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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 1510 Research Studies Displayed
Tan MS, Gomez-Lumbreras A, Villa-Zapata L
Colchicine and macrolides: a cohort study of the risk of adverse outcomes associated with concomitant exposure.
The authors conducted a cohort study using electronic health records comparing encounters with colchicine plus a macrolide and colchicine with an antibiotic non-macrolide, then assessed the relationship between the two groups. They found that heart failure was more frequent in the colchicine plus a macrolide cohort and that there was also a higher mortality rate. As there is a significant increase in the risk of hepatic failure and mortality when colchicine is concomitantly administered with a macrolide, they concluded that colchicine should not be used concomitantly with these antibiotics or should be temporarily discontinued to avoid toxic levels of colchicine.
Citation: Tan MS, Gomez-Lumbreras A, Villa-Zapata L . Colchicine and macrolides: a cohort study of the risk of adverse outcomes associated with concomitant exposure. Rheumatol Int 2022 Dec;42(12):2253-59. doi: 10.1007/s00296-022-05201-5..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Risk, Antibiotics, Medication: Safety, Patient Safety
Wurcel AG, Essien UR, Ortiz C
Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections.
This cohort study examined antibiotics prescribed and variations by race among hospitalized patients with skin and soft tissue infections (SSTIs). A subanalysis of multisite, cross-sectional data collected through a national survey of acute care hospital groups within Vizient, Inc. considering adult inpatients treated for SSTIs was used. Of the 1242 adult inpatients included from 91 US hospitals, 45% were female, 18% were Black, and 69% were White with a mean age of 58 years. Penicillin allergy with hives was found in 23%, 19% with rash, and 18% with unknown effects, with allergy found more frequent in Black patients (23%) versus White (18%). Adjusting for multiple factors, White inpatients were at an increased risk of cefazolin use and decreased risk of clindamycin use compared with Black inpatients. Cefazolin use with less likely to be prescribed to Black inpatients than White inpatients and they were likely to be prescribed clindamycin. Cefazolin is considered a first-line SSTI treatment with clindamycin not recommended given frequent dosing and high potential for adverse effects including Clostridioides difficile infection (CDI). Although penicillin allergy is described as more prevalent among White patients, the authors observed an increased prevalence among Black inpatients compared with White inpatients treated for SSTI.
Citation: Wurcel AG, Essien UR, Ortiz C . Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections. JAMA Netw Open 2021 Dec;4(12):e2140798. doi: 10.1001/jamanetworkopen.2021.40798..
Keywords: Antibiotics, Skin Conditions, Racial / Ethnic Minorities, Practice Patterns, Medication
Grove LR, Rao N, Domino ME
Are North Carolina clinicians delivering opioid use disorder treatment to Medicaid beneficiaries?
This study’s goal was to inform efforts to increase prescriptions of medications for opioid use disorder (MOUD) among Medicaid beneficiaries. A retrospective study of North Carolina licensed physicians, physician assistants, and nurse practitioners was conducted to estimate Medicaid participation prevalence among clinicians authorized to prescribe buprenorphine and to estimate the association between clinician characteristics and OUD care delivery to Medicaid beneficiaries. Outcomes looked for were indicators of any Medicaid professional claims and Medicaid claims data for buprenorphine and naltrexone. Licensure data from 2018 was merged with 2019 US Drug Enforcement Administration to identify clinicians who used the DEA waiver required to prescribe buprenorphine (n = 1714). Services by waivered clinicians to Medicare beneficiaries ranged from 67% of behavioral health clinicians to 82.9% of specialist physicians. Prevalence of prescribing buprenorphine to Medicaid beneficiaries ranged from 30.3% among specialist physicians to 51.6% among behavioral health clinicians.
Citation: Grove LR, Rao N, Domino ME . Are North Carolina clinicians delivering opioid use disorder treatment to Medicaid beneficiaries? Addiction 2022 Nov;117(11):2855-63. doi: 10.1111/add.15854..
Keywords: Opioids, Substance Abuse, Behavioral Health, Vulnerable Populations, Medication, Access to Care, Medicaid
Gibbons RD, Hur K, Lavigne JE
Association between folic acid prescription fills and suicide attempts and intentional self-harm among privately insured US adults.
