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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
76 to 100 of 1693 Research Studies DisplayedRanard BL, Chow CC, Megjhani M
A mathematical model of SARS-CoV-2 immunity predicts paxlovid rebound.
Researchers used a parsimonious mathematical model of immunity to SARS-CoV-2 infection to model the effect of nirmatrelvir/ritonavir (Paxlovid), an oral antiviral medication, in unvaccinated and vaccinated patients. Model simulations showed that viral rebound after treatment occurred only in vaccinated patients; unvaccinated treated with Paxlovid did not experience rebound in viral load. The researchers concluded that an approach combining parsimonious models of the immune system could be used to gain important insights in the context of emerging pathogens.
AHRQ-funded; HS026121.
Citation: Ranard BL, Chow CC, Megjhani M .
A mathematical model of SARS-CoV-2 immunity predicts paxlovid rebound.
J Med Virol 2023 Jun; 95(6):e28854. doi: 10.1002/jmv.28854..
Keywords: COVID-19, Medication
Earla JR, Li J, Hutton GJ
Comparative adherence trajectories of oral disease-modifying agents in multiple sclerosis.
This study’s objective was to compare the adherence trajectories of fingolimod (FIN), teriflunomide (TER), and dimethyl fumarate (DMF) users with multiple sclerosis (MS) as there is limited evidence regarding the comparative adherence patterns of different oral disease-modifying agents (DMAs). The authors used data from the IBM MarketScan Commercial Claims Database from 2015 to 2019. The study cohort included adults (≥18 years) with MS (International Classification of Diseases [ICD]-9/10-Clinical Modification [CM]:340/G35) diagnosis and ≥1 DMA prescription. 1913 patients with MS who were initiated with FIN (24.2%, n = 462), TER (24.0%, n = 458), and DMF (51.9%, n = 993) during 2016-2018 were included. The adherence rate among FIN, TER, and DMF users was found to be 70.8% (n = 327), 59.6% (n = 273), and 61.0% (n = 606), respectively. The Group-Based Trajectory Modeling (GBTM) grouped patients into three adherence trajectories: Complete Adherers-59.1%, Slow Decliners-22.6%, and Rapid Discontinuers-18.3%. DMF and TER users had higher odds to be rapid discontinuers than FIN users. In addition, TER users were more likely to be slow decliners compared with FIN users.
AHRQ-funded; HS028502.
Citation: Earla JR, Li J, Hutton GJ .
Comparative adherence trajectories of oral disease-modifying agents in multiple sclerosis.
Pharmacotherapy 2023 Jun; 43(6):473-84. doi: 10.1002/phar.2810..
Keywords: Medication, Patient Adherence/Compliance, Neurological Disorders
Kakiuchi S, Perencevich EN, Livorsi DJ
Is the number of prescriptions an appropriate metric for outpatient antimicrobial consumption? A comparison between the prescription counts and days supplied.
Monitoring antibiotic use is essential for encouraging the appropriate use of antibiotics. However, defining appropriate metrics presents multiple challenges. The purpose of this study was to compare 2 metrics for antibiotic outpatient consumption at the Veterans Health Administration (VHA) pharmacies: the number of prescriptions in EMRs and the number of dispensed days, or days supplied. During the study period, 13,373,460 clinic visits (5.0%) of the 265,613,607 total clinic visits had an antibiotic prescription, and the total of days supplied was 182,793,572. The study found that the mean days supplied per prescription continued mainly unchanged during the study period. Comparing the number of prescriptions and days supplied normalized by the number of clinic visits, these 2 metrics changed in parallel, with only minor differences from 2010 to 2019. When the researchers focused on short-term prescriptions usually utilized for acute illnesses (14 days or less), prescription number and days supplied reflected an increasing discrepancy. The number of prescriptions underestimated the decline compared to days supplied. Alternatively, long-term prescriptions (15 days or more) reflected the opposite discrepancy. For comparisons between facilities, the researchers found considerable differences in rankings of healthcare systems based on the 2 metrics.
AHRQ-funded; HS027472.
Citation: Kakiuchi S, Perencevich EN, Livorsi DJ .
Is the number of prescriptions an appropriate metric for outpatient antimicrobial consumption? A comparison between the prescription counts and days supplied.
