The association between prescription change frequency, chronic disease score and hospital admissions: a case control study

BACKGROUND: The aim of this study was to assess the association between prescription changes frequency (PCF) and hospital admissions and to compare the PCF to the Chronic Disease Score (CDS). The CDS measures comorbidity on the basis of the 1-year pharmacy dispensing data. In contrast, the PCF is based on prescription changes over a 3-month period. METHODS: A retrospective matched case–control design was conducted. 10.000 patients were selected randomly from the Dutch PHARMO database, who had been hospitalized (index date) between July 1, 1998 and June 30, 2000. The primary study outcome was the number of prescription changes during several three-month time periods starting 18, 12, 9, 6, and 3 months before the index date. For each hospitalized patient, one nonhospitalized patient was matched for age, sex, and geographic area, and was assigned the same index date as the corresponding hospitalized patient. We classified four mutually exclusive types of prescription changes: change in dosage, switch, stop and start. RESULTS: The study population comprised 8,681 hospitalized patients and an equal number of matched nonhospitalized patients. The odds ratio of hospital admission increased with an increase in PCF category. At 3 months before the index date from PCF=1 OR 1.4 [95% CI 1.3-1.5] to PCF= 2–3 OR 2.2 [95% CI 1.9-2.4] and to PCF ≥ 4 OR 4.1 [95% CI 3.1-5.1]. A higher CDS score was also associated with an increased odds ratio of hospitalization: OR 1.3 (95% CI 1.2-1.4) for CDS 3–4, and OR 3.0 (95% CI 2.7-3.3) for CDS 5 or higher. CONCLUSION: The prescription change frequency (PCF) is associated with hospital admission, like the CDS. Pharmacists and other healthcare workers should be alert when the frequency of prescription changes increases. Clinical rules could be helpful to make pharmacists and physicians aware of the risk of the number of prescription changes

Plasma levels of matrix metalloproteinase-2, -3, -10, and tissue inhibitor of metalloproteinase-1 are associated with vascular complications in patients with type 1 diabetes: The EURODIAB Prospective Complications Study

Impaired regulation of extracellular matrix remodeling by matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinase (TIMP) may contribute to vascular complications in patients with type 1 diabetes. We investigated associations between plasma MMP-1, -2, -3, -9, -10 and TIMP-1, and cardiovascular disease (CVD) or microvascular complications in type 1 diabetic patients. We also evaluated to which extent these associations could be explained by low-grade inflammation (LGI) or endothelial dysfunction (ED). Methods: 493 type 1 diabetes patients (39.5 ± 9.9 years old, 51% men) from the EURODIAB Prospective Complications Study were included. Linear regression analysis was applied to investigate differences in plasma levels of MMP-1, -2, -3, -9, -10, and TIMP-1 between patients with and without CVD, albuminuria or retinopathy. All analyses were adjusted for age, sex, duration of diabetes, Hba1c and additionally for other cardiovascular risk factors including LGI and ED. Results: Patients with CVD (n = 118) showed significantly higher levels of TIMP-1 [β = 0.32 SD (95%CI: 0.12; 0.52)], but not of MMPs, than patients without CVD (n = 375). Higher plasma levels of MMP-2, MMP-3, MMP-10 and TIMP-1 were associated with higher levels of albuminuria (p-trends were 0.028, 0.004, 0.005 and 0.001, respectively). Severity of retinopathy was significantly associated with higher levels of MMP-2 (p-trend = 0.017). These associations remained significant after further adjustment for markers of LGI and ED. Conclusions: These data support the hypothesis that impaired regulation of matrix remodeling by actions of MMP-2, -3 and-10 and TIMP-1 contributes to the pathogenesis of vascular complications in type 1 diabetes

Relationship Between Risk Factors and Mortality in Type 1 Diabetic Patients in Europe: The EURODIAB Prospective Complications Study (PCS)

OBJECTIVE—The purpose of this study was to examine risk factors for mortality in patients with type 1 diabetes

Medication changes in patients transitioning between health care settings

Pharmacotherapy is one the most commonly used medical interventions, and advances in pharmacotherapy have significantly contributed to the increase in life expectancy and quality of life that occurred during the last century. Many recent studies have revealed the impact of medication errors and the importance of continuity of care in medication management. A significant proportion of drug-related problems occur when patients transition from one healthcare setting to another. Care transitions are a natural occurrence in our healthcare system. With transitions across health care settings, nearly every patient is confronted with some form of medication discontinuity. During a single episode of an illness, patients may visit multiple care settings and be treated by different healthcare professionals. Transitions from one healthcare setting to another are associated with intentional and unintentional changes in drug use. Unintentional changes in drug therapy imply that the physician is unaware of these changes. During the short time of hospitalisation, the patient will be confronted with at least two transitions and at least three moments of (re)prescription and re-evaluation of drug therapy. First, upon admission, the preadmission medication regimen should be documented and evaluated. During this reconciliation process, intended but also unintended changes in prescribing and transcribing can occur. Second, during hospitalisation, a natural part of a patient treatment is the evaluation of any former drug treatment in the context of the patient’s (changing) clinical status and the prescription of new drugs. Finally, at discharge, the preadmission medication list will be compared with the current hospital medications to create a coherent set of discharge prescriptions. The aim of this thesis was to give more insight in the discontinuities in drug use seen around transitions between health care settings. Changes in drug use were quantitatively studied. We focused on hospitalisation as a determinant of medication changes and on medication changes as a determinant of hospitalisation. Two studies addressed that the reason for these changes was largely unknown i.e. that it was unknown whether changes in medication were the intention of the prescriber or whether it was unintended. This thesis confirms that transition into or out of the hospital are events associated with discontinuities in drug use. Patients transferred from the primary care setting to the hospital setting (or the reverse) may experience considerable (unintended) modifications to their drug regimen. We discussed the factors that were associated with the discontinuity of drug use and transitioning and factors that estimate the measurement of medication discontinuities. Recommendations for clinical practice and for future research are provided. In conclusion, transitions in care are periods when patients are vulnerable for discontinuities in drug use. Regardless of the patient’s movement through different healthcare settings, the prescribed medications should be consistent with his or her therapeutic needs. This thesis provides more insight regarding drug use and transitions between health care settings