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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 1693 Research Studies DisplayedLee AH, McEvoy DS, Stump T
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
This study analyzed the influence of clinical decision support (CDS) to prevent delays in second doses of broad-spectrum antibiotics in the emergency department (ED). The authors allocated adult patients who received cefepime or piperacillin/tazobactam in 9 EDs within an integrated health care system to an electronic alert that reminded ED clinicians to reorder antibiotics at the appropriate interval vs usual care. Primary outcome was a median delay in antibiotic administration, and secondary outcomes were rates of intensive care unit (ICU) admission, hospital mortality, and hospital length of stay. A total of 1,113 ED patients treated with cefepime or piperacillin/tazobactam were enrolled in the study, of whom 420 remained under ED care when their second dose was due. The electronic alert system was associated with reduced antibiotic delays, but there were no differences in ICU transfers, inpatient mortality, or hospital length of stay.
AHRQ-funded; HS027170.
Citation: Lee AH, McEvoy DS, Stump T .
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
Ann Emerg Med 2023 Apr;81(4):485-91. doi: 10.1016/j.annemergmed.2022.10.022.
Keywords: Antibiotics, Medication, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT)
Growdon ME, Gan S, Yaffe K
New psychotropic medication use among Medicare beneficiaries with dementia after hospital discharge.
Hospital stays often trigger behavioral shifts in people with dementia (PWD), potentially leading to the prescription of psychotropic drugs despite their limited effectiveness and potential for harmful side-effects. The purpose of this study was to ascertain the prevalence of new psychotropic drug prescriptions in PWD living in the community after their discharge from the hospital, and within these new users, the percentage who continued their use for an extended duration. The researchers conducted a retrospective cohort study, utilizing a random selection of Medicare claims from 2017. The study included PWD hospital patients who were 68 years or older and covered by traditional and Part D Medicare. The primary outcome was the event of prescribing at the time of discharge psychotropic drugs including antipsychotics, sedative-hypnotics, antiepileptics, and antidepressants. The initiation was characterized as new prescriptions (from classes not utilized in the 180 days preceding admission) filled within a week of discharge from the hospital or skilled nursing facility. Extended use was defined as the percentage of new users who continued to refill the newly prescribed medications for more than 90 days post-discharge. The study population consisted of 117,022 hospitalized PWD with an average age of 81 years, with 63% being female. The study found that prior to admission, 63% were already using at least one psychotropic drug; 10% were using drugs from three or more psychotropic classes. These classes included antidepressants (44% pre-admission), antiepileptics (29%), sedative-hypnotics (21%), and antipsychotics (11%). The percentage of PWD discharged with new psychotropic prescriptions ranged from 1.9% (antipsychotics) to 2.9% (antiepileptics); 6.6% had at least one new class initiated. Among these new users, prolonged use varied from 36% (sedative-hypnotics) to 63% (antidepressants); across drug classes, prolonged use was observed in 51%. Factors associated with the initiation of new psychotropics included duration of hospital stay and delirium.
AHRQ-funded; HS026383.
Citation: Growdon ME, Gan S, Yaffe K .
New psychotropic medication use among Medicare beneficiaries with dementia after hospital discharge.
J Am Geriatr Soc 2023 Apr; 71(4):1134-44. doi: 10.1111/jgs.18161..
Keywords: Elderly, Medication, Medicare, Dementia, Neurological Disorders, Hospitalization
Antoon JW, Grijalva CG, Carroll AR
Parental perceptions of penicillin allergy risk stratification and delabeling.
The purpose of this study was to explore parental perceptions of the PCN allergy evaluation and removal process, especially in the hospital setting. Investigators conducted focus groups consisting of parent of children and adolescents with a PCN allergy label discharged from a large academic children’s hospital between January 1, 2019, and April 15, 2020. The focus groups answered questions about PCN allergy testing and evaluation, accuracy of the PCN allergy diagnosis, amoxicillin oral challenges, delabeling process, and preferred setting for PCN allergy delabeling evaluation (outpatient clinic, hospital, etc). The study concluded family concerns remained even after children passed an oral challenge, and that some parents preferred testing in a hospital setting and thought it was a safer location for the procedure.
AHRQ-funded; HS026122.
