Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.439
Filtrar
1.
Anesth Analg ; 132(5): 1450-1456, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33667211

RESUMO

BACKGROUND: Pharmacological treatments for critical processes in patients need to be initiated as rapidly as possible; for this reason, it is a standard of care to prepare the main anesthesia and emergency drugs in advance. As a result, 20%-50% of the prepared drugs remain unused and are then discarded. Decreasing waste by optimizing drug use is an attractive strategy for meeting both cost containment and environmental sustainability. The primary end point of this study was to measure the actual amount of drug wastage in the operating rooms (ORs) and intensive care units (ICUs) of a Regional Health Service (RHS). The secondary end point was to analyze and estimate the economic implications of this waste for the Health Service and to suggest possible measures to reduce it. METHODS: This prospective observational multicenter study was conducted across 12 hospitals, all of which belong to the same RHS in the north-east of Italy. Data collection took place in March 2018 and included patients admitted to ICUs, emergency areas, and ORs of the participating hospitals. Data concerning drug preparation and administration were collected for all consecutive patients, independent of case types and of whether operations were scheduled or unscheduled. Drug wastage was defined as follows: drugs prepared in ready-to-use syringes but not administered at all and discarded untouched. We then estimated the costs of wasted drugs for a 1-year period using the data from this study and the yearly regional pharmacy orders of drugs provided to the ORs and ICUs. We also performed a sensitivity analysis to validate the robustness of our assumptions and qualitative conclusions. RESULTS: We collected data for a total of 13,078 prepared drug syringes. Drug wastage varied from 7.8% (Urapidil, an alpha-1 antagonist antihypertensive) to 85.7% (epinephrine) of prepared syringes, with an overall mean wastage rate of 38%. The estimated yearly waste was 139,531 syringes, for a total estimated financial cost of €78,060 ($92,569), and an additional quantity of medical waste amounting to 4968 kg per year. The total provider time dedicated to the preparation of unused drugs was predicted to be 1512 working hours per year. CONCLUSIONS: The overall extent of drug wastage in ORs and ICUs is concerning. Interventions aimed at minimizing waste-related costs and improving the environmental sustainability of our practice are paramount. Effort should be put into designing a more efficient workflow that reduces this waste while providing for the emergency availability of these medications in the OR and ICU.


Assuntos
Anestésicos/administração & dosagem , Anestésicos/economia , Custos de Medicamentos , Serviço Hospitalar de Emergência/economia , Custos Hospitalares , Unidades de Terapia Intensiva/economia , Resíduos de Serviços de Saúde/economia , Salas Cirúrgicas/economia , Anestésicos/provisão & distribuição , Redução de Custos , Análise Custo-Benefício , Composição de Medicamentos/economia , Uso de Medicamentos/economia , Humanos , Itália , Resíduos de Serviços de Saúde/prevenção & controle , Estudos Prospectivos , Seringas/economia , Fatores de Tempo , Fluxo de Trabalho
2.
Yakugaku Zasshi ; 141(3): 433-440, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33642513

RESUMO

Currently, various hyperphosphatemia drugs are administered orally to hemodialysis patients in order to lower serum phosphorus levels. However, it is known that medication adherence is poor, possibly due to greater pill burden taken each time and their complicated schedules. Therefore, large amounts of unused hyperphosphatemia drugs are likely to be leftover. The increase in leftover prescribed drugs leads to the unnecessary elevation of medical care costs. To date, however, the available information on leftover hyperphosphatemia drugs in hemodialysis outpatients is limited. In this study, we performed an interview survey of medication adherence to hyperphosphatemia drugs among 60 hemodialysis outpatients and evaluated the cost of the leftover drugs. Thirty-four patients showed good adherence. On the other hand, 19 patients self-adjusted to take hyperphosphatemia drugs according to their daily diet. When assessing the serum phosphorus levels for these patients over the past year, the values often exceeded the targeted range (3.5-6.0 mg/mL). Furthermore, 35 patients kept hyperphosphatemia drugs at their home. When estimating the cost derived from leftover drugs using the bootstrap method, main distribution of drug cost was shown to be in the range of 2000 to 2500 yen. This drug cost seemed to in part reflect preparation for an emergency. A serious problem was that 14 patients had previous experience in discarding hyperphosphatemia drugs. This study suggested that more appropriate pharmaceutical care according to each patient's situation is essential in improving phosphorus control in hemodialysis outpatients and in reducing the waste of medical resources.


Assuntos
Custos de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/economia , Custos de Cuidados de Saúde , Recursos em Saúde/economia , Hiperfosfatemia/tratamento farmacológico , Hiperfosfatemia/economia , Adesão à Medicação/estatística & dados numéricos , Pacientes Ambulatoriais/psicologia , Prescrições/economia , Prescrições/estatística & dados numéricos , Diálise Renal/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hiperfosfatemia/etiologia , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
3.
Ann Pharmacother ; 55(1): 44-51, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32578446

