemotherapy than younger patients
Nearly 9 percent of children experience agitation during sedation for nonsurgical procedures
Computerized provider order entry significantly reduces medication errors in an ambulatory setting
Using bar-code technology with eMAR reduces medication administration and transcription errors
Disparities widen in the use of asthma medications

Research Activities, June 2010:
Children with ADHD from larger families more likely to use stimulants
Nonplatinum chemotherapy agents more likely to lead to hospitalizations for older women with ovarian cancer
Patient tool helps determine adherence to asthma medication
Doctors underprescribe warfarin to prevent strokes in patients with atrial fibrillation and heart failure

Research Activities, May 2010:
Atypical antipsychotic medications increase fracture risk in patients with Parkinson's disease
Combination treatment reduces acute kidney injury due to infusion of contrast dye during cardiac catheterization
Cost-effectiveness analysis supports genetic testing before patients with metastatic colorectal cancer are given irinotecan
Published sources on warfarin interactions with other drugs, food, and supplements tend not to agree
Anti-tumor necrosis factor therapy increases risk for certain mycobacteria infections
Some patients are more satisfied when they are given usually unnecessary antibiotics for upper respiratory infections
Emergency department treatment of asthma with systemic corticosteroids is not always timely
Drug monitoring may be improved by the use of health information technology and clinical pharmacists
Opioid-naïve nursing home residents are commonly prescribed long-acting opioids, a potentially dangerous practice
Team-based care of patients with hypertension improves control of blood pressure
Patients who take a proton-pump inhibitor with medicine to prevent blood clots are less likely to be hospitalized for bleeding ulcers

Research Activities, April 2010:
Physicians need to be better educated about FDA-approved indications for drugs and evidence for off-label drug use
Types and rates of fungal infections vary among groups and treatment is often suboptimal
Chemotherapy that contains anthracyclines is associated with later cardiac illness in breast cancer patients
Outpatient advice on pediatric medication safety is inadequate
Veterans who use pharmacy services at VA facilities tend to be sicker, poorer, and have no alternative insurance
Lack of time, resources to blame for primary care doctors rarely counseling women on birth-defect-causing drugs
Medication review technique may help identify drug-related problems in the elderly
HIV patients with psychiatric disorders are less likely to discontinue HAART
Cholesterol and diabetes drugs lead drug spending for the elderly

Research Activities, March 2010:
Clinicians should be cautious when prescribing one class of diabetes drugs for patients at high risk for heart attack
Beta blockers are underused in patients receiving implantable cardioverter defibrillators
Antidepressants may help some HIV patients stick to their complex medication regimens
Inner-city minority adults with chronic asthma are more likely to take inhaled medicine if they believe in its benefits
Prescription drug purchases increase for digestive problems

Research Activities, February 2010:
COPD drug triad associated with reduced death and hospitalization rates
Medicaid drug restrictions may lead to adverse events for psychiatric patients

Research Activities, January 2010:
U.S. spends nearly $1 billion on blood thinners for adults
Administration of antimicrobials just prior to surgery reduces the risk of surgical site infections
Medication changes are not always documented properly in physician notes or the electronic medical record
Criteria used to identify "drugs to avoid" in the elderly are not very accurate
Antidepressant use rises while psychotherapy declines
Youths initially diagnosed with ADHD receive an array of medications
Antibiotic resistance is prevalent and varied in long-term-care facilities
Primary care physicians like e-prescribing systems, but make little use of their advanced features
Use of electronic prescribing has expanded among Massachusetts physicians

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