National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (6)
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- Provider: Pharmacist (1)
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- Quality of Care (2)
- Racial and Ethnic Minorities (1)
- Registries (1)
- Research Methodologies (2)
- Respiratory Conditions (1)
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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
26 to 47 of 47 Research Studies DisplayedKim HS, McCarthy DM, Hoppe JA
Emergency department provider perspectives on benzodiazepine-opioid coprescribing: a qualitative study.
This study examined attitudes of emergency department residents, attending physicians, and pharmacists from three hospitals on coprescribing benzodiazepines and opioids. There is mounting evidence that this increases overdose risk. Focus groups were conducted using semistructured interviews which were audio-recorded and transcribed. Participants were reluctant to admit coprescribing and said when they did that specific discharge instructions were provided. The decision was also influenced by a provider’s belief in the efficacy of combination therapy as well as self-imposed pressure to escalate care or avoid hospital admission. They did not like the idea of using computerized alerts, but were support of pharmacist-assisted interventions.
AHRQ-funded; HS023011; HS000078.
Citation: Kim HS, McCarthy DM, Hoppe JA .
Emergency department provider perspectives on benzodiazepine-opioid coprescribing: a qualitative study.
Acad Emerg Med 2018 Jan;25(1):15-24. doi: 10.1111/acem.13273..
Keywords: Emergency Department, Guidelines, Medication, Opioids, Practice Patterns, Provider: Clinician, Provider: Pharmacist, Provider: Physician
Carson NJ, Progovac AM, Wang Y
A decline in depression treatment following FDA antidepressant warnings largely explains racial/ethnic disparities in prescription fills.
The Food and Drug Administration's 2004 antidepressant warning was followed by decreases in antidepressant prescribing for youth. Little is known about how antidepressant prescribing patterns varied by race/ethnicity. This study analyzed Medicaid claims data from four U.S. states (2002-2009) for youth ages 5-17. The authors found that antidepressant prescription fills declined most post-warning for White youth, suggesting that risk information may have diffused less rapidly to prescribers or caregivers of minorities.
AHRQ-funded; HS021486.
Citation: Carson NJ, Progovac AM, Wang Y .
A decline in depression treatment following FDA antidepressant warnings largely explains racial/ethnic disparities in prescription fills.
Depress Anxiety 2017 Dec;34(12):1147-56. doi: 10.1002/da.22681..
Keywords: Medication, Children/Adolescents, Depression, Guidelines, Racial and Ethnic Minorities
Cosgrove L, Krimsky S, Wheeler EE
Conflict of interest policies and industry relationships of guideline development group members: A cross-sectional study of clinical practice guidelines for depression.
The purpose of the present study was to assess a) the disclosure requirements of guideline development groups in a cross-section of guidelines for major depression; and, b) the extent and type of conflicts of panel members. It found that most of the guidelines were developed by panels that had members with industry financial ties to drug companies that manufacture antidepressant medication.
AHRQ-funded; HS022940.
Citation: Cosgrove L, Krimsky S, Wheeler EE .
Conflict of interest policies and industry relationships of guideline development group members: A cross-sectional study of clinical practice guidelines for depression.
Account Res 2017;24(2):99-115. doi: 10.1080/08989621.2016.1251319.
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Keywords: Medication, Depression, Guidelines, Behavioral Health, Research Methodologies
Wasserman S, Avilla E, Ben-Shoshan M
Epinephrine autoinjectors: new data, new problems.
This paper reviews new data, and new problems in recently published literature on epinephrine autoinjectors. The authors emphasize that existing gaps in anaphylaxis management remain unaddressed. Patient needs are largely unmet, and very few studies are being designed to clarify and instill best practice, and to determine how to increase adherence to existing anaphylaxis guidelines through integrated knowledge translation strategies.
AHRQ-funded; HS024599.
Citation: Wasserman S, Avilla E, Ben-Shoshan M .
Epinephrine autoinjectors: new data, new problems.
J Allergy Clin Immunol Pract 2017 Sep - Oct;5(5):1180-91. doi: 10.1016/j.jaip.2017.06.027.