This paper describes a large-scale pharmacoepidemiologic study of folic acid prescription fills to determine if there is a decreased risk of suicide attempt. Data were collected from a pharmacoepidemiologic database of US medical claims (MarketScan) for 866,586 patients with private health insurance who filled a folic acid prescription from 2012 to 2017. In the cohort 81.3% were female, and 10.42% were 60 years and older. Overall, there were 261 suicidal events during covered by a folic acid prescription for a rate of 4.73 per 100,000 person-months, compared with 895 suicidal events during months without folic acid for a rate of 10.61 per 100,000 person-months. Adjusting for age and sex, diagnoses related to suicidal behavior, diagnoses related to folic acid deficiency, folate-reducing medications, history of folate-reducing medications, and history of suicidal events, the hazard ratio (HR) for folic acid for suicide events was 0.56, with similar results for the modal dosage of 1 mg of folic acid per day and women of childbearing age. The same association with the negative control cyanocobalamin found no association with suicide attempt.
Citation: Gibbons RD, Hur K, Lavigne JE . Association between folic acid prescription fills and suicide attempts and intentional self-harm among privately insured US adults. JAMA Psychiatry 2022 Nov;79(11):118-1123. doi: 10.1001/jamapsychiatry.2022.2990..
Keywords: Medication, Behavioral Health, Adverse Drug Events (ADE), Adverse Events
Chui MA, Berbakov ME, Gilson AM
Effectiveness and sustainment of a tailored over-the-counter medication safety intervention in community pharmacies: a randomized controlled trial.
This paper is a protocol of a pilot study to address a gap in medication safety and decrease misuse of over-the-counter (OTC) medications by older adults aged 65 years or older by creating a pharmacy “Senior Section”. The study will occur in three phases: adaptation, effectiveness using a randomized controlled trial, and sustainment. The study will take place within a regional Midwest integrated health system in conjunction with administration leadership and pharmacy sites. The authors hope this project will provide a road map for pharmacy organizations to tailor and adopt the Senior Section.
Citation: Chui MA, Berbakov ME, Gilson AM . Effectiveness and sustainment of a tailored over-the-counter medication safety intervention in community pharmacies: a randomized controlled trial. Res Social Adm Pharm 2022 Nov;18(11):3953-63. doi: 10.1016/j.sapharm.2022.06.008..
Keywords: Medication, Medication: Safety, Patient Safety, Provider: Pharmacist
Howard R, Gunaseelan V, Brummett C
New persistent opioid use after inguinal hernia repair.
The purpose of this retrospective cross-sectional study was to characterize the risk factors and incidence of new persistent use of opioids after inguinal hernia repair. During the study period of 208-2016, 59,795 patients met the inclusion criteria. The study found that 1.5% of patients continued filling their opioids prescriptions at least 3 months after their surgery. The greatest risk factor for developing new persistent opioid use after surgery was filling an opioid prescription in the 30 days before surgery. Other risk factors for new persistent opioid use after surgery included having a major postoperative complication, receiving a larger opioid prescription, having more comorbidities, and having certain mental health disorders or pain disorders.
Citation: Howard R, Gunaseelan V, Brummett C . New persistent opioid use after inguinal hernia repair. Ann Surg 2022 Nov 1;276(5):e577-e83. doi: 10.1097/sla.0000000000004560..
Keywords: Opioids, Surgery, Medication, Pain
Mackie TI, Schaefer AJ, Palatucci JS
The role of formal policy to promote informed consent of psychotropic medications for youth in child welfare custody: a national examination.
The purpose of this sequential multi-method study was to propose a classification for the procedural elements of informed consent policies based upon existing child welfare policies and then explored whether formal state policies across the United States authorized these elements. The researchers conducted interviews with 58 key informants primarily from state child welfare agencies to identify a classification of procedural elements for informed consent of psychotropic medications. A legislative review of the 50 states and D.C. was then conducted to characterize whether formal policies endorsed each procedural element. Key informants reported five procedural elements in policy, and 23 states endorsed relevant legislation. Only two states specified all five procedural elements, and the content of any procedural elements varied considerably across policies.
AHRQ-funded; HS02198501; HS026001
Citation: Mackie TI, Schaefer AJ, Palatucci JS . The role of formal policy to promote informed consent of psychotropic medications for youth in child welfare custody: a national examination. Adm Policy Ment Health 2022 Nov;49(6):986-1003. doi: 10.1007/s10488-022-01212-3..