Citation: Antoon JW, Grijalva CG, Carroll AR .
Parental perceptions of penicillin allergy risk stratification and delabeling.
Hosp Pediatr 2023 Apr; 13(4):300-08. doi: 10.1542/hpeds.2022-006737..
Keywords: Children/Adolescents, Antibiotics, Medication, Risk
Gamyroulas EM, Jones AE, Saunders JA
Trends in antiplatelet strategies 12-months following coronary stent placement in anticoagulated patients.
The guidelines for antithrombotic management in individuals undergoing percutaneous coronary interventions (PCIs) who also necessitate anticoagulant treatment are continually developing. The purpose of this study is to examine adjustments to antithrombotic regimens and correlated outcomes within a year following PCI in patients needing continued anticoagulation therapy. Data from patients discovered through electronic medical record searches were manually assessed to validate alterations in antithrombotic treatment from discharge up to one year post-PCI, as well as episodes of significant bleeding, clinically relevant non-major bleeding (CRNMB), major adverse cardiovascular or neurological events (MACNE), and all-cause mortality outcomes during an extra six-month follow-up period. The study found that one year after PCI, patients (n = 120) undergoing anticoagulation treatment were categorized based on their antiplatelet therapy status: no antiplatelet therapy (n = 16), single antiplatelet therapy (SAPT) (n = 85), or dual antiplatelet therapy (DAPT) (n = 19). Between 12 and 18 months post-PCI, there were two significant bleeds, seven CRNMB events, six MACNE incidents, two venous thromboembolisms, and five fatalities. All but one bleeding occurrence transpired in the SAPT group. The likelihood of maintaining DAPT at 12 months was elevated in patients who underwent PCI for acute coronary syndrome and those who experienced MACNE within one year post-PCI; however, these associations did not reach statistical significance.
AHRQ-funded; HS027960
Citation: Gamyroulas EM, Jones AE, Saunders JA .
Trends in antiplatelet strategies 12-months following coronary stent placement in anticoagulated patients.
BMC Cardiovasc Disord 2023 Mar 8;23(1):117. doi: 10.1186/s12872-023-03161-7.
Keywords: Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Adverse Drug Events (ADE), Adverse Events
Hansten PD, Tan MS, Horn JR
Colchicine drug interaction errors and misunderstandings: recommendations for improved evidence-based management.
Colchicine serves as an effective therapy for the management and prevention of gout and various other medical conditions. As a substrate for CYP3A4 and P-glycoprotein (P-gp), its simultaneous use with CYP3A4/P-gp inhibitors can lead to critical drug-drug interactions (DDIs) that may result in pancytopenia, multiorgan dysfunction, and cardiac irregularities. Additionally, colchicine's potential for myotoxicity could elevate the risk of myopathy and rhabdomyolysis when combined with other myotoxic medications. Numerous sources of DDI information, encompassing journal articles, product labels, and online resources, contain inaccuracies or vague statements regarding colchicine's interactions with other drugs and subpar guidance on managing DDIs to minimize patient harm. Moreover, assessments of the clinical significance of specific colchicine DDIs can differ substantially between sources. The purpose of this study was to present an evidence-based analysis of drugs that are likely to interact with colchicine, as well as those that have been cited to interact but are improbable to do so. Based on these assessments, the researchers proposes strategies to mitigate the risk of severe adverse consequences from colchicine DDIs. The frequent recommendation to decrease colchicine dosage when administered with CYP3A4/P-gp inhibitors may, in some cases, lead to colchicine toxicity or therapeutic failure. An exhaustive evaluation of nearly 100 documented instances of colchicine DDIs is provided in a table within the electronic supplementary material. While colchicine is a beneficial medication, enhancements to the available information on colchicine DDIs are necessary to reduce the risk of serious adverse events.
AHRQ-funded; HS025984
Citation: Hansten PD, Tan MS, Horn JR .
Colchicine drug interaction errors and misunderstandings: recommendations for improved evidence-based management.
Drug Saf 2023 Mar;46(3):223-42. doi: 10.1007/s40264-022-01265-1.
Keywords: Medication, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Evidence-Based Practice
Socal MP, Ahn K, Greene JA
Competition and vulnerabilities in the global supply chain for US generic active pharmaceutical ingredients.