RESUMO

BACKGROUND: Inappropriate albumin use in clinical practice remains problematic. Health-systems face continued challenges in promoting cost-appropriate use. OBJECTIVE: To evaluate the clinical and economic impact of a clinical pharmacist-led intervention strategy targeting inappropriate albumin use in general ward patients. METHODS: A retrospective cohort study evaluated all adult (≥18 years) general ward patients administered ≥1 dose of albumin at a university medical center over a 2-year period. The intervention consisted of a clinical pharmacist-led strategy intervening on all albumin orders not in accordance with institutional guidelines. The primary end point was to compare inappropriate albumin utilization before and after implementation. Secondary end points compared the rates of inappropriate albumin use adjusted for hospital admission and patient-days as well as associated costs by appropriateness between study periods. RESULTS: A total of 4420 patients were screened, with 1971 (44.6%) patients meeting inclusion criteria. The clinical pharmacist strategy significantly reduced inappropriate albumin (grams) utilization by 86.0% (P < 0.001). A 7-fold reduction of inappropriate albumin administered adjusted for the number of patient admissions was found from the preimplementation period following clinical pharmacist intervention strategy implementation (415.3 ± 83.2 vs 57.5 ± 34.2 g per 100 general ward hospital admissions, respectively; P < 0.001). Also, the adjusted inappropriate albumin rate was reduced from 62.2 ± 12.3 to 8.6 ± 5.2 g per 100 patient-days in the preimplementation and postimplementation periods, respectively (P < 0.001). Annual cost savings were $421 455 overall, with $341 930 resulting from mitigation of inappropriate use. CONCLUSION AND RELEVANCE: Clinical pharmacist-led interventions significantly reduced inappropriate albumin use and costs in hospitalized patients.


Assuntos
Albuminas/economia , Uso de Medicamentos/economia , Prescrição Inadequada/economia , Serviço de Farmácia Hospitalar/normas , Adulto , Albuminas/uso terapêutico , Redução de Custos , Custos de Medicamentos , Uso de Medicamentos/estatística & dados numéricos , Feminino , Hospitalização/economia , Hospitais de Ensino/economia , Hospitais de Ensino/organização & administração , Humanos , Prescrição Inadequada/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Farmacêuticos/normas , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Estudos Retrospectivos
4.
PLoS One ; 15(9): e0239704, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32976493

RESUMO

In developed countries, most people living with HIV/AIDS are treated with costly brand single-tablet regimens. Given the economic impact, French guidelines recommend using generic antiretroviral therapy when possible to decrease antiretroviral therapy costs. We aimed to study HIV-infected patients' acceptability to switch from a brand single-tablet regimens [abacavir/lamivudine/dolutegravir (Triumeq®) or emtricitabine/tenofovir disoproxil fumarate/rilpivirine (Eviplera®)] to a treatment comprising of two pills: one is a fixed-dose generic combination of 2 Nucleoside Analogs and the second tablet is the third antiretroviral. This study was a prospective observational study in a French hospital. During their follow-up, patients on stable single-tablet regimens were made aware of the possible cost-saving. They were questioned about their willingness and barriers accepting the substitution. Participants chose between the two regimens, either to remain on single-tablet regimens or switch to the de-simplified regimen. Six months later, a second survey was given to the patient who chose to de-simplify and HIV viral load was controlled. The study included 98 patients: 60 receiving emtricitabine/tenofovir disoproxil fumarate/rilpivirine (Eviplera®) and 38 on abacavir/lamivudine/dolutegravir (Triumeq®). Forty-five patients accepted the de-simplified treatment, 37 refused and 16 were undecided and followed the decision offered by their physician. The main reason for unwillingness to switch is the number of pills (77.3%). In multivariate model analysis, male patients (p = 0.001) who have taken antiretroviral therapy for over 20 years (p = 0.04) and who retrieve their treatment in their community hospital (p = 0.03) are more likely to accept the switch. Fifty-one patients accepted to replace their single-tablet regimens and six months later, the majority was satisfied; only four returned to single-tablet regimens because of suspected side effects. Half of the people living with HIV/AIDS in our cohort accepted to switch from brand single-tablet regimens to a two-tablet regimen containing generic drugs within a process that emphasizes health expenditure savings.


Assuntos
Fármacos Anti-HIV/economia , Redução de Custos , Medicamentos Genéricos/economia , Satisfação do Paciente , Comprimidos/economia , Adulto , Idoso , Fármacos Anti-HIV/administração & dosagem , Uso de Medicamentos/economia , Medicamentos Genéricos/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Comprimidos/administração & dosagem
5.
PLoS One ; 15(8): e0237790, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810185

RESUMO

This study determined the frequency and factors associated with EGFR testing rates and erlotinib treatment as well as associated survival outcomes in patients with non small cell lung cancer in Kentucky. Data from the Kentucky Cancer Registry (KCR) linked with health claims from Medicaid, Medicare and private insurance groups were evaluated. EGFR testing and erlotinib prescribing were identified using ICD-9 procedure codes and national drug codes in claims, respectively. Logistic regression analysis was performed to determine factors associated with EGFR testing and erlotinib prescribing. Cox-regression analysis was performed to determine factors associated with survival. EGFR mutation testing rates rose from 0.1% to 10.6% over the evaluated period while erlotinib use ranged from 3.4% to 5.4%. Factors associated with no EGFR testing were older age, male gender, enrollment in Medicaid or Medicare, smoking, and geographic region. Factors associated with not receiving erlotinib included older age, male gender, enrollment in Medicare or Medicaid, and living in moderate to high poverty. Survival analysis demonstrated EGFR testing or erlotinib use was associated with a higher likelihood of survival. EGFR testing and erlotinib prescribing were slow to be implemented in our predominantly rural state. While population-level factors likely contributed, patient factors, including geographic location (areas with high poverty rates and rural regions) and insurance type, were associated with lack of use, highlighting rural disparities in the implementation of cancer precision medicine.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Cloridrato de Erlotinib/uso terapêutico , Testes Genéticos/estatística & dados numéricos , Neoplasias Pulmonares/tratamento farmacológico , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Análise Mutacional de DNA/economia , Análise Mutacional de DNA/estatística & dados numéricos , Prescrições de Medicamentos/economia , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Receptores ErbB/antagonistas & inibidores , Receptores ErbB/genética , Feminino , Testes Genéticos/economia , Disparidades em Assistência à Saúde/economia , Humanos , Kentucky/epidemiologia , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/mortalidade , Masculino , Medicaid/economia , Medicaid/estatística & dados numéricos , Medicare/economia , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Mutação , Pobreza/estatística & dados numéricos , Medicina de Precisão/economia , Medicina de Precisão/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais , Análise de Sobrevida , Estados Unidos , Adulto Jovem
6.
PLoS One ; 15(6): e0234463, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525965

