Search All Research Studies
AHRQ Research Studies Date
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
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 1318 Research Studies Displayed
Hahn EE, Munoz-Plaza CE, Lee EA
Patient and physician perspectives of deprescribing potentially inappropriate medications in older adults with a history of falls: a qualitative study.
Investigators explored patient and clinician experiences with and perceptions of deprescribing potentially inappropriate medications in patients with a history of falls. Semi-structured interviews were conducted with primary care physicians from Kaiser Permanente Southern California (KPSC), and guided patient feedback sessions with patient members of the KPSC Regional Patient Advisory Committee. The investigators found that key barriers to deprescribing included primary care physician trepidation about raising a contentious topic and insufficient patient awareness of the potential seriousness of falls. They suggested a need for multifaceted, multilevel deprescribing approaches with clinician training strategies, patient educational resources, and a focus on building trusting patient-clinician relationships.
Citation: Hahn EE, Munoz-Plaza CE, Lee EA . Patient and physician perspectives of deprescribing potentially inappropriate medications in older adults with a history of falls: a qualitative study. J Gen Intern Med 2021 Oct;36(10):3015-22. doi: 10.1007/s11606-020-06493-8..
Keywords: Elderly, Medication, Falls
Butler AM, Durkin MJ, Keller MR
Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection.
This study compared treatment outcomes for various antibiotics in premenopausal women with uncomplicated urinary tract infections (UTIs). The authors compared treatment with fluoroquinolones (first-line), trimethoprim-sulfamethoxazole (TMP/SMX) (first-line), nitrofurantoin (first-line), narrow-spectrum β-lactams (non-first-line), and amoxicillin/ampicillin (non-recommended). Over 1.1 million patient outcomes were analyzed. The risk of treatment failure differed by the antibiotic type, with higher risk associated with TMP/SMX versus nitrofurantoin, and lower or similar risk associated with broad- versus narrow-spectrum β-lactams.
Citation: Butler AM, Durkin MJ, Keller MR . Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection. Pharmacoepidemiol Drug Saf 2021 Oct;30(10):1360-70. doi: 10.1002/pds.5237..
Keywords: Antibiotics, Medication, Urinary Tract Infection (UTI), Women
Enzinger AC, Ghosh K, Keating NL
US trends in opioid access among patients with poor prognosis cancer near the end-of-life.
This study looked at trends in opioid prescriptions for cancer patients near the end-of-life (EOL) defined as the 30 days before death or hospice enrollment. The authors looked at Medicare part D data from 2007 to 2017 for 270,632 Medicare fee-for-service decedents with poor prognosis cancers. During that time, the proportion of decedents with poor prognosis cancers receiving 1 or greater opioid prescriptions near EOL declined 15.5% and the proportion receiving 1 or greater long-acting opioid prescriptions declined 36.5% to 18.1%. The mean daily dose fell from 24.5%, from 85.6 morphine milligram equivalents per day (MMED) to 64.6. The total amount of opioids prescribed fell from 1,075 morphine milligram equivalents per decedent to 666 morphine milligram equivalents per decedents. At the same time, the proportion of patients with pain-related ED visits increase 50.8% from 13.2% to 19.9%.
Citation: Enzinger AC, Ghosh K, Keating NL . US trends in opioid access among patients with poor prognosis cancer near the end-of-life. J Clin Oncol 2021 Sep 10;39(26):2948-58. doi: 10.1200/jco.21.00476..
Keywords: Cancer, Opioids, Palliative Care, Pain, Access to Care, Medication, Practice Patterns
Roberts ET, Glynn A, Donohue JM
The relationship between take-up of prescription drug subsidies and Medicaid among low-income Medicare beneficiaries.
In this study, the investigators examined take-up of the Low-Income Subsidy (LIS) and Medicaid among Medicare beneficiaries who qualified for both programs. They went beyond prior analyses that reported average enrollment by program by 1.) examining whether LIS take-up mirrored Medicaid enrollment at income levels where individuals qualified for limited Medicaid benefits that had low take-up rates and 2.) highlighting opportunities for policy reforms to increase participation in both programs.