Researchers analyzed data from the Clarivate Analytics' Cortellis Generics Intelligence database to perform a systematic examination of generic active pharmaceutical ingredients (APIs) produced globally for the U.S. pharmaceutical market. Fourteen percent of APIs were manufactured in the U.S.; India, China, and Italy were the top producers. Three facilities manufactured approximately two-thirds of APIs. The researchers concluded that monitoring the API supply is crucial to identifying vulnerabilities in the U.S. pharmaceutical supply chain and identifying drugs that might represent potential priorities for domestic production. Incentives may be needed to support API production in the U.S. to safeguard against supply-chain disruptions.
AHRQ-funded; HS00002.
Citation: Socal MP, Ahn K, Greene JA .
Competition and vulnerabilities in the global supply chain for US generic active pharmaceutical ingredients.
Health Aff 2023 Mar;42(3):101377hlthaff202201120. doi: 10.1377/hlthaff.2022.01120.
Keywords: Medication
Vo H, Valentine KD, Barry MJ
Evaluation of the shared decision-making process scale in cancer screening and medication decisions.
The objectives of this study were to examine the reliability and validity of the Shared Decision-Making (SDM) Process scale for cancer screening and medication decisions. Researchers conducted a secondary data analysis of more than 6,000 participants who made decisions about breast, colon, or prostate cancer screening or taking medication for menopause, depression, hypertension or high cholesterol. They concluded that the SDM Process scale demonstrated construct validity and retest reliability.
AHRQ-funded; HS025718.
Citation: Vo H, Valentine KD, Barry MJ .
Evaluation of the shared decision-making process scale in cancer screening and medication decisions.
Patient Educ Couns 2023 Mar;108:107617. doi: 10.1016/j.pec.2022.107617.
Keywords: Shared Decision Making, Cancer, Medication, Screening
Thurman Johnson C, Ridge LJ, Hessels AJ
Nurse engagement in antibiotic stewardship programs: a scoping review of the literature.
This scoping review described how nurses are engaged in hospital-based antibiotic stewardship programs (ASPs) and to what extent this overlaps with the CDC framework. The authors concluded that, although hospitals were engaging nurses in antibiotic stewardship programs, their selected approaches did not reflect the full breadth of opportunities identified by the CDC. They noted that more detail as to how precisely nurses were engaged would be a useful addition to the literature; more research was also needed on nurse engagement in culturing or testing and penicillin allergy evaluation.
AHRQ-funded; HS026418.
Citation: Thurman Johnson C, Ridge LJ, Hessels AJ .
Nurse engagement in antibiotic stewardship programs: a scoping review of the literature.
J Healthc Qual 2023 Mar-Apr;45(2):69-82. doi: 10.1097/jhq.0000000000000372.
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Provider: Nurse
Olmeda K, Trautner BW, Laytner L
Prevalence and predictors of using antibiotics without a prescription in a pediatric population in the United States.
This study assessed the prevalence of antibiotic use in children in the previous 12 months, storage of antimicrobials, and intended use of non-prescription antibiotics (professed intention for future non-prescription antibiotic use). A diverse sample of caregivers of children under 18 years were surveyed in English and Spanish at two safety net clinics in Texas from January 2021 to April 2022. There was an 82% response rate, with 17% surveyed in Spanish. Approximately 21% reported storing antibiotics in their home, specifically amoxicillin (n = 52), clindamycin (n = 10), cephalexin (n = 5), penicillin (n = 3), and trimethoprim/sulfamethoxazole (n = 3). Nearly 15% reported intention to give non-prescription antibiotics to their children, with three Spanish-speaking caregivers reporting giving non-prescription antibiotics to their child in the previous 12 months. Younger caregivers were associated with storage and intended use of non-prescription antibiotics.
AHRQ-funded; HS027869.
Citation: Olmeda K, Trautner BW, Laytner L .
Prevalence and predictors of using antibiotics without a prescription in a pediatric population in the United States.
Antibiotics 2023 Mar;12(3). doi: 10.3390/antibiotics12030491..
Keywords: Children/Adolescents, Antibiotics, Medication, Antimicrobial Stewardship
Shmuel S, Leonard CE, Bykov K
Breaking research silos and stimulating "innovation at the edges" in epidemiology.
