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A systematic review of methods for determining cross-sectional active medications using pharmacy databases.

ABSTRACT: PURPOSE:Pharmacy dispensing databases are often used to identify patients' medications at a particular time point, for example to measure prescribing quality or the impact of medication use on clinical outcomes. We performed a systematic review of studies that examined methods to assess medications in use at a specific point in time. METHODS:Comprehensive literature search to identify studies that compared active medications identified using pharmacy databases to medications identified using nonautomated data sources. Two investigators independently reviewed abstracts and full-text material. RESULTS:Of 496 studies screened, 29 studies evaluating 50 comparisons met inclusion criteria. Twenty-nine comparisons evaluated fixed look-back period approaches, defining active medications as those filled in a specified period prior to the index date (range 84-730 days). Fourteen comparisons evaluated medication-on-hand approaches, defining active medications as those for which the most recent fill provided sufficient supply to last through the study index date. Sensitivity ranged from 48% to 93% for fixed look-back period approaches and 35% to 97% for medication-on-hand approaches. Interpretation of comparative performance of methods was limited by use of different reference sources, target medication classes, and databases across studies. In four studies with head-to-head comparisons of these methods, sensitivity of the medication-on-hand approach was a median of 7% lower than the corresponding fixed look-back approach. CONCLUSIONS:The reported accuracy of methods for identifying active medications using pharmacy databases differs greatly across studies. More direct comparisons of common approaches are needed to establish the accuracy of methods within and across populations, medication classes, and databases.

SUBMITTER: Anderson TS

PROVIDER: S-EPMC7050409 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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A systematic review of methods for determining cross-sectional active medications using pharmacy databases.

Anderson Timothy S TS Xu Edison E Whitaker Evans E Steinman Michael A MA

Pharmacoepidemiology and drug safety 20190213 4

<h4>Purpose</h4>Pharmacy dispensing databases are often used to identify patients' medications at a particular time point, for example to measure prescribing quality or the impact of medication use on clinical outcomes. We performed a systematic review of studies that examined methods to assess medications in use at a specific point in time.<h4>Methods</h4>Comprehensive literature search to identify studies that compared active medications identified using pharmacy databases to medications ident ...[more]

PMID: 30761662

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Project description:BACKGROUND:During the past two decades, the internet has become an accepted way to purchase products and services. Buying medications online are no exception. Besides its benefits, several patient safety risks are linked to the purchase of medicines outside the traditional supply chain. Although thousands of internet pharmacies are accessible on the web, the actual size of the market is unknown. Currently, there is limited data available on the use of internet pharmacies, the number, and attitude of people obtaining medications and other health products from the internet. OBJECTIVE:This study aims to gather information on the frequency and attitudes of patients purchasing medications online in a nationally representative sample of outpatients. Attitudes towards main supply chain channels, perceived benefits, and disadvantages of influencing online medication purchase are evaluated. METHODS:A cross-sectional explorative study using a personally administered survey was conducted in a representative sample of Hungarian outpatients in 2018. RESULTS:A total of 1055 outpatients completed the survey (response rate 77.23%). The mean age was 45 years, and 456 (43.22%) reported having chronic health conditions. The majority (872/1055, 82.65%) of the respondents were aware that medications could be obtained online, but only 44 (4.17%) used the internet for previous medication purchases. Attitudes towards the different pharmaceutical supply chain retail channels showed significant differences (P<.001), respondents accepted retail pharmacy units as the most appropriate source of medications while rejected internet pharmacies. Respondents were asked to evaluate 9 statements regarding the potential benefits and disadvantages about the online medicine purchase, and based on the computed relative attitude rate there is a weak still significant tendency toward rejection (P<.001). Correspondence of demographic factors, internet usage behavior, and prospective online drug purchase attitude was evaluated. Respondents who use the internet more and purchase goods online will be more likely to buy medications online. Furthermore, youth and education will determine the medication purchase behavior. CONCLUSIONS:Many patients will purchase medications on the internet in the future. Currently, there is an increased risk of patients buying products from illegal sites because these dominate the global online pharmacy market. Consequently, improved patient-provider communication and promotion campaigns are needed to inform the public about the safe use of internet pharmacies, as these initiatives can directly prevent patient safety threats.