Infect Control Hosp Epidemiol 2023 Jun; 44(6):941-44. doi: 10.1017/ice.2022.189..
Keywords: Medication, Ambulatory Care and Surgery, Antibiotics, Antimicrobial Stewardship
Suzuki H, Heintz BH, Livorsi DJ
Tracking antimicrobial stewardship activities beyond days of therapy (DOT): comparison of days of antibiotic spectrum coverage (DASC) and DOT at a single center.
Researchers evaluated the measurement performance by days of antibiotic spectrum coverage (DASC) versus days of therapy (DOT), the preferred metric for measuring inpatient antimicrobial consumption within the U.S. Their retrospective study analyzed inpatient antimicrobial use at the Iowa City Veterans’ Affairs Healthcare System acute-care hospital. Antimicrobial DOT did not decrease significantly during a period of robust stewardship activities, but a significant downward trend in the antimicrobial spectrum, as measured by DASC was detected. The researchers concluded that the DASC metric may help to monitor the effect of stewardship activities more broadly.
AHRQ-funded; HS027472.
Citation: Suzuki H, Heintz BH, Livorsi DJ .
Tracking antimicrobial stewardship activities beyond days of therapy (DOT): comparison of days of antibiotic spectrum coverage (DASC) and DOT at a single center.
Infect Control Hosp Epidemiol 2023 Jun; 44(6):934-37. doi: 10.1017/ice.2022.312..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication
Kim KC, Khouja T, Burgette JM
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
This study examined trends in prescription fills for opioids, benzodiazepines, gabapentin, and stimulants to children <18 years from 2012 to 2019 in a national dataset comprising 92% of dispensed outpatient prescriptions by dentists. During this time, 3.8 million children filled prescriptions for high-alert drugs from general dentists. Opioids accounts for 69.4% of high-alert prescriptions, however from 2012 to 2019 fills for opioids, sedatives, benzodiazepines, and stimulants decreased by 65.2%, 43.4%, 43.6% and 89.3%, respectively. Gabapentin prescriptions increased by 8.1%. Older teenagers (15-17 years) received 42.5% of high-alert prescriptions. Low-income counties in Southern states were overrepresented among top-prescribing areas in 2019.
AHRQ-funded; HS025177.
Citation: Kim KC, Khouja T, Burgette JM .
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
Pharmacoepidemiol Drug Saf 2023 Jun; 32(6):625-34. doi: 10.1002/pds.5589..
Keywords: Children/Adolescents, Dental and Oral Health, Opioids, Medication, Practice Patterns
Smith SN, Lanham M, Seagull FJ
Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial.
This article described a study designed to improve existing alert systems for direct oral anticoagulant medications (DOAC) by testing novel alerts that encourage collaboration between prescribers and expert pharmacists working in anticoagulation clinics. Its goals were to determine the effect of notifications targeting existing inappropriate DOAC prescriptions, to examine the effect of alerts on newly prescribed inappropriate DOACs, and to examine changes in the magnitude of effects over time for both the new and existing prescription alerts. Prescribing healthcare providers would be randomized to different types of electronic health record medication alerts when a patient has an unsafe anticoagulant prescription; the authors identified which alerts are most effective at encouraging evidence-based prescribing.
AHRQ-funded; HS028562.
Citation: Smith SN, Lanham M, Seagull FJ .
Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial.
Implement Sci 2023 May 15; 18(1):16. doi: 10.1186/s13012-023-01273-4..
Keywords: Provider: Pharmacist, Blood Thinners, Medication, Evidence-Based Practice
Enzinger AC, Ghosh K, Keating NL
Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life.
This research characterized racial and ethnic disparities and trends in opioid access and urine drug screening (UDS) among older patients dying of cancer, and to explore potential mechanisms. Among 18,549 non-Hispanic White (White), Black, and Hispanic Medicare decedents older than 65 years with poor-prognosis cancers, the authors examined 2007-2019 trends in opioid prescription fills and potency (morphine milligram equivalents [MMEs] per day [MMEDs]) near the end of life (EOL), defined as 30 days before death or hospice enrollment. They found that between 2007 and 2019, White, Black, and Hispanic decedents experienced steady declines in EOL opioid access and rapid expansion of UDS. Compared with White patients, Black and Hispanic patients were less likely to receive any opioid (Black, -4.3 percentage points; Hispanic, -3.6 percentage points) and long-acting opioids (Black, -3.1 percentage points; Hispanic, -2.2 percentage points). They also received lower daily doses (Black, -10.5 MMED; Hispanic, -9.1 MMED) and lower total doses (Black, -210 MMEs; Hispanic, -179 MMEs). Black patients were also more likely to undergo UDS (0.5 percentage points).
