Medicine Posters - 2019

Medicine Posters - 2019https://scholarlycommons.libraryinfo.bhs.org/research_education/1004/thumbnail.jp

Hospital patterns of use of positive inotropic agents in patients with heart failure

OBJECTIVES: This study sought to determine hospital variation in the use of positive inotropic agents in patients with heart failure. BACKGROUND: Clinical guidelines recommend targeted use of positive inotropic agents in highly selected patients, but data are limited and the recommendations are not specific. METHODS: We analyzed data from 376 hospitals including 189,948 hospitalizations for heart failure from 2009 through 2010. We used hierarchical logistic regression models to estimate hospital-level risk-standardized rates of inotrope use and risk-standardized in-hospital mortality rates. RESULTS: The risk-standardized rates of inotrope use ranged across hospitals from 0.9% to 44.6% (median: 6.3%, interquartile range: 4.3% to 9.2%). We identified various hospital patterns based on the type of agents: dobutamine-predominant (29% of hospitals), dopamine-predominant (25%), milrinone-predominant (1%), mixed dobutamine and dopamine pattern (32%), and mixed pattern including all 3 agents (13%). When studying the factors associated with interhospital variation, the best model performance was with the hierarchical generalized linear models that adjusted for patient case mix and an individual hospital effect (receiver operating characteristic curves from 0.77 to 0.88). The intraclass correlation coefficients of the hierarchical generalized linear models (0.113 for any inotrope) indicated that a noteworthy proportion of the observed variation was related to an individual institutional effect. Hospital rates or patterns of use were not associated with differences in length of stay or risk-standardized mortality rates. CONCLUSIONS: We found marked differences in the use of inotropic agents for heart failure patients among a diverse group of hospitals. This variability, occurring in the context of little clinical evidence, indicates an urgent need to define the appropriate use of these medications. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved

Effect of patient comorbidities on filling of antihypertensive prescriptions

OBJECTIVES: To evaluate the extent of patient failure to fill antihypertensive prescriptions and to test the hypothesis that the presence of noncardiovascular disease is negatively associated with filling an antihypertensive prescription, and, conversely, that the presence of cardiovascular disease is positively associated with filling an antihypertensive prescription. STUDY DESIGN: Cross-sectional. METHODS: We sampled prescriptions written for 327 African Americans aged \u3eor=18 years. Patients were enrolled in a Medicaid managed care plan and treated in 6 primary care practices between January 1, 2003, and February 8, 2005. Prescription filling was defined as a match between a new or renewed electronic prescription and an insurance claim within the next 30 days. We assessed the association of comorbidity type with filling an antihypertensive prescription by using an adjusted logistic regression model that accounted for clustering of prescriptions within patients. RESULTS: Of 1742 antihypertensive prescriptions, 1309 (75.1%) were filled. Prescriptions written for persons with 5 or more noncardiovascular comorbidities were significantly more likely to be filled (adjusted odds ratio [OR], 1.59; 95% confidence interval [CI], 1.07 2.36) versus those for persons with fewer noncardiovascular comorbidities. The presence of cardiovascular comorbidities was not associated with filling of an antihypertensive prescription (adjusted OR, 0.72; 95% CI, 0.45-1.14). CONCLUSION: Many antihypertensive prescriptions were not filled. Different types of patient comorbidity may differentially impact prescription filling. Further studies should examine whether these results generalize to other populations

Physician, monitor thyself: professionalism and accountability in the use of social media

The recent report of the AMA Council on Ethical and Judicial Affairs (CEJA), Professionalism in the Use of Social Media, describes the types of social media medical professionals use, outlines ways in which existing AMA policies address issues of online professionalism, and makes a list of recommendations for physicians to maintain online professionalism. CEJA recommends directed efforts towards educating physicians about the benefits and pitfalls of social media and, in particular, underscores the difficulties of maintaining professional boundaries in the digital age. In this commentary, we highlight issues introduced by the report and suggest some specific ways that the recommendations of the committee can be implemented by medical schools, residency programs, and practicing physicians