RESUMO

The affordability of pharmaceuticals has been a major challenge in US health care. Generic substitution has been proposed as an important tool to reduce the costs, yet little is known how the prices of more expensive brand-name drugs would be affected by an increased utilization of generics. We aimed to examine the trend of overall utilization and the total costs of brand-name oral contraceptive pills (OCPs), the most widely used form of contraception, and its association with the pharmaceutical market concentration among the OCPs. Data from the Medical Expenditure Panel Survey (MEPS) 2011-2014, a nationally representative survey of healthcare utilization, were extracted on the utilization of generic and brand-name OCPs. A multiple logit regression analysis was conducted to assess the trend in utilization of brand-name OCPs over time. Total costs, including the costs to the payers and consumers, were synthesized. The Herfindahl-Hirschman Index (HHI), an index describing market concentration, was constructed, and a multiple regression analysis was conducted to evaluate the association between the brand-name OCP prices and the market share of individual brand-name drugs. The odds of utilizing brand-name drugs decreased steadily in 2012, 2013, and 2014 compared to 2012 (AOR 0.87, 0.73, 0.55, respectively, p<0.05) controlling for patient mix. Despite significant decline in total utilization, there was a 90% increase in the price of brand-name OCPs, resulting an 18% increase in revenue from 2011 to 2014 for the industry. During this time, pharmaceutical market concentration for OCPs increased (HHI increased from 1105 in 2011 to 2415 in 2014). Each percentage point increase in the market share by a brand-name OCPs was associated with a $3.12 increase in its price. Market mechanisms matter. Practitioners and policy makers need to take market mechanisms into account in order to realize the benefits of generic substitutions.


Assuntos
Anticoncepcionais Orais Combinados/economia , Custos de Medicamentos/tendências , Indústria Farmacêutica/tendências , Uso de Medicamentos/tendências , Gastos em Saúde/tendências , Adulto , Anticoncepção/economia , Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Anticoncepção/tendências , Comportamento Contraceptivo/estatística & dados numéricos , Custos de Medicamentos/estatística & dados numéricos , Indústria Farmacêutica/economia , Indústria Farmacêutica/estatística & dados numéricos , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Medicamentos Genéricos/economia , Competição Econômica/estatística & dados numéricos , Competição Econômica/tendências , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Custos de Cuidados de Saúde/tendências , Gastos em Saúde/estatística & dados numéricos , Humanos , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos , Adulto Jovem
7.
Nature ; 581(7806): 94-99, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32376956

RESUMO

Vaccines may reduce the burden of antimicrobial resistance, in part by preventing infections for which treatment often includes the use of antibiotics1-4. However, the effects of vaccination on antibiotic consumption remain poorly understood-especially in low- and middle-income countries (LMICs), where the burden of antimicrobial resistance is greatest5. Here we show that vaccines that have recently been implemented in the World Health Organization's Expanded Programme on Immunization reduce antibiotic consumption substantially among children under five years of age in LMICs. By analysing data from large-scale studies of households, we estimate that pneumococcal conjugate vaccines and live attenuated rotavirus vaccines confer 19.7% (95% confidence interval, 3.4-43.4%) and 11.4% (4.0-18.6%) protection against antibiotic-treated episodes of acute respiratory infection and diarrhoea, respectively, in age groups that experience the greatest disease burden attributable to the vaccine-targeted pathogens6,7. Under current coverage levels, pneumococcal and rotavirus vaccines prevent 23.8 million and 13.6 million episodes of antibiotic-treated illness, respectively, among children under five years of age in LMICs each year. Direct protection resulting from the achievement of universal coverage targets for these vaccines could prevent an additional 40.0 million episodes of antibiotic-treated illness. This evidence supports the prioritization of vaccines within the global strategy to combat antimicrobial resistance8.


Assuntos
Antibacterianos , Países em Desenvolvimento/economia , Uso de Medicamentos/estatística & dados numéricos , Vacinas , Antibacterianos/administração & dosagem , Antibacterianos/economia , Pré-Escolar , Diarreia/tratamento farmacológico , Diarreia/prevenção & controle , Diarreia/virologia , Resistência Microbiana a Medicamentos , Uso de Medicamentos/economia , Humanos , Incidência , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/imunologia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/microbiologia , Infecções Respiratórias/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Vacinas contra Rotavirus/imunologia , Vacinas/administração & dosagem , Vacinas/economia , Vacinas/imunologia , Organização Mundial da Saúde/organização & administração
9.
Biol Pharm Bull ; 43(4): 693-696, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32238711