The authors discuss the importance of promoting an exchange of ideas across seemingly disparate epidemiologic subdisciplines. This exchange could lead to opportunities to learn from and to merge knowledge across subdisciplines, as well as promote "innovation at the edges." The authors also outline specific steps to promote such innovation at the researcher, institution, and professional society level.
AHRQ-funded; HS027623.
Citation: Shmuel S, Leonard CE, Bykov K .
Breaking research silos and stimulating "innovation at the edges" in epidemiology.
Am J Epidemiol 2023 Feb 24;192(3):323-27. doi: 10.1093/aje/kwac192.
Keywords: Evidence-Based Practice, Research Methodologies, Medication
Gay HC, Yu J, Persell SD
Comparison of sodium-glucose cotransporter-2 inhibitor and glucagon-like peptide-1 receptor agonist prescribing in patients with diabetes mellitus with and without cardiovascular disease.
Researchers sought to describe trends in prescribing for sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1-RAs) to reduce cardiovascular events and mortality in adult patients with type 2 diabetes mellitus (T2DM) in diverse care settings. Their focus was on outpatient clinics in a midwestern integrated health system and small- and medium-sized community-based primary care practices and health centers in three Midwestern states. Results showed that an increase in prescription rates was greater for SGLT2is than for GLP1-RAs in a large integrated medical center and community primary care practices; overall, prescription rates for eligible patients were low, and the researchers observed racial disparities.
AHRQ-funded; HS026385; HS023921.
Citation: Gay HC, Yu J, Persell SD .
Comparison of sodium-glucose cotransporter-2 inhibitor and glucagon-like peptide-1 receptor agonist prescribing in patients with diabetes mellitus with and without cardiovascular disease.
Am J Cardiol 2023 Feb 15; 189:121-30. doi: 10.1016/j.amjcard.2022.10.041..
Keywords: Diabetes, Cardiovascular Conditions, Chronic Conditions, Medication, Primary Care
Cook RR, Foot C, Arah OA
Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations.
The co-use of stimulants and opioids is increasing rapidly. Medications for opioid use disorder (MOUD) have demonstrated efficacy in randomized clinical trials (RCTs), but stimulant use may decrease the likelihood of initiating MOUD treatment. Moreover, trial participants may not represent "real-world" populations who would benefit from treatment. The study analyses included 673 clinical trial participants, 139 NSDUH respondents (weighted to represent 661,650 people), 71,751 TEDS treatment episodes, and 1,933 ROI participants. The study found that in RCTs, stimulant use reduced the likelihood of MOUD initiation by 32%. Stimulant use associations were slightly attenuated and non-significant among housed adults needing treatment and adults entering OUD treatment. The association was more pronounced, but still non-significant among rural people injecting drugs. Stimulant use had a larger negative impact on XR-NTX initiation compared to buprenorphine, especially in the rural population. The researchers concluded that stimulant use is a barrier to buprenorphine or XR-NTX initiation in clinical trials and real-world populations that would benefit from OUD treatment. Interventions to address stimulant use among patients with OUD are urgently needed, particularly among rural people injecting drugs, who already face limited access to MOUD.
AHRQ-funded; HS026370.
Citation: Cook RR, Foot C, Arah OA .
Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations.
Addict Sci Clin Pract 2023 Feb 14; 18(1):11. doi: 10.1186/s13722-023-00364-3..
Keywords: Substance Abuse, Behavioral Health, Opioids, Medication
Chiotos K, Blumenthal J, Boguniewicz J
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
The purpose of this study was to describe indications and appropriateness of antibiotic orders in pediatric intensive care unit (PICU) patients. The study found that of 1462 patients admitted to participating PICUs, 58% had at least 1 antibiotic order, with 1277 antibiotic orders being reviewed. Common indications were empiric therapy for suspected bacterial infections without sepsis or septic shock, nonoperative prophylaxis, empiric therapy for sepsis or septic shock, community-acquired pneumonia, and post-operative prophylaxis. Appropriateness was evaluated for 985 orders for which an evidence-based heading for appropriateness could be created. Of these, 34% were categorized as inappropriate. Indications with the most orders classified as inappropriate were empiric therapy for suspected bacterial infection without sepsis or septic shock, sepsis or septic shock, CAP, ventilator-associated infections, and post-operative prophylaxis. The proportion of antibiotics classified as inappropriate differed across institutions.
