Predictors of medication use during pregnancy: a cohort study

Background Sociodemographic characteristics and health behaviours are associated with medication use in pregnancy, but it is unclear if they are independent predictors because women´s health status has hardly been accounted for. We aimed to identify predictors of use of medications and of iron/folic acid. Methods This cohort included pregnant women recruited in a prenatal clinic in Trieste, Italy, from 2007 to 2009. Dispensations were obtained from the regional outpatient dispensation database through record linkage. We calculated the Odds Ratio (OR), with 95% confidence interval (95%CI), of ≥ 1 dispensation of (a) any medication and (b) iron/folic acid, using unconditional logistic regression. The final model adjusted for age, partner education, housing size, comorbidities.   Findings Of 767 women, 70.5% had ≥ 1 dispensation of any medication and 46.1% of iron/folic acid. Use of any medication was predicted by immigrant status of the woman (OR 1.21; 95%CI 0.57–2.53) or of her partner (1.51; 0.67–3.40), ≤ high school degree of the woman (1.11; 0.61–2.03) or of her partner (1.21; 0.75–1.95), unemployment (1.47; 0.72–2.98), smoking (1.25; 0.65–2.40), alcohol consumption (≥5 drinks/week: 2.78; 1.78–4.34), and obesity (1.33; 0.59–2.99). Use of iron and/or folic acid was predicted by ≤ high school degree (0.65; 0.40–1.08), smoking (0.80: 0.47–1.37), and obesity (0.62; 0.31–1.25). Discussion In this cohort, characteristics including education, immigrant and employment status, smoking, alcohol consumption, and obesity independently predicted medication use. Interventions to promote safe use of medications should carefully consider women´s characteristics

Parental trust and beliefs after the discovery of a six-year-long failure to vaccinate

Background: In Italy vaccine hesitancy worsened after a failure to vaccinate episode that took place in Friuli Venezia-Giulia Region until early 2017 which undermined herd immunity by leaving unprotected more than 5,444 children. Methods: Between May and June 2017, 2,557 parents were surveyed at the local vaccination clinic where they were invited within the subsequent extraordinary vaccination campaign. The aim of the survey was to evaluate whether the multi-channel extraordinary vaccination campaign had reached the target population and to know parental beliefs and trusted sources of information after the failure to vaccinate event. Results: While 279 parents were non-hesitant (10.9%) and 1,491 hesitant acceptors (58.3%), just 38 (1.5%) refused to have their children revaccinated. Overall, the most consulted sources of information were print media (18.8%), physicians (16.0%), relatives and friends (12.1%). The majority of parents considered vaccination as a fundamental practice (73.9%), but many were worried about potential side effects (38.8%) or doubtful about the effectiveness of some vaccines (11.0%). According to parents, 19.7% of them (57) changed their opinion about vaccines after the Codroipo case. Conclusions: After the Codroipo case, most parents chose to have their children re-vaccinated and just a little proportion refused the re-administration of vaccines. More studies are needed to confirm the importance of a coherent multi-channel communication strategy using both traditional and new media in order to counteract vaccine hesitancy

Predictors of medication use during pregnancy: A cohort study

4nonenoneRomanese, Federico; Palese, Francesca; Barbone, Fabio; Pisa, Federica EdithRomanese, Federico; Palese, Francesca; Barbone, Fabio; Pisa, Federica Edit

Predictors of medication use during pregnancy: A cohort study

Background Sociodemographic characteristics and health behaviours are associated with medication use in pregnancy, but it is unclear if they are independent predictors because women´s health status has hardly been accounted for. We aimed to identify predictors of use of medications and of iron/folic acid. Methods This cohort included pregnant women recruited in a prenatal clinic in Trieste, Italy, from 2007 to 2009. Dispensations were obtained from the regional outpatient dispensation database through record linkage. We calculated the Odds Ratio (OR), with 95% confidence interval (95%CI), of ≥ 1 dispensation of (a) any medication and (b) iron/folic acid, using unconditional logistic regression. The final model adjusted for age, partner education, housing size, comorbidities.   Findings Of 767 women, 70.5% had ≥ 1 dispensation of any medication and 46.1% of iron/folic acid. Use of any medication was predicted by immigrant status of the woman (OR 1.21; 95%CI 0.57–2.53) or of her partner (1.51; 0.67–3.40), ≤ high school degree of the woman (1.11; 0.61–2.03) or of her partner (1.21; 0.75–1.95), unemployment (1.47; 0.72–2.98), smoking (1.25; 0.65–2.40), alcohol consumption (≥5 drinks/week: 2.78; 1.78–4.34), and obesity (1.33; 0.59–2.99). Use of iron and/or folic acid was predicted by ≤ high school degree (0.65; 0.40–1.08), smoking (0.80: 0.47–1.37), and obesity (0.62; 0.31–1.25). Discussion In this cohort, characteristics including education, immigrant and employment status, smoking, alcohol consumption, and obesity independently predicted medication use. Interventions to promote safe use of medications should carefully consider women´s characteristics