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Keywords: Evidence-Based Practice, Guidelines, Medication, Patient-Centered Outcomes Research, Patient Self-Management
Salber GJ, Wang YB, Lynch JT
Metformin use in practice: compliance with guidelines for patients with diabetes and preserved renal function.
This article reports on an examination of a population of patients with diabetes with preserved renal function to evaluate provider compliance with guidelines on metformin use and to identify factors that contributed when practice diverged from recommendations. It found that although providers generally follow current recommendations for the use of metformin, deviations from guidelines in practice are common.
AHRQ-funded; HS019474.
Citation: Salber GJ, Wang YB, Lynch JT .
Metformin use in practice: compliance with guidelines for patients with diabetes and preserved renal function.
Clin Diabetes 2017 Jul;35(3):154-61. doi: 10.2337/cd15-0045.
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Keywords: Medication, Guidelines, Diabetes, Adverse Drug Events (ADE)
Parikh KS, Lippmann SJ, Greiner M
Scope of sacubitril/valsartan eligibility after heart failure hospitalization: findings from the GWTG-HF Registry (Get With The Guidelines-Heart Failure).
Researchers used the Get With The Guidelines-Heart Failure (GWTG-HF) registry to characterize patients’ eligibility and potential barriers for sacubitril/valsartan initiation. The GWTG-HF registry was established by the American Heart Association to improve adherence to quality of care guidelines for patients hospitalized with heart failure. The FDA has approved sacubitril/valsartan for patients with heart failure with reduced ejection fraction (HFrEF); however, FDA labeling is broader than the trial entry criteria, and the scope of potential sacubitril/valsartan use in HFrEF is not well understood. Findings suggest that discharge from hospitalization from acute heart failure may be an opportunity for re-evaluating medications, including potentially switching the patient from ACEI/ARB, or starting sacubitril/valsartan.
AHRQ-funded; HS021092.
Citation: Parikh KS, Lippmann SJ, Greiner M .
Scope of sacubitril/valsartan eligibility after heart failure hospitalization: findings from the GWTG-HF Registry (Get With The Guidelines-Heart Failure).
Circulation 2017 May 23;135(21):2077-80. doi: 10.1161/circulationaha.117.027773..
Keywords: Cardiovascular Conditions, Guidelines, Heart Disease and Health, Hospitalization, Medication, Registries
Encinosa W, Davidoff AJ
AHRQ Author: Encinosa W
Changes in antiemetic overuse in response to Choosing Wisely recommendations.
Antiemetics are used to prevent chemotherapy-induced nausea and vomiting in patients with cancer. Newer antiemetic agents (serotonin and neurokinin-1 receptor antagonists) have increased efficacy but are expensive. This study estimating the baseline prevalence, trends, determinants, and costs of antiemetic overuse found that antiemetic overuse is prevalent and results in unnecessary spending associated with systemic chemotherapy treatment.
AHRQ-authored.
Citation: Encinosa W, Davidoff AJ .
Changes in antiemetic overuse in response to Choosing Wisely recommendations.
JAMA Oncol 2017 Mar;3(3):320-26. doi: 10.1001/jamaoncol.2016.2530.
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Keywords: Guidelines, Medication, Prevention, Shared Decision Making
Romagnoli KM, Nelson SD, Hines L
Information needs for making clinical recommendations about potential drug-drug interactions: a synthesis of literature review and interviews.
To better understand the information needs and work practices of specialists who search and synthesize potential drug-drug interactions (PDDIs) evidence for drug information resources, the researchers conducted an inquiry that combined a thematic analysis of published literature with unstructured interviews. Their review of 92 papers and 10 interviews identified 56 categories of information needs related to the interpretation of PDDI information including drug and interaction information, study design and evidence including clinical details.
AHRQ-funded; HS019461.
Citation: Romagnoli KM, Nelson SD, Hines L .
Information needs for making clinical recommendations about potential drug-drug interactions: a synthesis of literature review and interviews.
BMC Med Inform Decis Mak 2017 Feb 22;17(1):21. doi: 10.1186/s12911-017-0419-3.