Citation: Roberts ET, Glynn A, Donohue JM . The relationship between take-up of prescription drug subsidies and Medicaid among low-income Medicare beneficiaries. J Gen Intern Med 2021 Sep;36(9):2873-76. doi: 10.1007/s11606-020-06241-y..
Keywords: Medicaid, Medicare, Medication, Low-Income, Health Insurance
Chua KP, Linder JA
Prevalence of inappropriate antibiotic prescribing by antibiotic among privately and publicly insured non-elderly US patients, 2018.
The authors used 2018 commercial and Medicaid claims to assess inappropriate prescribing of antibiotics. In their analysis, 22% of antibiotic claims were inappropriate. Azithromycin had an outsized role in inappropriate prescribing. They concluded that broad-based stewardship initiatives remain important given widespread inappropriate prescribing of all antibiotics.
AHRQ-funded; HS024930; HS026506; 2332015000201.
Citation: Chua KP, Linder JA . Prevalence of inappropriate antibiotic prescribing by antibiotic among privately and publicly insured non-elderly US patients, 2018. J Gen Intern Med 2021 Sep;36(9):2861-64. doi: 10.1007/s11606-020-06189-z..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Medicaid, Health Insurance
AHRQ Author: Abdus S
Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans.
This study examines financial burdens of out-of-pocket prescription drug expenditures across different levels of deductibles, focusing on low-income adults with multiple, prevalent chronic conditions. The results of this study suggest that for low-income adults with multiple chronic conditions who are enrolled in employer-sponsored high-deductible plans, out-of-pocket prescription drug costs may still result in significant financial hardships. The key takeaway point of this paper for general internists is that for patients with chronic conditions, out-of-pocket costs of prescription drugs could be excessively burdensome if they are enrolled in high-deductible plans.
Citation: Abdus S . Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans. J Gen Intern Med 2021 Sep;36(9):2903-05. doi: 10.1007/s11606-020-06226-x..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Medication
Ko JY, Hirai AH, Owens PL
AHRQ Author: Owens PL
Neonatal abstinence syndrome and maternal opioid-related diagnoses: analysis of ICD-10-CM transition, 2013-2017.
Researchers sought to evaluate whether the transition from ICD-9-CM to ICD-10-CM may have affected surveillance on rates of neonatal abstinence syndrome (NAS), maternal opioid use disorder (OUD), and opioid-related diagnoses. Using HCUP data, they found that the ICD-10-CM transition did not appear to affect NAS. However, coding of maternal OUD alone may not capture the same population across the transition, potentially confounding the interpretation of trend data spanning this time period.
Citation: Ko JY, Hirai AH, Owens PL . Neonatal abstinence syndrome and maternal opioid-related diagnoses: analysis of ICD-10-CM transition, 2013-2017. Hosp Pediatr 2021 Aug;11(8):902-08. doi: 10.1542/hpeds.2021-005845..
Keywords: Healthcare Cost and Utilization Project (HCUP), Newborns/Infants, Opioids, Medication, Pregnancy, Substance Abuse
Vu K, Zhou J, Everhart A
Uptake of evidence by physicians: de-adoption of erythropoiesis-stimulating agents after the TREAT trial.
Variation in de-adoption of ineffective or unsafe treatments is not well-understood. In this study the investigators examined de-adoption of erythropoiesis-stimulating agents (ESA) in anemia treatment among patients with chronic kidney disease (CKD) following new clinical evidence of harm and ineffectiveness (the TREAT trial) and the FDA's revision of its safety warning. The investigators found that physician specialty had a dominant role in prescribing decision, and specializations with higher use of treatment (nephrologists) were more responsive to new evidence of unsafety and ineffectiveness.
Citation: Vu K, Zhou J, Everhart A . Uptake of evidence by physicians: de-adoption of erythropoiesis-stimulating agents after the TREAT trial. BMC Nephrol 2021 Aug 21;22(1):284. doi: 10.1186/s12882-021-02491-y..
