Prescribing of potentially inappropriate medications for older adults is common and costly in Canada, especially for women. Multipronged and well-coordinated strategies to reduce the use and cost of potentially inappropriate drugs would likely generate significant health system savings while simultaneously generating major benefits to patient health.
There remains an important ongoing contribution of prescribed opioids to overdoses across Canada, but non-prescribed opioids play a growing role, particularly in BC. These findings underscore the importance of more judicious opioid prescribing, harm reduction programs, and improved access to addiction care for people with an opioid use disorder.
Differing public drug reimbursement criteria for triptans may be one contributing factor that has led to our observation of considerable variation in both prevalence of triptan prescribing and potential overuse of these medications. We offer that monthly quantity limits may be considered as a tool to decrease risks for medication overuse headache.
Aims To determine the prevalence, incidence rate, lifetime risk and prognosis of heart failure.
Methods and ResultsThe Rotterdam Study is a prospective population-based cohort study in 7983 participants aged P55. Heart failure was defined according to criteria of the European Society of Cardiology. Prevalence was higher in men and increased with age from 0.9% in subjects aged 55-64 to 17.4% in those aged P85. Incidence rate of heart failure was 14.4/1000 person-years (95% CI 13.4-15.5) and was higher in men (17.6/1000 man-years, 95% CI 15.8-19.5) than in women (12.5/1000 woman-years, 95% CI 11.3-13.8). Incidence rate increased with age from 1.4/1000 person-years in those aged 55-59 to 47.4/1000 person-years in those aged P90. Lifetime risk was 33% for men and 29% for women at the age of 55. Survival after incident heart failure was 86% at 30 days, 63% at 1 year, 51% at 2 years and 35% at 5 years of follow-up. Conclusion Prevalence and incidence rates of heart failure are high. In individuals aged 55, almost 1 in 3 will develop heart failure during their remaining lifespan. Heart failure continues to be a fatal disease, with only 35% surviving 5 years after the first diagnosis.
what drives patients' choice and behavior regarding patterns of long-term medication use. Using a large heterogeneous cohort of patients, we aimed to investigate the patterns and predictors of switch and discontinuation among patients initiating NOACs. Methods: We performed a retrospective cohort analysis using a large U.S. commercial insurance database, OptumLabs Data Warehouse. We identified 10,147 privately insured and Medicare Advantage patients with nonvalvular atrial fibrillation who initiated apixaban, dabigatran and rivaroxaban in 2013 and 2014, the time period when all three NOACs had become available in the U.S. Discontinuation of anticoagulation was defined as having at least 3 months of gap in days of supply of any oral anticoagulants. Two multivariable logistic regression models were performed to assess the risk factors related switch and discontinuation, respectively. Results: Within one year of NOACs initiation, 13% of the patients switched to another oral anticoagulant, among whom the majority (64%) switched to warfarin. Nearly 40% of patients discontinued oral anticoagulants. Patients initiating apixaban were less likely to switch or discontinue compared to those initiating dabigatran or rivaroxaban. Other risk factors for switch include high out-of-pocket costs, prior warfarin use, and a stroke during follow up. Risk factors for discontinuation include high out-of-pocket costs, no prior warfarin exposure, and a major bleeding during follow up. ConClusions: Medication discontinuation and switching are common among patients treated with NOACs in routine clinical practice. Medication use may be affected by the choice of initial medication, out-of-pocket costs, and clinical events occurring during follow up.
As they age, many seniors develop a progressively more complex mix of health conditions. Multiple prescription medications are often required to help manage these conditions and control symptoms, with the goal of maintaining seniors' health for as long as possible. This article explores trends in the number and types of medications used by seniors on public drug programs in Canada. Our findings suggest that a high proportion of Canadian seniors are taking several medications, highlighting the need for medication management systems focusing on this population.
der commercial plans and PDP for 2 high-use drugs in each of the six therapeutic classes deemed medically necessary by CMS for beneficiaries as well as two statins, for reference. METHODS: TRx and OPC were collected annually from 2002 to 2009 for the two most prescribed drugs in the six medically necessary classes: anticonvulsants, antidepressants, oral antineoplastics, antipsychotics, immunosuppressants, and HIV/AIDS-plus statins (14 drugs total). Data are from SDI's VONA and VOPA, analyzed with 2-way ANOVA; significance at pϽ0.05. RESULTS: All drugs analyzed had annual increases of Ͼ10% per year in PDP prescription volume. However, nine drugs had significantly greater annual increases in commercial plan prescription volumes before PDP than after, compared to only one with significantly greater increases after PDP. Six drugs had significantly greater increases in overall prescription volume after PDP compared to before. Five drugs had annual OPC increases of at Ͼ10% per year in PDP compared to two that posted at least 10% annual decreases. Six drugs had significantly greater annual OPC increases before PDP compared to after under commercial plans; only one had greater increases after Part D compared to before. Five drugs showed significantly greater increases in overall OPC (all payment forms averaged) before PDP compared to after. CONCLUSIONS: In commercial drug plans, the advent of Part D correlates with slower increases in drug utilization. However, Part D utilization has increased significantly for all drugs, indicating a greater shift toward Part D plans. That only five drugs under Part D increased in OPC by more than 10% (and two decreased overall) suggests that this shift may be due to greater patient access.
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