AHRQ-funded; HS024072.
Citation: Enzinger AC, Ghosh K, Keating NL .
Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life.
J Clin Oncol 2023 May 10; 41(14):2511-22. doi: 10.1200/jco.22.01413..
Keywords: Elderly, Opioids, Medication, Cancer, Racial and Ethnic Minorities, Disparities, Access to Care
Laytner L, Chen P, Nash S
Perspectives on non-prescription antibiotic use among Hispanic patients in the Houston Metroplex.
This study examined non-prescription use of antibiotics among Hispanic adults in the Houston area. The study included Hispanic primary care clinic patients with different types of health insurance coverage in the Houston metroplex who endorsed non-prescription use in a previous survey. Semistructured interviews were conducted in English or Spanish with 35 participants primarily female (68.6%) and aged 27 to 66. Participants reported obtaining antibiotics through under-the-counter US markets, trusted persons, and purchased without a prescription abroad. Factors contributing to non-prescription use included beliefs that the doctor visit was unnecessary, limited access to healthcare, and communication difficulties. However, participants expressed confidence in medical recommendations from pharmacists and trusted community members.
AHRQ-funded; HS026901.
Citation: Laytner L, Chen P, Nash S .
Perspectives on non-prescription antibiotic use among Hispanic patients in the Houston Metroplex.
J Am Board Fam Med 2023 May 8; 36(3):390-404. doi: 10.3122/jabfm.2022.220416R1..
Keywords: Racial and Ethnic Minorities, Antibiotics, Medication, Antimicrobial Stewardship
Sikora A, Rafiei A, Rad MG
Pharmacophenotype identification of intensive care unit medications using unsupervised cluster analysis of the icurx common data model.
The Common Data Model for Intensive Care Unit (ICU) Medications (CDM-ICURx) may provide the needed infrastructure to clinicians and researchers to support artificial intelligence analysis of medication-related outcomes and healthcare costs. The purpose of this study was to identify novel patterns of medication clusters (termed 'pharmacophenotypes') correlated with ICU adverse events (e.g., fluid overload) and patient-centered outcomes (e.g., mortality). The researchers conducted a retrospective, observational cohort study of 991 critically ill adults with a total of 30,550 medication orders. To identify pharmacophenotypes, unsupervised machine learning analysis with automated feature learning was performed on the medication administration records of each patient during the first 24 hours of their stay in the intensive care unit. Five unique patient clusters and six unique pharmacophenotypes were identified. For patient outcomes, compared to patients in Clusters 1 and 3, patients in Cluster 5 had a significantly shorter duration of mechanical ventilation and ICU length of stay; for medications, Cluster 5 had a higher distribution of Pharmacophenotype 1 and a smaller distribution of Pharmacophenotype 2, compared to Clusters 1 and 3. For outcomes, patients in Cluster 2 had the highest severity of illness and greatest medication regimen complexity, but they also had the lowest overall mortality; for medications, Cluster 2 also had a higher distribution of Pharmacophenotype 6.
AHRQ-funded; HS028485.
Citation: Sikora A, Rafiei A, Rad MG .
Pharmacophenotype identification of intensive care unit medications using unsupervised cluster analysis of the icurx common data model.
Crit Care 2023 May 2; 27(1):167. doi: 10.1186/s13054-023-04437-2..
Keywords: Medication, Intensive Care Unit (ICU)
Patel D, Ng T, Madani LS
Antibiotic stewardship to reduce inappropriate antibiotic prescribing in integrated academic health-system urgent care clinics.
