Predictors of Potentially Inappropriate Stimulant Prescribing Among Adults.

IF 2.4 4区医学 Q3 PHARMACOLOGY & PHARMACY Pharmacoepidemiology and Drug Safety Pub Date : 2025-01-01 DOI:10.1002/pds.70079

Pavan V Thakkar, Angelique E Boutzoukas, Scott N Compton, Ohviya Sivashankar, Kanecia O Zimmerman, Daniel K Benjamin, M Alan Brookhart

{"title":"Predictors of Potentially Inappropriate Stimulant Prescribing Among Adults.","authors":"Pavan V Thakkar, Angelique E Boutzoukas, Scott N Compton, Ohviya Sivashankar, Kanecia O Zimmerman, Daniel K Benjamin, M Alan Brookhart","doi":"10.1002/pds.70079","DOIUrl":null,"url":null,"abstract":"Purpose: Increases in adult stimulant prescribing pose a potential risk due to the higher prevalence of contraindicated conditions among this population. We sought to identify patient, provider, and visit characteristics predictive of potentially inappropriate adult stimulant prescriptions.Methods: We conducted a repeated cross-sectional study using the National Ambulatory Medical Care Survey, a nationally representative weighted sample of 5 453 702 723 ambulatory care visits from 2012 to 2019. Potentially inappropriate prescriptions were defined as prescriptions to patients with potentially contraindicated conditions, as determined by US Food and Drug Administration stimulant labels.Results: Of the 5 453 702 723 visits, stimulant use was prevalent at 121384694 (2.23%) visits and newly prescribed at 18880152 (0.34%) visits. Of these, 4 620 138 (24.47%) new stimulant prescriptions and 28 055 947 (23.11%) prevalent prescriptions were potentially inappropriate. Potentially inappropriate prescribing increased over time and with age. Visits to primary care providers (relative risk [RR] 1.65, 95% CI 1.05-2.59) were predictive of inappropriate prescribing. Non-Hispanic Black (RR 0.48, 95% CI 0.33-0.70) and Hispanic race/ethnicity (RR 0.46, 95% CI 0.35-0.60), coronary artery disease (RR 0.54, 95% CI 0.33-0.86), pregnancy (RR 0.05, 95% CI 0.03-0.11), hypertension (RR 0.69, 95% CI 0.56-0.84), and glaucoma (RR 0.07, 95% CI 0.02-0.24) were predictive of decreased prevalent stimulant prescriptions; substance abuse was predictive of new stimulant prescribing (RR 2.14, 95% CI 1.07-4.27).Conclusions: The proportion of potentially inappropriate adult stimulant prescriptions increased over time and with patient age. Visits to primary care providers were predictive of potentially inappropriate prescribing, and a history of substance abuse was predictive of new stimulant prescriptions; therefore, quality improvement interventions regarding safe stimulant prescribing practices may be warranted.","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 1","pages":"e70079"},"PeriodicalIF":2.4000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731891/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pharmacoepidemiology and Drug Safety","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/pds.70079","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: Increases in adult stimulant prescribing pose a potential risk due to the higher prevalence of contraindicated conditions among this population. We sought to identify patient, provider, and visit characteristics predictive of potentially inappropriate adult stimulant prescriptions.

Methods: We conducted a repeated cross-sectional study using the National Ambulatory Medical Care Survey, a nationally representative weighted sample of 5 453 702 723 ambulatory care visits from 2012 to 2019. Potentially inappropriate prescriptions were defined as prescriptions to patients with potentially contraindicated conditions, as determined by US Food and Drug Administration stimulant labels.

Results: Of the 5 453 702 723 visits, stimulant use was prevalent at 121384694 (2.23%) visits and newly prescribed at 18880152 (0.34%) visits. Of these, 4 620 138 (24.47%) new stimulant prescriptions and 28 055 947 (23.11%) prevalent prescriptions were potentially inappropriate. Potentially inappropriate prescribing increased over time and with age. Visits to primary care providers (relative risk [RR] 1.65, 95% CI 1.05-2.59) were predictive of inappropriate prescribing. Non-Hispanic Black (RR 0.48, 95% CI 0.33-0.70) and Hispanic race/ethnicity (RR 0.46, 95% CI 0.35-0.60), coronary artery disease (RR 0.54, 95% CI 0.33-0.86), pregnancy (RR 0.05, 95% CI 0.03-0.11), hypertension (RR 0.69, 95% CI 0.56-0.84), and glaucoma (RR 0.07, 95% CI 0.02-0.24) were predictive of decreased prevalent stimulant prescriptions; substance abuse was predictive of new stimulant prescribing (RR 2.14, 95% CI 1.07-4.27).