AHRQ-funded; HS026393.
Citation: Chiotos K, Blumenthal J, Boguniewicz J .
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
Clin Infect Dis 2023 Feb 8; 76(3):e1021-e30. doi: 10.1093/cid/ciac698..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Antibiotics, Medication, Antimicrobial Stewardship, Sepsis
DiStefano MJ, Markell JM, Doherty CC
Association between drug characteristics and manufacturer spending on direct-to-consumer advertising.
The purpose of this exploratory cross-sectional study was to pinpoint the attributes of drugs that correlate with a larger portion of promotional expenditure on consumer-targeted advertising. The researchers conducted an examination of drug traits and promotional expenses for the top 150 best-selling branded prescription medications in the US in 2020, using data from IQVIA National Sales Perspectives. IQVIA Channel Dynamics provided promotional spending information. Various drug features were assessed, including 2020 total sales and promotional spending, clinical benefit ratings, number of indications, off-label usage, molecule type, condition treated, administration method, generic availability, FDA approval year, World Health Organization anatomical therapeutic chemical classification, Medicare average annual spending per beneficiary, drug sales percentage, market size, and market competitiveness. Data was obtained from health technology assessment agencies and drug databases. The study found that in 2020, the median proportion of promotional spending allocated to direct-to-consumer advertising was 13.5% with a median promotional spending of $20.9 million and median total sales of $1.51 billion. Sixteen of the top 150 drugs had incomplete data, resulting in a primary study sample of 134 drugs. After adjusting for multiple drug characteristics, the mean proportion of total promotional spending allocated to direct-to-consumer advertising for the remaining 134 drugs was an absolute 14.3% higher for drugs with low added clinical benefit compared to those with high added clinical benefit and an absolute 1.5% higher for each 10% increase in total sales.
AHRQ-funded; HS000029.
Citation: DiStefano MJ, Markell JM, Doherty CC .
Association between drug characteristics and manufacturer spending on direct-to-consumer advertising.
JAMA 2023 Feb 7; 329(5):386-92. doi: 10.1001/jama.2022.23968..
Keywords: Medication, Communication
Jallow F, Stehling E, Sajwani-Merchant Z
A multisite qualitative analysis of perceived roles in medication safety: older adults' perspectives.
The objective of this study was to identify the roles of patients, providers, and pharmacists in medication safety from the perspective of older adults. Researchers conducted semi-structured qualitative interviews with community-dwelling adults over 65 years old who took five or more prescription medications daily. Their results suggested that older adults' perceptions of their role and the roles of primary care providers and pharmacists in medication safety varied widely. The researchers concluded that educating providers and pharmacists about the expectations of this population can ultimately improve medication safety.
AHRQ-funded; HS027277.
Citation: Jallow F, Stehling E, Sajwani-Merchant Z .
A multisite qualitative analysis of perceived roles in medication safety: older adults' perspectives.
J Patient Exp 2023 Jan-Dec; 10:23743735231158887. doi: 10.1177/23743735231158887..
Keywords: Elderly, Medication, Medication: Safety, Patient Safety, Patient Experience
Stone CA, Jr., Robinson LB, Li L
Clinical phenotypes of immediate first-dose reactions to mRNA COVID-19: a multicenter latent class analysis.
The objectives of this retrospective study were to define distinct clinical phenotypes of immediate reactions after dose 1 of mRNA COVID-19 vaccination, and to assess the relation of clinical phenotype to mRNA COVID-19 vaccine second dose tolerance. Researchers identified 265 patients who experienced dose-1 immediate reactions with 3 phenotype clusters: limited or predominantly cutaneous, sensory, or systemic. Of these, 223 patients received a second dose and 200 tolerated the second dose; sensory cluster (numbness or tingling) was associated with a higher likelihood of second dose intolerance, but this finding did not persist when accounting for objective signs.
AHRQ-funded; HS026395.
Citation: Stone CA, Jr., Robinson LB, Li L .
Clinical phenotypes of immediate first-dose reactions to mRNA COVID-19: a multicenter latent class analysis.
