The Experts below are selected from a list of 324 Experts worldwide ranked by ideXlab platform
Narendra C Singh - One of the best experts on this subject based on the ideXlab platform.
-
antibiotic prescribing patterns in the pediatric emergency department at georgetown public hospital corporation a retrospective chart review
BMC Infectious Diseases, 2016Co-Authors: S P Sharma, Clive Bowman, Bibi Alladinkaran, Narendra C SinghAbstract:The increase in antimicrobial-resistant infections has led to significant morbidity, mortality, and healthcare costs. The impact of antimicrobial resistance is greatest on low-income countries, which face the double burden of fewer antibiotic choices and higher rates of infectious diseases. Currently, Guyana has no national policy on rational prescribing. This study aims to characterize antibiotic prescribing patterns in children discharged from the emergency department at Georgetown Public Hospital Corporation (GPHC), as per the World Health Organization (WHO) prescribing indicators. A retrospective chart review of pediatric patients (aged 1 month–13 years) seen in the GPHC emergency department between January and December 2012 was conducted. Outpatient prescriptions for eligible patients were reviewed. Patient demographics, diagnosis, and Drugs prescribed were recorded. The following WHO Prescribing Indicators were calculated: i) average number of Drugs prescribed per patient encounter, ii) percentage of encounters with an antibiotic prescribed, iii) percentage of antibiotics prescribed by generic name, and iv) percentage of antibiotics prescribed from essential Drugs list or Formulary. Eight hundred eleven patient encounters were included in the study. The mean patient age was 5.55 years (s = 3.98 years). 59.6 % (n = 483) patients were male. An average of 2.5 Drugs were prescribed per encounter (WHO standard is 2.0). One or more antibiotic was prescribed during 36.9 % (n = 299) of all encounters (WHO standard is 30 %). 90.83 % of antibiotics were prescribed from the essential Drugs Formulary list and 30 % of the prescriptions included the Drug’s generic name. The average duration of antibiotic therapy was 5.73 days (s = 3.53 days). Of the 360 antibiotics prescribed, 74.7 % (n = 269) were broad-spectrum. B-lactam penicillins were prescribed most frequently (51.4 %), with amoxicillin being the most popular choice (33.9 %). The most common diagnoses were injuries (25.8 %), asthma (20 %), respiratory infections (19.5 %), and gastrointestinal infections (12.1 %). Per WHO prescribing indicators, the pediatric emergency department at GPHC has higher than standard rates of antibiotic use and polypharmacy. The department excels in adhering to the essential Drug Formulary. Our findings provide support for investigating Drug utilization in other Guyanese settings, and to work towards developing a national rational prescribing strategy.
Suzanne M Cadarette - One of the best experts on this subject based on the ideXlab platform.
-
uptake and characteristics of zoledronic acid and denosumab patients and physicians in ontario canada impact of Drug Formulary access
Osteoporosis International, 2015Co-Authors: Andrea M Burden, Mina Tadrous, Andrew Calzavara, Suzanne M CadaretteAbstract:Summary The addition of Limited Use criteria (less restrictive access) for zoledronic acid resulted in an immediate and significant increase in uptake and resulted in differences in patient/physician characteristics. In comparison, the uptake of denosumab (only listed with Limited Use) was rapid. Thus, Formulary access restrictions have significant implications for prescribing.
-
uptake and characteristics of zoledronic acid and denosumab patients and physicians in ontario canada impact of Drug Formulary access
Osteoporosis International, 2015Co-Authors: Andrea M Burden, Mina Tadrous, Andrew Calzavara, Suzanne M CadaretteAbstract:The addition of Limited Use criteria (less restrictive access) for zoledronic acid resulted in an immediate and significant increase in uptake and resulted in differences in patient/physician characteristics. In comparison, the uptake of denosumab (only listed with Limited Use) was rapid. Thus, Formulary access restrictions have significant implications for prescribing. We sought to describe the use of zoledronic acid and denosumab by physicians and patients over time and examine the impact of a 2012 provincial Formulary modification that removed the administrative burden on physicians when prescribing zoledronic acid. We identified users of zoledronic acid and denosumab using Ontario pharmacy claims data. The number of new patients and physicians was plotted and examined over time. Interrupted time series analysis examined the impact of a Formulary modification to zoledronic acid use and prescribing. Descriptive characteristics of patients and prescribers were summarized pre- and post-Formulary modification for zoledronic acid and overall for denosumab. We identified 1463 zoledronic acid patients treated by 627 physicians and 16,736 denosumab patients treated by 2904 physicians. In the first 2 months on the market, we identified a rapid uptake of denosumab (>450 physicians and >1200 patients) in contrast to zoledronic acid (<10 physicians and <10 patients). Zoledronic acid use increased significantly in the 2-month post-Formulary change, yet no change in denosumab was observed. Prior to the Formulary modification, more zoledronic acid patients had a history of osteoporosis therapy (41 vs. 26 %) or bone density testing (30 vs. 10 %). Compared to zoledronic patients (post-Formulary modification), more denosumab patients had prior osteoporosis therapy (55 vs. 26 %), yet fewer had a gastrointestinal diagnosis (6 vs. 11 %). We identified a rapid uptake of denosumab in only 15 months of observation. A provincial Formulary modification to zoledronic acid resulted in an increase in utilization and impacted patient characteristics.
