Susan L. Cooper

Inadequate Treatment of Depressed Nursing Home Elderly

To determine the prevalence of antidepressant drug treatment among nursing home elderly with major depression.

Assessment of Hypercholesterolemia Control in a Managed Care Organization

To determine the extent of achievement of goal low‐density lipoprotein cholesterol (LDL) as defined by National Cholesterol Education Program—Adult Treatment Panel II (NCEP‐ATP II) and American Diabetes Association (ADA) 2000 guidelines, we conducted a retrospective study by integrating data from medical, laboratory, and pharmacy claims databases. Subjects were selected from a 232,000‐member staff‐model managed care organization consisting of 19 clinics in the Minneapolis—St. Paul, Minnesota, metropolitan area. A total of 124,971 members aged 18 years and older, who had been continuously enrolled from July 1, 1996–June 6, 1998, were included. Outcome measures were the extent of achievement of goal LDL as defined by NCEP‐ATP II and the use of antihyperlipidemic drugs for patients with and without diabetes at various levels of risk for coronary heart disease (CHD). Of 124,971 subjects, 6538 had a history of CHD, 1523 of whom met their LDL goal. Of the population with CHD who did not achieve goal, 1141 (43%) missed by over 30 mg/dl; 621 (54%) of these patients were not receiving drug therapy. A total of 17,267 had no history of CHD but had two or more risk factors; 3298 of these achieved their LDL goal. Of those who did not achieve goal, 1136 (35%) missed by over 30 mg/dl; 897 (79%) of these were not receiving drug therapy. A total of 6586 had a history of diabetes; 1004 and 2340 reached an LDL of 100 mg/dl or lower and less than 130 mg/dl, respectively. Of those with diabetes who had an LDL greater than 100 mg/dl, 1276 (49%) missed their goal by over 30 mg/dl; 898 (70%) of these were not receiving drug therapy. Inadequate use of pharmacologic agents plays a significant role in failure to achieve goal LDL for patients with CHD, without CHD, and with diabetes. Analysis of the data based on the new ADA guidelines for LDL demonstrates the need for continued vigilance. Finally, the successful merging of medical, laboratory, and pharmacy claims databases provides a benchmark for other institutions.

Occurrence of Adverse Effects and High Amantadine Concentrations With Influenza Prophylaxis in the Nursing Home

Amantadine, in a dose of 100 mg/day, is recommended for influenza prevention in older nursing home residents. We studied an influenza prevention protocol in a 98‐bed community nursing home (96% female; mean age = 87.4 years). Fifty‐five residents received amantadine when influenza A was confirmed. Although no further influenza cases were diagnosed, 22% experienced adverse events. Dose in mg/kg/day was significantly higher in the group experiencing adverse events (2.24 ± 0.98 vs 1.76 ± 0.35; P < .01). Amantadine concentrations in 32 residents ranged from 128–5,810 ng/mL. Six residents had amantadine concentrations greater than 1,000 ng/mL. Seventy‐eight percent would have qualified for further dose reduction on the basis of estimated creatinine clearance. The results suggest that adverse events may be an important problem with the 100 mg/day dose, and this dose may be excessive for influenza prophylaxis in many nursing home residents.

Achieving cholesterol target in a managed care organization (ACTION) trial.

Study Objectives. To objectively compare the results of a collaborative approach using pharmacists with the results of usual care for achieving a low‐density lipoprotein cholesterol (LDL) goal of 100 mg/dl or less in outpatients with documented coronary heart disease (CHD) who are not at goal, and to document the effect on LDL after removal of such a collaborative model from the study population.

Comparison of pharmacokinetic and safety profiles of amantadine 50- and 100-mg daily doses in elderly nursing home residents

Pharmacokinetic and adverse event profiles of 50‐ and 100‐mg amantadine doses administered daily for up to 21 days for influenza prophylaxis were compared in 82 elderly nursing home residents (mean age 85 yrs, 68% female). We sought to determine if a standard daily dose of 50 mg would achieve mean steady‐state trough serum concentrations (CPSSt) of 300 ng/ml and be associated with a lower frequency of adverse events than 100‐mg doses. Statistically significant relationships were found between CPSSt and dosage (in mg/kg/day) and serum creatinine. Adverse events were more common with the 100‐mg dose (24% vs 14%); 94% occurred in women. Amantadine CPSSt and apparent clearance were not significantly different between sexes. Thirty‐nine residents (89%) receiving 50 mg daily achieved CPSSt below 300 ng/ml compared to 42% receiving 100 mg. Standard daily amantadine doses of 50 mg may not achieve adequate CPSSt in elderly nursing home residents, but 100 mg may lead to excessive CPSSt and adverse events, especially in the presence of renal impairment.