Project description:Background: The use of psychotropic medications and illegal drugs is a worldwide public health issue, leading to addiction, psychiatric and somatic disorders, and death. Pharmacy students are more exposed to psychotropic medications than other students (non-medical), which could lead to an overuse. The main objective of this study was to assess the prevalence of psychotropic drug use (medications and illegal drugs) by French pharmacy students, by carrying out a nationwide cross-sectional study. The relation of these medications and illegal drug use with several comorbidities and academic achievement was also assessed. Methods: This online survey was performed by emails sent to all French pharmacy faculties over a period of 66 days (March 16, 2016 to May 20, 2016). The survey assessed the prevalence of uses of psychotropic medications and illegal drugs during the last 3 months. These uses were compared to student characteristics (personal and university) and comorbidities (anxiety, depression, stress, and fatigue). Results: Of the 2,609 questionnaires received, 2,575 were completed and useable for the analysis. Among French pharmacy students and during the 3 last months, 9.4% have used psychotropic medications, 21.5% illegal drugs and 3.3% both psychotropic medications and illegal drugs. Psychotropic medications were used in the cases of a medical prescription (49.0%), a self-medication (42.4%) or a non-medical intent (26.3%). Stress scores of the last 7 days were higher for psychotropic medication users compared to non-users and illegal drug users. Proportions of anxiety and depression at the time of answer were higher for psychotropic medication users than for non-users and illegal drug users. Fatigue scores of the last 7 days were lower for illegal drug users compared to non-users and self-medicated students. Annual average marks of the last year, attendance and perception of study difficulty were lower for illegal drug users than for non-users. Conclusion: French pharmacy students were less exposed to psychotropic medications and illegal drugs than the general French population. However, in comparison to other students in other countries, the use of psychotropic medications seemed to be lower, but with a proportionally higher use of anxiety/sedative medications and a lower use of opioid medications.

Project description:BackgroundCrusted scabies is endemic in some remote Aboriginal communities in the Northern Territory (NT) of Australia and carries a high mortality risk. Improvement in active case detection (ACD) for crusted scabies is hampered by a lack of evidence about best practice. We therefore conducted a systematic review of ACD methods for leprosy, a condition with similar ACD requirements, to consider how findings could be informative to crusted scabies detection.Methods and principle findingsWe conducted systematic searches in MEDLINE, CINAHL, Scopus and the Cochrane Database for Systematic Reviews for studies published since 1999 that reported at least one comparison rate (detection or prevalence rate) against which the yield of the ACD method could be assessed. The search yielded 15 eligible studies from 511. Study heterogeneity precluded meta-analysis. Contact tracing and community screening of marginalised ethnic groups yielded the highest new case detection rates. Rapid community screening campaigns, and those using less experienced screening personnel, were associated with lower suspect confirmation rates. There is insufficient data to assess whether ACD campaigns improve treatment outcomes or disease control.ConclusionThis review demonstrates the importance of ACD campaigns in communities facing the highest barriers to healthcare access and within neighbourhoods of index cases. The potential benefit of ACD for crusted scabies is not quantified, however, lessons from leprosy suggest value in follow-up with previously identified cases and their close contacts to support for scabies control and to reduce the likelihood of reinfection in the crusted scabies case. Skilled screening personnel and appropriate community engagement strategies are needed to maximise screening uptake. More research is needed to assess ACD cost effectiveness, impact on disease control, and to explore ACD methods capable of capturing the homeless and highly mobile who may be missed in household centric models.

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A systematic review of methods for determining cross-sectional active medications using pharmacy databases.

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A systematic review of methods for determining cross-sectional active medications using pharmacy databases.

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