Adolfo Figueiras - One of the best experts on this subject based on the ideXlab platform.
-
Impact of a change of bronchodilator medications in a hospital Drug Formulary on intra- and out-of-hospital Drug prescriptions: interrupted time series design with comparison group.
Implementation science : IS, 2020Co-Authors: Raquel Vázquez-mourelle, Eduardo Carracedo-martínez, Adolfo FigueirasAbstract:Hospital Drug formularies are reduced lists of Drugs designed to optimise inpatient care. Adherence to the Drugs included in such formularies is not always 100% but is generally very high. Little research has targeted the impact of a change in these formularies on outpatient Drug prescriptions. This study therefore sought to evaluate the impact of a change affecting bronchodilator medications in a hospital Drug Formulary on intra- and out-of-hospital Drug prescriptions in a region in north-western Spain. Two new Drugs belonging to this same class were brought onto the out-of-hospital market, overlapping with the intervention. We used a natural before-after quasi-experimental design with control group based on monthly data. The intervention evaluated was the modification of a hospital Drug Formulary, which involved withdrawing salmeterol/fluticasone in order to retain formoterol/budesonide as the sole inhaled corticosteroid and long-acting beta-agonist (ICS/LABA). Using official data sources, we extracted the following dependent variables: defined daily doses (DDD) per 1000 inhabitants per day, DDD per 100 bed-days, and cost per DDD. Intra-hospital use showed a 173.2% rise (95% CI 47.3-299.0%) in the medication retained in the Formulary, formoterol/budesonide, and a 94.9% drop (95% CI 77.9-111.9%) in the medication withdrawn from the Formulary, salmeterol/fluticasone. This intervention led to an immediate reduction of 75.9% (95% CI 82.8-68.9%) in the intra-hospital cost per DDD of ICS/LABA. No significant changes were observed in out-of-hospital use. Although this intervention was cost-effective in the intra-hospital setting, the out-of-hospital impact of a change in the Drug Formulary cannot be generalised to all types of medications and situations.
-
Impact of removal and restriction of me-too medicines in a hospital Drug Formulary on in- and outpatient Drug prescriptions: interrupted time series design with comparison group.
Implementation science : IS, 2019Co-Authors: Raquel Vázquez-mourelle, Eduardo Carracedo-martínez, Adolfo FigueirasAbstract:The study covered in- and out-of-hospital care in a region in north-western Spain. The intervention evaluated took the form of a change in the hospital Drugs Formulary. Before the intervention, the Formulary contained four of the five low molecular weight heparins (LMWHs) marketed in Spain. The intervention consisted of withdrawing two LMWHs (bemiparin and dalteparin) from the Formulary and restricting the use of another (tinzaparin), leaving only enoxaparin as an unrestricted prescription LMWH. Accordingly, the aim of this study was to evaluate the effect on in- and outpatient Drug prescriptions of removing and restricting the use of several LMWHs in a hospital Drugs Formulary. We used a natural, before-after, quasi-experimental design with a control group and monthly data from January 2011 to December 2016. Based on data drawn from official Public Health Service sources, the following dependent variables were extracted: defined daily doses (DDD) per 1000 inhabitants per day (DDD/TID), DDD per 100 stays per day, and expenditure per DDD. The two compounds that were removed from the Formulary registered an immediate decrease at both an intra- and out-of-hospital level (66.6% and 55.6% for bemiparin and 73.0% and 92.2% for dalteparin, respectively); similarly, the compound that was restricted also registered an immediate decrease (36.1% and 9.0% at the in- and outpatient levels, respectively); in contrast, the remaining LMWH (enoxaparin) registered an immediate, significant increase at both levels (44.9% and 32.6%, respectively). The intervention led to an immediate reduction of 6.8% and a change in trend in out-of-hospital cost/DDD; it also avoided an expenditure of €477,317.1 in the 21 months following the intervention. The results indicate that changes made in a hospital Drugs Formulary towards more efficient medications may lead to better use of pharmacotherapeutic resources in its health catchment area.
