Discrepancies between prescribed and defined daily doses: a matter of patients or drug classes?

International audienc

Appropriateness of treatment recommendations for PPI in hospital discharge letters

International audienc

Influence of hospitalisation on the prescription of drugs in the primary care sector

To explore the influence of hospitalisation on the prescription of drugs in the primary care sector, particularly on HMG CoA reductase inhibitors (statins) and proton pump inhibitors (PPIs). Methods: Analysis of outpatient drug prescriptions of members of a statutory health insurance that were inpatient in the I. quarter 2004. Prescriptions done within three months before admission or after discharge were analysed. Drugs were coded with central pharmaceutical number, active substances and costs were linked with the ATC-Code and the pharmacy price schedule, respectively. Results: 2,426 patients received drugs before and after hospitalisation. After discharge the mean number of prescription per patient remained unchanged, while the number of different active substances decreased (-4%). Still overall costs increased after discharge due to higher costs per prescription (+17%). Changes in medication affected nearly every patient, and more than 50% of all substances prescribed to an individual before admission or after discharge were cancelled or newly started, respectively. In both therapeutic subgroups analysed in detail, PPIs and statins, significant increases in the number of patients under therapy occurred (+27% and +16%, respectively). The increase in PPI-medication was due to a 58% rise in the number of patients getting pantoprazole, while that for statins comprised all relevant agents with a slight preference of the on-patent agents atorvastatin and fluvastatin. Conclusion: Hospitalisation exerts a marked influence on drug therapy in ambulatory care. Thereby a change towards on-patent drugs occur despite less pricey alternatives. Out-patient prescription data are suitable to describe these changes

Polypharmacy in primary care practices: an analysis using a large health insurance database

Purpose To ascertain the rate and range of continuous polypharmacy in German general practices and compare practice characteristics and prescribing profiles in practices with a high rate of polypharmacy patients (HPP) and a low rate of polypharmacy patients (LPP), respectively. Methods This observational study used a database composed of prescription data from a large German statutory health insurance. We defined polypharmacy as the continuous prescription of five or more drugs and calculated the percentage of polypharmacy patients for each practice to identify HPP and LPP. Results A total of 136 521 patients in 730 general practices received continuous medication. About 10% of these patients (14 293/136 521) received five or more different drugs. HPP had, on average, 15.1% polypharmacy patients compared to 4.2% in LPP. The total number of patients attending either a HPP or LPP was comparable (437 vs. 416; p = 0.102), but HPP had a higher number of patients with prescriptions (76.9% vs. 70.8%; p < 0.0001). The patients' age distribution was similar (68.0 in LPP vs. 68.8 in RPP) and there were slightly more female, patients in LPP. Doctors in HPP prescribed proton pump inhibitors and NSAIDs more frequently than doctors in LPP, but there was no difference in the prescription of me-too drugs. Conclusion The absolute differences in age and gender distribution between HPP and LPP were modest. Prescribing quality, as measured by the rate of me-too drug prescriptions, was similar across all practices. Therefore, differences in the rate of polypharmacy in general practice cannot sufficiently be explained by these factors. Copyright (C) 2009 John Wiley & Sons, Ltd

The 10-year trend in drug prescriptions for attention-deficit/hyperactivity disorder (ADHD) in Germany

Purpose!#!The aim of this study was to analyse whether the global trend in drug prescriptions for attention-deficit hyperactivity disorders (ADHD), as observed during the last years and often criticized as medicalization, have remained stable or shifted.!##!Methods!#!This observational study was based on a secondary analysis of data from a large German database including patients with an ADHD diagnosis between 2008 and 2018. Prescription data comprised all important ADHD drugs.!##!Results!#!A total of 620 practices delivered data from a total of 77,504 patients (31% of them females) with a diagnosis of AHDH. Nearly 38% (29,396/77,504) of all patients received, at least, one prescription for an ADHS medicine between 2008 and 2018. The number of patients receiving a drug steadily increased annually until 2012 and then slowly fell, but unevenly distributed across the age groups. While the number of younger patients ( ≤ 16 years) receiving a prescription fell by 24% and the defined daily doses (DDDs) remained stable, the number of patients between 17 and 24 years receiving a prescription increased by 113% and the DDDs by 150%. Respectively, the number of older adults (≥ 25 years) with a prescription increased by 355% and the DDDs by 515%. Nearly one-third of older adults received an ADHD medicine only once.!##!Conclusion!#!The ever-increasing prescription of ADHD medicines stopped some years ago for children. ADHS and its pharmacological management are increasingly observed among older adolescents and adults, with a different pattern of drug persistence compared with children

Dual renin‐angiotensin‐aldosterone blockade: Implementation of published research and Dear Doctor letters in ambulatory care: A retrospective observational study using prescription data

Abstract Purpose This study aims to assess the implementation of published research, contraindications, and warnings on the prescription of dual renin‐angiotensin‐hormone system (RAS) blockade in ambulatory care in Germany. Methods Cohort study based on health claims data of 6.7 million subjects from 2008 to 2015. Yearly prevalence and incidence for dual RAS blockade with (a) angiotensin‐converting enzyme inhibitors and angiotensin‐receptor blockers (ACEI + ARB) and (b) aliskiren and ACEI or ARB (aliskiren + ACEI/ARB) were calculated. We assessed prescriber specialty and associations between discontinuing dual RAS blockade with specialist (internal medicine, cardiology, nephrology) visits and hospital discharge in the previous year. Results A total of 2 984 517 patients were included (age 51.4 ± SD 18.4 y, 48.5% male). Prescription rates for ACEI + ARB decreased from 0.6% (n = 17 907) to 0.4% (n = 12 237) and for aliskiren + ACEI/ARB from 0.23% (n = 6634) to 0.03% (n = 818). Incident prescriptions decreased from 0.23% (n = 6705) to 0.19% (n = 5055) (ACE + ARB) and from 0.1% (n = 2796) to 0.005% (n = 142) (aliskiren + ACE/ARB); 59% of ACEI + ARB and 48% of aliskiren + ACE/ARB combinations were prescribed only by one physician. Of those, 73% (ACEI + ARB) and 58% (aliskiren + ACE/ARB) were primary care providers (PCPs). Discontinuing dual RAS blockade was associated with specialist care and hospital discharge in the previous year (specialist care: RR 1.4, 95% CI, 1.3‐1.6; hospital visit: RR 1.5, 95% CI, 1.3‐1.6). Conclusions Our results suggest a delayed uptake of treatment recommendation for ACEI + ARB and a higher impact of Dear Doctor letters addressing PCPs directly compared with published research, contraindications, and warnings. Targeted continuous medical education, practice software alerts, and stronger involvement of pharmacists might improve the implementation of medication safety recommendations in ambulatory care