Charmaine Cooke

Gout in the Elderly — A Population Health Study

Objective. To determine the incidence, healthcare utilization, and costs in older adults with gout. Methods. A 5-year retrospective case-control study of patients with incident gout and matched controls was performed. Study variables were derived from health administrative data and included patient demographics, International Classification of Diseases diagnostic codes, and healthcare cost information. Results. There were 4,071 cases and 16,281 controls, providing a 5-year incidence of gout of 4.4%. The mean (± SD) age (77 ± 7.3 and 76 ± 7.1 yrs) and the male:female ratio (1.0:1.04) were similar in both groups. Gout was diagnosed by family physicians (77%), nonrheumatology subspecialists (18%), general internists (4%), and rheumatologists (0.02%). Hospitalizations were significantly higher in cases (p < 0.001) in the year of diagnosis. Patients with gout had an average of 28.1 physician visits per year compared to 20.6 for controls (p < 0.0001). Drug utilization for the treatment (nonsteroidal antiinflammatory drugs, colchicine, corticosteroids) and prevention (allopurinol, probenecid, sulfinpyrazone) of gout was significantly higher (p < 0.0001). The average healthcare cost differential was +

A comparison of antidepressant use in Nova Scotia, Canada and Australia.

134 (Cdn) per month (p < 0.001) and +

An epidemiologic study of psychotropic medication and obesity-related chronic illnesses in older psychiatric patients

8,020 per case over 5 years. These costs were due to hospital utilization (64.4%), medications (23.1%), and physician visits (12.5%). Conclusion. Gout is associated with a high disease burden in older men and women. The cost is primarily attributable to hospitalization, probably due to the comorbidities associated with gout. As the majority of cases are managed by nonrheumatologists, it is important that guidelines for the diagnosis and treatment of gout are disseminated to and met by all physician groups.

The impact of statins on health services utilization and mortality in older adults discharged from hospital with ischemic heart disease: a cohort study

The prevalence of major depression is reported as approximately 8% in Canada and 7.5% in Australia, the use of antidepressants is therefore common. However, questions remain about whether depression is under‐diagnosed and whether patients are appropriately treated with antidepressants once the disorder is recognized. We compared the use of antidepressant medicines, in Nova Scotia, Canada and Australia, in populations receiving public drug subsidy.

The impact of socioeconomic and demographic factors on the utilization of smoking cessation medications in patients hospitalized with cardiovascular disease in Nova Scotia, Canada.

Objective: Adverse effects from medication vary with age. Weight gain with several psychotropics is well known in adults but less information is available related to extent and complications of psychotropic-induced weight gain in older psychiatric patients. We determined the relative incidence of 2 obesity-related conditions (diabetes and hypertension) in older psychiatric patients receiving antipsychotics, antidepressants, and mood stabilizers. Method: A population-based case–control study of all psychiatric patients aged 67 years or older in contact with either specialist services or primary care using administrative data from Nova Scotia. Results: We identified incident cases of diabetes (n = 608) and of hypertension (n = 1056), as well as an equal number of control subjects for each condition. Amitryptiline, selective serotonin reuptake inhibitors (SSRIs), and olanzapine were associated with an increased risk of presenting with hypertension 6 months after initial prescription. By contrast, conventional antipsychotics were associated with a reduced incidence of hypertension. Olanzapine was also significantly associated with diabetes after 6 months (ORadj = 2.58, 95% CI 1.12 to 5.92). The findings for SSRIs and olanzapine remained significant after adjusting for potential confounders such as sociodemographic characteristics, schizophrenia, beta blockers, thiazide diuretics, and corticosteroids. Conclusions: Our results suggest that the association of psychotropics and 2 obesity-related conditions, hypertension and diabetes, applies to older psychiatric patients as well as younger populations. Within drug classes, there are drugs that have a greater association than others, and this may be a factor when choosing a specific agent.

Differences in utilisation of gastroprotective drugs between 2001 and 2005 in Australia and Nova Scotia, Canada†

