Medication use and potentially high‐risk prescribing in older patients hospitalized for diabetes: a missed opportunity to improve care?

Caughey, Gillian E.; Barratt, John D.; Shakib, Sepehr; Kemp-Casey, Anna; Roughead, Elizabeth E.

doi:10.1111/dme.13148

Cited by 19 publications

(13 citation statements)

References 28 publications

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“…18,19 For the purposes of this study, patients dispensed medicines for dementia were defined as those These medicines are restricted for use in mild to moderately severe AD, and the diagnosis must be confirmed by a specialist or consultant physician. This method has been extensively used in pharmacoepidemiological research using administrative claims data, where comorbidities are identified via medicine use.…”

Section: Study Populationmentioning

confidence: 99%

“…This method has been extensively used in pharmacoepidemiological research using administrative claims data, where comorbidities are identified via medicine use. 18,19 For the purposes of this study, patients dispensed medicines for dementia were defined as those dispensed rivastigmine (ATC code N06DA03), donepezil (ATC code N06DA02), galantamine (ATC code N06DA04), or memantine (ATC code N06DX01) between 1 January 2005 and 31 December 2015.…”

Section: Study Populationmentioning

confidence: 99%

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Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

Eshetie

Nguyen

Gillam

et al. 2019

Int J Geriat Psychiatry

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Objective To investigate the prevalence of potentially inappropriate prescribing (PIP) using the Screening Tool of Older Person's Prescriptions (STOPP) criteria in people with dementia compared with people without dementia. Methods A retrospective cohort study was conducted using the Pharmaceutical Benefits Scheme 10% sample of pharmacy claims. People with dementia were defined as those dispensed a medicine for dementia (cholinesterase inhibitors, memantine, or risperidone for behavioural and psychological symptoms of dementia) between 1 January 2005 and 31 December 2015, aged 65 years or older at 1 January 2016 and alive at the end of 2016. An age‐ and gender‐matched comparison cohort of people not dispensed medicines for dementia was identified. PIP prevalence was determined between 1 January 2016 and 31 December 2016. Results In total, 8280 people dispensed medicines for dementia and 41 400 comparisons not dispensed medicines for dementia were included: 63% were female and the median age was 82 years. PIP prevalence was 79% among people with dementia compared with 70% among the comparison group (P < .0001). Use of anticholinergics, long‐term use of high‐dose proton pump inhibitors, and use of benzodiazepines were the most common instances of PIP in people with dementia. After adjustments for age, gender, comorbidity, and number of prescribers, people with dementia were more likely to be exposed to PIP than comparisons (adjusted OR 1.44, 95% CI, 1.35‐1.53, P < .0001). Conclusions PIP was more common in people dispensed medicines for dementia than comparisons. These results highlight the need for effective interventions to optimize prescribing in people with dementia.

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Section: Study Populationmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

Eshetie

Nguyen

Gillam

et al. 2019

Int J Geriat Psychiatry

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“…With respect to undertaking exposure-outcomes studies, the Australian Institute of Health and Welfare's development of multi-source enduring linked data assets (MELDAs) comprising continuing cross-jurisdictional, person-level linkages of medicines exposure with hospitalisation and mortality data show strong potential to further accelerate national population-based research capacity [25,26]. At the time of writing, there were no formal policies around third-party access (including to academic researchers) to the current suite of MELDAs; this should be considered an immediate priority to realise this significant investment in public money [27].…”

Section: Initiatives Improving Availability and Ascertainment Of Dispensing Claims Datamentioning

confidence: 99%

The changing face of Australian data reforms: Impact on pharmacoepidemiology research