The purpose of this study was to conceptualize and implement antibiotic stewardship activities in urgent care that targets non-antibiotic-appropriate acute respiratory tract infections (ARIs) that also decreases general antibiotic prescribing and preserves patient satisfaction. The stewardship initiative commenced in fiscal year 2020 and included development of measures, comparative feedback, and education for clinicians and patients. The study measured antibiotic prescribing in fiscal years (FY) 2019, 2020, and 2021 for the stewardship goals, possible diagnosis-shifting visits, and overall prescribing. The researchers also collected patient satisfaction data for ARI visits. The study found that from FY 2019 to FY21, 576,609 patients made 1,358,816 visits to 17 urgent care clinics, including 105,781 visits for which stewardship measures were applied and 149,691 visits for which diagnosis shifting measures were applied. The antibiotic prescribing rate decreased for stewardship-measure visits from 34% in FY 2019 to 12% in FY 2021 The antibiotic prescribing rate decreased for diagnosis-shifting visits from 63% to 35%, and the antibiotic prescribing rate decreased overall from 30% to 10%. The patient satisfaction rate increased from 83% in FY 2019 to 89% in FY 2020 and FY 2021. There was no significant relationship between antibiotic prescribing rates of individual clinicians and ARI visit patient satisfaction.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Patel D, Ng T, Madani LS .
Antibiotic stewardship to reduce inappropriate antibiotic prescribing in integrated academic health-system urgent care clinics.
Infect Control Hosp Epidemiol 2023 May; 44(5):736-45. doi: 10.1017/ice.2022.164..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication
Jazowski SA, Samuel-Ryals CA, Wood WA
Association between low-income subsidies and inequities in orally administered antimyeloma therapy use.
This study’s goal was to determine the association between low-income subsidies and inequities in orally administered antimyeloma therapy use. This retrospective cohort study used Surveillance, Epidemiology, and End Results-Medicare data to identify beneficiaries diagnosed with multiple myeloma between 2007 and 2015. The authors examined therapy initiation in the 30, 60, and 90 days following diagnosis and adherence to and discontinuation of treatment in the 180 days following initiation. They found that receipt of full subsidies was not associated with earlier initiation of or improved adherence to orally administered antimyeloma therapy. Full-subsidy enrollees were 22% more likely to experience earlier treatment discontinuation than nonsubsidy enrollees. Black full-subsidy and nonsubsidy enrollees were 14% less likely than their White counterparts to ever initiate treatment.
AHRQ-funded; HS026122.
Citation: Jazowski SA, Samuel-Ryals CA, Wood WA .
Association between low-income subsidies and inequities in orally administered antimyeloma therapy use.
Am J Manag Care 2023 May; 29(5):246-54. doi: 10.37765/ajmc.2023.89357..
Keywords: Healthcare Costs, Medication, Low-Income
Marcaccio CL, Patel PB, Rastogi V
Efficacy and safety of single versus dual antiplatelet therapy in carotid artery stenting.
This study’s objective was to examine the efficacy and safety of preoperative single antiplatelet therapy (AP) therapy vs double antiplatelet therapy (DAPT) in patients who had undergone transfemoral CAS (tfCAS) or transcarotid artery revascularization (TCAR). The authors identified all patients who had undergone tfCAS or TCAR in the Vascular Quality Initiative database from 2016 to 2021. A total of 18,570 tfCAS patients were included, of which 70% had received DAPT, 5.6% no AP therapy, 10% ASA only, 8.0% ASA + AP loading dose, 4.6% P2Y12 inhibitor (P2Yi) only, and 2.9% P2Yi + AP loading dose. After adjustment, compared with DAPT, the incidence of stroke/death was higher with no AP therapy, ASA only, and ASA + AP loading dose, but was similar with P2Yi only, and P2Yi + AP loading dose. No differences were found in the incidence of bleeding rates between the treatment groups after tfCAS or TCAR. These findings support the current guidelines recommending DAPT before CAS but also suggest that P2Yi monotherapy might confer thromboembolic benefits similar to those with DAPT.
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Rastogi V .
Efficacy and safety of single versus dual antiplatelet therapy in carotid artery stenting.
J Vasc Surg 2023 May; 77(5):1434-46.e11. doi: 10.1016/j.jvs.2022.12.034..
Keywords: Blood Thinners, Medication, Medication: Safety, Cardiovascular Conditions, Stroke, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Wilson AS, Pham T, Mbusa D
Pharmacist-led, checklist intervention did not improve adherence in ambulatory patients starting/resuming DOACs.
