Drs Hincapie-Castillo and Vouri had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

No abstract

Objectives: To evaluate the prescription sequence symmetry analysis assumption regarding balance between marker drug (i.e., medication used to treat a drug-induced adverse event) initiation rates before and after initiation of an index drug (i.e., medication that is potentially associated with the drug-induced adverse event) in the absence of prescribing cascades, we used a well-described example of loop diuretic initiation to treat dihydropyridine calcium channel blockers (DH CCB)induced edema.

No abstract

No abstract

Purpose: The distribution and vaccination of COVID-19 vaccines to billions of people worldwide will likely be one of the biggest public health undertakings in history. There has been a large focus on identifying processes to safely, efficiently, and effectively vaccinate large populations. We aimed to describe the development and operationalization of a drive-in COVID-19 vaccine site in a parking garage adjacent to outpatient clinics at University of Florida (UF) Health Physicians and how it was informed by the roll-out of SARS-CoV-2 testing and administration of respiratory vaccinations. Design/Methodology/Approach: A technical description and analysis of a drive-in COVID-19 vaccine site. Findings: We incrementally increased the number of vaccines performed per day from 300 in the first 2 weeks to 700 an additional 2 weeks later. By the end of January, we completed nearly 14 000 vaccinations. At this capacity, we estimate the site could performed 5000 vaccinations per week. Practical Implications: This manuscript provides step-by-step guidance how to develop, operationalize, and implement a sustainable drive-in COVID-19 vaccination site. Originality/Value: To our knowledge, this is the first description of a drive-in approach to COVID-19 vaccination. Our findings can help inform other health entities as they develop or expand vaccination efforts that may serve as a template for other sites to adapt.

To the Editor: The most commonly used medications for patients with dementia are acetylcholinesterase inhibitors (AChEIs; donepezil, rivastigmine, galantamine). 1 Use of these medications are often limited by adverse events (AEs) including nausea, vomiting, diarrhea, incontinence, hypersalivation, sweating, lacrimation, rhinorrhea, and bronchorrhea. 1-3 In particular, rhinorrhea is not a well-recognized AE of AChEI and was only previously documented in a meta-analysis of randomized controlled trials of donepezil. 4 This AE may result in a prescribing cascade (PC) in which AChEI-induced rhinorrhea results in the use of a rhinorrhea medication rather than discontinuation or a dose reduction of AChEI. 5 The AChEI-induced rhinorrhea PC has not been described beyond a case report. 6 We aimed to assess this PC using a sample of patient visits from the United States.We used the 2014 and 2015 National Ambulatory Medical Care Survey (NAMCS) data that comprises medications from providers' notes including prescription and over-thecounter (OTC) products. Patient visits included those aged 55 years and older and treated with an antidementia medication (AChEI or memantine, an N-methyl-D-aspartate [NMDA] antagonist). We compared AChEI users (AChEI with or without memantine) with non-AChEI users (memantine only) because memantine is not associated with rhinorrhea. 7 We assessed the co-use of rhinorrhea medications (RMs; ie, medications used to treat rhinorrhea) that served as markers for a potential AChEI-induced rhinorrhea PC. RMs included firstgeneration histamine 1 (H 1 )-blockers, second-generation H 1 blockers, nasal anticholinergics, nasal glucocorticoids, and montelukast, a leukotriene antagonist (full list available on request). 8 We adjusted for age, sex, race, geographic region, year, comorbidities, and number of concomitant medications excluding RMs. 9 Data were analyzed using the sampling visit weights that were used to produce national estimates and account for survey clustering. We compared the percentage of visits in which RMs were used among AChEI users vs non-AChEI users. Weighted odds ratios (ORs) and 95% confidence intervals (CIs) were used to calculate univariate and multivariable analyses. We also estimated the percentage of patient visits impacted by the AChEI-induced rhinorrhea PC by subtracting the percentages of AChEI users from non-AChEI users who co-used RMs.There were an estimated 14 743 000 (95% CI = 11 493 000-17 993 000) patient visits in which a patient aged 55 years or older was taking an antidementia medication (using weighted estimates). Among antidementia medication user visits, 85.6% (n = 12 606 000) were taking an AChEI (with donepezil the most common [n = 10 813 000]). Memantine was used in

Objective To assess the impact of Florida’s 3-day opioid prescription supply law, effective July 2018, on opioids dispensed for acute pain patients. Methods Pharmacy claims from a health plan serving a large Florida employer from January 2015 through March 2019 were analyzed. We used an interrupted time series study design accounting for autocorrelation of trends before and after policy change. Acute pain patients met inclusion criteria if they had not received any opioid containing medications in the past 180 days. Patients could contribute to additional new use time if subsequent opioid claims occurred ≥180 days since the previous claim. Outcomes included mean number of units dispensed of the initial opioid prescription, mean morphine milligram equivalents (MMEs) per day of initial prescription by month, and mean total MMEs per initial prescription by month. Results A total of 8,375 enrollees had 10,583 unique opioid starts in the given timeframe. Following the policy, there was an immediate significant decrease in the units dispensed per prescription of 4.9 (95% CI -8.95, -0.82 units). Additionally, there was a significant immediate reduction in total MMEs dispensed per prescription of 25.6 (95% CI -44.76, -6.44 MMEs). Conclusions Among a group of privately-insured plan enrollees in Florida, and as a result of the law, there were significant decreases in the number of units dispensed, and total MMEs of opioid prescriptions. The immediate reduction in new opioid utilization following policy implementation suggests effective policy; however, impacts on chronic pain patients were not assessed.