Medications Prescription at Hospital Discharge in Patients with Validated Diagnosis of Dementia

Background: Health databases may be used to assess cases of dementia (D), among the main causes of morbidity in the elderly, if the data are accurate. Objectives: We present the preliminary results of a cohort study aimed at assessing a) validity of discharge diagnosis of D; b) medication prescribed at discharge; c) prescription redemption after discharge, through record-linkage with outpatient prescription database. Methods: Sources of Data: Friuli Venezia Giulia (FVG), Italy, Regional Health Database of Hospitalizations and hospital electronic medical records (HEMR). Study population: all records of discharge from the Udine University Hospital (FVG) 2012-2014 with International Classification of Diseases, 9th Revision Clinical Modification (ICD-9-CM) code for D (senile, presenile, vascular 290.0-290.43; degenerative 290.9; alcohol persistent 291.2; drug persistent 292.82; D in other diseases 294.1-294.8; frontotemporal 331.0-331.19; Lewy body 331.82; Creutzfeldt Jakob 046.1) in any position were selected from the Hospitalizations Database. The diagnosis was confirmed through HEMR review by trained Medical Doctors. Case confirmation required a written diagnosis of D and/or severe cognitive deficit. Reasons for not confirmation included wrong code, evidence of another disease. Statistical analysis: Positive Predictive Value (PPV), with Wilson 95% Confidence Interval (95%CI), as the ratio of confirmed to potential cases. Results: From 1 July to 31 December 2014, 445 hospitalizations with discharge code for D occurred, for 424 (94.4%) the information in HEMR was complete, in 404 of these the diagnosis was confirmed (PPV 96.2%; 95%CI 94.4-98.0). The most common diagnoses were the senile 290.0, (N=186, 46.0%), vascular 290.4X, (N=158, 39.1%) and presenile 290.1X, (N=26, 6.4%) D subtypes. Proton pump inhibitors (A02BC, N=210, 52.0%), Platelet aggregation inhibitors (B01AC, N=166, 41.1%) and Antipsychotics (N05A, N=141, 34.9%) were the most prescribed medications. Conclusions: Consistently with prior studies, codes for D showed high validity. Review of hospital charts is required when the information in HEMR is lacking

Predictors of discrepancies between electronic medical records medication list and dispensing data in elderly inpatients with dementia

Background: Inaccuracies in pre-admission medication list are common and have been associated with adverse outcomes. Patients with dementia are frequently in polypharmacy and hospitalized. Discrepancies between hospital records and multiple integrated sources (e.g. community pharmacy, GPs letters, and patient owned medications) have been associated with increasing number of medications and emergency admission. Objectives: To assess predictors of discrepancies between hospital Electronic Medical Records (EMR) pre-admission medication list and prescription data in inpatients with dementia. Methods: Source of information: Hospital Services and Outpatient prescription Databases, hospital EMRs; Study design: retrospective cohort; Study population: all patients hospitalized at the Udine University Hospital, Italy, from 01.01.2012 to 31.12.2014 with primary or secondary ICD-9-CM discharge code for dementia and continuous enrolment for ≥1 year before admission; Data collection: for each hospitalization (a) the EMR pre-admission medication list; (b) all prescriptions dispensed within 3 months prior to the date of admission through record linkage with prescription database. An omission was defined as any dispensed medication not registered in EMR; an addition as any medication not dispensed registered in EMR. Statistical analysis: conditional logistic regression odds ratio (OR), with 95% confidence interval (95% CI), of ≥1 omission or ≥1 addition through generalized estimating equations to account for repeated hospitalizations of the same patient. Final model adjusted for type of admission (planned and emergency), patient age and sex, number of pre-admission prescriptions, and neuropsychiatric disturbances. Analysis performed with SAS© software, version 9.3 (SAS, Cary, NC, USA). The protocol was approved by the FVG regional Ethics Committee

Do hospital electronic medical records reliably register pre-admission medications in patients with dementia?

