Prescribing trends of proton pump inhibitors, antipsychotics and benzodiazepines of medicare part d providers.

BACKGROUND: Proton pump inhibitors, benzodiazepines, and antipsychotics are considered potentially inappropriate medications in older adults according to the American Geriatric Society Beers Criteria, and deprescribing algorithms have been developed to guide use of these drug classes. The objective of this study was to describe the number of beneficiaries prescribed these medications, provider specialty and regional trends in prescribing, and the aggregate costs for these claims in Medicare Part D. METHODS: This was a retrospective cross-sectional study using publicly available Medicare Provider Utilization and Payment Data: Part D Prescriber data for years 2013-2019. Descriptive statistics and the Cochrane-Armitage test were used to summarize the trends. RESULTS: Overall, 30.1%, 25.6%, 4.6% of Medicare Part D beneficiaries had a proton pump inhibitor, benzodiazepine, and antipsychotic claim in 2013, respectively. These rates decreased to 27.5%, 17.5%, 4.1% in 2019 (p-value < 0.0001). However, the number of standardized 30-day claims increased from 63 million in 2013 to 84 million in 2019 for proton pump inhibitors, remained steady for benzodiazepines and slightly increased (10 million to 13 million) for antipsychotics. Total aggregate costs decreased by almost $1.5 billion for proton pump inhibitor, $100 million for benzodiazepine, and $700 million for antipsychotic from 2013 to 2019 (p-value < 0.0001). Almost 93% of gastroenterologists prescribed a proton pump inhibitor, and 60% of psychiatrists prescribed benzodiazepines and antipsychotics all seven years. The Other region had the highest percentage of providers prescribing all three classes and the highest number of standardized 30-day benzodiazepine claims. CONCLUSIONS: The overall rate of use of proton pump inhibitors, benzodiazepines, and antipsychotics decreased from 2013-2019 among Medicare Part D beneficiaries. Despite the increase in raw number of standardized 30-day claims, the costs decreased which is likely due to generics made available. These prescribing trends may aid in identifying and targeting potential deprescribing interventions.

Mapping the impact of the COVID-19 pandemic on pharmacy graduate students' wellness.

BACKGROUND: The COVID-19 pandemic has resulted in significant changes in pharmacy graduate students' (PhGS) lives. While pharmacy graduate programs across the U.S. have reported adjustments due to the pandemic, there is currently no data on the PhGS' wellness, and the impact on and extent to which offered supports and guidance has met PhGS needs. OBJECTIVE: This study's objectives were 1) to explore PhGS' perspectives on their challenges and the impact of these challenges on their wellness, and 2) to identify PhGS' suggestions for pharmacy graduate programs to improve guidance and support offered during the COVID-19 pandemic. METHODS: This study conducted semi-structured interviews based on the Objective, Reflective, Interpretative, Decisional (ORID) methodology. Pharmacy students working on completing a PhD in programs across the United States were invited to participate. All interviews were conducted using the Zoom platform between May and June 2020. Digital audio recordings were auto transcribed using the Trint platform. Thematic analysis was conducted using the six-dimensional model of wellness developed by Hettler as a guide, while open coding of the PhGS' suggestions was conducted inductively. RESULTS: Thirteen PhGS across six universities in the U.S. were interviewed. During the pandemic, all six dimensions of the Wellness model were found to be challenged for PhGS. PhGS' challenges differed based on their laboratory-based vs. non-laboratory-based research settings. International PhGS reported differing challenges from domestic PhGS. PhGS also provided 18 practical suggestions for improving the teaching process and facilitating student's academic growth in the context of the COVID-19 pandemic. CONCLUSIONS: Despite the COVID-19 pandemic, graduate programs should continue developing a robust and tailored system to encourage and maintain mentorship programs to facilitate graduate students' successful path through their doctoral studies. Moreover, the suggestions offered by the PhGS participants in this study, when appropriately implemented, can also position graduate program success post-pandemic.

Role of social determinants of health in pneumococcal vaccination among high-risk adults.

OBJECTIVES: To determine the influence of select social determinants of health on uptake of and time to pneumococcal vaccination among those deemed high-risk. METHODS: Using nationwide claims data for years 2013-2016, adult patients (aged 18-64 years) were followed from their first diagnosis for a condition deeming them high-risk for invasive pneumococcal disease through the subsequent 365 days and observed for pneumococcal vaccination in outpatient clinics and pharmacies. Publicly-available data on select social determinants of health were incorporated into analyses, guided by the WHO vaccine hesitancy matrix. Controlling for baseline demographic and clinical characteristics, logistic regression determined predictors of vaccination and a general linear model compared days to being vaccinated. RESULTS: A total of 173,712 patients were analyzed of which approximately one quarter (25.3%) were vaccinated against invasive pneumococcal disease within the first year of being deemed high risk, nearly all of which (98.5%) were received in outpatient clinics. The odds of vaccination were higher among urban residents (OR: 1.18; 95% CI: 1.144-1.223), areas of higher health literacy (OR: 1.02; 95% CI: 1.019-1.025), and more Democratic-voting communities (OR: 1.5; 95% CI: 1.23-1.88). Conversely, the likelihood of vaccination was particularly low in areas of higher poverty (OR: 0.14; 95% CI: 0.068-0.304) and with limited Internet access (OR: 0.14; 95% CI: 0.062-0.305) as well as among adults who did not also get a seasonal influenza vaccine (OR: 0.05; 95% CI: 0.048-0.052). Time to vaccination was longer in rural residents (B = 8.3, p < 0.0001) and communities with less Internet access (B = 75.6, p < 0.001). CONCLUSION: Social determinants may be influencing pneumococcal vaccine-seeking behavior among those deemed high-risk, but a more formal and comprehensive framework must be assessed to determine the full impact of these factors across vaccines recommended in adults.