RESUMO

In Japan, there is no national surveillance study of Clostridioides (Clostridium) difficile infection (CDI), and details about the epidemiology and treatment status of CDI are unknown. Additionally, clinical practice guidelines (CPGs) for CDI are published by four different institutions. All CPGs recommend that the antimicrobials, vancomycin (VCM) and metronidazole (MNZ), should be selected according to disease severity. However, the trends for VCM and MNZ use in Japan remain unclear. Therefore, this study was aimed at clarifying the secular trends for VCM and MNZ use based on sales data from 2006 to 2015 and discussing its impact on CDI status and drug costs. This is the first study to clarify the antibiotic use trends for CDI treatment. We found that the total use increased over time (r = 0.0013, Pfor trend < 0.0001). While VCM use significantly decreased (r = -0.0003, Pfor trend = 0.0002), MNZ use increased (r = 0.0017, Pfor trend < 0.0001). These results show that although treatment for CDI was in line with CPGs, CDI incidence might be on an increasing trend. Additionally, despite the increased total use, the total drug costs decreased by 55% ($ 25 million) from 2006 to 2015. It was also surmised that CDI treatment in compliance with CPGs would lead to a reduction in drug costs. Hence, to understand the epidemiology of CDI, it is important to continuously investigate the use of drugs used for CDI therapy.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Clostridium/tratamento farmacológico , Metronidazol/uso terapêutico , Vancomicina/uso terapêutico , Antibacterianos/economia , Infecções por Clostridium/economia , Custos de Medicamentos , Uso de Medicamentos/economia , Uso de Medicamentos/tendências , Humanos , Japão , Metronidazol/economia , Vancomicina/economia
10.
Mycoses ; 63(5): 500-508, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32048335

RESUMO

BACKGROUND: Monitoring of superficial mycoses requires more attention due to their important incidence, health costs and antifungal drugs consumption. OBJECTIVES: The objectives were to estimate the burden of superficial mycoses in Belgium and to assess trends in associated antifungal consumption. METHODS: The burden of dermatophytoses (including onychomycosis), as well as skin and genital candidiasis, was estimated using disability-adjusted life years (DALY). Moreover, trends in systemic and topical antifungal consumption in ambulatory care were examined for the period 2010-2017, together with their associated costs. RESULTS: Due to their high incidence and long treatment duration, dermatophytoses represented the bulk of the burden, accounting for 92.2% of the total DALYs of superficial mycoses. Terbinafine was the most prescribed antifungal in terms of doses (35.4% of the total doses) while fluconazole was the most delivered drug in terms of packages (29.1% of the total packages). More than 70% of the prescriptions were made by general practitioners while consumption varied according to age and gender of the patients. A global 12% decrease in antifungal prescriptions was observed between 2011 and 2017. However, this reduction would result mainly from packaging changes and increased self-medication. A significant decrease in itraconazole treatments was notably compensated by an increased prescription of fluconazole packages. CONCLUSION: This study emphasises that dermatological presentations of superficial mycoses are the most important in terms of both burden and antifungal consumption in Belgium. Further reduction in antifungals use can be achieved by applying the adequate treatment after identification of the causative agent.


Assuntos
Antifúngicos/uso terapêutico , Efeitos Psicossociais da Doença , Uso de Medicamentos/estatística & dados numéricos , Micoses/tratamento farmacológico , Micoses/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/economia , Bélgica/epidemiologia , Criança , Pré-Escolar , Uso de Medicamentos/economia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Micoses/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Adulto Jovem
11.
J Am Acad Orthop Surg ; 28(21): e954-e961, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32044822

RESUMO

INTRODUCTION: Proximal humerus fractures (PHF) are a common upper extremity fracture in the elderly cohort. An aging and more comorbid cohort, along with recent trends of increased operative intervention, suggests that there could be an increase in resource utilization caring for these patients. We sought to quantify these trends and quantify the impact that comorbidity burden has on resource utilization. METHODS: Data on 83,975 patients with PHFs were included from the Premier Healthcare Claims database (2006 to 2016) and stratified by Deyo-Charlson index. Multivariable models assessed associations between Deyo-Charlson comorbidities and resource utilization (length and cost of hospitalization, and opioid utilization in oral morphine equivalents [OME]) for five treatment modalities: (1) open reduction internal fixation (ORIF), (2) closed reduction internal fixation (CRIF), (3) hemiarthroplasty, (4) reverse total shoulder arthroplasty, and (5) nonsurgical treatment (NST). We report a percentage change in resource utilization associated with an increasing comorbidity burden. RESULTS: Overall distribution of treatment modalities was (proportion in percent/median length of stay/cost/opioid utilization): ORIF (19.1%/2 days/$11,183/210 OME), CRIF (1.1%/4 days/$11,139/220 OME), hemiarthroplasty (10.7%/3 days/$17,255/275 OME), reverse total shoulder arthroplasty (6.4%/3 days/$21,486/230 OME), and NST (62.7%/0 days/$1,269/30 OME). Patients with an increased comorbidity burden showed a pattern of (1) more pronounced relative increases in length of stay among those treated operatively (65.0% for patients with a Deyo-Charlson index >2), whereas (2) increases in cost of hospitalization (60.1%) and opioid utilization (37.0%) were more pronounced in the NST group. DISCUSSION: In patients with PHFs, increased comorbidity burden coincides with substantial increases in resource utilization in patients receiving surgical and NSTs. Combined with known increases in operative intervention, trends in increased comorbidity burden may have profound effects on the cohort level and resource utilization for those with PHFs, especially because the use of bundled payment strategies for fractures increases. LEVEL OF EVIDENCE: Level III.


