Yea Huei Kao Yang

Validation of Acute Myocardial Infarction Cases in the National Health Insurance Research Database in Taiwan

Background The aim of this study was to determine the validity of acute myocardial infarction (AMI) diagnosis coding in the National Health Insurance Research Database (NHIRD) by cross-comparisons of discharge diagnoses listed in the NHIRD with those in the medical records obtained from a medical center in Taiwan. Methods This was a cross-sectional study comparing records in the NHIRD and discharge notes in one medical center (DNMC) in the year 2008. Positive predictive values (PPVs) for AMI diagnoses were evaluated by reviewing the relevant clinical and laboratory data recorded in the discharge notes of the medical center. Agreement in comorbidities, cardiac procedures, and antiplatelet agent (aspirin or clopidogrel) prescriptions between the two databases was evaluated. Results We matched 341 cases of AMI hospitalizations from the two databases, and 338 cases underwent complete chart review. Of these 338 AMI cases, 297 were confirmed with clinical and lab data, which yielded a PPV of 0.88. The consistency rate for coronary intervention, stenting, and antiplatelet prescription at admission was high, yielding a PPV over 0.90. The percentage of consistency in comorbidity diagnoses was 95.9% (324/338) among matched AMI cases. Conclusions The NHIRD appears to be a valid resource for population research in cardiovascular diseases.

Compliance with antithrombotic prescribing guidelines for patients with atrial fibrillation-A nationwide descriptive study in Taiwan

OBJECTIVESnThis study examined compliance with prescribing guidelines for antithrombotic therapy in patients with atrial fibrillation (AF) in Taiwan, using the 2001 joint guideline from the American College of Cardiology, American Heart Association, and European Society of Cardiology. The study also sought to identify factors associated with the appropriate prescribing of antithrombotic therapy.nnnMETHODSnPatients with AF were identified by the presence of > or =2 inpatient or outpatient claims with an International Classification of Diseases, Ninth Revision, Clinical Modification code of 427.31 in the Taiwanese National Health Insurance claims database between July 1, 2003, and June 30, 2004. Patients were stratified according to their stroke risk (highest, high, low, or lowest) and antithrombotic medication (aspirin, warfarin, ticlopidine/clopidogrel, or none). Based on these categories, rates of prescribed treatments that were compliant with the antithrombotic guidelines were calculated. Antithrombotic therapies were considered guideline compliant when warfarin was prescribed for the highest- or high-risk patients, aspirin was prescribed for low-risk patients, and aspirin or no antithrombotic treatment was prescribed for the lowest-risk patients. Because the role of ticlopidine/clopidogrel in AF remains unclear, prescription of these drugs without aspirin or warfarin was considered noncompliant with the guidelines.nnnRESULTSnOf 39,541 identified patients with AF, 70.3% were at high risk for thromboembolic events and 18.3% were at highest risk; however, only 24.7% of the overall population received appropriate antithrombotic therapy. When patients with risk factors for bleeding were excluded, the rate of compliance increased to 26.2%. Factors that were inversely associated with prescription of warfarin included risk factors for bleeding (cancer, predisposition to falls, previous hemorrhage, history of peptic ulcer, cirrhosis, renal dialysis, and psychiatric disease), hypertension, coronary artery disease, thyrotoxicosis, and age > or =60 years.nnnCONCLUSIONSnMost of these patients with AF in Taiwan did not receive appropriate antithrombotic therapy over the period studied. Bleeding risk factors, hypertension, coronary artery disease, thyrotoxicosis, and older age were associated with low rates of warfarin use.

Use of the beers criteria to predict adverse drug reactions among first-visit elderly outpatients

Study Objective. To determine whether the Beers criteria can predict adverse drug reactions (ADRs) in first‐visit elderly outpatients.

Statins and Intracerebral Hemorrhage: Collaborative Systematic Review and Meta-analysis

