Complications associated with VTE are frequent and costly. In particular, the cost of complications resulting from prophylaxis and treatment of VTE, such as post-thrombotic syndrome and heparin-induced thrombocytopenia, had a considerable economic impact.

Even among high-risk groups it is not possible to identify individuals who will go on to develop VTE, and, therefore, thromboprophylaxis is a recommended component of the management of high-risk patients. Ensuring patients receive safe, effective, easily administered antithrombotic therapy both in hospital and post-discharge, for a sufficient length of time, should be central to any strategy to reduce incident or recurrent VTE and minimise the risk of long-term complications.

Data of prescribing practices for antipsychotics are of great interest with respect to quality of care. Consequently, we analysed all prescriptions under the statutory health insurance redeemed at pharmacies in Southern Germany between July 1999 and December 2001. The database covers prescriptions for approximately 25 million people. Up to 6% of the population were prescribed an antipsychotic at least once during the study period. Most prescriptions were for conventional antipsychotics and written by non-specialists. Patients receiving second generation antipsychotics were more likely to receive continuous antipsychotic therapy. For a large proportion of patients, antipsychotic polypharmacy, as well as comedication for somatic illnesses, were observed. In particular, drugs for the treatment of cardiovascular and metabolic disorders were frequently co-prescribed. Physicians should consider patients' cardiovascular and metabolic risk profile when making treatment choices. The data suggest that the majority of antipsychotics are used for the treatment of disorders other than schizophrenia. It is important to raise awareness among non-specialists about the indications, efficacy and side-effects of the antipsychotics because these physicians account for the majority of antipsychotic prescriptions.

No abstract

several sources of real world data available to researchers. METHODS: We compare and contrast the pros and cons of data available from administrative (payment) databases, electronic medical record (EMR) databases, and surveys. RESULTS: Administrative claims databases provide fully-integrated, all-encounter patient data on diagnoses, procedures, and payments. However, data quality varies depending upon whether particular fields are required for provider payment. Data on lab and test values are typically lacking. Prescriptions that are written, but not filled by the patient, are usually not captured. Medical record data overlap, to a certain extent, with administrative data. While information on payments for services may not be included, detailed information on test results and lab values are usually captured in the EMR. Data are included on written prescriptions, but the researcher will not know whether the prescription was filled by the patient. Depending upon the clinical system covered, only some encounters (e.g., ambulatory care in the outpatient setting) may be available. Both administrative and EMR data hold the potential to provide longitudinal patient information that is not subject to recall or social desirability biases that often affect survey data. However, information on satisfaction with care, quality of life, activities of daily living, and many other metrics, may only be captured with survey data. CONCLUSIONS: Several sources of rich, longitudinal patient data are available to provide real world evidence on drug effectiveness and cost. In some cases, data may be combined to overcome limitations of a single source. With care, data may be found that will produce generalizable findings for the population of interest.