Andrea M Burden - One of the best experts on this subject based on the ideXlab platform.
-
uptake and characteristics of zoledronic acid and denosumab patients and physicians in ontario canada impact of Drug Formulary access
Osteoporosis International, 2015Co-Authors: Andrea M Burden, Mina Tadrous, Andrew Calzavara, Suzanne M CadaretteAbstract:Summary The addition of Limited Use criteria (less restrictive access) for zoledronic acid resulted in an immediate and significant increase in uptake and resulted in differences in patient/physician characteristics. In comparison, the uptake of denosumab (only listed with Limited Use) was rapid. Thus, Formulary access restrictions have significant implications for prescribing.
-
uptake and characteristics of zoledronic acid and denosumab patients and physicians in ontario canada impact of Drug Formulary access
Osteoporosis International, 2015Co-Authors: Andrea M Burden, Mina Tadrous, Andrew Calzavara, Suzanne M CadaretteAbstract:The addition of Limited Use criteria (less restrictive access) for zoledronic acid resulted in an immediate and significant increase in uptake and resulted in differences in patient/physician characteristics. In comparison, the uptake of denosumab (only listed with Limited Use) was rapid. Thus, Formulary access restrictions have significant implications for prescribing. We sought to describe the use of zoledronic acid and denosumab by physicians and patients over time and examine the impact of a 2012 provincial Formulary modification that removed the administrative burden on physicians when prescribing zoledronic acid. We identified users of zoledronic acid and denosumab using Ontario pharmacy claims data. The number of new patients and physicians was plotted and examined over time. Interrupted time series analysis examined the impact of a Formulary modification to zoledronic acid use and prescribing. Descriptive characteristics of patients and prescribers were summarized pre- and post-Formulary modification for zoledronic acid and overall for denosumab. We identified 1463 zoledronic acid patients treated by 627 physicians and 16,736 denosumab patients treated by 2904 physicians. In the first 2 months on the market, we identified a rapid uptake of denosumab (>450 physicians and >1200 patients) in contrast to zoledronic acid (<10 physicians and <10 patients). Zoledronic acid use increased significantly in the 2-month post-Formulary change, yet no change in denosumab was observed. Prior to the Formulary modification, more zoledronic acid patients had a history of osteoporosis therapy (41 vs. 26 %) or bone density testing (30 vs. 10 %). Compared to zoledronic patients (post-Formulary modification), more denosumab patients had prior osteoporosis therapy (55 vs. 26 %), yet fewer had a gastrointestinal diagnosis (6 vs. 11 %). We identified a rapid uptake of denosumab in only 15 months of observation. A provincial Formulary modification to zoledronic acid resulted in an increase in utilization and impacted patient characteristics.
Mina Tadrous - One of the best experts on this subject based on the ideXlab platform.
-
impact of delisting high strength opioid formulations from a public Drug benefit Formulary on opioid utilization in ontario canada
Pharmacoepidemiology and Drug Safety, 2019Co-Authors: Diana Martins, Mina Tadrous, Muhammad Mamdani, David N Juurlink, Wayne Khuu, Michael J Paterson, Tara GomesAbstract:PURPOSE High-strength opioid formulations were delisted (removed) from Ontario's public Drug Formulary in January 2017, except for palliative patients. We evaluated the impact of this policy on opioid utilization and dosing. METHODS We conducted a longitudinal study among patients receiving publicly funded, high-strength opioids from August 2016 to July 2017. The primary outcome measure was weekly median daily opioid dose (in milligrams of morphine or equivalent; MME) of (1) publicly funded and (2) all opioid prescriptions irrespective of funding source, evaluated using interrupted time series analyses and stratified by palliative care status. RESULTS Following policy implementation, the weekly median daily dose of publicly funded opioids decreased immediately among non-palliative patients by 10 MME (95% confidence limit [CL], -16.8 to -3.1) from a pre-intervention dose of 424.5 MME (95% CL, 417.8-431.2) and fell gradually among palliative patients by 3.9 MME per week (95% CL, -5.5 to -2.3) from a pre-intervention dose of 450.1 MME (95% CL, 432.5-467.7). In contrast, among all opioid prescriptions, gradual reductions in weekly median daily doses were observed only for non-palliative patients, which decreased by 0.7 MME per week (95% CL, -1.3 to -0.2) from a pre-intervention dose of 426.2 MME (95% CL, 420.9-431.5). CONCLUSION The delisting of publicly-funded, high-strength opioids was accompanied by changes in funding source and small reductions in the weekly median daily doses dispensed. Although observed dose reductions of less than 1 MME weekly are likely not clinically relevant, safety implications of these changes require further monitoring.