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Keywords: Guidelines, Clinical Decision Support (CDS), Medication, Adverse Drug Events (ADE)
Dhruva SS, Desai NR, Karaca-Mandic P
Medicare formulary changes after the 2013 American College of Cardiology/American Heart Association Cholesterol Guideline.
This letter describes a study which examined the use of statins and non-statin medications at Medicare formularies before and after the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guideline was released. The study found that while many formularies did restrict nonstatin medications as per the new guidelines, many others did not.
AHRQ-funded; HS023000.
Citation: Dhruva SS, Desai NR, Karaca-Mandic P .
Medicare formulary changes after the 2013 American College of Cardiology/American Heart Association Cholesterol Guideline.
J Am Coll Cardiol 2017 Jan 17;69(2):244-46. doi: 10.1016/j.jacc.2016.10.053..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Guidelines, Medicare, Medication
Shekelle PG, Newberry SJ, FitzGerald JD
Management of gout: a systematic review in support of an American College of Physicians clinical practice guideline.
The authors reviewed evidence about treatment of acute gout attacks, management of hyperuricemia to prevent attacks, and discontinuation of medications for chronic gout in adults. They concluded that colchicine, NSAIDs, and corticosteroids relieve pain in adults with acute gout. Urate-lowering therapy decreases serum urate levels and reduces risk for acute gout attacks.
AHRQ-funded; 290201200006I.
Citation: Shekelle PG, Newberry SJ, FitzGerald JD .
Management of gout: a systematic review in support of an American College of Physicians clinical practice guideline.
Ann Intern Med 2017 Jan 3;166(1):37-51. doi: 10.7326/m16-0461.
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Keywords: Evidence-Based Practice, Guidelines, Prevention, Medication, Comparative Effectiveness
Manojlovich M, Ratz D, Miller MA
AHRQ Author: Miller MA
Use of daily interruption of sedation and early mobility in US hospitals.
Although the Awakening and Breathing Coordination, Delirium assessment, and Early exercise/mobility (ABCDE) bundle may be effective, individual components of ABCDE may not be implemented as intended. The researchers examined the use of daily interruption of sedation and early mobility, looking for an association between these bundle elements.
AHRQ-authored.
Citation: Manojlovich M, Ratz D, Miller MA .
Use of daily interruption of sedation and early mobility in US hospitals.
J Nurs Care Qual 2017 Jan/Mar;32(1):71-76. doi: 10.1097/ncq.0000000000000222.
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Keywords: Evidence-Based Practice, Guidelines, Medication, Patient Safety, Healthcare Delivery
Meisel ZF, Metlay JP, Sinnenberg L
A randomized trial testing the effect of narrative vignettes versus guideline summaries on provider response to a professional organization clinical policy for safe opioid prescribing.
The authors compared whether narrative vignettes embedded in the American College of Emergency Physicians (ACEP) daily e-newsletter improved dissemination of the clinical policy to ACEP members, and engagement of members with the clinical policy, compared with traditional summary text. They found that the vignettes outperformed traditional guideline text in promoting engagement with an evidence-based clinical guideline related to opioid prescriptions.
AHRQ-funded; HS021956.
Citation: Meisel ZF, Metlay JP, Sinnenberg L .
A randomized trial testing the effect of narrative vignettes versus guideline summaries on provider response to a professional organization clinical policy for safe opioid prescribing.
Ann Emerg Med 2016 Dec;68(6):719-28. doi: 10.1016/j.annemergmed.2016.03.007.
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Keywords: Communication, Evidence-Based Practice, Guidelines, Opioids, Medication, Medication: Safety, Policy, Provider
Cram P, Wolinsky FD, Lou Y
Patient-activation and guideline-concordant pharmacological treatment after bone density testing: the PAADRN randomized controlled trial.
In a clinical trial of 7749 patients, the researchers tested whether usual care augmented by a tailored patient-activation DXA result letter accompanied by an educational brochure would improve guideline-concordant pharmacological treatment compared to usual care only. They found that treatment rates did not improve.
AHRQ-funded; HS023009.
Citation: Cram P, Wolinsky FD, Lou Y .
Patient-activation and guideline-concordant pharmacological treatment after bone density testing: the PAADRN randomized controlled trial.
