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  • Pharmacoepidemiology  (3)
  • 1
    ISSN: 1573-739X
    Keywords: Benzodiazepines ; Anxiolytics ; Hypnotics ; Pharmacoepidemiology ; Drug utilization ; Longitudinal study ; Usage patterns
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract Only a few longitudinal studies have addressed benzodiazepine use over time. We therefore conducted a 10‐year follow‐up study (1983‐1992) on usage patterns of benzodiazepines in a Dutch community of 13500 people. Use decreased during the time of the study. Twelve (1983) to ten (1992) percent of the inhabitants was a recipient at least once a year of a benzodiazepine prescription. The use by gender showed more women using more prescriptions as men. Women were not prescribed more DDDs per prescription as men. Individual benzodiazepines showed differences in use by gender. Use increased with age among both women and men. Most of the users were 55 years or older. One out of three patients was either an incidental user (1‐30 days use in one calendar year), a regular (31‐180 days), or a long term user (more than 180 days). The use of long half‐life hypnotics decreased, the use of the short half‐life ones showed an increase. Behind a stable overall trend we found strong fluctuations in use of individual benzodiazepines.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1573-739X
    Keywords: Asthma ; Long acting β2‐agonists ; Pharmacoepidemiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract Long acting β2‐agonists (LBA) have become an important therapeutic strategy in the treatment of asthma. There is, however, debate whether LBA increase the risk of asthma exacerbations (AE). We studied whether the risk of AE was increased in patients starting LBA therapy and whether the risk was associated with severity. Patients, aged 5‐49 years, who were firstly prescribed LBA between 1992 and 1995, and who had at least two consecutive prescriptions of LBA, were selected from the PHARMO‐RLS database. The exposure period was the interval between the first and last dispensing of the first exposure episode. The year before the onset was the control period. Single short courses of oral glucocorticosteroids or antibiotics were used as proxy indicators for AE. Severity indicators, assessed in the 6 months before initiation of LBA, were used to classify patients' severity. A total of 788 patients met the inclusion criteria (men: 45.1%, median age: 35). The incidence rate of AE increased significantly (p〈0.001) with severity from 1.7 to 2.4 and 1.1 to 2.7 AE per person year in index and control period, respectively. The risk was merely elevated among patients who start LBA therapy without being treated with other anti‐asthma drugs before (RR 1.4, 95% CI 1.0‐2.2). First starters of LBA showed no overall change in incidence of AE when compared with the year before starting treatment. A total of 6.9% of patients used LBA as step‐one therapy. These patients suffer, in contrast to the whole population, a 40% increased risk of having AE. Although this could be due to confounding, we recommend being reluctant to prescribe LBA to patients who have not been treated before with other anti‐asthma drugs.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1573-739X
    Keywords: Adverse drug events ; Hospitalized patients ; Risk factors ; Pharmacoepidemiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract Adverse drug events in hospitalized patients lead to increased morbidity, mortality and costs. Early detection of adverse drug events could aid in the prevention of these adverse outcomes. A cost‐effective system for the early detection of adverse drug events should focus on high risk patients. A study was set up with the primary aim to identify characteristics that are associated with the development of adverse drug events (ADEs) in hospitalized patients.ADE reports were gathered from physicians and nurses (spontaneous reports) and from patients after intensive ward interviews by hospital pharmacists. All patients admitted to the internal medicine wards of two Dutch hospitals, during a two month period, were included.The following characteristics were analyzed for their potential relationship to the occurence of ADEs: age (categorized), gender, number of drugs prescribed during hospital stay, types of drugs used and changes in drug use on admission.Age was found to be inversely associated with the development of ADEs (OR 0.36, CI 0.21‐0.61 for age category 〉 80 years; OR 0.56; CI 0.31‐1.02 for age category 75‐80 years and OR 0.69; CI 0.42‐1.11 for age category 60‐74 years). Furthermore, statistically significant associations were found for the number of drugs prescribed per hospitalized patient (for the class of 4‐6 drugs per patient OR 2.61, CI 1.32‐5.18), for newly prescribed drugs (OR 6.65, CI 2.63‐16.81) and for the cessation of drugs on hospital admission (OR 1.50, CI 1.02‐2.20). The use of gastrointestinal drugs (OR 2.13, CI 1.32‐3.45), central nervous system drugs (OR 1.66, CI 1.07‐2.57) and antibiotics (OR 2.44, CI 1.65‐3.60) were associated with the development of ADEs, when compared to all other drugs taken by the patients.In this study, the most important risk factors are the number of drugs used per patient and the starting of a new drug during hospitalization. As most hospitalized patients start new drug therapies while in hospital, this seems an inappropriate focus. However, careful monitoring of patients using more than 7 drugs at a time may be possible in a cost‐effective system for the early detection of ADEs.
    Type of Medium: Electronic Resource
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