Assuntos
Efeitos Psicossociais da Doença , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fraturas do Ombro/economia , Fraturas do Ombro/cirurgia , Idoso , Artroplastia do Ombro/economia , Estudos de Coortes , Comorbidade , Tratamento Conservador/economia , Custos e Análise de Custo , Feminino , Fixação Interna de Fraturas/economia , Hemiartroplastia/economia , Hospitalização/economia , Humanos , Masculino , Redução Aberta/economia , Fraturas do Ombro/epidemiologia
12.
Med Care ; 58(6): 504-510, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32011425

RESUMO

BACKGROUND: The 2010 Patient Protection and Affordable Care Act reformed the individual and small group health insurance markets and established a risk adjustment program to create a level playing field for competition. A new set of predictive models for measuring enrollee risk across plans was developed for the Patient Protection and Affordable Care Act-reformed markets, referred to as the Department of Health and Human Services Hierarchical Condition Category (HHS-HCC) models. Beginning in 2018, selected prescription drug classes were added to the models as risk markers. OBJECTIVE: We describe the motivations, concerns, methodology, and results of adding prescription drug utilization to the HHS-HCC models. METHODS: Separate HHS-HCC models are estimated by enrollee age and plan actuarial value. We defined and added 10 prescription drug classes, called RXCs, to the HHS-HCC adult models. RESULTS: Using selected RXCs alongside demographic and diagnostic indicators yielded modest overall improvement in HHS-HCC models' predictive power. Also, adding RXCs captures the higher costs of enrollees taking certain expensive pharmaceuticals and allows imputation of diagnoses for enrollees utilizing a drug but lacking the associated diagnosis. CONCLUSIONS: Including selected drugs in risk adjustment improved the models' predictive power. In addition, inclusion of selected drugs may discourage insurers from using formulary and drug benefit design to avoid enrollment of patients taking high-cost drugs, such as for HIV, multiple sclerosis, and rheumatoid arthritis, and improve access for enrollees taking these drugs. Adding RXCs also may improve plan risk measurement for plans with less complete diagnosis reporting.


Assuntos
Modelos Estatísticos , Patient Protection and Affordable Care Act/legislação & jurisprudência , Medicamentos sob Prescrição/administração & dosagem , Risco Ajustado/métodos , Uso de Medicamentos/economia , Humanos , Medição de Risco , Fatores Socioeconômicos
13.
Eur J Clin Pharmacol ; 76(4): 547-555, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31822956

RESUMO

PURPOSE: The study's aim was to compare the use of proton pump inhibitors (PPIs), histamine 2-receptor antagonists (H2RAs) and mucoprotective medicines (MPs) used for gastric acid-related disorders (GARD) in Australia and South Korea (Korea) from 2004 to 2017. METHODS: Prescription data for PPIs, H2RAs and MPs for Australian outpatients were extracted from the Australian Statistics on Medicines annual reports, with dose-specific and expenditure data obtained from Medicare. Similar data were obtained from Korean National Health Insurance Service claims data. We analysed the volume and expenditure of medicines use annually using the defined daily dose per 1,000 population per day. We calculated which medicines accounted for 90% of use and estimated the proportions of use for low- and high-dose PPIs. RESULTS: While total utilisation for GARD medicines increased over time in both countries, patterns of use differed. Overall, use was somewhat higher in Australia but increased more rapidly in Korea. PPIs were used more extensively in Australia, while more MPs and H2RAs were used in Korea. Expenditure and use of low-dose PPIs is escalating in Korea. CONCLUSION: There were substantial differences in the use of GARD medicines in Australia and Korea over 14 years. Both countries face similar challenges to promote rational medicines use and contain medical care costs. The discrepant prescribing patterns can be attributed to differences in healthcare systems, pharmaceutical policies and demographics. This study provides a baseline to influence more rational use of these medicines. It provides insight into medicines policies for other countries that face similar challenges.


Assuntos
Antiulcerosos/administração & dosagem , Uso de Medicamentos/estatística & dados numéricos , Dispepsia/tratamento farmacológico , Ácido Gástrico/metabolismo , Antagonistas dos Receptores H2 da Histamina/administração & dosagem , Inibidores da Bomba de Prótons/administração & dosagem , Antiulcerosos/economia , Antiulcerosos/uso terapêutico , Austrália , Uso de Medicamentos/economia , Dispepsia/metabolismo , Gastos em Saúde , Antagonistas dos Receptores H2 da Histamina/economia , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Humanos , Programas Nacionais de Saúde , Padrões de Prática Médica/estatística & dados numéricos , Inibidores da Bomba de Prótons/economia , Inibidores da Bomba de Prótons/uso terapêutico , República da Coreia
14.
J Dairy Sci ; 103(1): 473-491, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31629507