Keywords: Evidence-Based Practice, Medication: Safety, Medication, Patient Safety, Practice Patterns, Provider: Physician
Van Gerwen OT, Camino AF, Bourla LN
Management of trichomoniasis in the setting of 5-nitroimidazole hypersensitivity.
Metronidazole and other 5-nitroimidazoles are the mainstay of Trichomonas vaginalis treatment, with few efficacious and safe treatment options available outside of this class. Patients with trichomoniasis and a history of a clinically confirmed hypersensitivity reaction to 5-nitroimidazoles present a management challenge for clinicians. In this study, the investigators examine management of Trichomoniasis in the setting of 5-nitroimidazole hypersensitivity.
Citation: Van Gerwen OT, Camino AF, Bourla LN . Management of trichomoniasis in the setting of 5-nitroimidazole hypersensitivity. Sex Transm Dis 2021 Aug;48(8):e111-e15. doi: 10.1097/olq.0000000000001326..
Keywords: Infectious Diseases, Sexual Health, Antibiotics, Medication
McCoy RG, Van Houten HK, Dunlay SM
Race and sex differences in the initiation of diabetes drugs by privately insured US adults.
The authors examined the differences in the use of three glucose-lowering medications as a function of both sex and race. They found that, compared to white men, GLP-1RA were 43% more likely to be started by White women, 12% more likely to be started by non-White men, and 21% less likely to be started by non-White women. SGLT2i were at least 10% less likely to be started by all groups compared to White men, and DPP4i were used more often by non-White than White patients of both sexes.
Citation: McCoy RG, Van Houten HK, Dunlay SM . Race and sex differences in the initiation of diabetes drugs by privately insured US adults. Race and sex differences in the initiation of diabetes drugs by privately insured US adults..
Keywords: Diabetes, Chronic Conditions, Medication, Sex Factors, Racial / Ethnic Minorities
Hoffmann JA, Pergjika A, Konicek CE
Pharmacologic management of acute agitation in youth in the emergency department.
In this article, the authors reviewed the definition of agitation and pharmacologic management for youth with acute agitation, including common classes of medications, indications for use, and adverse effects. They also discussed the need to integrate the use of medications into a comprehensive strategy for agitation management that begins with proactive prevention of aggressive behavior, creation of a therapeutic treatment environment, and verbal de-escalation strategies.
Citation: Hoffmann JA, Pergjika A, Konicek CE . Pharmacologic management of acute agitation in youth in the emergency department. Pediatr Emerg Care 2021 Aug;37(8):417-22. doi: 10.1097/pec.0000000000002510..
Keywords: Children/Adolescents, Emergency Department, Medication, Care Management
Snyder ME, Adeoye-Olatunde OA, Gernant SA
A user-centered evaluation of medication therapy management alerts for community pharmacists: recommendations to improve usability and usefulness.
Community pharmacists provide comprehensive medication reviews (CMRs) through pharmacy contracts with medication therapy management (MTM) vendors. These CMRs are documented in the vendors' web-based MTM software platforms, which often integrate alerts to assist pharmacists in the detection of medication therapy problems. The objectives of this study were to 1) assess the usability and usefulness of MTM alerts for MTM vendor-contracted community pharmacists and 2) generate recommendations for improving MTM alerts for use by community pharmacists.
Citation: Snyder ME, Adeoye-Olatunde OA, Gernant SA . A user-centered evaluation of medication therapy management alerts for community pharmacists: recommendations to improve usability and usefulness. Res Social Adm Pharm 2021 Aug;17(8):1433-43. doi: 10.1016/j.sapharm.2020.10.015..
Keywords: Medication, Provider: Pharmacist, Community-Based Practice
Bedford T, Adediran T, Haycock NR
Patient and provider acceptability of a patient preauthorized concealed opioid reduction.
