Medication Management Program, Institute of Therapeutic Innovations and Outcomes (ITIO), The Ohio State University College of Pharmacy, 921 Chatham Lane Suite 100, Columbus, OH, 43221, USA.
The Ohio State University College of Medicine, Columbus, OH, USA.
Am J Cardiovasc Drugs. 2020 Dec;20(6):603-610. doi: 10.1007/s40256-020-00396-z.
The unintentional prescribing of medications harmful for patients with heart failure (HF) remains an ongoing problem. The American Heart Association published a scientific statement detailing a list of medications that may worsen or exacerbate a patient's HF. The use of potentially harmful medications has not been studied in Medicare patients with HF.
The aim of this study was to assess the prevalence of prescribing these harmful medications in a Medicare-enrolled medication therapy management (MTM)-eligible population with HF and to identify the characteristics associated with this potentially harmful prescribing.
This cross-sectional analysis involved utilization of a national MTM provider's database for the 2018 calendar year. Eligible patients were included if they were Medicare enrolled, MTM eligible, and with International Classification of Disease 9/10 codes for HF. Counts and percentages were used to describe the prevalence of potentially harmful medication use and prescribing, by physician specialty. Exploratory logistic regression assessed the relationship between unique patient characteristics and potentially harmful prescribing.
A total of 13,250 patients were included, of whom 7017 (53%) were prescribed at least one potentially harmful medication. The most frequently prescribed medications in this cohort were nonsteroidal anti-inflammatory drugs (NSAIDs; 3357, 25%), dipeptidyl peptidase-4 (DPP4) inhibitors (3117, 24%), and non-dihydropyridine calcium channel blockers (CCBs; 936, 7%). A logistic regression found female sex, increasing polypharmacy, years qualified for MTM, higher poverty level, number of prescribers, and number of pharmacies were associated with potentially harmful medication prescribing. Of 17,548 potentially harmful medications encountered in a 4-month span, 9433 (54%) were prescribed by physician primary care providers.
Over one-half of patients with HF were prescribed one or more potentially harmful medication(s). Automated monitoring of prescription claims and implementation of alerts in electronic health records in primary care is warranted to reduce potentially harmful medication use among Medicare MTM-eligible patients.
无意中为心力衰竭 (HF) 患者开处方开具有害药物仍然是一个持续存在的问题。美国心脏协会发布了一份科学声明，详细列出了可能加重或恶化患者 HF 的药物清单。尚未在 Medicare 心力衰竭患者中研究潜在有害药物的使用情况。
本研究旨在评估 Medicare 注册的药物治疗管理 (MTM) 合格人群中开具这些有害药物的流行率，并确定与这种潜在有害处方相关的特征。
本横断面分析利用了全国 MTM 提供者的数据库，用于 2018 年的日历年。如果患者是 Medicare 参保者、MTM 合格者且具有 HF 的国际疾病分类 9/10 代码，则将其纳入合格患者。通过医生专业，使用计数和百分比描述潜在有害药物使用和处方的流行率。探索性逻辑回归评估了独特的患者特征与潜在有害处方之间的关系。
共纳入 13250 名患者，其中 7017 名（53%）至少开了一种潜在有害药物。在该队列中，最常开的药物是非甾体抗炎药（NSAIDs；3357 例，25%）、二肽基肽酶-4（DPP4）抑制剂（3117 例，24%）和非二氢吡啶钙通道阻滞剂（CCBs；936 例，7%）。逻辑回归发现女性、药物种类增加、MTM 合格年限、较高的贫困水平、开方医生数量和配药药房数量与潜在有害药物的处方有关。在 4 个月的时间内遇到的 17548 种潜在有害药物中，有 9433 种（54%）由初级保健医生开具。
超过一半的 HF 患者开了一种或多种潜在有害药物。需要在初级保健中自动监测处方索赔，并在电子健康记录中实施警报，以减少 Medicare MTM 合格患者潜在有害药物的使用。