RESUMO

Antibiotics use (ABU) in animal agriculture has been implicated in the emergence of antibiotic resistance, a global public health threat. Economically justifiable antibiotic reduction strategies can motivate farmers to reduce ABU for clinical mastitis (CM) and metritis, the most common reasons for ABU on dairy farms. Our objective was to quantify the reduction in incidence of CM, metritis, and ABU, and the herd performance of a representative US herd that uses genomic selection for Lifetime Net Merit 2018 (NM$) selection index, compared with genetic selection based only on the mastitis (MAST) or metritis resistance (METR) trait or a health trait subindex (HTH$). A stochastic dynamic simulation model of a 1,000-cow herd with multi-trait genetics for 19 correlated traits included in the NM$ affected the performance of animals. The incidence of CM and metritis for each animal was affected by the genetic and environmental components of the MAST or METR, along with a standard phenotypic function that calculated the daily underlying herd probability to contract CM or metritis. Selection decisions were made based on genomic estimated breeding values of the traits of interest. A strategy named AI-NM$ based decisions on the NM$ trait so that the correlated genetic trends in MAST and METR are improved. Three other strategies named AI-MAST, AI-METR, and AI-HTH$ maximized respectively MAST, METR, and HTH$ genetic merit, but with a tradeoff in NM$ genetic merit. The cumulative true breeding values (TBV) of NM$ for 15 yr showed a difference of $4,947 per cow between the AI-NM$ (best strategy for NM$) and AI-METR (worst strategy for NM$). However, the 15-yr cumulative TBV of MAST was 26.50 percentage points (PP) higher in AI-MAST, and 18.5 PP higher for METR in AI-METR, compared with AI-NM$. As a result, the 15-yr cumulative phenotypic CM and metritis incidence was respectively 94.03 PP and 58 PP lower in AI-MAST and AI-METR compared with AI-NM$. Therefore the corresponding 15-yr cumulative ABU decreased by 42% in AI-MAST and by 53% in AI-METR. We found that AI-MAST had the lowest CM incidence across the 15 yr, whereas AI-METR had the lowest incidence of metritis and the smallest total ABU for 15 yr. To achieve the lowest incidence of CM, metritis, and ABU strategies AI-MAST, AI-METR, and AI-HTH$ had to incur 15-yr discounted cumulative losses per cow of $1,486, $1,434, and $1,130, respectively, compared with AI-NM$. Hence, AI-NM$ had the best financial performance, despite having slightly higher incidence of CM, metritis, and ABU.


Assuntos
Antibacterianos/economia , Cruzamento , Doenças dos Bovinos/economia , Indústria de Laticínios/economia , Doença Inflamatória Pélvica/veterinária , Seleção Genética , Animais , Bovinos , Doenças dos Bovinos/tratamento farmacológico , Doenças dos Bovinos/epidemiologia , Cruzamentos Genéticos , Uso de Medicamentos/economia , Feminino , Genômica , Incidência , Doença Inflamatória Pélvica/tratamento farmacológico , Doença Inflamatória Pélvica/economia , Doença Inflamatória Pélvica/epidemiologia , Fenótipo
15.
Ann Pharmacother ; 54(2): 105-112, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31544470

RESUMO

Background:Optimal albumin use in the intensive care unit (ICU) remains challenging with inappropriate use approaching 50%. No published reports have described clinical pharmacist impact aimed at mitigating inappropriate albumin use in the ICU. Objective: To evaluate the clinical and economic impact of a clinical pharmacist-led intervention strategy targeting inappropriate albumin in the ICU. Methods: A retrospective cohort study evaluated all adult (≥18 years) ICU patients administered albumin at an academic medical center over a 2-year period. Institutional guidelines were developed with clinical pharmacists targeting inappropriate albumin use. The primary end point was to compare inappropriate use of albumin administered before and after pharmacist intervention implementation. Secondary analyses compared the overall albumin use between study periods. In-hospital mortality, length of stay, and albumin-related costs between study periods were also compared. Results: A total of 4419 patients were identified, with 2448 (55.4%) critically ill patients included. The pharmacist-led strategy resulted in a 50.9% reduction of inappropriate albumin use (P < 0.001). The rate of inappropriate albumin use was 44.3 ± 10.5 and 5.5 ± 2.9 g per patient-day in the preimplementation and postimplementation periods, respectively (P < 0.001). Costs associated with overall and inappropriate albumin use in the ICU decreased by 34.8% and 87.1%, respectively. Total annual cost-savings was $355 393 in the ICUs. No differences in clinical outcomes were found. Conclusion and Relevance: Clinical pharmacist-led interventions reduced overall and inappropriate albumin use and costs without negatively affecting clinical outcomes.


Assuntos
Albuminas/uso terapêutico , Cuidados Críticos/métodos , Uso de Medicamentos/estatística & dados numéricos , Prescrição Inadequada/prevenção & controle , Unidades de Terapia Intensiva , Farmacêuticos , Centros Médicos Acadêmicos , Adulto , Albuminas/administração & dosagem , Albuminas/economia , Redução de Custos , Estado Terminal , Uso de Medicamentos/economia , Feminino , Mortalidade Hospitalar , Humanos , Prescrição Inadequada/economia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
O.F.I.L ; 30(4): 301-311, 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197505

RESUMO

OBJETIVO: Evaluar el impacto en el gasto, consumo y aceptabilidad tras la implantación de prescripción electrónica y un sistema de dispensación automático en una unidad de hospitalización. MATERIAL Y MÉTODOS: Estudio retrospectivo pre-post implantación, comparativo en consumo (unidades) y gasto (euros) de medicamentos durante los periodos enero-noviembre 2017 y enero-noviembre 2018. Se midió impacto económico de la implantación aplicando costes de 2017 a la actividad 2018. Se realizó una encuesta de valoración de la seguridad, calidad asistencial y aceptación al personal de enfermería. RESULTADOS: El consumo en medicamentos tras la implantación fue un 5,76% inferior con respecto al periodo anterior. La distribución porcentual del consumo de unidades según vía de administración fue similar entre ambos periodos. Durante el periodo 2018, el gasto fue un 2,76% superior, asociado a un aumento en la actividad y al incremento del coste por unidad de medicamento. Sin embargo, el gasto y consumo ponderados por ingreso, fueron un 10% y 16,5% inferiores, respectivamente. El impacto económico de la implantación supuso una disminución del gasto en medicamentos de 15.656 euros. El resultado de las encuestas arrojó una valoración positiva en seguridad, más del 70% de los encuestados consideraron que los armarios previenen administraciones innecesarias, alergias y errores en la selección de medicamentos. CONCLUSIÓN: La implantación de la prescripción electrónica y de un sistema automatizado de dispensación disminuye los costes asociados al consumo de medicamentos. Mejora la adaptación de las presentaciones farmacéuticas a la prescripción y la seguridad en el uso de los medicamentos