Background: Pre-admission medication list was reported to be inaccurate in up to 60% of inpatients. Inaccuracies concur to inappropriate prescribing, medication discontinuation, failure in recognizing adverse events and have been associated with adverse outcomes. Accuracy is challenging in patients with dementia at risk of severe adverse events, frequently in polypharmacy and hospitalized. Objectives: To estimate the percentage of discrepancy and the agreement between hospital electronic medical records (EMRs) pre-admission medication list and dispensing data in patients with dementia. Methods: Source of information: Hospital services and outpatient prescription databases, hospital EMRs; Study design: retrospective cohort study; Study population: all patients hospitalized at the Udine University Hospital, Italy, from 01.01.2012 to 31.12.2014 with primary or secondary ICD-9-CM discharge code for dementia and continuous enrolment for 651 year before admission; Data collection: for each hospitalization (a) the EMRs pre-admission medication list and (b) all prescriptions dispensed within 3 months prior to the date of admission through record linkage with the prescription database. An omission was defined as any dispensed medication not registered in EMR; an addition as any not dispensed medication registered in EMR. Statistical analysis: we calculated: (a) percentage of omissions and additions; (b) Kappa coefficient and prevalence and bias-adjusted Kappa (PABAK); The analysis was performed with SAS\ua9 software 9.3 (SAS, Cary, NC, USA). The protocol was approved by the Friuli Venezia Giulia regional Ethics Committee. Results: Among 2,777 (89.5%) of 3,104 hospitalizations (exclusions: hospitalizations with EMR unavailable, record linkage unsuccessful, of non-residents), 58.8% had 651 medication registered in EMR and 84.7% 651 pre-admission dispensing, Kappa 0.10 and PABAK 0.22. In 68.2% (65.9% excluding vitamins, minerals, topicals) 65 1 omission occurred and in 44.5% (43.5%) 651 addition. Percentage of omissions was 69.1% in respiratory medications (ATC class R), 41.7% in cardiovascular (C) and 42.9% in nervous system (N); of additions 42.9%, 20.1% and 34.6%, respectively. Omissions of anti-dementia agents occurred in 41.5% and additions in 48.2% of hospitalizations. Conclusions: Discrepancies were common, particularly omissions. EMR list has limited utility as a unique source of information on pre-admission medication use

Managing unexpected failure in vaccination coverage:2017 extraordinary vaccination campaign in Italy

Issue: On April 20th, 2017 an alert was issued by Veneto Region and forwarded to the Local Health Agency n.3 (AAS3) of Friuli Venezia Giulia Region. It stated that a nurse, in charge of vaccine administration in both regions, allegedly pretended to inoculate vaccines during 2009-2015, thus exposing several cohorts of children to vaccine preventable diseases (VPDs) outbreaks. We report what done by AAS3 to cope with such an unexpected and potentially risky situation. Description: A task force including experts in pediatrics, public health, immunology and infectious diseases as well as citizens and AAS3 area Majors\u2019 delegates was created. Preliminary laboratory results from a sample of 200 children confirmed the lack of VDPs coverage and prompted the task force to rearrange resources for an extraordinary vaccination plan aimed to re-administer 20441 vaccine doses to 5444 children. They were distinguished according to the number of vaccine doses received from that nurse: every (high risk) or just one (low risk). Consistently with this, information release and families\u2019 reassurance were organized and managed through ad-hoc channels: a toll free number, an email address and Whatsapp chats. Results: The high risk group included 2406 children (44%), 3038 being at low risk (56%). AAS3 invited parents to have their children re-vaccinated by phone (2249 answers) and by mail (4402 letters delivered), starting on May 2nd, 2017. 26 alternative vaccination schedules have been created and 11303 vaccines doses (55%) have been administered until the end of January 2018, for a total of 6644 outpatient consultations. Vaccinations are still ongoing. Lessons: The creation of the task force allowed AAS3 to cope with such an undesired situation in a quick and coherent manner. Actions implemented consistently by all stakeholders after the alert allowed an effective public health response, enabling AAS3 to recover more than 50% of missing vaccines in 9 months, in addition to routine activity. Key messages: The engagement of all stakeholders from the start is a fundamental step in dealing with both ordinary and extraordinary public health issues. The long-term effects on children vaccine coverage and herd immunity require a continuous monitoring of the extraordinary vaccination plan implementation