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A change from subcutaneous to intravenous erythropoietin increases the cost of anemia therapy.

https://arctichealth.org/en/permalink/ahliterature161154
Source
Nephron Clin Pract. 2007;107(3):c90-6
Publication Type
Article
Date
2007
Author
Philip A McFarlane
Michael P Hillmer
Niki Dacouris
Author Affiliation
Home Dialysis, St. Michael's Hospital, Toronto, Ontario, Canada. phil.mcfarlane@utoronto.ca
Source
Nephron Clin Pract. 2007;107(3):c90-6
Date
2007
Language
English
Publication Type
Article
Keywords
Aged
Anemia - drug therapy - economics - epidemiology
Erythropoietin - administration & dosage - economics
Female
Health Care Costs - statistics & numerical data
Humans
Injections, Intravenous - economics - statistics & numerical data
Injections, Subcutaneous - economics - statistics & numerical data
Male
Middle Aged
Models, Economic
Ontario - epidemiology
Abstract
It seems that more erythropoietin (EPO) is required when given intravenously (IV) than when given subcutaneously (SC). Estimates of the magnitude of this difference vary widely, impeding development of economic models in this area. Concerns about pure red cell aplasia led our program to switch from SC to IV EPO, so we studied the impact of this change on the cost of anemia therapy.
All in-center hemodialysis patients who had received EPO for at least 3 months prior to and following conversion to IV EPO were studied. Data was obtained retrospectively for 1 year prior to and prospectively for 1 year following conversion. The costs of anemia therapy (EPO, transfusions and iron) were calculated from the hospital's perspective.
158 patients were studied. One month after switching, the hemoglobin fell significantly, reaching a nadir at 3 months. This triggered more use of EPO, iron and transfusions. By month 7 hemoglobin levels had returned to initial levels, with a median rise in EPO dose of 1,250 units/week (p
PubMed ID
17890876 View in PubMed
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The relationship between variations in antipsychotic prescribing across nursing homes and short-term mortality: quality of care implications.

https://arctichealth.org/en/permalink/ahliterature149349
Source
Med Care. 2009 Sep;47(9):1000-8
Publication Type
Article
Date
Sep-2009
Author
Susan E Bronskill
Paula A Rochon
Sudeep S Gill
Nathan Herrmann
Michael P Hillmer
Chaim M Bell
Geoffrey M Anderson
Thérèse A Stukel
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario. susan.bronskill@ices.on.ca
Source
Med Care. 2009 Sep;47(9):1000-8
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antipsychotic Agents - therapeutic use
Drug Prescriptions
Female
Humans
Male
Mortality - trends
Nursing Homes
Ontario - epidemiology
Physician's Practice Patterns
Proportional Hazards Models
Quality of Health Care
Abstract
High rates of antipsychotic drug prescribing in nursing homes can signal poor quality processes, but also raise concerns about drug safety due to the mortality risk of this therapy. Determining the extent to which variations in antipsychotic use are a symptom of facility-level quality problems as compared with a drug safety issue is important for selecting the correct interventions to effect change.
To determine whether nursing homes with higher rates of antipsychotic dispensing had higher rates of short-term mortality among their residents.
This population-based study examined 60,105 older adults newly admitted to nursing homes in Ontario between April 1, 2000 and March 31, 2004. Using adjusted Cox proportional hazard models, we explored the relationship between facility-level dispensing rates and mortality, controlling for resident characteristics. Facilities were grouped into quintiles according to mean antipsychotic rate. All-cause mortality at 30 and 120 days after admission was stratified by recent hospital discharge and analyzed by quintile.
Average antipsychotic dispensing ranged from 11.6% in the lowest quintile to 30.0% in the highest. Among residents with no recent hospitalization, all-cause mortality at 30 days was 2.5% in the lowest compared with 3.3% in the highest quintile (adjusted hazard ratio: 1.28, confidence interval: 1.06-1.56) and at 120 days was 9.3% compared with 11.7% (adjusted hazard ratio: 1.25, confidence interval: 1.13-1.39).
Residents were at increased risk of death simply by being admitted to a facility with a higher intensity of antipsychotic drug use, despite similar clinical characteristics at admission.
PubMed ID
19648835 View in PubMed
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Representation of patients with dementia in clinical trials of donepezil.

https://arctichealth.org/en/permalink/ahliterature176933
Source
Can J Clin Pharmacol. 2004;11(2):e274-85
Publication Type
Article
Date
2004
Author
Sudeep S Gill
Susan E Bronskill
Muhammad Mamdani
Kathy Sykora
Ping Li
Kenneth I Shulman
Geoffrey M Anderson
Michael P Hillmer
Walter P Wodchis
Paula A Rochon
Author Affiliation
Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Toronto, Ontario. sudeep.gill@ices.on.ca
Source
Can J Clin Pharmacol. 2004;11(2):e274-85
Date
2004
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy
Cholinesterase Inhibitors - therapeutic use
Cohort Studies
Dementia - drug therapy
Female
Humans
Indans - therapeutic use
Male
Middle Aged
Ontario
Patient Dropouts
Patient Selection
Physician's Practice Patterns
Piperidines - therapeutic use
Randomized Controlled Trials as Topic
Abstract
To evaluate the representation of frail older adults in randomized controlled trials (RCTs), and to assess consequences of under representation by analyzing drug discontinuation rates.
A cohort of older adults newly dispensed donepezil in Ontario between September 2001 and March 2002 was constructed using administrative data. A systematic review of the literature identified RCTs of donepezil. Patients dispensed donepezil were then compared to clinical trial subjects. Discontinuation rates were examined for patients with and without potential contraindications to this drug.
There were 6,424 older adults in the Ontario cohort with new claims for donepezil. Ten RCTs evaluating the use of donepezil were identified (n = 3,423). Between 51% and 78% of the Ontario cohort would have been ineligible for RCT enrollment. Patients dispensed donepezil were older (80.3 vs. 73.7 years, p
PubMed ID
15604527 View in PubMed
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