OBJECTIVE: Impact evaluation of expenditure, consumption and acceptability in the implementation of the electronic prescription and the automatic dispensing cabinet in a hospitalization unit. MATERIAL AND METHODS: Pre-post implantation comparative retrospective study, in which the consumption (units) and expenditure (euros) of drugs were compared during 2 periods, pre-period (January-November 2017) and post-period (January-November 2018). The economic impact of the implementation was measured by applying the costs of 2017 to the activity of 2018. A survey was also carried out to assess the safety, quality of care and acceptability of nursing staff of the unit. RESULTS: Total units of drugs consumed after implementation were 5.76% lower compared to the previous period. The distribution of unit consumption according to the route of administration was similar between both periods. During the period of 2018, spending on medicines was 2.76% higher, associated with an increase in activity, spending and consumption weighted by income, 10% and 16.5% lower, respectively. The economic impact of the implementation meant a decrease in the cost of medicines of 15,656 euros. The result of the surveys yielded a positive evaluation in security, more than 70% of the nurses considered the automated dispensing cabinet prevent administration in case the allergies and the errors in the selection of medicines. CONCLUSIONS: complementation of electronic prescription and automatic dispensing cabinet produce a decrease in the healthcare costs. As well as a better adaptation to the prescription and an increase in the safety use of medicines. The nursing staff recognizes this new system as safer than the manual floor stock system


Assuntos
Humanos , Prescrição Eletrônica/economia , Sistemas de Medicação no Hospital/economia , Automação/economia , Uso de Medicamentos/economia , Estudos Retrospectivos , Uso de Medicamentos/estatística & dados numéricos , Prescrição Eletrônica/estatística & dados numéricos , Sistemas de Medicação no Hospital/estatística & dados numéricos , Inquéritos e Questionários , Espanha
17.
Am J Prev Med ; 57(6): 775-785, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31753258

RESUMO

INTRODUCTION: Benzodiazepines are commonly prescribed in the U.S. but entail safety concerns, including dependency. In pediatrics, many indications lack trial data. Authors aimed to describe youth initiating prescription benzodiazepine treatment, identify potential indications and prescribing concerns, estimate the duration of treatment by potential indication, and identify factors that predict long-term use. METHODS: The study cohort included children (aged 3-12 years) and adolescents (aged 13-17 years) initiating prescription benzodiazepine treatment (≥3 days' supply) from January 2010 to September 2015 in a U.S. commercial claims database. Potential indications included selected ICD-9-CM diagnoses (≤30 days prior). Long-term (≥6 months) benzodiazepine treatment was estimated with Kaplan-Meier estimation and modified Poisson regression identified independent predictors of long-term benzodiazepine treatment (analysis completed in 2018). RESULTS: Of 24,504 children and 61,046 adolescents initiating benzodiazepines, 62% of the children and 68% of the adolescents had a potential indication. Anxiety disorders were the most common indication, with mental health indications more common among adolescents (45%) than children (23%) and epilepsy and movement disorders higher in children. Recent opioid prescriptions were common before benzodiazepine initiation (children, 22%; adolescents, 21%). Six percent of the initiators became long-term benzodiazepine users. Potential indication, provider contact, psychotropic medication, and chronic conditions independently predicted long-term benzodiazepine treatment in adolescents and children. CONCLUSIONS: U.S. children and adolescents are prescribed benzodiazepines for various mental health and other medical conditions, many lacking evidence of pediatric efficacy. Long-term benzodiazepine treatment, concurrent opioid prescriptions, psychotropic use, and prior substance use disorder diagnoses suggest safety risks among some youth prescribed benzodiazepines.


Assuntos
Benzodiazepinas/uso terapêutico , Depressores do Sistema Nervoso Central/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Planos de Seguro com Fins Lucrativos/estatística & dados numéricos , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Adolescente , Saúde do Adolescente , Transtornos de Ansiedade/tratamento farmacológico , Benzodiazepinas/economia , Depressores do Sistema Nervoso Central/economia , Criança , Saúde da Criança , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Prescrições de Medicamentos/economia , Uso de Medicamentos/economia , Feminino , Planos de Seguro com Fins Lucrativos/economia , Humanos , Masculino , Saúde Mental , Medição de Risco , Fatores de Tempo
18.
Cochrane Database Syst Rev ; 2019(11)2019 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-31721159