Researchers investigated patient and provider acceptance of a concealed opioid reduction for chronic pain. They conducted a cross-sectional survey with patients who are taking or have taken high dose opioids via REDcap, and with providers via a validated questionnaire. They found that patients and providers have positive attitudes toward a concealed reduction of opioid dosages. They concluded that their findings support future randomized controlled trials that compare concealed and overt opioid tapering in patients with chronic pain.
Citation: Bedford T, Adediran T, Haycock NR . Patient and provider acceptability of a patient preauthorized concealed opioid reduction. Pain Med 2021 Jul 25;22(7):1651-59. doi: 10.1093/pm/pnaa454..
Keywords: Opioids, Medication, Pain, Chronic Conditions
Morden NE, Chyn D, Wood A
Racial inequality in prescription opioid receipt - role of individual health systems.
The purpose of this study was to explore the contribution of individual health systems in the receipt of prescription opioids among racial groups in the United States. Medicare claims data for 2016-2017 was used to obtain a random 40% national sample of fee-for-service, Black and White beneficiaries 18 to 64 years of age and identify 310 racially diverse systems. Findings showed that, within individual health systems, Black and White patients received markedly different opioid doses. These system-specific findings could facilitate exploration of the causes and consequences of these differences.
Citation: Morden NE, Chyn D, Wood A . Racial inequality in prescription opioid receipt - role of individual health systems. N Engl J Med 2021 Jul 22;385(4):342-51. doi: 10.1056/NEJMsa2034159..
Keywords: Opioids, Medication, Racial / Ethnic Minorities, Disparities, Practice Patterns
Ibrahim S, Lowe JR, Bramante CT
Metformin and Covid-19: focused review of mechanisms and current literature suggesting benefit.
In the current Covid-19 pandemic, four observational studies have been published showing reduced mortality among individuals with home metformin use. This article discusses these studies.
Citation: Ibrahim S, Lowe JR, Bramante CT . Metformin and Covid-19: focused review of mechanisms and current literature suggesting benefit. Front Endocrinol 2021 Jul 22;12:587801. doi: 10.3389/fendo.2021.587801..
Keywords: COVID-19, Medication, Treatments
Goodman KE, Cosgrove SE, Pineles L
Significant regional differences in antibiotic use across 576 US hospitals
This study’s objective was to examine adult antibiotic use across 576 hospitals and nearly 12 million encounters in 2016-2017. Findings showed that adult inpatient antibiotic use remained high, driven predominantly by broad-spectrum agents. Recommendations included better understanding of the reasons for interhospital usage differences, including by region and teaching status, in order to inform efforts to reduce inappropriate antibiotic prescribing.
Citation: Goodman KE, Cosgrove SE, Pineles L . Significant regional differences in antibiotic use across 576 US hospitals Significant regional differences in antibiotic use across 576 US hospitals and 11 701 326 adult admissions, 2016-2017..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Hospitals
Wu P, Nelson SD, Zhao J
DDIWAS: high-throughput electronic health record-based screening of drug-drug interactions.
In this study, the investigators developed and evaluated Drug-Drug Interaction Wide Association Study (DDIWAS). This novel method detected potential drug-drug interactions (DDIs) by leveraging data from the electronic health record (EHR) allergy list. The investigators concluded that they demonstrated the value of incorporating information mined from existing allergy lists to detect DDIs in a real-world clinical setting. They indicate that since allergy lists are routinely collected in EHRs, DDIWAS has the potential to detect and validate DDI signals across institutions.
Citation: Wu P, Nelson SD, Zhao J . DDIWAS: high-throughput electronic health record-based screening of drug-drug interactions. J Am Med Inform Assoc 2021 Jul 14;28(7):1421-30. doi: 10.1093/jamia/ocab019..
Keywords: Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Medication: Safety, Patient Safety
Watterson TL, Stone JA, Brown R
CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting.
Medication list discrepancies between outpatient clinics and pharmacies can lead to medication errors. Within the last decade, a new health information technology (IT), CancelRx, emerged to send a medication cancellation message from the clinic's electronic health record (EHR) to the outpatient pharmacy's software. The objective of this study was to measure the impact of CancelRx on reducing medication discrepancies between the EHR and pharmacy dispensing software.