Conclusions: The proportion of potentially inappropriate adult stimulant prescriptions increased over time and with patient age. Visits to primary care providers were predictive of potentially inappropriate prescribing, and a history of substance abuse was predictive of new stimulant prescriptions; therefore, quality improvement interventions regarding safe stimulant prescribing practices may be warranted.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

成人中潜在不适当兴奋剂处方的预测因素。

目的：由于该人群中禁忌症的患病率较高，成人兴奋剂处方的增加构成了潜在的风险。我们试图确定患者、提供者和访问特征，以预测可能不适当的成人兴奋剂处方。方法：我们使用国家门诊医疗调查进行了重复横断面研究，这是一个具有全国代表性的加权样本，包括2012年至2019年的5 453 702 723次门诊就诊。潜在不适当处方被定义为根据美国食品和药物管理局兴奋剂标签确定的具有潜在禁忌症的患者的处方。结果：在5 453 702 723次就诊中，兴奋剂使用率为121384694次（2.23%），新开处方为18880152次（0.34%）。其中，新开兴奋剂处方4 620 138张（24.47%），常用兴奋剂处方28 055 947张（23.11%）存在潜在不适宜处方。潜在的不当处方随着时间和年龄的增长而增加。到初级保健提供者就诊（相对危险度[RR] 1.65, 95% CI 1.05-2.59）可预测处方不当。非西班牙裔黑人（RR 0.48, 95% CI 0.33-0.70）和西班牙裔人种/民族（RR 0.46, 95% CI 0.35-0.60）、冠状动脉疾病（RR 0.54, 95% CI 0.33-0.86）、妊娠（RR 0.05, 95% CI 0.03-0.11）、高血压（RR 0.69, 95% CI 0.56-0.84）和青光眼（RR 0.07, 95% CI 0.02-0.24）预示着普遍的兴奋剂处方减少；药物滥用可预测新兴奋剂处方（RR 2.14, 95% CI 1.07-4.27）。结论：可能不合适的成人兴奋剂处方比例随着时间和患者年龄的增加而增加。对初级保健提供者的访问可以预测可能不适当的处方，药物滥用史可以预测新的兴奋剂处方；因此，关于安全兴奋剂处方实践的质量改进干预措施可能是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Pharmacoepidemiology and Drug Safety 医学-药学

CiteScore

4.80

自引率

7.70%

发文量

173

审稿时长

3 months

期刊介绍： The aim of Pharmacoepidemiology and Drug Safety is to provide an international forum for the communication and evaluation of data, methods and opinion in the discipline of pharmacoepidemiology. The Journal publishes peer-reviewed reports of original research, invited reviews and a variety of guest editorials and commentaries embracing scientific, medical, statistical, legal and economic aspects of pharmacoepidemiology and post-marketing surveillance of drug safety. Appropriate material in these categories may also be considered for publication as a Brief Report. Particular areas of interest include: design, analysis, results, and interpretation of studies looking at the benefit or safety of specific pharmaceuticals, biologics, or medical devices, including studies in pharmacovigilance, postmarketing surveillance, pharmacoeconomics, patient safety, molecular pharmacoepidemiology, or any other study within the broad field of pharmacoepidemiology; comparative effectiveness research relating to pharmaceuticals, biologics, and medical devices. Comparative effectiveness research is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, as these methods are truly used in the real world; methodologic contributions of relevance to pharmacoepidemiology, whether original contributions, reviews of existing methods, or tutorials for how to apply the methods of pharmacoepidemiology; assessments of harm versus benefit in drug therapy; patterns of drug utilization; relationships between pharmacoepidemiology and the formulation and interpretation of regulatory guidelines; evaluations of risk management plans and programmes relating to pharmaceuticals, biologics and medical devices.