J Allergy Clin Immunol Pract 2023 Feb;11(2):458-65.e1. doi: 10.1016/j.jaip.2022.08.048.
Keywords: COVID-19, Medication, Adverse Drug Events (ADE), Adverse Events, Infectious Diseases, Vaccination
Jindai K, Itaya T, Ogawa Y
Decline in oral antimicrobial prescription in the outpatient setting after nationwide implementation of financial incentives and provider education: an interrupted time-series analysis.
Researchers examined the impact of financial incentives to providers and provider education on overall antimicrobial prescription rates. They also analyzed how nationwide outpatient antimicrobial stewardship interventions in cases where antimicrobials were deemed unnecessary for uncomplicated respiratory infections and acute diarrhea affected different age groups before and after their implementation. The results indicated that prescription rates for all age groups showed a downward trend throughout the study period. Substantial reductions in prescription rates were observed among infants under 2 years, while provider education immediately reduced prescription rates in all age groups uniformly. Interventions did not affect the long-term trend for any age group.
AHRQ-funded; HS027472.
Citation: Jindai K, Itaya T, Ogawa Y .
Decline in oral antimicrobial prescription in the outpatient setting after nationwide implementation of financial incentives and provider education: an interrupted time-series analysis.
Infect Control Hosp Epidemiol 2023 Feb; 44(2):253-59. doi: 10.1017/ice.2022.49..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Ambulatory Care and Surgery
Becker NV, Seelye S, Chua KP
Dispensing of ivermectin from Veterans Administration pharmacies during the COVID-19 pandemic.
The purpose of this cohort study was to evaluate changes between the Veterans Administration and retail pharmacies in how ivermectin was dispensed during the COVID-19 pandemic. Additionally, this study examined the association of the VA national formulary restriction with ivermectin dispensing. The study concluded that ivermectin dispensing minimally increased in VA pharmacies during the COVID-19 pandemic compared to more significant increases in retail pharmacies. This cohort study found that, in contrast to retail pharmacies, Study limitations include lack of complete capture of all retail pharmacies in IQVIA data and the lack of a control group for the analysis of the VA formulary restriction.
AHRQ-funded; HS028817.
Citation: Becker NV, Seelye S, Chua KP .
Dispensing of ivermectin from Veterans Administration pharmacies during the COVID-19 pandemic.
JAMA Netw Open 2023 Feb; 6(2):e2254859. doi: 10.1001/jamanetworkopen.2022.54859..
Keywords: COVID-19, Medication
Djulbegovic B, Hozo I, Lizarraga D
Evaluation of a fast-and-frugal clinical decision algorithm ('pathways') on clinical outcomes in hospitalised patients with COVID-19 treated with anticoagulants.
The objective of this study was to assess if delivery of anticoagulant prophylaxis according to an algorithm improved clinical outcomes in patients hospitalized with COVID-19 in comparison with anticoagulant treatment given at individual practitioners' discretion. Findings indicated that the algorithm did not reduce death, venous thromboembolism, nor major bleeding, but helped avoid longer hospital stay and admission to an intensive-care unit.
AHRQ-funded; HS024917.
Citation: Djulbegovic B, Hozo I, Lizarraga D .
Evaluation of a fast-and-frugal clinical decision algorithm ('pathways') on clinical outcomes in hospitalised patients with COVID-19 treated with anticoagulants.
J Eval Clin Pract 2023 Feb; 29(1):3-12. doi: 10.1111/jep.13780..
Keywords: COVID-19, Clinical Decision Support (CDS), Blood Thinners, Medication, Evidence-Based Practice, Health Information Technology (HIT)
Pham T, Patel P, Mbusa D
Impact of a pharmacist intervention on DOAC knowledge and satisfaction in ambulatory patients.