Citation: Watterson TL, Stone JA, Brown R . CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting. J Am Med Inform Assoc 2021 Jul 14;28(7):1526-33. doi: 10.1093/jamia/ocab038..
Keywords: Medication: Safety, Medication, Medical Errors, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery
Rogal S, Youk A, Agbalajobi O
Medication treatment of active opioid use disorder in veterans with cirrhosis.
Although opioid use disorder (OUD) is common in patients with cirrhosis, it is unclear how medication treatment for OUD (MOUD) is used in this population. In this study, the investigators aimed to assess the factors associated with MOUD and mortality in a cohort of Veterans with cirrhosis and OUD. The investigators found that few Veterans with active OUD and cirrhosis received MOUD, and those with alcohol use disorder, schizophrenia, and previous prescriptions for opioids were least likely to receive these effective therapies.
Citation: Rogal S, Youk A, Agbalajobi O . Medication treatment of active opioid use disorder in veterans with cirrhosis. Am J Gastroenterol 2021 Jul;116(7):1406-13. doi: 10.14309/ajg.0000000000001228..
Keywords: Veterans, Opioids, Substance Abuse, Medication
Bushnell GA, Crystal S, Olfson M
Trends in antipsychotic medication use in young privately insured children.
This study’s objective was to estimate trends in annual antipsychotic medication use by privately insured young children (aged 2-7 years) in the United States and to describe the clinical and treatment characteristics of these children. Young children from a nationwide commercial claims database from 2007-2017 was used to estimate annual antipsychotic use by age and sex. Annual antipsychotic use decreased over the time period, from a peak of 0.29% in 2009 and significantly declined to 0.17% in 2017. Antipsychotic use was higher in boys than in girls with a greater proportion receiving a mental disorder diagnosis in 2017 than in 2009. The most common clinical diagnoses were pervasive development disorder, conduct or disruptive behavior disorder, and attention-deficit/hyperactivity disorder. In 2017, 32% had 4+ psychotherapy claims, 43% had a psychiatrist visit, and the majority used another psychotropic medication, most commonly a stimulant.
AHRQ-funded; HS023258; HS026001.
Citation: Bushnell GA, Crystal S, Olfson M . Trends in antipsychotic medication use in young privately insured children. J Am Acad Child Adolesc Psychiatry 2021 Jul;60(7):877-86. doi: 10.1016/j.jaac.2020.09.023..
Keywords: Children/Adolescents, Medication, Behavioral Health
Bramante CT, Buse J, Tamaritz L
Outpatient metformin use is associated with reduced severity of COVID-19 disease in adults with overweight or obesity.
This study investigated whether outpatient metformin use is associated with reduced severity of COVID-19 in adults with overweight or obesity. Metformin can decrease interleukin-6 and tumor-necrosis factor- α, which appears to contribute to COVID-19 mortality. The authors conducted a retrospective cohort analysis of electronic health record (EHR) data that was pooled across multiple EHR systems from 12 hospitals and 60 primary care clinics in the Midwest between March and December 2020. Inclusion criteria included data for BMI > 25 kg/m(2); age range 30-85 years; and a positive SARS-CoV-2 polymerase chain reaction test. Metformin was associated with a decrease in mortality from COVID-19 and a nonsignificant decrease in hospital admission in the overall cohort.
Citation: Bramante CT, Buse J, Tamaritz L . Outpatient metformin use is associated with reduced severity of COVID-19 disease in adults with overweight or obesity. J Med Virol 2021 Jul;93(7):4273-79. doi: 10.1002/jmv.26873..
Keywords: COVID-19, Infectious Diseases, Obesity, Medication, Treatments, Outcomes
Chou LN, Kuo YF, Raji MA
Potentially inappropriate medication prescribing by nurse practitioners and physicians.
