Abstract:This study is the first to determine the prevalence of NSAID TD and the factors that were associated with its occurrence in South Korea. These results may help prevent TD and improve appropriate medication use.
“…Moreover, duplicated prescriptions of NSAIDs may exacerbate NSAID‐associated adverse reactions (6). In a previous study, the prevalence of duplication of NSAIDs and analgesics was reported to be 13.3% of all prescriptions in Korea in 2011 (7), higher than the 8% in Iran (8) and the 5.4% in Belgium (9). The higher prevalence of therapeutic duplication (TD), defined as prescribing and dispensing 2 or more drugs in the identical therapeutic group, underlined the need for an appropriate risk management tool.We assessed the effect of a nationwide real‐time drug utilization review (DUR) system on safe use of nonsteroidal antiinflammatory drugs (NSAIDs) among knee osteoarthritis patients, using a large administrative database.After implementing new DUR criteria on therapeutic duplication (TD) of NSAIDs, a significant decrease in the prevalence of NSAID TDs was observed, mainly involving TDs on separate prescriptions.…”
Objective
Since January 2013, a nationwide drug utilization review (DUR) system for therapeutic duplication (TD) of nonsteroidal antiinflammatory drugs (NSAIDs) has been implemented in Korea. Our objective was to perform an interrupted time series study to assess changes in the pattern of NSAIDs use in knee osteoarthritis patients after implementation of the regulations.
Methods
We compared the prescribing patterns in 2012 and 2013 by means of an interrupted time series study, using the Health Insurance Review and Assessment Service database. TD was defined as use of concurrent NSAIDs either on the same or on different prescriptions for >3 days in a patient. Level change and trend change (with 95% confidence intervals [95% CIs]), and absolute and relative changes in the proportion of TDs, were estimated using segmented regression models. Multivariable logistic regression models were used to explore patient and provider characteristics associated with the TDs.
Results
Approximately 2.5 million patients were prescribed NSAIDs in both 2012 and 2013. The proportion of TDs before and after introduction of the DUR system was 7.4% and 5.6%, respectively. Overall, an absolute reduction of 89% and a relative reduction of 30% in TDs were observed. In the postregulation period, older patients, medical aid subscribers (odds ratio [OR] 1.87 [95% CI 1.84, 1.90]), and veterans (OR 3.28 [95% CI 3.10, 3.46]) were most likely to receive NSAID TDs.
Conclusion
The prescription of NSAID TDs decreased with the introduction of the nationwide DUR system. Continuous adherence to the DUR regulations and safety monitoring are needed, especially with the elderly, medical aid subscribers, and veterans.
“…Moreover, duplicated prescriptions of NSAIDs may exacerbate NSAID‐associated adverse reactions (6). In a previous study, the prevalence of duplication of NSAIDs and analgesics was reported to be 13.3% of all prescriptions in Korea in 2011 (7), higher than the 8% in Iran (8) and the 5.4% in Belgium (9). The higher prevalence of therapeutic duplication (TD), defined as prescribing and dispensing 2 or more drugs in the identical therapeutic group, underlined the need for an appropriate risk management tool.We assessed the effect of a nationwide real‐time drug utilization review (DUR) system on safe use of nonsteroidal antiinflammatory drugs (NSAIDs) among knee osteoarthritis patients, using a large administrative database.After implementing new DUR criteria on therapeutic duplication (TD) of NSAIDs, a significant decrease in the prevalence of NSAID TDs was observed, mainly involving TDs on separate prescriptions.…”
Objective
Since January 2013, a nationwide drug utilization review (DUR) system for therapeutic duplication (TD) of nonsteroidal antiinflammatory drugs (NSAIDs) has been implemented in Korea. Our objective was to perform an interrupted time series study to assess changes in the pattern of NSAIDs use in knee osteoarthritis patients after implementation of the regulations.
Methods
We compared the prescribing patterns in 2012 and 2013 by means of an interrupted time series study, using the Health Insurance Review and Assessment Service database. TD was defined as use of concurrent NSAIDs either on the same or on different prescriptions for >3 days in a patient. Level change and trend change (with 95% confidence intervals [95% CIs]), and absolute and relative changes in the proportion of TDs, were estimated using segmented regression models. Multivariable logistic regression models were used to explore patient and provider characteristics associated with the TDs.
Results
Approximately 2.5 million patients were prescribed NSAIDs in both 2012 and 2013. The proportion of TDs before and after introduction of the DUR system was 7.4% and 5.6%, respectively. Overall, an absolute reduction of 89% and a relative reduction of 30% in TDs were observed. In the postregulation period, older patients, medical aid subscribers (odds ratio [OR] 1.87 [95% CI 1.84, 1.90]), and veterans (OR 3.28 [95% CI 3.10, 3.46]) were most likely to receive NSAID TDs.
Conclusion
The prescription of NSAID TDs decreased with the introduction of the nationwide DUR system. Continuous adherence to the DUR regulations and safety monitoring are needed, especially with the elderly, medical aid subscribers, and veterans.