Keywords: Children/Adolescents, Vulnerable Populations, Medication, Behavioral Health, Policy
Gomez Lumbreras A, Reese TJ, Del Fiol G
Shared decision-making for drug-drug interactions: formative evaluation of an anticoagulant drug interaction.
This study evaluated a tool called DDInteract that was developed to enhance and support shared decision-making (SDM) between patients and physicians when both warfarin and NSAIDs are used concurrently. The study used case vignettes with physicians and patients on warfarin to conduct simulated virtual clinical encounters where they discussed the use of taking ibuprofen and warfarin concurrently and determined an appropriate therapeutic plan based on the patient’s individualized risk. Participants completed a postsession interview and SDM process survey, including the 9-item Shared Decision-Making Questionnaire (SDM-Q-9), tool usability and workload National Aeronautics and Space Administration (NASA) Task Load Index, Unified Theory of Acceptance and Use of Technology (UTAUT), Perceived Behavioral Control (PBC) scale, System Usability Scale (SUS), and Decision Conflict Scale (DCS). A total of 12 physician-patient dyads were used, with over 91% of the patients over 50 and 75% had been taking warfarin for over 2 years. Most participants rated DDInteract higher than usual care (UC) and would be willing to use the tool for an interaction involving warfarin and NSAIDs.
Citation: Gomez Lumbreras A, Reese TJ, Del Fiol G . Shared decision-making for drug-drug interactions: formative evaluation of an anticoagulant drug interaction. JMIR Form Res 2022 Oct 19;6(10):e40018. doi: 10.2196/40018..
Keywords: Decision Making, Medication, Blood Thinners, Clinical Decision Support (CDS), Health Information Technology (HIT), Medication: Safety, Patient Safety
Assimon MM, Pun PH, Al-Khatib SM
The modifying effect of the serum-to-dialysate potassium gradient on the cardiovascular safety of SSRIs in the hemodialysis population: a pharmacoepidemiologic study.
This study’s objective was to examine if higher QT-prolonging selective serotonin reuptake inhibitors (SSRIs) causes more cardiac risks to hemodialysis (HD) patients than lower serum-to-dialysate potassium gradient medications. The authors compared 1-year sudden cardiac death (SCD) risk among HD patients newly treated with higher (citalopram, escitalopram) versus lower (fluoxetine, fluvoxamine, paroxetine, sertraline) QT-prolonging potential SSRIs, overall and stratified by baseline potassium gradient. The study included 25,099 patients, with 44.3% newly prescribed higher QT-prolonging potential SSRIs and 55.7% lower QT-prolonging potential SSRIs. Overall, higher versus lower QT-prolonging potential SSRI use was not associated with SCD. However, a greater risk of SCD was associated with higher versus lower QT-prolonging potential SSRI use among patients with baseline potassium gradients ≥4 mEq/l but not among those with gradients <4 mEq/l versus 0.95.
Citation: Assimon MM, Pun PH, Al-Khatib SM . The modifying effect of the serum-to-dialysate potassium gradient on the cardiovascular safety of SSRIs in the hemodialysis population: a pharmacoepidemiologic study. Nephrol Dial Transplant 2022 Oct 19;37(11):2241-52. doi: 10.1093/ndt/gfac214..
Keywords: Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events
McNeil JC, Sommer LM, Vallejo JG
Reduced ceftaroline susceptibility among invasive mrsa infections in children: a clinical and genomic investigation.
The purpose of this study was to assess the frequency of reduced susceptibility (RS) to ceftaroline among pediatric methicillin-resistant Staphylococcus aureus (MRSA) infections. The researchers evaluated MRSA isolates at a tertiary children's hospital for ceftaroline RS. Ceftaroline RS occurred only among health care associated infections in 2.9% of isolates, and were more often clindamycin-resistant.
Citation: McNeil JC, Sommer LM, Vallejo JG . Reduced ceftaroline susceptibility among invasive mrsa infections in children: a clinical and genomic investigation. Antimicrob Agents Chemother 2022 Oct 18;66(10):e0074522. doi: 10.1128/aac.00745-22..
