Using Routinely Collected Prescribing Data to Determine Drug Persistence for the Purpose of Pharmacovigilance

Mohamed, Isa Naina; Helms, Peter Joseph Benedict; Simpson, Colin R; McLay, James S.

doi:10.1177/0091270010366444

Cited by 9 publications

(10 citation statements)

References 30 publications

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“…In this context it is likely that early discontinuation reflects the appearance of unwanted poorly tolerated ADRs, while later discontinuation represents a perceived lack of response [35]. The levels of UMD in this study are similar to those reported by Viner at al, who noted orlistat discontinuations of 45% at one month, 75% at 3 months and 90% at 6 months [36].…”

Section: Discussionsupporting

confidence: 83%

See 1 more Smart Citation

Unplanned medication discontinuation as a potential pharmacovigilance signal: a nested young person cohort study

Sun

Kirby

Black

et al. 2014

BMC Pharmacol Toxicol

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BackgroundBecause of relatively small treatment numbers together with low adverse drug reaction (ADR) reporting rates the timely identification of ADRs affecting children and young people is problematic. The primary objective of this study was to assess the utility of unplanned medication discontinuation as a signal for possible ADRs in children and young people.MethodsUsing orlistat as an exemplar, all orlistat prescriptions issued to patients up to 18 years of age together with patient characteristics, prescription duration, co-prescribed medicines and recorded clinical (Read) codes were identified from the Primary Care Informatics Unit database between 1st Jan 2006-30th Nov 2009. Binary logistic regression was used to assess association between characteristics and discontinuation.ResultsDuring the study period, 79 patients were prescribed orlistat (81% female, median age 17 years). Unplanned medication discontinuation rates for orlistat were 52% and 77% at 1 and 3-months. Almost 20% of patients were co-prescribed an anti-depressant. One month unplanned medication discontinuation was significantly lower in the least deprived group (SIMD 1–2 compared to SIMD 9–10 OR 0.09 (95% CI0.01 – 0.83)) and those co-prescribed at least one other medication. At 3 months, discontinuation was higher in young people (≥17 yr versus, OR 3.07 (95% CI1.03 – 9.14)). Read codes were recorded for digestive, respiratory and urinary symptoms around the time of discontinuation for 24% of patients. Urinary retention was reported for 7.6% of patients.ConclusionsIdentification of unplanned medication discontinuation using large primary care datasets may be a useful tool for pharmacovigilance signal generation and detection of potential ADRs in children and young people.

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Section: Discussionsupporting

confidence: 83%

“…We have previously reported that electronic prescribing databases can be used to identify UMD in adult patients, and that such UMD rates can be used as a surrogate for ADR/AE rates [28,35]. However, the use of UMD does not identify the reasons for discontinuation or the nature of possible ADRs/AEs.…”

Section: Discussionmentioning

confidence: 99%

Unplanned medication discontinuation as a potential pharmacovigilance signal: a nested young person cohort study

Sun

Kirby

Black

et al. 2014

BMC Pharmacol Toxicol

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“…Currently, with increasing concern about long-term medication and the potential adverse effects of antihypertensive drugs [44–46], nondrug therapy and natural herbal products have gained more and more popularity by hypertensive patients worldwide [47–54]. As a special form of exercise, Tai Chi has made great contributions to the healthcare and well-being of the people for its unique advantages in preventing and curing diseases, especially in China.…”

Section: Discussionmentioning

confidence: 99%

Tai Chi for Essential Hypertension

Wang

Feng

Yang

et al. 2013

Evidence-Based Complementary and Alternative Medicine

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Objectives. To assess the current clinical evidence of Tai Chi for essential hypertension (EH). Search Strategy. 7 electronic databases were searched until 20 April, 2013. Inclusion Criteria. We included randomized trials testing Tai Chi versus routine care or antihypertensive drugs. Trials testing Tai Chi combined with antihypertensive drugs versus antihypertensive drugs were also included. Data Extraction and Analyses. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards. Results. 18 trials were included. Methodological quality of the trials was low. 14 trials compared Tai Chi with routine care. 1 trial compared Tai Chi with antihypertensive drugs. Meta-analysis all showed significant effect of TaiChi in lowering blood pressure (BP). 3 trials compared Tai Chi plus antihypertensive drugs with antihypertensive drugs. Positive results in BP were found in the other 2 combination groups. Most of the trials did not report adverse events, and the safety of Tai Chi is still uncertain. Conclusions. There is some encouraging evidence of Tai Chi for EH. However, due to poor methodological quality of included studies, the evidence remains weak. Rigorously designed trials are needed to confirm the evidence.

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“…Critics might argue that some of the potential confounders like patients' knowledge, beliefs, and self‐efficacy regarding medication taking were lacking, and the variables tested in the regression analysis accounted for only 11.3% of the variability of the outcome variable. The discontinuation of medications might have been initiated jointly by clinicians and patients 41 . Also, studies using clinical databases necessitate an assumption that patients actually took their medications as dispensed.…”

Section: Discussionmentioning

confidence: 99%

Adherence to Oral Hypoglycemic Agents in 26 782 Chinese Patients: A Cohort Study

Wong

Kong²,

So³

et al. 2011

The Journal of Clinical Pharmacology

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This study evaluated the factors associated with adherence to oral hypoglycemic agents (OHAs) among Chinese patients. A validated clinical database was used to include all adult patients who were prescribed an OHA in any of the government clinics in a large territory of Hong Kong from January 1, 2004, to June 30, 2007 and made 1 or more subsequent visits for OHA refill. Patients with medication possession ratio (MPR) 0.8 or greater were regarded as medication adherent. One binary logistic regression analysis was performed to test the association between age, gender, visit types (new vs follow-up visits), and MPR while controlling for socioeconomic status, service settings, number of comorbidities, and the medication class prescribed (sulphonylurea vs biguanide vs combination of both). Among 26,782 patients, 89.6% were adherent. Older patients (aged 50-59 years; adjusted odds ratio [AOR] 1.19; 95% confidence interval [CI], 1.06-1.34, P = .004; 60-69 years; AOR 1.37; 95% CI, 1.21-1.55, P < .001; ≥70 years; AOR 1.52; 95% CI, 1.34-1.72, P < .001) and follow-up visitors (AOR 3.89; 95% CI, 3.55-4.27, P < .001) were more likely to be medication adherent. Male subjects were less likely to adhere (AOR 0.84; 95% CI, 0.77-0.91, P < .001). Newer medication adherence-enhancing strategies should be implemented, especially among younger patients, male subjects, and new clinic attendees to secure optimal adherence.

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Using Routinely Collected Prescribing Data to Determine Drug Persistence for the Purpose of Pharmacovigilance

Cited by 9 publications

References 30 publications

Unplanned medication discontinuation as a potential pharmacovigilance signal: a nested young person cohort study

Unplanned medication discontinuation as a potential pharmacovigilance signal: a nested young person cohort study

Tai Chi for Essential Hypertension

Adherence to Oral Hypoglycemic Agents in 26 782 Chinese Patients: A Cohort Study

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