This study compared prescribing rates for potentially inappropriate medications (PIMs) by physicians and nurse practitioners (NPs). The authors used 100% Texas Medicare data to define physician and NP visits in 2016. Rates of visits with a PIM prescription from the same provider was measured by initial and refill visits. There were 24.1 per 1000 visits for PIM prescriptions, 9.0 per 1000 visits for an initial PM and 15.1 per 1000 visits for a refill PIM. Visits to an NP was less likely to result in an initial and refill PIM visit than a visit to a physician. There was a strong association of lower odds of a black enrollee receiving a PIM by an NP than white enrollees. There was also less likelihood of receiving a PIM refill from an NP in older patients and in those with more comorbidities.
AHRQ-funded; HS020642; HS020642.
Citation: Chou LN, Kuo YF, Raji MA . Potentially inappropriate medication prescribing by nurse practitioners and physicians. J Am Geriatr Soc 2021 Jul;69(7):1916-24. doi: 10.1111/jgs.17120..
Keywords: Medication: Safety, Medication, Provider: Physician, Provider: Nurse, Hospitalization, Practice Patterns, Ambulatory Care and Surgery
Klompas M, Imrey PB, Yu PC
Respiratory viral testing and antibacterial treatment in patients hospitalized with community-acquired pneumonia.
Researchers studied the frequency of respiratory viral testing and its associations with antimicrobial utilization in adult patients hospitalized with community-acquired pneumonia. They found that, of patients with pneumonia on admission, 24.5% were tested for respiratory viruses, 94.8% were tested for influenza, and 20.7% were tested for other viruses. They concluded that a minority of patients hospitalized with pneumonia were tested for respiratory viruses; only a fraction of potential viral pathogens were assayed; and patients with positive viral tests often received long antibacterial courses.
AHRQ-funded; HS025008; HS024277.
Citation: Klompas M, Imrey PB, Yu PC . Respiratory viral testing and antibacterial treatment in patients hospitalized with community-acquired pneumonia. Infect Control Hosp Epidemiol 2021 Jul;42(7):817-25. doi: 10.1017/ice.2020.1312..
Keywords: Pneumonia, Community-Based Practice, Respiratory Conditions, Antibiotics, Medication
Bishop JR, Huang RS, Brown JT
Pharmacogenomics education, research and clinical implementation in the state of Minnesota.
This article looks at the development and implementation of formal pharmacogenomic (PGx) clinical programs at several healthcare organizations across Minnesota. These programs increase drug safety and effectiveness. The article reviews the state of PGx activities in the state of Minnesota including educational programs, research, national consortia involvement, technology, clinical implementation and utilization and reimbursement, and outlines the challenges and opportunities in equitable implementation of these activities.
Citation: Bishop JR, Huang RS, Brown JT . Pharmacogenomics education, research and clinical implementation in the state of Minnesota. Pharmacogenomics 2021 Jul;22(11):681-91. doi: 10.2217/pgs-2021-0058..
Keywords: Medication, Implementation, Learning Health Systems, Evidence-Based Practice, Patient-Centered Outcomes Research
Lillie KM, Shaw J, Jansen KJ
Buprenorphine/naloxone for opioid use disorder among Alaska Native and American Indian people.
Opioid-related disparities are magnified among Alaska Native and American Indian (ANAI) people. Yet, no outcome studies on medication for addiction treatment, an effective treatment in other populations, among ANAI people exist. The objective of this study was to identify variables associated with buprenorphine/naloxone retention among ANAI people with opioid use disorder (OUD). The investigators concluded that younger patients and those with co-occurring substance use remained at higher risk of discontinuing buprenorphine/naloxone treatment for OUD in this population of ANAI people.
Citation: Lillie KM, Shaw J, Jansen KJ . Buprenorphine/naloxone for opioid use disorder among Alaska Native and American Indian people. J Addict Med 2021 Jul-Aug 01;15(4):297-302. doi: 10.1097/adm.0000000000000757..
Keywords: Opioids, Substance Abuse, Behavioral Health, Medication, Racial / Ethnic Minorities, Vulnerable Populations