Keywords: Children/Adolescents, Medication, Methicillin-Resistant Staphylococcus aureus (MRSA), Infectious Diseases, Genetics
Snyder BM, Patterson MF, Gebretsadik T
Association between asthma status and prenatal antibiotic prescription fills among women in a Medicaid population.
The objective of this study was to assess the relationship between maternal asthma and outpatient prenatal antibiotic prescription fills to inform antibiotic stewardship. With data from the Tennessee Medicaid Program, findings showed that women with asthma had an increased risk of filling at least one prenatal antibiotic prescription and had an increased number of fills during pregnancy compared to women without asthma. These findings highlight that pregnant women with asthma disproportionately fill more antibiotic prescriptions during pregnancy.
Citation: Snyder BM, Patterson MF, Gebretsadik T . Association between asthma status and prenatal antibiotic prescription fills among women in a Medicaid population. J Asthma 2022 Oct;59(10):2100-07. doi: 10.1080/02770903.2021.1993247..
Keywords: Asthma, Respiratory Conditions, Pregnancy, Antibiotics, Antimicrobial Stewardship, Medication, Maternal Care, Women, Chronic Conditions
Yan CH, Ramanathan S, Suda KJ
Barriers to and facilitators of opioid prescribing by dentists in the United States: a qualitative study.
In this study, a national sample of US dentists was interviewed to understand the barriers and facilitators to opioid prescribing. Findings showed that dentists' opioid decision making is influenced by a range of real-world practice experiences and patient and clinic factors. Recommendations included targeting knowledge gaps in dentistry for education, clinical guidelines, and policy interventions in order to ensure safe and appropriate prescribing of opioids.
Citation: Yan CH, Ramanathan S, Suda KJ . Barriers to and facilitators of opioid prescribing by dentists in the United States: a qualitative study. J Am Dent Assoc 2022 Oct;153(10):957-69.e1. doi: 10.1016/j.adaj.2022.05.009..
Keywords: Dental and Oral Health, Opioids, Medication
Glynn A, Hernandez I, Roberts ET
Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.
This study’s objective was to estimate the take-up of the Medicare Part D Low-Income Subsidy (LIS) among Medicare beneficiaries with diabetes and examine differences in out-of-pocket costs and prescription drug use between LIS enrollees and LIS-eligible non-enrollees. Data from the Health and Retirement Study linked to Medicare administrative data from 2008 to 2016 was used. The authors first estimated LIS take-up stratified by income (≤100% of the Federal Poverty Level [FPL] and >100% to ≤150% of FPL). Second, to assess the consequences of forgoing the LIS among near-poor beneficiaries (incomes >100% to ≤150% of FPL), they conducted propensity score-weighted regression analyses to compare out-of-pocket costs, prescription drug use, and cost-related medication non-adherence among LIS enrollees and LIS-eligible non-enrollees. Among Medicare beneficiaries with diabetes, 68.1% of those considered near-poor (incomes >100% to ≤150% of FPL) received the LIS, compared to 90.3% of those with incomes ≤100% of FPL. Among near-poor beneficiaries, LIS-eligible non-enrollees incurred higher annual out-of-pocket drug spending ($518], filled 7.3 fewer prescriptions for diabetes, hypertension, and hyperlipidemia drugs, and were 8.9 percentage points more likely to report skipping drugs due to cost. all compared to LIS enrollees.
Citation: Glynn A, Hernandez I, Roberts ET . Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes. Health Serv Res 2022 Oct;57(5):1136-44. doi: 10.1111/1475-6773.13990..
Keywords: Medication, Diabetes, Chronic Conditions, Low-Income, Medicare, Healthcare Costs
Tisdale RL, Cusick MM, Aluri KZ
Cost-effectiveness of dapagliflozin for non-diabetic chronic kidney disease.
The purpose of this study was to determine the cost-effectiveness of adding dapagliflozin to standard management of patients with non-diabetic chronic kidney disease (CKD). Findings showed that adding dapagliflozin to standard care improved life expectancy by 2 years, increased discounted quality-adjusted life years, and reduced the total incidence of both kidney failure on kidney replacement therapy (KRT) and average years on KRT over the lifetime of the cohort. Further, dapagliflozin plus standard care was more effective than standard care alone while increasing lifetime costs.
Citation: Tisdale RL, Cusick MM, Aluri KZ . Cost-effectiveness of dapagliflozin for non-diabetic chronic kidney disease. J Gen Intern Med 2022 Oct;37(13):3380-87. doi: 10.1007/s11606-021-07311-5..