This study’s aim was to determine whether checklist-driven care from a clinical pharmacist improved adherence in ambulatory patients starting a direct-acting anticoagulant (DOAC) or resuming it after a setback (thromboembolic event or bleeding) in an ambulatory setting. Clinical pharmacists using the DOAC checklist verified DOAC appropriateness, instructed dose de-escalation, educated through 3 tele-visits, fielded hotline calls, and handed off to a continuity provider after 3 months. Coupons and help with completing manufacturer-based medication assistance applicants were made available to intervention and control patients. Using pharmacy dispense records, the authors measured medication possession ratio (MPR) at 90 days (primary outcome) and proportion of days covered (PDC) at 90 days and MPR and PDC at 180 and 365 days (secondary outcomes). Of the 561 patients randomized, only 427 had sufficient records to analyze. Adherence was high with only 41 patients having MPR less than 80% at 90 days. There was no difference in adherence between intervention and control patients for primary outcome (odds ratio 0.94)) or secondary outcomes. The authors felt that given the already high levels of adherence in both study groups, reassessing the DOAC checklist outside of a traditional trial may be more fruitful.
AHRQ-funded; HS02592401.
Citation: Wilson AS, Pham T, Mbusa D .
Pharmacist-led, checklist intervention did not improve adherence in ambulatory patients starting/resuming DOACs.
J Am Pharm Assoc 2023 May-Jun; 63(3):878-84.e3. doi: 10.1016/j.japh.2023.02.019..
Keywords: Provider: Pharmacist, Patient Adherence/Compliance, Blood Thinners, Medication
Alpert A, Lakdawalla D, Sood N
Prescription drug advertising and drug utilization: the role of Medicare Part D.
The purpose of this paper was to explore how direct-to-consumer advertising (DTCA) for prescription drugs affects use by leveraging a large and plausibly exogenous shock to DTCA influenced by the introduction of Medicare Part D. Part D led to greater increases in advertising in geographic areas with greater concentrations of Medicare beneficiaries. The researchers explored the effect of this increase in advertising on non-elderly individuals to separate the effects of advertising from the direct effects of Part D. The study found that exposure to advertising resulted in large increases in treatment initiation and improved adherence to medication. Advertising also had substantial positive spillover effects on non-advertised generic drugs.
AHRQ-funded; HS025983.
Citation: Alpert A, Lakdawalla D, Sood N .
Prescription drug advertising and drug utilization: the role of Medicare Part D.
J Public Econ 2023 May; 221. doi: 10.1016/j.jpubeco.2023.104860..
Keywords: Communication, Medication, Medicare
Keller S, Miller MA, Cosgrove SE
AHRQ Author: Miller MA
The AHRQ Safety Program for Improving Antibiotic Use in Practice.
The Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use was an antibiotic stewardship intervention implemented across the United States in 2020 in 389 primary and urgent care practices. The AHRQ Toolkit to Improve Antibiotic Use in Ambulatory Care has been created based on integration of the educational material used in the AHRQ safety program and the experiences of the participating practices. The toolkit includes presentations on developing, implementing, and maintaining antibiotic stewardship activities; a gap analysis tool; and a guide to accessing and reporting antibiotic prescription data. Practices can use these tools to build their antibiotic stewardship teams and begin working on programs. Improving antibiotic prescribing in ambulatory care is a critical need. Utilizing the AHRQ Toolkit to Improve Antibiotic Use in Ambulatory Care can assist practices in achieving their antibiotic stewardship goals.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller S, Miller MA, Cosgrove SE .
The AHRQ Safety Program for Improving Antibiotic Use in Practice.
Am Fam Physician 2023 May; 107(5):456-57..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Ambulatory Care and Surgery, Tools & Toolkits
Bond AM, Dean EB, Desai SM
The role of financial incentives in biosimilar uptake in Medicare: Evidence from the 340b program.
This study’s goal was to investigate whether the 340B Drug Pricing Program, which offers eligible hospitals substantial discounts on drug purchases, inhibits biosimilar uptake. Almost one-third of eligible US hospitals participate in the program. The authors used regression discontinuity design and two high-volume biologics with biosimilar competitors, filgrastim and infliximab to estimate that 340B program eligibility was associated with a 22.9-percentage-point reduction in biosimilar adoption. Additionally, 340B program eligibility was associated with 13.3 more biologic administrations annually per hospital and $17,919 more biologic revenue per hospital. The effect was found to be that it inhibited biosimilar uptake, possibly because of financial incentives that make reference drugs more profitable than biosimilar medications.