This randomized clinical trial’s goal was to assess the impact on knowledge and satisfaction of an intervention framed around a newly developed direct oral anticoagulants (DOAC) Checklist to guide and educate patients initiating or resuming DOACs. The cohort included ambulatory patients starting a DOAC or resuming one after setback (bleeding, stroke, or transient ischemic attack) in an ambulatory setting (office, emergency department, or short stay hospitalization). The study included three educational clinical pharmacist tele-visits, hotline access to the pharmacist, and coordination with continuity providers in 3 months. An abbreviated version of the Duke Anticoagulation Satisfaction Survey was administered to 463 patients. Scores were similar for the 233 intervention patients vs. 203 control patients (63.7% vs 62.2% correct). Satisfaction scores on the 7-point Likert scale were also virtually identical. The pharmacist-led intervention framed around the DOAC checklist had little impact on knowledge and satisfaction. There were delays between the intervention end and completion of the follow-up questionnaires, which may have obscured benefits experienced earlier.
AHRQ-funded; HS026859.
Citation: Pham T, Patel P, Mbusa D .
Impact of a pharmacist intervention on DOAC knowledge and satisfaction in ambulatory patients.
J Thromb Thrombolysis 2023 Feb;55(2):346-54. doi: 10.1007/s11239-022-02743-0.
Keywords: Provider: Pharmacist, Blood Thinners, Medication, Patient Experience, Ambulatory Care and Surgery
Goodhope NR, Anderson TS, Jung Y
Initiation of psychotropic and opioid medications after hospital discharge in older adults with dementia.
Despite the high number of people suffering from opioid addiction in the USA, access to treatment remains limited, with only a fraction of those in need receiving life-saving medications for opioid use disorder (MOUD). The current healthcare system and policies create unnecessary barriers to care, exacerbating treatment and illness burdens. This study proposes the use of a minimally disruptive medicine (MDM) framework to reduce disruptions in patients' lives, improve healthcare quality and delivery, and save lives. To achieve this, the authors suggest policy changes that expand MOUD to all healthcare settings, promote flexible and patient-centered medication choices, reduce treatment requirements, and address systemic disparities and inequities. By adopting an MDM approach, clinicians, health systems, and policymakers can create a more patient-centered and accessible care system for those battling opioid addiction.
AHRQ-funded; HS026216.
Citation: Goodhope NR, Anderson TS, Jung Y .
Initiation of psychotropic and opioid medications after hospital discharge in older adults with dementia.
J Gen Intern Med 2023 Feb; 38(3):824-27. doi: 10.1007/s11606-022-07874-x..
Keywords: Elderly, Opioids, Medication, Dementia, Hospital Discharge
Nguyen T, Meille G, Buchmueller T
AHRQ Author: Meille G
Mandatory prescription drug monitoring programs and overlapping prescriptions of opioids and benzodiazepines: evidence from Kentucky.
This AHRQ-authored study examined how overlapping benzodiazepine and opioid prescription rates changed after Kentucky implemented a PDMP mandate in July 2012 in response to the opioid epidemic. The authors conducted an interrupted time series analysis using monthly data from Kentucky's PDMP from 2010 to 2016. They also conducted an individual-level longitudinal analysis that compared changes in utilization patterns after the mandate went into effect to changes in earlier periods during which the mandate was not in effect. The PDMP mandate was associated with an immediate 7.5 % decline in the rate of overlapping benzodiazepine and opioid prescriptions and a significant change in the trend from increasing to decreasing. A single provider was responsible for approximately half of the immediate effect in level terms who was writing overlapping benzodiazepine and opioid prescriptions. Their longitudinal analysis suggests that over one year the mandate reduced initiation of overlapping prescriptions by 29.3 % and reduced continuation of overlapping prescriptions by 9.4 %, with effects of the policy being largest for women and men aged 36-50.
AHRQ-authored.
Citation: Nguyen T, Meille G, Buchmueller T .
Mandatory prescription drug monitoring programs and overlapping prescriptions of opioids and benzodiazepines: evidence from Kentucky.
Drug Alcohol Depend 2023 Feb 1; 243:109759. doi: 10.1016/j.drugalcdep.2022.109759..
Keywords: Opioids, Medication, Practice Patterns
Chiotos K, Marshall D, Kellom K
Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.