-
Evaluating the early impacts of delisting high-strength opioids on patterns of prescribing in Ontario
Public Health Agency of Canada, 2018Co-Authors: Qi Guan, Mina Tadrous, Diana Martins, Wayne Khuu, Maria Chiu, Tara GomesAbstract:Introduction: Ontario delisted high-strength fentanyl, hydromorphone and morphine from the public Drug Formulary for non-palliative care prescribers on 31 January, 2017. Our aim is to assess the early impact of this policy on prescribing patterns and to examine whether this impact varied by prescriber type, opioid type and opioid strength. Methods: We conducted a population-based, cross-sectional study on palliative and non-palliative care patients dispensed fentanyl, hydromorphone or morphine through the Ontario public Drug program between 1 January, 2014, and 31 July, 2017. For each month during the study period, we reported the total number of high-strength opioid recipients stratified by prescriber type, and the total volume of each Drug dispensed, stratified by strength. We used interventional autoregressive integrated moving average (ARIMA) models to assess the policy’s impact on prescribing patterns. Results: We observed a 98% decrease in the total number of publicly funded recipients of high-strength opioids between December 2016 and July 2017 (5930 to 133 recipients) for all prescribers. The policy led to a significant decline in the total volume of all three opioids dispensed: hydromorphone from 20 374 621 to 16 952 097 mg (p $lt; .01); morphine from 40 644 190 to 33 555 480 mg (p $lt; .03); and fentanyl from 9 604 913 to 5 842 405 mcg/h (p $lt; .01). For both fentanyl and hydromorphone, this reduction generally corresponded to an increase in the number of low-strength opioids dispensed. Conclusion: Delisting high-strength opioids substantially reduced the number of highstrength opioid recipients and reduced the overall volume of long-acting opioids dispensed in Ontario through the public Drug program. Future studies should examine its impact on patient outcomes
-
uptake and characteristics of zoledronic acid and denosumab patients and physicians in ontario canada impact of Drug Formulary access
Osteoporosis International, 2015Co-Authors: Andrea M Burden, Mina Tadrous, Andrew Calzavara, Suzanne M CadaretteAbstract:Summary The addition of Limited Use criteria (less restrictive access) for zoledronic acid resulted in an immediate and significant increase in uptake and resulted in differences in patient/physician characteristics. In comparison, the uptake of denosumab (only listed with Limited Use) was rapid. Thus, Formulary access restrictions have significant implications for prescribing.
-
uptake and characteristics of zoledronic acid and denosumab patients and physicians in ontario canada impact of Drug Formulary access
Osteoporosis International, 2015Co-Authors: Andrea M Burden, Mina Tadrous, Andrew Calzavara, Suzanne M CadaretteAbstract:The addition of Limited Use criteria (less restrictive access) for zoledronic acid resulted in an immediate and significant increase in uptake and resulted in differences in patient/physician characteristics. In comparison, the uptake of denosumab (only listed with Limited Use) was rapid. Thus, Formulary access restrictions have significant implications for prescribing. We sought to describe the use of zoledronic acid and denosumab by physicians and patients over time and examine the impact of a 2012 provincial Formulary modification that removed the administrative burden on physicians when prescribing zoledronic acid. We identified users of zoledronic acid and denosumab using Ontario pharmacy claims data. The number of new patients and physicians was plotted and examined over time. Interrupted time series analysis examined the impact of a Formulary modification to zoledronic acid use and prescribing. Descriptive characteristics of patients and prescribers were summarized pre- and post-Formulary modification for zoledronic acid and overall for denosumab. We identified 1463 zoledronic acid patients treated by 627 physicians and 16,736 denosumab patients treated by 2904 physicians. In the first 2 months on the market, we identified a rapid uptake of denosumab (>450 physicians and >1200 patients) in contrast to zoledronic acid (<10 physicians and <10 patients). Zoledronic acid use increased significantly in the 2-month post-Formulary change, yet no change in denosumab was observed. Prior to the Formulary modification, more zoledronic acid patients had a history of osteoporosis therapy (41 vs. 26 %) or bone density testing (30 vs. 10 %). Compared to zoledronic patients (post-Formulary modification), more denosumab patients had prior osteoporosis therapy (55 vs. 26 %), yet fewer had a gastrointestinal diagnosis (6 vs. 11 %). We identified a rapid uptake of denosumab in only 15 months of observation. A provincial Formulary modification to zoledronic acid resulted in an increase in utilization and impacted patient characteristics.