AHRQ-funded; HS027531.
Citation: Bond AM, Dean EB, Desai SM .
The role of financial incentives in biosimilar uptake in Medicare: Evidence from the 340b program.
Health Aff 2023 May; 42(5):632-41. doi: 10.1377/hlthaff.2022.00812..
Keywords: Medicare, Medication, Healthcare Costs
Orth LE, Feudtner C, Kempe A
A coordinated approach for managing polypharmacy among children with medical complexity: rationale and design of the Pediatric Medication Therapy Management (pMTM) randomized controlled trial.
Pediatric polypharmacy (the use of 5 concurrent medications or more) is widespread and increases the risk of medication-related problems (MRPs). Although MRPs are related with pediatric morbidity and healthcare use, polypharmacy is rarely evaluated during typical clinical care for CMC. The purpose of this randomized controlled trial will be to examine whether a pharmacist-led Pediatric Medication Therapy Management (pMTM) intervention decreases MRP counts, as well as symptom burden and acute healthcare use, and will test the hypotheses that a patient-centered medication optimization intervention delivered by pediatric pharmacists will result in lower MRP counts, stable or improved symptom burdens, and fewer cumulative acute healthcare encounters at 90 days following pMTM compared to usual care. Eligible participants include all children ages 2 to 18 years old, with more than 1 complex chronic condition, and with 5 or more active medications, as well as their primary caregivers. Child participants and their primary caregivers will be randomized to pMTM or usual care before a non-acute primary care visit and followed for 90 days. Secondary outcomes include Parent-Reported Outcomes of Symptoms (PRO-Sx) symptom burden scores and acute healthcare visit counts. Costs of program replication will be evaluated using time-driven activity-based scoring.
AHRQ-funded; HS028979.
Citation: Orth LE, Feudtner C, Kempe A .
A coordinated approach for managing polypharmacy among children with medical complexity: rationale and design of the Pediatric Medication Therapy Management (pMTM) randomized controlled trial.
BMC Health Serv Res 2023 Apr 29; 23(1):414. doi: 10.1186/s12913-023-09439-y..
Keywords: Children/Adolescents, Medication, Patient-Centered Healthcare
Zhang J, Kummerfield E, Hultman G
Application of causal discovery algorithms in studying the nephrotoxicity of remdesivir using longitudinal data from the EHR.
Researchers analyzed the role of remdesivir in the mechanism and optimal treatment of the development of acute kidney injury (AKI) in the setting of COVID. Applying causal discovery machine learning techniques, they built multifactorial causal models of COVID-AKI; risk factors and renal function measures were represented in a temporal sequence using longitudinal data from Electronic Health Records. Their results indicated a need for assessment of renal function on second- and third-day use of remdesivir, and also showed that remdesivir may pose less risk to AKI than existing conditions of chronic kidney disease.
AHRQ-funded; HS024532.
Citation: Zhang J, Kummerfield E, Hultman G .
Application of causal discovery algorithms in studying the nephrotoxicity of remdesivir using longitudinal data from the EHR.
AMIA Annu Symp Proc 2023 Apr 29; 2022:1227-36..
Keywords: COVID-19, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Adverse Drug Events (ADE), Adverse Events
Taft T, Rudd EA, Thraen I
"Are we there yet?" Ten persistent hazards and inefficiencies with the use of medication administration technology from the perspective of practicing nurses.
The objectives of this study were to characterize persistent hazards and inefficiencies in inpatient medication administration, to explore cognitive attributes of medication administration tasks, and to discuss strategies to reduce technology-related hazards. Researchers interviewed nurses at two urban US health systems. Persistent safety hazards and inefficiencies related to medication administration technology were organized around the perception-action cycle (PAC) cycle. The researchers concluded that errors may persist in medication administration despite successful deployment of Bar Code Medication Administration and Electronic Medication Administration Record. Opportunities to improve would require a deeper understanding of high-level reasoning in medication administration.
AHRQ-funded; HS025136.
Citation: Taft T, Rudd EA, Thraen I .
"Are we there yet?" Ten persistent hazards and inefficiencies with the use of medication administration technology from the perspective of practicing nurses.
J Am Med Inform Assoc 2023 Apr 19; 30(5):809-18. doi: 10.1093/jamia/ocad031..