The purpose of this study was to perform an evaluation of a diagnostic stewardship initiative for respiratory culture in the healthcare setting within a pediatric intensive care unit (PICU) in a tertiary-care center. The study found that the frequency of culture collection per day of service differed among attending physicians, ranging from 2.2 to 27 cultures per 100 days. A total of 14 interviews were conducted, and 87 clinicians (response rate: 47%) along with 77 nurses or respiratory therapists (response rate: 17%) participated in the survey. There was a variation in clinicians' stated practices concerning culture ordering, which was influenced by both their specialty and their perception of the respiratory culture's usefulness. Additionally, group "default" practices, fear, and hierarchy affected the decision to order cultures. Obstacles to standardization encompassed concerns about missing a diagnosis and the conflict between standardized practices and individual judgment.
AHRQ-funded; HS026393.
Citation: Chiotos K, Marshall D, Kellom K .
Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.
Infect Control Hosp Epidemiol 2023 Feb; 44(2):191-99. doi: 10.1017/ice.2022.299..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Antibiotics, Medication, Antimicrobial Stewardship, Intensive Care Unit (ICU)
Dorsch MP, Chen CS, Allen AL
Nationwide implementation of a population management dashboard for monitoring direct oral anticoagulants: Insights from the Veterans Affairs health system.
Although they exhibit a robust efficacy and safety profile, prescribing Direct oral anticoagulants (DOACs) in accordance with evidence-based practices can be difficult due to varying dosage requirements based on factors like indication, renal function, and drug interactions. To assist pharmacists in reviewing anticoagulant prescriptions, the Veterans Health Affairs (VHA) created and deployed a population management dashboard that displays information on DOACs, prescribed dosages, renal function, age, weight, potential drug interactions, and refill needs. This dashboard operates as a standalone system. The purpose of this study was to assess the DOAC dashboard using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, analyzing login data from the dashboard. The study found that from August 2016 to June 2020, 150 out of 164 VHA sites utilized the dashboard, with an average of 1875 patients per site. The dashboard was introduced to sites in a staggered manner. Moderate or high adoption, defined as logging in on at least two separate days per month, started slowly with 3 out of 5 pilot sites but quickly rose to 142 out of 150 (94.7%) sites by June 2020. The mean number of unique users per site grew from 2.4 to 7.5 during the study. By the end of the research period, 126 out of 150 (84.0%) sites maintained moderate to high adoption of the dashboard for over six months. The researchers concluded that the population health dashboard for evidence-based anticoagulant prescribing witnessed rapid and sustained implementation and adoption across the national VHA health system in the United States. Investigating the tool's impact on clinical outcomes and replicating this care model in other healthcare systems would be crucial for widespread dissemination and adoption.
AHRQ-funded; HS026874.
Citation: Dorsch MP, Chen CS, Allen AL .
Nationwide implementation of a population management dashboard for monitoring direct oral anticoagulants: Insights from the Veterans Affairs health system.
Circ Cardiovasc Qual Outcomes 2023 Feb; 16(2):e009256. doi: 10.1161/circoutcomes.122.009256..
Keywords: Blood Thinners, Medication, Implementation
Smith SS, Caliendo A, Cheng BT
Patient perspectives on the drivers and deterrents of antibiotic treatment of acute rhinosinusitis: a qualitative study.
This study examined patient perceptions regarding what drives or deters them from wanting, seeking, and taking antibiotics for treatment of acute rhinosinusitis (ARS). Nineteen adults diagnosed with ARS within the prior 60 days at the Northwestern Medicine General Internal Medicine clinic in Chicago, IL were interviewed. Drivers of antibiotic use were: (1) symptoms, especially discolored rhinorrhea, and seeking relief, (2) belief that antibiotics are a convenient and/or effective way to relieve/cure sinusitis, and (3) desire for tangible outcomes of a clinic visit. Deterrents included: (1) concern about antibiotic resistance, (2) preference for other treatments or preference to avoid medications, and (3) desire to avoid a healthcare visit. A trustworthy physician’s recommendations for antibiotics were a driver, and a recommendation against antibiotics as well as a delayed antibiotic prescription also served as a deterrent.
AHRQ-funded; HS023011; 233201500020I; HS026506; HS028127.
Citation: Smith SS, Caliendo A, Cheng BT .
Patient perspectives on the drivers and deterrents of antibiotic treatment of acute rhinosinusitis: a qualitative study.
J Gen Intern Med 2023 Feb; 38(3):683-90. doi: 10.1007/s11606-022-07811-y..
Keywords: Antibiotics, Medication, Respiratory Conditions