Outpatient Antibiotic Prescribing Patterns for Adult End-Stage Renal Disease Patients in New York State.

BACKGROUND: Infections are important complications of end-stage renal disease (ESRD) with few studies having investigated oral antibiotic use. Inappropriate antibiotic prescribing can contribute to multidrug-resistant organisms and Clostridioides difficile infections seen in ESRD. This study investigates antibiotic prescribing practices in ESRD across New York State (NYS). METHODS: Retrospective case-control study from 2016 to 2017 of NYS ESRD and non-ESRD patients analyzing Medicare part B billing codes, 7 days before and 3 days after part D claims. Frequencies of each infection, each antibiotic, dosages, and the antibiotics associated with infections were assessed using χ 2 analysis. A NYS small dialysis organization comprising approximately 2200 patients was also analyzed. Outcomes measured were the frequencies of infections and of each antibiotic prescribed. Incidence measures included antibiotics per 1000 and individuals receiving antibiotics per 1000. RESULTS: A total of 48 100 infections were treated in 35 369 ESRD patients and 2 544 443 infections treated in 3 777 314 non-ESRD patients. ESRD patients were younger, male, and African American. ESRD and non-ESRD patients receiving antibiotics was 520.29/1000 and 296.48/1000, respectively (P < .05). The prescription incidence was 1359.95/1000 ESRD vs 673.61/1000 non-ESRD patients. In 36%, trimethoprim-sulfamethoxazole dosage was elevated by current ESRD guidelines. Top infectious categories included nonspecific symptoms, skin, and respiratory for ESRD; and respiratory, nonspecific symptoms, and genitourinary in non-ESRD. CONCLUSIONS: This study identifies issues with appropriate antibiotic usage stressing the importance of antibiotic education to nephrologist and nonnephrologist providers. It provides support for outpatient antibiotic stewardship programs.

Uptake and Utilization of the Management of Anticoagulation in the Periprocedural Period App: Longitudinal Analysis.

BACKGROUND: Anticoagulants are major contributors to preventable adverse drug events, and their optimal management in the periprocedural period is particularly challenging. Traditional methods of disseminating clinical guidelines and tools cannot keep pace with the rapid expansion of available therapeutic agents, approved indications for use, and published medical evidence, so a mobile app, Management of Anticoagulation in the Periprocedural Period (MAPPP), was developed and disseminated to provide clinicians with guidance that reflects the most current medical evidence. OBJECTIVE: The objective of this study was to assess the global, national, and state-level acquisition of a mobile app since its initial release and characterize individual episodes of use based on drug selection, procedural bleeding risk, and patient thromboembolic risk. METHODS: Data were extracted from a mobile app usage tracker (Google Analytics) to characterize new users and completed episodes temporally (by calendar quarter) and geographically (globally, nationally, and in the targeted US state of New York) for the period between April 1, 2016 and September 30, 2017. RESULTS: The app was acquired by 2866 new users in the measurement period, and the users completed nearly 10,000 individual episodes of use. Acquisition and utilization spanned 51 countries globally, predominantly in the United States and particularly in New York State. Warfarin and rivaroxaban were the most frequently selected drugs, and completed episodes most frequently included the selection of high bleeding risk (4888/9963, 49.06%) and high thromboembolic risk categories (4500/9963, 45.17%). CONCLUSIONS: The MAPPP app is a successful means of disseminating current guidance on periprocedural anticoagulant use, as indicated by broad global uptake and upward trends in utilization. Limitations in access to provider and patient-specific data preclude objective evaluation of the clinical impact of the app. An ongoing study incorporating app logic into electronic health record systems at participant health systems will provide a more definitive evaluation of the clinical impact of the app logic.

Mammography-facility-based patient reminders and repeat mammograms for Medicare in New York State.

BACKGROUND: Women who receive mammograms may fail to regularly return for repeat mammography. Many mammography facilities send annual patient reminders, but there are no large studies of their impact on overall mammography return rates, or by patient population subgroups. METHODS: Medicare claims data were used to identify New York women with claims for mammograms during a baseline and an 18-month follow-up period (1999-2000). Receipt of a second mammogram was examined in relation to whether the facility sends annual reminders, while controlling for other patient factors. RESULTS: Of 97,506 women studied, 76% attended facilities that send annual reminders. Of these women, 74% received a second mammogram within 18 months compared to 67% for other women. The impact of reminders was significant in all subgroups, but was less for women who were younger, minority, in Medicaid, in New York City or who received a diagnostic mammogram. In multivariate analysis, the adjusted odds ratio for return within 18 months if the facility uses reminders was 1.42 (95% CI 1.37-1.47). CONCLUSIONS: Annual patient reminders from mammography facilities are effective in increasing regular repeat mammography in Medicare women, although their impact is smaller in some groups. Facilities that do not currently send reminders should be encouraged to do so.

Assessing pneumococcal revaccination safety among New York State Medicare beneficiaries.

OBJECTIVE: There have not been adequate studies of the safety of pneumococcal revaccination, especially for revaccination at intervals of less than five years. The objective of this study was to assess revaccination safety by determining whether pneumococcal revaccination is associated with greater utilization of postvaccination health care, compared with initial vaccination. METHODS: The authors conducted a retrospective cohort study of 119,990 New York State Medicare beneficiaries 65 years of age and older who received pneumococcal vaccinations from February 1, 1999, through December 17, 1999. The study used a multivariate regression model with three primary outcome measures-emergency room visits, hospitalizations, and office visits during the two weeks postvaccination. Secondary outcome measures were specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes potentially related to adverse vaccine reactions. RESULTS: Of 119,990 patients, 23,663 had previous claims for pneumococcal vaccination, including 13,466 for whom the revaccination interval was less than five years. After adjustment for demographic and comorbidity factors, revaccination at less than five years was associated with higher rates of emergency room visits (odds ratio [OR] = 1.17; 95% confidence interval [CI] 1.02, 1.34) and office visits (OR = 1.13; 95% CI 1.09, 1.18) during the two-weeks postvaccination, compared with initial vaccination. In addition, several ICD-9-CM codes that might indicate vaccine reactions were recorded more frequently for the revaccination group than for the comparison group. CONCLUSIONS: Because of potential policy implications, further investigation is needed of the causes and consequences of short-interval revaccination.