Keywords: Kidney Disease and Health, Medication, Chronic Conditions, Healthcare Costs
Warren DK, Peacock KM, Nickel KB
Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction.
The authors investigated factors associated with post-discharge prophylactic antibiotic use after mastectomy with and without immediate reconstruction and the impact on surgical-site infection (SSI). They found that anti-methicillin-sensitive Staphylococcus aureus antibiotics were associated with decreased risk of SSI for patients who had mastectomy only and those who had mastectomy with immediate reconstruction. They concluded that the high numbers needed to treat suggest that potential benefits of post-discharge antibiotics should be weighed against potential harms associated with antibiotic overuse.
Citation: Warren DK, Peacock KM, Nickel KB . Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction. Infect Control Hosp Epidemiol 2022 Oct;43(10):1382-88. doi: 10.1017/ice.2021.400..
Keywords: Antibiotics, Cancer: Breast Cancer, Cancer, Medication, Surgery, Healthcare-Associated Infections (HAIs), Prevention, Women, Practice Patterns
Oke I, Badami A, Kosteva KL
Systemic barriers in receiving electronically prescribed glaucoma medications.
The purpose of this cross-sectional study was to quantify glaucoma medication treatment interruptions attributable to electronically prescribed medications and recommend interventions to reduce this barrier. The researchers reviewed Glaucoma medication refill requests received over a 6-week interval, and then contacted patient pharmacies 1 month after the request date to determine whether the medication was picked up by the patient. Patients who did not pick up the prescriptions were contacted and consented to participate in a survey to identify the barriers to getting the medications. The study found that a prior authorization requirement was significantly associated with patients not obtaining their medication, as well as insurance coverage (32.2%) and availability of the medication at the pharmacy (22.6%). The study concluded that due to the need for prior authorization, insurance coverage, and pharmacy availability, approximately one third of electronically prescribed glaucoma medications were not picked up by patients within one month of the refill request.
Citation: Oke I, Badami A, Kosteva KL . Systemic barriers in receiving electronically prescribed glaucoma medications. J Glaucoma 2022 Oct;31(10):812-15. doi: 10.1097/ijg.0000000000002100..
Keywords: Medication, Patient Adherence/Compliance, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT)
Vaughn VM, Ratz D, Greene MT
Antibiotic stewardship strategies and their association with antibiotic overuse after hospital discharge: an analysis of the Reducing Overuse of Antibiotics at Discharge (ROAD) home framework.
Researchers sought to understand strategies to optimize antibiotic prescribing at discharge. Surveying Michigan hospitals on their antibiotic stewardship strategies for community-acquired pneumonia (CAP) and urinary tract infection (UTI), they found that the more stewardship strategies a hospital reported, the lower its antibiotic overuse at discharge.
Citation: Vaughn VM, Ratz D, Greene MT . Antibiotic stewardship strategies and their association with antibiotic overuse after hospital discharge: an analysis of the Reducing Overuse of Antibiotics at Discharge (ROAD) home framework. Clin Infect Dis 2022 Sep 29;75(6):1063-72. doi: 10.1093/cid/ciac104..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Hospital Discharge, Transitions of Care
Dutta S, McEvoy DS, Rubins DM
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
This paper discusses the outcomes of using a clinical decision support (CDS) tool that was implemented in emergency departments (EDs) for sepsis patients to remind healthcare staff to take blood cultures before administration of intravenous (IV) antibiotics. The study compared timely blood culture collection outcomes prior to IV antibiotics for 54,538 adult ED patients 1 year before and after a CDS intervention implementation in the electronic health record. The baseline phase found that 46.1% had blood cultures prior to IV antibiotics, compared to 58.8% after the intervention. The CDS improved blood culture collection rates without increasing overutilization.
Citation: Dutta S, McEvoy DS, Rubins DM . Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department. J Am Med Inform Assoc 2022 Sep 12;29(10):1705-14. doi: 10.1093/jamia/ocac115..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Antibiotics, Emergency Department, Medication, Sepsis
Kakiuchi S, Livorsi DJ, Perencevich EN
Days of antibiotic spectrum coverage: a novel metric for inpatient antibiotic consumption.