BackgroundCardiovascular disease (CVD) carries a high burden of morbidity and mortality and is associated with significant utilization of health care resources, especially in the elderly. Numerous randomized trials have established the efficacy of cholesterol reduction with statin medications in decreasing mortality in high-risk populations. However, it is not known what the effect of the utilization of these medications in complex older adults has had on mortality and on the utilization of health services, such as physician visits, hospitalizations or cardiovascular procedures.MethodsThis project linked clinical and hospital data from the Improving Cardiovascular Outcomes in Nova Scotia (ICONS) database with administrative data from the Population Health Research Unit to identify all older adults hospitalized with ischemic heart disease between October 15, 1997 and March 31, 2001. All patients were followed for at least one year or until death. Multiple regression techniques, including Cox proportional hazards models and generalized linear models were employed to compare health services utilization and mortality for statin users and non-statin users.ResultsOf 4232 older adults discharged alive from the hospital, 1629 (38%) received a statin after discharge. In multivariate models after adjustment for demographic and clinical characteristics, and propensity score, statins were associated with a 26% reduction in all- cause mortality (hazard ratio (HR) 0.74, 95% confidence interval (CI) 0.63-0.88). However, statin use was not associated with subsequent reductions in health service utilization, including re-hospitalizations (HR, 0.98, 95% CI 0.91-1.06), physician visits (relative risk (RR) 0.97, 95% CI 0.92-1.02) or coronary revascularization procedures (HR 1.15, 95% CI 0.97-1.36).ConclusionAs the utilization of statins continues to grow, their impact on the health care system will continue to be important. Future studies are needed to continue to ensure that those who would realize significant benefit from the medication receive it.

Youth, Caregiver, and Prescriber Experiences of Antipsychotic-Related Weight Gain

Objective:  To determine whether any demographic or socioeconomic factors affect the use of smoking cessation medications in patients hospitalized with heart disease.

Comparison of nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 (COX-2) inhibitors use in Australia and Nova Scotia (Canada)

This study aimed to compare use of histamine H2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs), 2001–2005, in the elderly and social security beneficiaries in Australia (AUS) and Nova Scotia, Canada (NS).

System struggles and substitutes: A qualitative study of general practitioner and psychiatrist experiences of prescribing antipsychotics to children and adolescents.

Objectives. To explore the lived experience of youth, caregivers, and prescribers with antipsychotic medications. Design. We conducted a qualitative interpretive phenomenology study. Youth aged 11 to 25 with recent experience taking antipsychotics, the caregivers of youth taking antipsychotics, and the prescribers of antipsychotics were recruited. Subjects. Eighteen youth, 10 caregivers (parents), and 11 prescribers participated. Results. Eleven of 18 youth, six of ten parents, and all prescribers discussed antipsychotic-related weight gain. Participants were attuned to the numeric weight changes usually measured in pounds. Significant discussions occurred around weight changes in the context of body image, adherence and persistence, managing weight increases, and metabolic effects. These concepts were often inextricably linked but maintained the significance as separate issues. Participants discussed tradeoffs regarding the perceived benefits and risks of weight gain, often with uncertainty and inadequate information regarding the short- and long-term consequences. Conclusion. Antipsychotic-related weight gain in youth influences body image and weight management strategies and impacts treatment courses with respect to adherence and persistence. In our study, the experience of monitoring for weight and metabolic changes was primarily reactive in nature. Participants expressed ambiguity regarding the short- and long-term consequences of weight and metabolic changes.

Differences in Gastroprotective Medication Use between Australia and Nova Scotia, Canada

AIMS Cyclooxygenase-2 (COX-2) inhibitors were marketed aggressively and their rapid uptake caused safety concerns and budgetary challenges in Canada and Australia. The objectives of this study were to compare and contrast COX-2 inhibitors and nonselective nonsteroidal anti-inflammatory drug (ns-NSAID) use in Nova Scotia (Canada) and Australia and to identify lessons learned from the two jurisdictions. METHODS Ns-NSAID and COX-2 inhibitor Australian prescription data (concession beneficiaries) were downloaded from the Medicare Australia website (2001-2006). Similar Pharmacare data were obtained for Nova Scotia (seniors and those receiving Community services). Defined daily doses per 1000 beneficiaries day(-1) were calculated. COX-2 inhibitors/all NSAIDs ratios were calculated for Australia and Nova Scotia. Ns-NSAIDs were divided into low, moderate and high risk for gastrointestinal side-effects and the proportions of use in each group were determined. Which drugs accounted for 90% of use was also calculated. RESULTS Overall NSAID use was different in Australia and Nova Scotia. However, ns-NSAID use was similar. COX-2 inhibitor dispensing was higher in Australia. The percentage of COX-2 inhibitor prescriptions over the total NSAID use was different in the two countries. High-risk NSAID use was much higher in Australia. Low-risk NSAID prescribing increased in Nova Scotia over time. The low-risk/high-risk ratio was constant throughout over the period in Australia and increased in Nova Scotia. CONCLUSIONS There are significant differences in Australia and Nova Scotia in use of NSAIDs, mainly due to COX-2 prescribing. Nova Scotia has a higher proportion of low-risk NSAID use. Interventions to provide physicians with information on relative benefits and risks of prescribing specific NSAIDs are needed, including determining their impact.