Osteoporos Int 2016 Dec;27(12):3513-24. doi: 10.1007/s00198-016-3681-9.
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Keywords: Education: Patient and Caregiver, Guidelines, Medication, Osteoporosis, Patient and Family Engagement
Wu AC, Li L, Fung V
Mismatching among guidelines, providers, and parents on controller medication use in children with asthma.
The authors sought to assess provider prescribing patterns for asthma controller medications and to assess how frequently parental reports of children's asthma controller medicine use were mismatched with provider recommendations. They found that mismatches between parental reports and provider intentions regarding how the child was supposed to use inhaled steroids occurred for half of the children. They recommended that efforts focus on ways to reduce these mismatches.
AHRQ-funded; HS019669.
Citation: Wu AC, Li L, Fung V .
Mismatching among guidelines, providers, and parents on controller medication use in children with asthma.
J Allergy Clin Immunol Pract 2016 Sep-Oct;4(5):910-6. doi: 10.1016/j.jaip.2016.04.004.
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Keywords: Asthma, Children/Adolescents, Guidelines, Medication, Practice Patterns
Fan T, Blitz J
AHRQ Author: Fan T
Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women.
This case study involves a 40-year-old woman presenting for a routine antepartum visit. She is 20 weeks pregnant and smokes half a pack of cigarettes per day. She asks if your clinic offers services to help with tobacco smoking cessation and if she should try using e-cigarettes to stop smoking. The authors next pose three multiple choice questions and then give the U.S. Preventive Services Task Force recommendations and related background information.
AHRQ-authored.
Citation: Fan T, Blitz J .
Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women.
Am Fam Physician 2016 May 15;93(10):861-2.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Tobacco Use, Behavioral Health, Medication, Guidelines
Williams DJ, Edwards KM, Self WH
Antibiotic choice for children hospitalized with pneumonia and adherence to national guidelines.
The 2011 national guidelines for the management of childhood community-acquired pneumonia (CAP) recommended narrow-spectrum antibiotics (e.g., ampicillin) for most children hospitalized with CAP. The researchers assessed the impact of these guidelines on antibiotic prescribing at 3 children’s hospitals. They found that, after publication of national guidelines, third-generation cephalosporin use declined and penicillin/ampicillin use increased among children hospitalized with CAP.
AHRQ-authored; HS022342.
Citation: Williams DJ, Edwards KM, Self WH .
Antibiotic choice for children hospitalized with pneumonia and adherence to national guidelines.
Pediatrics 2015 Jul;136(1):44-52. doi: 10.1542/peds.2014-3047..
Keywords: Children/Adolescents, Hospitalization, Guidelines, Medication, Practice Patterns
Tjia J, Field T, Mazor K
Dissemination of evidence-based antipsychotic prescribing guidelines to nursing homes: a cluster randomized trial.
This study evaluated the effectiveness of efforts to translate and disseminate evidence-based guidelines about atypical antipsychotic use to nursing homes (NHs). It found that RE-AIM indicators suggest some success in disseminating the toolkit and differences in reach, adoption, and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends.
AHRQ-funded; HS019351.
Citation: Tjia J, Field T, Mazor K .
Dissemination of evidence-based antipsychotic prescribing guidelines to nursing homes: a cluster randomized trial.
J Am Geriatr Soc 2015 Jul;63(7):1289-98. doi: 10.1111/jgs.13488..
Keywords: Communication, Evidence-Based Practice, Guidelines, Long-Term Care, Medication, Nursing Homes, Practice Patterns, Tools & Toolkits, Implementation
O'Brien EC, Kim S, Hess PL
Effect of the 2014 atrial fibrillation guideline revisions on the proportion of patients recommended for oral anticoagulation.
Researchers assessed the potential effect of a new guideline for atrial fibrillation (AF) by comparing the proportion of patients with AF recommended for oral anticoagulation (OAC) under the 2011 and 2014 guidelines. They found that two-thirds of patients with AF who were previously not recommended for OAC are newly recommended under the 2014 guideline. They advised future studies evaluating longitudinal changes in anticoagulation treatment patterns and outcomes among patients reclassified by the new guidelines.