“…NSAID duplication was previously investigated in Korea due to concerns of high rates of NSAID duplication. 26 , 27 In 21 million patient visits by individuals of all ages, Kang and colleagues 26 identified 59,636,222 NSAID prescriptions with 13.3% involving therapeutic duplication over the first 3 months of 2011. Follow-up study in Korea by Jung and colleagues 27 showed NSAID duplication fell to 5.6% after implementation of a nationwide drug utilization monitoring program.…”
Background
Concurrent use of 2 nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, loop diuretics, angiotensin-converting enzyme inhibitors, or anticoagulants is considered potentially inappropriate by Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment criteria.
Objective
The objective was to examine drug duplication in a cohort of older adults with dementia.
Methods
Cohort entry for Nova Scotia Seniors’ Pharmacare Program beneficiaries was the date an International Classification of Diseases ninth edition or 10th edition code for dementia was recorded in accessed databases between March 1, 2005, and March 31, 2015. Medication dispensation and sociodemographic data were captured from the Nova Scotia Seniors’ Pharmacare Program database between April 1, 2010, and March 31, 2015. Duplication was considered when 2 drugs from the same class were dispensed such that the supply in the patient's possession could overlap for more than 30 days. We reported number of cases of duplication and duration of overlap. Sex differences in drug duplication were assessed with bivariate logistic regression.
Results
In the cohort of 28,953 Nova Scotia Seniors’ Pharmacare Program beneficiaries with dementia, we documented concurrent use in 101 (1.7%) nonsteroidal anti-inflammatory drugs users (mean duration = 75.6 days), 95 (1.0%) selective serotonin reuptake inhibitors users (mean duration = 146.6 days), 5 (0.07%) loop diuretic users (mean duration = 530.6 days), 183 (2.0%) angiotensin-converting enzyme inhibitor users (mean duration = 123.9 days), and 160 (3.5%) anticoagulant users (mean duration = 63.6 days). Nonsteroidal anti-inflammatory drug pairs were most commonly celecoxib with naproxen or diclofenac. Selective serotonin reuptake inhibitors duplication was most commonly sertraline with citalopram. No sex differences in risk for drug duplication were identified.
Conclusions
Drug duplication was identified in a cohort of older adults with dementia and is a feasible target for intervention. (
Curr Ther Res Clin Exp
. 2021; 82:XXX–XXX)
“…Thirdly, we distinguished ED from duplication by ruling out accidentally overlapped prescriptions. By excluding those with less than 10% duplication during the total prescription period from the ED group, we tried to provide a more clinically significant definition of duplication of tramadol use than previous studies which defined one day or more of overlapping as duplication . Also, we identified factors that could affect tramadol use, including patients’ age and special comorbidities.…”
Section: Discussionmentioning
confidence: 99%
“…Although the literature on duplicated tramadol use is sparse, one study found that the 1-year incidence rate of tramadol shopping behaviour was 1.0% (95% CI 0.7-1.5) in France. 16 Another study showed that the therapeutic duplication rate of NSAID/analgesic prescriptions in Korea was 13.3%, 25 and a third study found that 2.7% of Z-drug users in Ireland received duplicate prescriptions. 26 Tramadol is used frequently as an alternative to NSAIDs because it has fewer side effects on the kidney or stomach, which explains its wide usage in older adults or patients with a comorbid disease.…”
Section: Discussionmentioning
confidence: 99%
“…Although the literature on duplicated tramadol use is sparse, one study found that the 1‐year incidence rate of tramadol shopping behaviour was 1.0% (95% CI 0.7‐1.5) in France . Another study showed that the therapeutic duplication rate of NSAID/analgesic prescriptions in Korea was 13.3%, and a third study found that 2.7% of Z‐drug users in Ireland received duplicate prescriptions …”
Tramadol is a weak opioid that is commonly used for chronic low back pain (LBP). Despite its effectiveness, duplicated use of tramadol, which may indicate abuse or dependence, may exacerbate potential adverse reactions. This population‐based, cross‐sectional study aimed to investigate the prevalence of duplication of tramadol and its associated factors among patients with LBP. From a Korean nationwide claims database, non‐hospitalized patients aged 40‐99 years with LBP without malignancy were prescribed tramadol during 2014‐2016. Duplication of tramadol was defined as overlapping of prescription days. Among them, we defined “extensive duplication (ED)” when days of tramadol duplication cover 10% or more of the days prescribed tramadol. Patient and healthcare utilization factors associated with ED were examined using a logistic regression model. The study population was 6 417 503 patients. Of these, 13.7% were ED users. The age‐ and sex‐standardized prevalence of using tramadol twice or more a year was 14.06 per 100 people in 2014, 13.74 per 100 people in 2015 and 13.52 per 100 people in 2016. ED occurred more in those in the group aged 70‐79 years (OR 1.12, 95% CI 1.11‐1.13) than 40‐49 years and in those with comorbidities, such as drug abuse (OR 2.99, 95% CI 2.05‐4.36) or depression (OR 1.75, 95% CI 1.72‐1.77). Based on the results of this study, a proper management system is needed to avoid tramadol duplication among older people and patients with drug abuse or depression.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