The purpose of this study was to develop a novel metric for antibiotic consumption, days of antibiotic spectrum coverage (DASC), to address the limitations of the current benchmarking metric days of therapy (DOT). The researchers developed their spectrum scoring system by assessing 77 antibiotics in 16 categories of antibacterial activity and creating a cumulative daily antibiotic spectrum coverage (ASC) score. To compare hospital benchmarking using DOT and DASC, the researchers conducted a retrospective cohort study of adult patients admitted to acute care units within the Veterans Health Administration system in 2018. The study found little relationship between DOT per 1000 and DASC per DOT, suggesting that lower antibiotic consumption at a hospital does not necessarily mean more frequent use of narrow-spectrum antibiotics. The researchers concluded that DASC is a potential replacement for DOT.
Citation: Kakiuchi S, Livorsi DJ, Perencevich EN . Days of antibiotic spectrum coverage: a novel metric for inpatient antibiotic consumption. Clin Infect Dis 2022 Sep 10;75(4):567-76. doi: 10.1093/cid/ciab1034..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship
Jiang Y, Mason M, Cho Y
Tolerance to oral anticancer agent treatment in older adults with cancer: a secondary analysis of data from electronic health records and a pilot study of patient-reported outcomes.
The purpose of this study was to explore the tolerance of capecitabine oral chemotherapy among older adults with cancer and investigate factors associated with related side effects and treatment changes. The researchers combined data from electronic health records and a pilot study of patient-reported outcomes, and found that older adults were more likely to experience fatigue and experienced more severe fatigue and hand-foot syndrome (HFS) than younger adults. The severity of fatigue and HFS were associated with the number of outpatient medications and the duration of treatment respectively. Female sex, breast cancer diagnosis, capecitabine monotherapy, and severe HFS were found to be associated with subsequent dose reductions. The study concluded that older adults were less likely to tolerate capecitabine treatment and had different co-occurring side effects compared to younger adults.
Citation: Jiang Y, Mason M, Cho Y . Tolerance to oral anticancer agent treatment in older adults with cancer: a secondary analysis of data from electronic health records and a pilot study of patient-reported outcomes. BMC Cancer 2022 Sep 3;22(1):950. doi: 10.1186/s12885-022-10026-3..
Keywords: Elderly, Cancer, Medication, Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT)
Tracer H, Newhouse CN
AHRQ Author: Tracer H
Aspirin use to prevent cardiovascular disease.
This Putting Prevention into Practice case study involves a 56-year-old man, a wellness visit, and aspirin usage to prevent cardiovascular disease. Three questions based on U.S. Preventative Serices Task Force recommendations are presented, followed by the answers.
Citation: Tracer H, Newhouse CN . Aspirin use to prevent cardiovascular disease. Am Fam Physician 2022 Sep;106(3):327-28..
Keywords: Medication, Cardiovascular Conditions, Prevention, Guidelines, Evidence-Based Practice
Ramadan OI, Dember LM, Wang GJ
Association between anaesthesia type and arteriovenous fistula maturation.
The purpose of this study was to measure the relationship between anesthesia type and arteriovenous fistula maturation. The researchers conducted a secondary analysis of data from 602 participants of the Hemodialysis Fistula Maturation study, a prospective cohort study of advanced chronic kidney disease patients who underwent single-stage upper extremity fistula creation between 2010 and 2013. The current study found that 55.8% of patients received regional/local anesthesia and 44.2% received general anesthesia. Unassisted maturation took place in 53.1% of patients after regional/local anesthesia vs 40.3% after general anesthesia. After adjustment for patient factors and fistula type, regional/local anesthesia was related with higher odds of unassisted maturation than general anesthesia. However, after further adjustment for clinical center fixed effects, odds of unassisted maturation did not differ by anesthesia type. The researchers concluded that regional/local anesthesia was related with higher odds of fistula maturation when adjusting for patient factors and fistula type, but the relationship association did not endure after adjusting for center fixed effects.
Citation: Ramadan OI, Dember LM, Wang GJ . Association between anaesthesia type and arteriovenous fistula maturation. BJA Open 2022 Sep;3. doi: 10.1016/j.bjao.2022.100031..
Keywords: Kidney Disease and Health, Medication
Wei YJ, Chen C, Cheng TD
Association of injury after prescription opioid initiation with risk for opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study.
