Matthew Perri

Adverse Outcomes Associated with Inappropriate Drug Use in Nursing Homes

BACKGROUND: Little empirical evidence exists regarding the influence and outcomes of inappropriate medication use among elderly nursing home residents. OBJECTIVE: To identify the prevalence of inappropriate medication use among elderly patients in Georgia nursing homes using the Beers criteria and identify the relationship between inappropriate drug use and the likelihood of an adverse health outcome. METHODS: A cohort design was used to review 1117 patient medical records in 15 Georgia nursing homes with a high risk of polypharmacy. Prevalence of inappropriate medication use among elderly patients, as defined by the Beers criteria, was estimated. The adverse health outcomes of hospitalizations, emergency department visits, or deaths were identified from Medicaid claims data. RESULTS: A total of 519 (46.5%) patients received at least one inappropriate medication and 143 (12.8%) patients experienced at least one adverse health outcome. Logistic regression revealed that the total number of medications taken (OR 1.139, 95% CI 1.105 to 1.173) significantly increased the likelihood of receiving an inappropriate drug, while having a diagnosis of “dementia” (OR 0.748, 95% CI 0.565 to 0.991) decreased the likelihood. Inappropriate medication use increased the likelihood of experiencing at least one adverse health outcome more than twofold (OR 2.34, 95% CI 1.61 to 3.40). Propoxyphene use alone was significantly associated with the occurrence of an adverse health outcome (OR 2.39, 95% CI 1.54 to 3.71). CONCLUSIONS: Inappropriate drug use was common in our study cohort. Inappropriate use of medication in the elderly, particularly propoxyphene, is associated with a higher risk of adverse health outcomes.

Potentially inappropriate medication use and healthcare expenditures in the US community-dwelling elderly.

Background:Potentially inappropriate medication (PIM) use is a major source of drug-related problems in the elderly. Few studies have quantified the effect of PIM use on total healthcare expenditures in the United States. Objectives:We sought to determine the relationship between PIM use and healthcare expenditure and to estimate the annual incremental healthcare expenditures related to PIM use in the community-dwelling elderly population in the United States in 2001. Methods:This was a retrospective cohort study. Participants were age 65 years or older who had no PIM use in rounds 1 and 2 of the 2000–2001 Medical Expenditure Panel Survey, a nationally representative survey of the US noninstitutionalized population. On the basis of the 2002 Beers criteria, PIM users were identified as those who had been prescribed at least one PIM during specified time periods in the study. Propensity scores were used to match PIM users and nonusers in the analysis examining differences in total healthcare expenditures. Results:PIM utilization is a significant predictor for higher healthcare expenditures (P < 0.05). A conservative estimate of the incremental healthcare expenditures related to PIM use in the community-dwelling elderly population would be

A model assessing the effectiveness of direct-toconsumer advertising: integration of concepts and measures from marketing and healthcare

7.2 billion (95% confidence interval,

Consumers’ Attention to the Brief Summary in Print Direct-to-Consumer Advertisements: Perceived Usefulness in Patient-Physician Discussions

3.4 billion–

The past, present, and future of direct-to-consumer prescription drug advertising

15.7 billion) in the United States in 2001. Conclusions:PIM use is a major patient safety concern that results in increased healthcare expenditures. This study emphasizes the need for continued provider education to inform prescribers of the potential risks of using certain medications in the elderly and to improve prescribing practices.

Assessment of Changes in Utilization of Health-Care Services after Implementation of a Prior Authorization Policy for Atypical Antipsychotic Agents

The advertising of prescription medications directly to consumers (DTC advertising) has become a familiar practice in the USA. As with all advertising spending, key questions include: how effective is this advertising?; what are the best ways to measure advertising effectiveness? This paper identifies key effectiveness measures that are appropriate for the unique situation of DTC advertising, and presents these measures in a unified framework. In addition, it briefly describes candidate predictors of DTC ad effectiveness. In an attempt to gain a better understanding of DTC advertising, the paper integrates concepts and measures from the fields of marketing and healthcare.

Single-Item vs Multiple-Item Measures of Stage of Change in Compliance with Prescribed Medications

To what extent does direct-to-consumer prescription drug advertising communicate detailed technical information (e.g., relevant to risks, warnings, indications, contraindications, adverse effects)? This study examines whether consumers attend to the brief summary of risk information in product-specific print direct-to-consumer advertisements and whether they find it useful in discussing the risks of taking the drug with their physicians. The authors analyze data from a 1999 national survey of 1205 consumers. A discussion of the study findings highlights the implications for the development of future public policy in this area.

Formulary management of low molecular weight heparins.

Since the first experiences with direct-to-consumer (DTC) prescription drug advertising in the early 1980s, pharmaceutical marketers, government regulators, researchers, health practitioners, and consumers have been both perplexed and intrigued by this practice. As experience with DTC advertising has expanded, so has knowledge and understanding of its risks and rewards. This article discusses important issues in DTC advertising, such as the effects it may have on the patient-practitioner relationship, the diffusion and adoption of new drugs, prices, and competition. It also discusses the future of DTC advertising.

Nonbranded or Branded Direct-to-Consumer Prescription Drug Advertising-Which is More Effective?

BACKGROUND: In 2004, the Georgia Medicaid program implemented a prior authorization (PA) policy for certain atypical antipsychotic agents, resulting in an average savings of

Impact of Celebrity Pitch in Direct-to-Consumer Advertising of Prescription Drugs

2.7 million per year. OBJECTIVE: To determine whether implementation of a PA policy for atypical antipsychotic drugs increased health-care utilization in the Georgia Medicaid program from July 2003 to April 2006. METHODS: A single cohort observational study employing segmented regression and time series analysis was conducted to determine health-care services utilization, including emergency department (ED) visits, outpatient office visits, hospital admissions, and length of stay (LOS). Study subjects included continuously eligible adult Georgia Medicaid recipients with a schizophrenia-related diagnosis and documented use of an atypical antipsychotic medication (N = 12,120). Where applicable, analysis of a noncontinuously eligible population was also performed to investigate disenrollment bias in study results. RESULTS: A significant decline in post-policy trend for the average number of ED visits (absolute difference −0.042 per member per month (PMPM); relative difference −20.92%) and average number of hospital admissions PMPM (absolute difference −0.010 PMPM; relative difference −22.27%) was observed at the end of the study period. Baseline and pre-policy trends were found to be significant predictors for both endpoints. Significant models were not identified for average outpatient office visits PMPM or average LOS per admission. CONCLUSIONS: In contrast to other published studies on PA for atypical antipsychotics, patient outcomes improved after the initiation of the policy. To the extent that medical utilization reflects patient health outcomes and health status, the results of this study indicate that the PA program has potentially improved the health of schizophrenic patients in Georgia and lowered program costs.