RESUMO

BACKGROUND: Pharmaceuticals make an important contribution to people's health. Medicines, however, are frequently not used appropriately. Improving the use of medicines can improve health outcomes and save resources. On the other hand, regulatory and educational policies may have unintended effects on health and costs. OBJECTIVES: To assess the effects of pharmaceutical educational and regulatory policies targeting prescribers on medicine use, healthcare utilisation, health outcomes and costs (expenditures). SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two trial registries in March 2018 and several other databases between 2014 and 2018. We reviewed the reference lists of included studies and other relevant reviews, contacted authors of relevant reviews and studies to identify additional studies, and did a citation search for all included studies using ISI Web of Science (searched 05 January 2016). SELECTION CRITERIA: Randomised trials, non-randomised trials, interrupted time series studies, repeated measures studies and controlled before‒after studies of policies regulating who can prescribe medicines and other policies targeted at prescribers. We included in this category monitoring and enforcement of restrictions, generic prescribing, programmes to implement treatment guidelines, system-wide policies regarding monitoring medicine safety, and legislated or mandatory continuing education or quality improvement specifically targeted at prescribing. We defined 'policies' in this review as laws, rules, financial and administrative orders made by governments, non-governmental organisations or private insurers. We excluded interventions applied at the level of a single facility. For us to include a study, it had to include an objective measure of at least one of the following outcomes: medicine use, healthcare utilization, health outcomes, or costs. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed abstracts and reference lists of relevant reports, assessed full-text studies for inclusion, extracted data, and assessed risk of bias and certainty of the evidence (GRADE). For all the steps in the above process we resolved disagreements by discussion. MAIN RESULTS: We identified two studies that met our selection criteria: a controlled interrupted time series study evaluating a regulatory policy involving the monitoring of prescribing of benzodiazepines; and a controlled before‒after study of an educational policing involving mailed educational materials on prescribing for physicians and Health Maintenance Organization (HMO) members as well as an intervention to regulate drug reimbursement. We are uncertain about the effects on medicine use of a regulatory policy involving the monitoring of prescribing with triplicate prescriptions, compared with no regulatory intervention (very low certainty evidence). We are also uncertain about the effects on medicine use, assessed through doctors' prescribing, and costs of an educational policy involving mailed educational materials on prescribing for physicians and HMO members, compared to no educational intervention or an intervention to regulate drug reimbursement (very low certainty evidence). Neither of the included studies measured healthcare utilization, health outcomes, or additional costs, if any, to patients. AUTHORS' CONCLUSIONS: We are uncertain of the effects of educational or regulatory policies targeting prescribers due to very limited evidence of very low certainty. The impacts of these policies therefore need to be evaluated rigorously using appropriate study designs. Evaluations are needed across a range of settings, including low- and middle-income countries, and across different types of prescribers and medicines.


Assuntos
Uso de Medicamentos/legislação & jurisprudência , Farmacoeconomia , Legislação de Medicamentos , Educação de Pacientes como Assunto , Uso de Medicamentos/economia , Controle de Medicamentos e Entorpecentes , Gastos em Saúde , Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Reembolso de Seguro de Saúde/economia , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Cad Saude Publica ; 35(10): e00065118, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31596393

RESUMO

The study aimed to investigate the population's perceptions of generic drugs compared to original brand-name drugs in Peruvian hospitals. Participation included 4,914 persons 18 years and older in 13 cities in Peru, categorized as Lima, large cities, and small cities. The study explored socioeconomic and demographic characteristics and perceptions of generics in comparison to brand-name drugs. In determining the associations for each intersection of variables, the authors calculated the prevalence ratios (PR) and 95% confidence intervals (95%CI), using crude and adjusted Poisson regression with robust variance with Stata 14.0. Of the 4,914 participants, 46.7% felt that generics are less effective than brand-name drugs and 49.3% had recommended or would recommend generics to other people; multivariate analysis showed that individuals with income less than PEN 1,000 (USD 300) were prone to recommending a generic drug (PR = 1.36; 95%CI: 1.14-1.63). The results indicate that the Peruvian population still has mistaken concepts and low acceptance of generic drugs, and the study should serve to develop health policies that ensure low cost and quality when choosing medicines.


Assuntos
Uso de Medicamentos , Medicamentos Genéricos , Adolescente , Adulto , Estudos Transversais , Prescrições de Medicamentos , Uso de Medicamentos/economia , Medicamentos Genéricos/economia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Fatores Socioeconômicos , Adulto Jovem
20.
Artigo em Inglês | MEDLINE | ID: mdl-31547325

RESUMO

The over-use of antibiotics has been identified as a major global challenge, where there is insufficient knowledge about the use of antibiotics in primary healthcare settings, especially at a population level. This study aims to investigate the trends and patterns of antibiotic sales in primary care in Hubei, China over a six-year period from 2012 to 2017. Antibiotic sales were expressed with Defined Daily Doses per 1000 inhabitants per day (DIDs) and compared with European countries using the 12 quality indicators proposed by the scientific advisory board of the European Surveillance of Antimicrobial Consumption (ESAC) project. Antibiotic sales increased from 12.8 DID in 2012 to 15.3 DID in 2013, and then declined afterwards. The most commonly used antibiotics, J01C (beta-lactam antimicrobials, penicillins), accounted for 40.5% of total antibiotic sales. Parenteral administration of antibiotics accounted for over 50% of total antibiotic sales. Total antibiotic sales were almost on a par with the 31 European countries monitored by the ESAC project, but cephalosporin sales were higher than at least three quarters of the compared countries, resulting in a significant higher proportion of third-generation cephalosporin consumption (13.8-19.43%). The relative consumption of Fluoroquinolone (9.26-9.89%) was also higher than at least half of the compared countries. There is a lack of robust evidence to show that antibiotic consumption in primary care is lower in Hubei compared with other countries. The preference of clinicians in China to use broad-spectrum and parenteral antibiotics deserves further study and policy attention.


Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Antibacterianos/classificação , Antibacterianos/economia , China , Comércio , Uso de Medicamentos/economia , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...