AHRQ-funded; HS021092.
Citation: O'Brien EC, Kim S, Hess PL .
Effect of the 2014 atrial fibrillation guideline revisions on the proportion of patients recommended for oral anticoagulation.
JAMA Intern Med 2015 May;175(5):848-50. doi: 10.1001/jamainternmed.2015.13.
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Keywords: Heart Disease and Health, Blood Thinners, Guidelines, Medication, Cardiovascular Conditions, Evidence-Based Practice, Patient-Centered Outcomes Research
Gidengil CA, Linder JA, Hunter G
The volume-quality relationship in antibiotic prescribing: when more isn't better.
The researchers examined the impact of volume on more common medical conditions such as acute respiratory infections (ARIs). They found that higher ARI volume physicians had lower quality across a number of domains, including higher antibiotic prescribing rates, higher broad-spectrum antibiotic prescribing, and lower guideline concordance. When they prescribed an antibiotic for a diagnosis for which an antibiotic may be indicated, they were less likely to prescribe guideline-concordant antibiotics.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Linder JA, Hunter G .
The volume-quality relationship in antibiotic prescribing: when more isn't better.
Inquiry 2015 Feb 10;52. doi: 10.1177/0046958015571130..
Keywords: Quality of Care, Medication, Respiratory Conditions, Guidelines
Kealey E, Scholle SH, Byron SC
Quality concerns in antipsychotic prescribing for youth: a review of treatment guidelines.
The authors reviewed treatment guidelines relevant to 7 quality concepts for appropriate use and management of youth on antipsychotics.They found that all 7 quality concepts were strongly endorsed by 1 or more guidelines, and 2 or more guidelines assigned their highest strength of recommendation ratings to 6 of the 7 concepts. Two guidelines rated evidence, providing high strength of evidence for 2 quality concepts.
AHRQ-funded; HS020503.
Citation: Kealey E, Scholle SH, Byron SC .
Quality concerns in antipsychotic prescribing for youth: a review of treatment guidelines.
Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S68-75. doi: 10.1016/j.acap.2014.05.009.
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Keywords: Evidence-Based Practice, Children/Adolescents, Guidelines, Quality of Care, Medication
Camp KM, Parisi MA, Acosta PB
AHRQ Author: Chang CS
Phenylketonuria Scientific Review Conference: state of the science and future research needs.
An NIH State-of-the-Science Conference was convened in 2012 to address new findings, particularly the use of the medication sapropterin to treat some individuals with phenylketonuria (PKU), and to develop a research agenda. An AHRQ Evidence-based Practice Center conducted a systematic review of adjuvant treatments for PKU and presented its conclusions at the conference. New drugs that are safe, efficacious, and impact a larger proportion of individuals with PKU are needed. The identification of a research agenda has facilitated the development of clinical practice guidelines by professional organizations and serves as a model for other inborn errors of metabolism.
AHRQ-authored.
Citation: Camp KM, Parisi MA, Acosta PB .
Phenylketonuria Scientific Review Conference: state of the science and future research needs.
Mol Genet Metab 2014 Jun;112(2):87-122. doi: 10.1016/j.ymgme.2014.02.013.
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Keywords: Comparative Effectiveness, Evidence-Based Practice, Guidelines, Medication, Research Methodologies
Nuckols TK, Anderson L, Popescu I
Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain.
This review evaluated the quality and content of guidelines on the use of opioids for chronic pain. Despite limited evidence and variable development methods, it concluded that recent guidelines on chronic pain agree on several opioid risk mitigation strategies, including upper dosing thresholds; cautions with certain medications; attention to drug–drug and drug–disease interactions; and use of risk assessment tools, treatment agreements, and urine drug testing.
AHRQ-funded; HS017954.
Citation: Nuckols TK, Anderson L, Popescu I .
Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain.
Ann Intern Med 2014 Jan 7;160(1):38-47. doi: 10.7326/0003-4819-160-1-201401070-00732..
Keywords: Opioids, Pain, Guidelines, Medication, Evidence-Based Practice, Chronic Conditions