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Article ; Online: Antibiotic Prescribing Patterns for Urinary Tract Infections and Pneumonia by Prescriber Type and Specialty in Nursing Home Care, 2016-2018.

Silva, Joe B B / Riester, Melissa R / Zullo, Andrew R

Journal of the American Medical Directors Association

2024

Abstract: Objective: To identify whether differences in antibiotic prescribing practices by prescriber type and specialization in nursing home (NH) care exist for urinary tract infection (UTI) and pneumonia.: Design: Retrospective cohort.: Setting and ... ...

Abstract	Objective: To identify whether differences in antibiotic prescribing practices by prescriber type and specialization in nursing home (NH) care exist for urinary tract infection (UTI) and pneumonia. Design: Retrospective cohort. Setting and participants: This national study included antibiotic dispensings to traditional Medicare beneficiaries aged ≥65 years with UTI or pneumonia infections residing long-term (≥100 days) in US NHs between 2016 and 2018. Methods: Minimum Data Set assessment data were linked to Medicare data [Part D prescription drug, inpatient hospital (MedPAR), prescriber characteristics, and enrollment]. We compared antibiotic prescribing patterns by prescriber type [physician vs advanced practice practitioner (AP)] and NH specialization (≥90% vs <90% of all associated medication dispensings to NH residents). Antibiotic dispensing measures included the total number of dispensings and duration of therapy (median number of days supplied) by antibiotic class. Results: There were 264,735 antibiotic dispensings prescribed by 32,437 prescribers for 140,360 residents in 14,035 NHs. NH specialists were less likely to prescribe fluoroquinolones for UTI (22.9% NH specialist physician, 23.9% non-NH specialist physician, 21.3% NH specialist AP, 24.2% non-NH specialist AP), but more likely to prescribe fluoroquinolones for pneumonia (38.9%, 37.8%, 38.8%, 37.3%, respectively). Over time, NH specialists reduced fluoroquinolone prescribing for pneumonia to a greater extent than non-NH specialists. The duration of therapy was similar across prescriber groups for UTI, but longer among non-NH specialist APs for several antibiotic classes for pneumonia, including tetracyclines, glycopeptides and lipoglycopeptides, and metronidazole. Conclusions and implications: There were differences in antibiotic prescribing patterns by prescriber type and specialization in NH care between 2016 and 2018. Understanding how antibiotic prescribing differs based on prescriber characteristics is essential to inform antibiotic stewardship efforts. Tailoring antibiotic stewardship efforts to prescribers by NH specialization is rational given differences in antibiotic prescribing patterns based on NH specialization.
Language	English
Publishing date	2024-02-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2024.01.019
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Article ; Online: Trends in medication importation by U.S. adults over time.

Zullo, Andrew R

Journal of the American Pharmacists Association : JAPhA

2020 Volume 61, Issue 1, Page(s) e115–e118

Abstract: Objective: Few data are available about how personal prescription drug importation behavior has changed over time in tandem with increases in the U.S. prices of many medications, or how importation has varied over time as a function of access to ... ...

Abstract	Objective: Few data are available about how personal prescription drug importation behavior has changed over time in tandem with increases in the U.S. prices of many medications, or how importation has varied over time as a function of access to licensed prescribers. The study objective was to examine trends in personal drug importation by U.S. adults over time and assess these trends stratified by access to a provider. Methods: This cross-sectional study used data from the 2011-2018 National Health Interview Survey on adults aged 18 years or older. Using procedures that accounted for the complex survey design, linear trends in the prevalence of importation were assessed using linear regression models fit with ordinary least squares. Prevalence ratios with 95% CIs comparing other survey years with 2015 were estimated using log-binomial regression models. Results: Between 2011 and 2015, the percentage of U.S. adults importing medications from foreign countries decreased from 1.91% to 1.28%, an average decrease of 0.19% per year (95% CI 0.14-0.24, P < 0.001). However, in 2016, the percentage of adults importing medications increased to 1.49%. The percentage remained stable in 2017 at 1.50% and then increased slightly to 1.57% in 2018. Compared with 2015, the prevalence ratio for importation was 1.50 (95% CI 1.31-1.73, P < 0.001) in 2011, 1.17 (95% CI 0.96-1.42, P = 0.12) in 2016, and 1.23 (95% CI 1.01-1.50, P = 0.05) in 2018. Individuals who had difficulty finding a licensed prescriber were consistently more likely to import medications than those who had no difficulty across all years, with no marked difference in trend by prescriber access. Conclusion: The importation of medication and its relationship to provider access should continue to merit the attention of legislators, clinicians, and researchers.
MeSH term(s)	Adult ; Cross-Sectional Studies ; Humans ; Internationality ; Prescription Drugs ; Prevalence ; Surveys and Questionnaires ; United States
Chemical Substances	Prescription Drugs
Language	English
Publishing date	2020-05-29
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2118585-2
ISSN	1544-3450 ; 1544-3191 ; 1086-5802
ISSN (online)	1544-3450
ISSN	1544-3191 ; 1086-5802
DOI	10.1016/j.japh.2020.04.021
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Article ; Online: Prediction tool Development and Implementation in pharmacy praCTice (PreDICT) proposed guidance.

Riester, Melissa R / Zullo, Andrew R

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

2022 Volume 80, Issue 3, Page(s) 111–123

Abstract: Purpose: Proposed guidance is presented for Prediction tool Development and Implementation in pharmacy praCTice (PreDICT). This guidance aims to assist pharmacists and their collaborators with planning, developing, and implementing custom risk ... ...