Keywords: Medication, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Patient Safety, Adverse Drug Events (ADE), Medical Errors, Medication: Safety
Grauer A, Rosen A, Applebaum JR
Examining medication ordering errors using AHRQ network of patient safety databases.
Research on the impact of Computerized Physician Order Entry (CPOE) systems on drug order inaccuracies has shown inconsistent results, with CPOE not reliably preventing such mistakes. The study utilized the Network of Patient Safety Databases (NPSD) from the Agency for Healthcare Research and Quality (AHRQ) to explore the frequency and degree of harm associated with reported events during the ordering stage, and to classify them by error type.
The researchers conducted a retrospective analysis of reported safety incidents provided by healthcare systems associated with patient safety organizations from June 2010 to December 2020. All errors related to medication and other substance orders reported to the NPSD using the common format v1.2 during this period were assessed. The researchers grouped and categorized the prevalence of reported medication order errors by error type, harm levels, and demographic data. The study found that during the study period, 12,830 mistakes were reported. Incorrect dosage accounted for 3,812 errors (29.7%), followed by incorrect medicine 2,086 (16.3%), and incorrect duration 765 (6.0%). Out of 5,282 incidents that affected the patient and had a known severity level, 12 resulted in fatalities, 4 led to severe harm, 45 caused moderate harm, 341 led to minor harm, and 4,880 resulted in no harm. The study concluded that the most frequently reported and damaging types of medication order errors were incorrect dose and incorrect medication orders.
The researchers conducted a retrospective analysis of reported safety incidents provided by healthcare systems associated with patient safety organizations from June 2010 to December 2020. All errors related to medication and other substance orders reported to the NPSD using the common format v1.2 during this period were assessed. The researchers grouped and categorized the prevalence of reported medication order errors by error type, harm levels, and demographic data. The study found that during the study period, 12,830 mistakes were reported. Incorrect dosage accounted for 3,812 errors (29.7%), followed by incorrect medicine 2,086 (16.3%), and incorrect duration 765 (6.0%). Out of 5,282 incidents that affected the patient and had a known severity level, 12 resulted in fatalities, 4 led to severe harm, 45 caused moderate harm, 341 led to minor harm, and 4,880 resulted in no harm. The study concluded that the most frequently reported and damaging types of medication order errors were incorrect dose and incorrect medication orders.
AHRQ-funded; HS026121.
Citation: Grauer A, Rosen A, Applebaum JR .
Examining medication ordering errors using AHRQ network of patient safety databases.
J Am Med Inform Assoc 2023 Apr 19; 30(5):838-45. doi: 10.1093/jamia/ocad007..
Keywords: Medication, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Patient Safety, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Medication: Safety
Rao Rao, Akrobetu DJ, Dickert NW
Deciding whether to take sacubitril/valsartan: how cardiologists and patients discuss out-of-pocket costs.
The purpose of this study was to characterize patient-cardiologist discussions concerning out-of-pocket costs associated with sacubitril/valsartan during the early post-approval period. Researchers conducted a content analysis of 222 deidentified transcripts of audio-recorded outpatient encounters in which cardiologists and patients discussed whether to initiate, continue, or discontinue sacubitril/valsartan. Issues of cost occurred in nearly half the discussions, but the researchers note that cost conversations were generally superficial, rarely addressing affordability or cost-value judgments. Cardiologists frequently provided patients with free sacubitril/valsartan samples with no plan to address costs after the sample course ran out.
AHRQ-funded; HS026081.
Citation: Rao Rao, Akrobetu DJ, Dickert NW .
Deciding whether to take sacubitril/valsartan: how cardiologists and patients discuss out-of-pocket costs.
J Am Heart Assoc 2023 Apr 4; 12(7):e028278. doi: 10.1161/jaha.122.028278..
Keywords: Shared Decision Making, Medication, Cardiovascular Conditions, Healthcare Costs
McClintock HF, Edmonds SE, Bogner HR
Adherence patterns to oral hypoglycemic agents among primary care patients with type 2 diabetes.