Costa

Bruno

Schaffer

et al. 2021

IJPDS

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ObjectiveA wealth of data is generated through Australia’s universal health care arrangements. However, use of these data has been hampered by different federal and state legislation, privacy concerns and challenges in linking data across jurisdictions. A series of data reforms have been touted to increase population health research capacity in Australia, including pharmacoepidemiology research. Here we catalogued research leveraging Australia’s Pharmaceutical Benefits Scheme (PBS) data (2014–2018) and discussed these outputs in the context of previously implemented and new data reforms. MethodsWe conducted a systematic review of population-based studies using PBS dispensing claims. Independent reviewers screened abstracts of 4,996 articles and 310 full-text manuscripts. We characterised publications according to study population, analytical approach, data sources used, aims and medicines focus. ResultsWe identified 180 studies; 133 used individual-level data, 70 linked PBS dispensing claims with other health data (66 across jurisdictions). Studies using individual-level data focussed on Australians receiving government benefits (87 studies) rather than all PBS-eligible persons. 63 studies examined clinician or patient practices and 33 examined exposure-outcome relationships (27 evaluated medicines safety, 6 evaluated effectiveness). Medicines acting on the nervous and cardiovascular system account for the greatest volume of PBS medicines dispensed and were the most commonly studied (67 and 40 studies, respectively). Antineoplastic and immunomodulating agents account for approximately one third of PBS expenditure but represented only 10% of studies in this review. ConclusionsThe studies in this review represent more than a third of all population-based pharmacoepidemiology research published in the last three decades in Australia. Recent data reforms have contributed to this escalating output. However, studies are concentrated among specific subpopulations and medicines classes, and there remains a limited understanding of population benefits and harms derived from medicines use. The current draft Data Availability and Transparency legislation should further bolster efforts in population health research.

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“…Glycaemic target range of the algorithm: The goal of the basal insulin algorithm is to maintain fasting BG (FBG) within the FBG target range according to the predefined health status (e.g. number of comorbidities, care dependency, life expectancy, …) [ 8 , 24 , 25 ]: Healthy: FBG target 5.0–7.2 mmol/L, Complex: FBG target 5.0–8.3 mmol/L, Poor: FBG target 5.6–10.0 mmol/L. …”

Section: Study Schedulementioning

confidence: 99%

Study protocol for assessing the user acceptance, safety and efficacy of a tablet-based workflow and decision support system with incorporated basal insulin algorithm for glycaemic management in participants with type 2 diabetes receiving home health care: A single-centre, open-label, uncontrolled proof-of-concept study

Libiseller

Kopanz

Lichtenegger

et al. 2020

Contemporary Clinical Trials Communications

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Introduction Diabetes management can be especially complex for older adults who receive health care at home. Thus, international guidelines recommend basal-insulin regimens due to simpler handling and low hypoglycaemia risk. A basal-insulin algorithm (including basal-plus) was developed to also include participant's health status and subsequently implemented into a tablet-based workflow and decision support system, GlucoTab@MobileCare. This study protocol describes a proof-of-concept study to investigate user acceptance, safety and efficacy of the GlucoTab@MobileCare system in participants receiving home health care. Methods The open-label, single-centre, uncontrolled study will recruit a maximum of ten participants with insulin treated type-2-diabetes (age ≥18 years) who receive home health care. During a three month study period participants will receive basal- or basal-plus-insulin therapy once daily as suggested by the GlucoTab@MobileCare system. Statistical analysis will be conducted on an intention-to-treat basis. The primary endpoint is the percentage of tasks (BG measurements, insulin dose calculations, insulin injections) that were performed according to GlucoTab@MobileCare suggestions relative to the total of suggested tasks. Secondary endpoints include user acceptance, safety and efficacy parameters. The study was approved by the ethics committee and regulatory authorities. Before obtaining written informed consent, all participants will receive oral and written information about all aspects of the study. Results will be published in a peer-reviewed journal and at diabetes and geriatric conferences. Discussion Potential implications may be improved quality and safety of basal-insulin therapy in older adults as well as support for health-care-providers in daily routine including evidence-based knowledge. Trial registration German Clinical Trials Register (DRKS00015059);

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Medication use and potentially high‐risk prescribing in older patients hospitalized for diabetes: a missed opportunity to improve care?

Cited by 19 publications

References 28 publications

Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

The changing face of Australian data reforms: Impact on pharmacoepidemiology research

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