Background— A recent large, randomized trial suggested that statins may increase the risk of intracerebral hemorrhage. Accordingly, we systematically reviewed the association of statins with intracerebral hemorrhage in randomized and observational data. Methods and Results— We screened 17 electronic bibliographic databases to identify eligible studies and consulted with experts in the field. We used DerSimonian-Laird random-effects models to compute summary risk ratios with 95% confidence intervals. Randomized trials, cohort studies, and case-control studies were analyzed separately. Only adjusted risk estimates were used for pooling observational data. We included published and unpublished data from 23 randomized trials and 19 observational studies. The complete data set comprised 248 391 patients and 14 784 intracerebral hemorrhages. Statins were not associated with an increased risk of intracerebral hemorrhage in randomized trials (risk ratio, 1.10; 95% confidence interval, 0.86–1.41), cohort studies (risk ratio, 0.94; 95% confidence interval, 0.81–1.10), or case-control studies (risk ratio, 0.60; 95% confidence interval, 0.41–0.88). Substantial statistical heterogeneity was evident for the case-control studies (I2=66%, P=0.01), but not for the cohort studies (I2=0%, P=0.48) or randomized trials (I2=30%, P=0.09). Sensitivity analyses by study design features, patient characteristics, or magnitude of cholesterol lowering did not materially alter the results. Conclusions— We found no evidence that statins were associated with intracerebral hemorrhage; if such a risk is present, its absolute magnitude is likely to be small and outweighed by the other cardiovascular benefits of these drugs.Background— A recent large, randomized trial suggested that statins may increase the risk of intracerebral hemorrhage. Accordingly, we systematically reviewed the association of statins with intracerebral hemorrhage in randomized and observational data.nnMethods and Results— We screened 17 electronic bibliographic databases to identify eligible studies and consulted with experts in the field. We used DerSimonian-Laird random-effects models to compute summary risk ratios with 95% confidence intervals. Randomized trials, cohort studies, and case-control studies were analyzed separately. Only adjusted risk estimates were used for pooling observational data. We included published and unpublished data from 23 randomized trials and 19 observational studies. The complete data set comprised 248 391 patients and 14 784 intracerebral hemorrhages. Statins were not associated with an increased risk of intracerebral hemorrhage in randomized trials (risk ratio, 1.10; 95% confidence interval, 0.86–1.41), cohort studies (risk ratio, 0.94; 95% confidence interval, 0.81–1.10), or case-control studies (risk ratio, 0.60; 95% confidence interval, 0.41–0.88). Substantial statistical heterogeneity was evident for the case-control studies (I2=66%, P =0.01), but not for the cohort studies (I2=0%, P =0.48) or randomized trials (I2=30%, P =0.09). Sensitivity analyses by study design features, patient characteristics, or magnitude of cholesterol lowering did not materially alter the results.nnConclusions— We found no evidence that statins were associated with intracerebral hemorrhage; if such a risk is present, its absolute magnitude is likely to be small and outweighed by the other cardiovascular benefits of these drugs.nn# Clinical Perspective {#article-title-52}

Financial incentives and physicians' prescription decisions on the choice between brand-name and generic drugs: evidence from Taiwan.

This paper tests the hypothesis of whether or not financial incentives affect a physicians prescription decision on the choice of generic versus brand-name drugs within a system in which physicians prescribe and dispense drugs. By using data obtained from Taiwan and focusing on diabetic patients, our empirical results provide several consistent findings in support of the hypothesis that profit incentives do affect the physicians prescribing decision, suggesting that physicians act as imperfect agents. An important implication of our findings is that rent seeking for profit margin between the reimbursement and the acquisition price instead of reducing costs is the major driving force behind generic substitution. As a result, the providers instead of the payers or consumers reap the financial benefits of generic substitution.

The asian pharmacoepidemiology network (AsPEN): Promoting multi-national collaboration for pharmacoepidemiologic research in Asia

Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden Medical Research Collaborating Center, Seoul National University Hospital/Seoul National University College of Medicine, Seoul, South Korea Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA Department of Medicine, Division of Pharmacoepidemiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA Department of Medical Informatics, School of Medicine, Hamamatsu University, Shizuoka, Japan Department of Pharmacoepidemiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan Institute of Clinical Pharmacy and Pharmaceutical Sciences, and Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan Department of Preventative Medicine, College of Medicine, Seoul National University, Seoul, South Korea Korea Institute of Drug Safety and Risk Management, Seoul, South Korea Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia Duke Clinical Research Institute, Durham, NC, USA Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden Karolinska University Hospital, Stockholm, Sweden Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, South Korea Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA

Multi-country rapid adverse drug event assessment: the Asian Pharmacoepidemiology Network (AsPEN) antipsychotic and acute hyperglycaemia study.

To undertake a multi‐country study to investigate the risk of acute hyperglycaemia with antipsychotic use.

Pharmacovigilance systems and databases in Korea, Japan, and Taiwan

The aim of this article is to qualitatively describe the characteristics of spontaneous reporting systems, signal detection methods, and observational databases in Korea, Japan, and Taiwan.

Potentially Inappropriate Drug Prescribing Among First‐Visit Elderly Outpatients in Taiwan

Study Objective. To determine the prevalence and risk factors of potentially inappropriate drug prescribing among first‐visit elderly outpatients.

Comparative stroke risk of antiepileptic drugs in patients with epilepsy

Purpose:u2002 Patients with epilepsy have higher stroke‐related morbidity and mortality, leading to the suspicion that the increased stroke events may be associated with antiepileptic drug (AED) exposure. We evaluated the comparative risk of stroke in adult patients with epilepsy receiving phenytoin (PHT), valproic acid (VPA), or carbamazepine (CBZ) to help determine the stroke risk for Asian patients with specific AED exposure.