This study’s objective was to examine patterns of adherence to oral hypoglycemic agents among primary care patients with type 2 diabetes mellitus and to assess whether these patterns were associated with baseline intervention allocation, sociodemographic characteristics, and clinical indicators. Adherence patterns for 72 participants were examined by Medication Event Monitoring System (MEMS) caps at baseline and 12 weeks. Participants were randomly allocated to a Patient Prioritized Planning (PPP) intervention or a control group. A card-sort task was used in the PPP intervention to identify health-related priorities that included social determinants of health to address medication nonadherence. Afterward, a problem-solving process was used to address unmet needs involving referral to resources. Patients were found to be either adherent, increasingly adherent, or non-adherent. Participants assigned to the PPP intervention were significantly more likely to have a pattern of improving adherence and adherence than participants assigned to the control group.
AHRQ-funded; HS023445.
Citation: McClintock HF, Edmonds SE, Bogner HR .
Adherence patterns to oral hypoglycemic agents among primary care patients with type 2 diabetes.
Prim Care Diabetes 2023 Apr;17(2):180-84. doi: 10.1016/j.pcd.2023.01.014.
Keywords: Diabetes, Patient Adherence/Compliance, Primary Care, Medication, Chronic Conditions
Levin JS, Komanduri S, Whaley C
Association between hospital-physician vertical integration and medication adherence rates.
This study’s goal was to test the association between vertical integration of primary care providers (PCPs) and adherence rates for anti-diabetics, renin angiotensin system antagonists (RASA), and statins. Data was extracted from Medicare Part B outpatient fee-for-service claims and Medicare Part D event data from 2014 to 2017. There was a 23% increase in the proportion of patients who had a vertically integrated PCP during the study period. Changes in adherence did not differ significantly between patients based on whether their PCP became integrated. However, among patients with PCPs who become integrated, there were significant decreases in patients who were above 80 years old, were Black, Asian, Hispanic, or Native America, and had greater comorbidities for all three classes.
AHRQ-funded; HS024067.
Citation: Levin JS, Komanduri S, Whaley C .
Association between hospital-physician vertical integration and medication adherence rates.
Health Serv Res 2023 Apr; 58(2):356-64. doi: 10.1111/1475-6773.14090.
Keywords: Medication, Patient Adherence/Compliance, Medicare, Primary Care
Sun EC, Rishel CA, Waljee JF
Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients.
The objective of this study was to examine whether laws limiting opioid prescribing were associated with reductions in the incidence of persistent postoperative opioid use. Over identified 950,000 privately insured patients who had undergone one of 10 procedures were identified; researchers then estimated the association between persistent postoperative opioid use and whether state opioid prescribing limits were in effect on the day of surgery. The findings suggested that laws limiting opioid prescriptions were not associated with subsequent reductions in persistent postoperative opioid use.
AHRQ-funded; HS026753.
Citation: Sun EC, Rishel CA, Waljee JF .
Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients.
Ann Surg 2023 Apr;277(4):e759-e65. doi: 10.1097/sla.0000000000005283.
Keywords: Opioids, Medication, Surgery, Substance Abuse, Practice Patterns
Carroll AR, Schlundt D, Bonnet K
Caregiver and clinician perspectives on discharge medication counseling: a qualitative study.
This study’s objective was to explore the perspectives of multidisciplinary clinicians and caregivers regarding discharge medication counseling for children and to develop a conceptual model to inform intervention efforts to reduce discharge medication dosing errors. The authors conducted a qualitative analysis using results from focus groups and individual interviews with 17 caregivers and 16 clinicians. Domains and subthemes included: (1) infrastructure of healthcare delivery, including supplies for counseling, content and organization of discharge instructions, clinician training and education, roles and responsibilities of team members, and hospital pharmacy delivery and counseling program; (2) processes of healthcare delivery, including medication reconciliation, counseling content, counseling techniques, and language barriers and health literacy; and (3) measurable outcomes, including medication dosing accuracy and caregiver understanding and adherence to discharge instructions. The conceptual model that resulted from this analysis can be applied to the development and evaluation of interventions to reduce discharge medication dosing errors following a hospitalization.
AHRQ-funded; HS026122.
Citation: Carroll AR, Schlundt D, Bonnet K .
Caregiver and clinician perspectives on discharge medication counseling: a qualitative study.
Hosp Pediatr 2023 Apr; 13(4):325-42. doi: 10.1542/hpeds.2022-006937..
Keywords: Children/Adolescents, Medication, Hospital Discharge, Education: Patient and Caregiver, Caregiving