This study’s objectives were to examine the association between incident injury after prescription opioid initiation and subsequent risk of opioid-related adverse events (ORAEs) and to assess whether the association differs by recency of injury among older patients. The researchers observed that incident diagnosis of injury following opioid initiation was associated with subsequent increased risk of ORAEs, and the risk was only significant among patients with injury in the month before the index date. They recommended regular monitoring for injury in order to identify older opioid users at high risk for ORAEs.
Citation: Wei YJ, Chen C, Cheng TD . Association of injury after prescription opioid initiation with risk for opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study. PLoS Med 2022 Sep;19(9):e1004101. doi: 10.1371/journal.pmed.1004101..
Keywords: Opioids, Medication, Adverse Drug Events (ADE), Substance Abuse, Elderly, Adverse Events
Miano TA, Hennessy S, Yang W
Association of vancomycin plus piperacillin-tazobactam with early changes in creatinine versus cystatin C in critically ill adults: a prospective cohort study.
The purpose of this study was to test the hypothesis that the association between vancomycin + piperacillin-tazobactam and increased acute kidney injury (AKI) risk by contrasting changes in creatinine concentration after antibiotic initiation with changes in cystatin C concentration. The researchers included patients enrolled in the Molecular Epidemiology of SepsiS in the ICU (MESSI) prospective cohort who were treated for greater than or equal to 48 h with vancomycin + piperacillin-tazobactam or vancomycin + cefepime. The kidney function biomarkers of blood urea nitrogen (BUN), creatinine, and cystatin C were measured before antibiotic treatment and again on day two after initiation. Creatinine-defined AKI and dialysis were evaluated through day14, and mortality was assessed through day 30. The study found that in the 739 patients vancomycin + piperacillin-tazobactam was associated with a higher percentage increase of creatinine at day-two and a higher incidence of creatinine-defined AKI: rate ratio. Vancomycin + piperacillin-tazobactam was not associated with change in alternative biomarkers. The researchers concluded that the study supports the hypothesis that vancomycin + piperacillin-tazobactam effects on creatinine represent pseudotoxicity.
Citation: Miano TA, Hennessy S, Yang W . Association of vancomycin plus piperacillin-tazobactam with early changes in creatinine versus cystatin C in critically ill adults: a prospective cohort study. Intensive Care Med 2022 Sep;48(9):1144-55. doi: 10.1007/s00134-022-06811-0..
Keywords: Critical Care, Medication, Kidney Disease and Health, Adverse Drug Events (ADE), Adverse Events
Oronce CIA, Arbanas JC, Leng M
Estimated wasteful spending on aducanumab dispensing in the U.S. Medicare population: a cross-sectional analysis.
The purpose of this study was to quantify the amount of aducanumab that is discarded because of vial dose size and calculate the potential Medicare savings that could be created by changing the vial size and drug weight to make dispensing more efficient and reduce the amount of discarded drug. The researchers calculated estimates for the monthly amount of discarded drug for each study participant, and then annualized the estimates. Costs were calculated using the 300 mg vial price, which is the larger of the two vial sizes currently available, and calculations were then made for simulated vials in three combinations (100 and 170 mg; 170 and 250mg; and 80mg, 170, and 300 mg.) Costs for each combination were then calculated. The study found that assuming a 10% drug uptake, the equivalent of between 132,398 and 694,258 vials of aducanumab would be discarded costing Medicare between $115.4 million and $604.9
million each year. If the 300 mg/3.0 ml vial was reduced to 100 mg/1.0 ml, Medicare savings would range between $70.9 and $369.0 million per year. The researchers concluded that reducing aducanumab vial size could decrease wasteful spending from discarded vials by over 60%.
million each year. If the 300 mg/3.0 ml vial was reduced to 100 mg/1.0 ml, Medicare savings would range between $70.9 and $369.0 million per year. The researchers concluded that reducing aducanumab vial size could decrease wasteful spending from discarded vials by over 60%.
Citation: Oronce CIA, Arbanas JC, Leng M . Estimated wasteful spending on aducanumab dispensing in the U.S. Medicare population: a cross-sectional analysis. J Am Geriatr Soc 2022 Sep;70(9):2714-18. doi: 10.1111/jgs.17891..
Keywords: Medicare, Healthcare Costs, Medication