Abstract	Purpose: Proposed guidance is presented for Prediction tool Development and Implementation in pharmacy praCTice (PreDICT). This guidance aims to assist pharmacists and their collaborators with planning, developing, and implementing custom risk prediction tools for use by pharmacists in their own health systems or practice settings. We aimed to describe general considerations that would be relevant to most prediction tools designed for use in health systems or other pharmacy practice settings. Summary: The PreDICT proposed guidance is organized into 3 sequential phases: (1) planning, (2) development and validation, and (3) testing and refining prediction tools for real-world use. Each phase is accompanied by a checklist of considerations designed to be used by pharmacists or their trainees (eg, residents) during the planning or conduct of a prediction tool project. Commentary and a worked example are also provided to highlight some of the most relevant and impactful considerations for each phase. Conclusion: The proposed guidance for PreDICT is a pharmacist-focused set of checklists for planning, developing, and implementing prediction tools in pharmacy practice. The list of considerations and accompanying commentary can be used as a reference by pharmacists or their trainees before or during the completion of a prediction tool project.
MeSH term(s)	Humans ; Pharmaceutical Services ; Pharmacists ; Pharmacies ; Attitude of Health Personnel ; Pharmacy
Language	English
Publishing date	2022-10-14
Publishing country	England
Document type	Journal Article
ZDB-ID	1224627-x
ISSN	1535-2900 ; 1079-2082
ISSN (online)	1535-2900
ISSN	1079-2082
DOI	10.1093/ajhp/zxac298
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Article ; Online: Sliding Scale Insulin Use in Nursing Homes Before and After Onset of the COVID-19 Pandemic.

Tat, Darlene P / Zullo, Andrew R / Mor, Vincent / Hayes, Kaleen N

Journal of the American Medical Directors Association

2024 Volume 25, Issue 3, Page(s) 459–464

Abstract: Objective: To characterize sliding-scale insulin (SSI) use in US nursing homes (NHs) before and after the COVID-19 pandemic.: Design: Cross-sectional study.: Setting and participants: A total of 129,829 US NH residents on SSI (01/2018-06/2022) ... ...

Abstract	Objective: To characterize sliding-scale insulin (SSI) use in US nursing homes (NHs) before and after the COVID-19 pandemic. Design: Cross-sectional study. Setting and participants: A total of 129,829 US NH residents on SSI (01/2018-06/2022) across 12 NH chains with a common electronic health record system. Methods: Among all residents with at least 1 administration of SSI documented in the electronic medication administration record, we described resident demographics, frequency of SSI monotherapy vs combination therapy with another diabetes medication, number of daily capillary blood glucose readings ("fingersticks"), and hypoglycemia (capillary blood glucose <70 mg/dL) and hyperglycemia after first SSI use. We used interrupted time series analysis (ITS) with segmented linear regression models to examine whether the monthly prevalence of SSI use changed at and after the onset of the COVID-19 pandemic (March 2020). Results: There were 129,829 unique NH residents with SSI use [51% women, average age 71.3 (SD 11.7) years]. Of these, 36% of residents received SSI monotherapy and 64% received SSI combination therapy. Residents on SSI received an average of 3.96 (SD 1.41) fingersticks per day. Overall, 26% of SSI users experienced a hypoglycemic event within 30 days of the first SSI dose. The ITS analysis identified a step decrease in the rate of SSI use following the onset of the COVID-19 pandemic (43 fewer SSI users per 1000 insulin users) but no change in overall trend over time from before the onset of the pandemic. Conclusions and implications: SSI use and fingerstick burden are high in NH residents. Hypoglycemia occurred commonly among residents on SSI. Future research should compare the safety and effectiveness of SSI monotherapy vs other diabetes medication regimens to guide person-centered prescribing decisions in NHs.
MeSH term(s)	Humans ; Female ; Aged ; Male ; Pandemics ; Diabetes Mellitus, Type 2/drug therapy ; Blood Glucose ; Cross-Sectional Studies ; COVID-19 ; Insulin/therapeutic use ; Hypoglycemia ; Nursing Homes
Chemical Substances	Blood Glucose ; Insulin
Language	English
Publishing date	2024-01-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2024.01.004
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Article ; Online: Antibiotic Prescribing in United States Nursing Homes, 2013-2017.

Riester, Melissa R / Deng, Yalin / Zullo, Andrew R

The Journal of infectious diseases

2023 Volume 228, Issue 4, Page(s) 464–468

Abstract: In this national cohort of older adults residing long-term in US nursing homes between 2013 and 2017, we calculated period prevalence estimates for antibiotic prescribing, rates of prescribing, and days of therapy. Among 1 375 062 residents, 66.2% were ... ...

Abstract	In this national cohort of older adults residing long-term in US nursing homes between 2013 and 2017, we calculated period prevalence estimates for antibiotic prescribing, rates of prescribing, and days of therapy. Among 1 375 062 residents, 66.2% were prescribed at least 1 antibiotic during the nursing home stay. The most prevalent antibiotic classes were fluoroquinolones, sulfonamides and related agents, and first-generation cephalosporins. Levofloxacin, ciprofloxacin, and sulfamethoxazole-trimethoprim were the most prevalent antibiotics. These results can inform antibiotic stewardship interventions to reduce antibiotic overprescribing, improve appropriateness, and reduce related adverse outcomes in nursing homes.
MeSH term(s)	Humans ; United States ; Aged ; Anti-Bacterial Agents/therapeutic use ; Nursing Homes ; Ciprofloxacin ; Trimethoprim, Sulfamethoxazole Drug Combination
Chemical Substances	Anti-Bacterial Agents ; Ciprofloxacin (5E8K9I0O4U) ; Trimethoprim, Sulfamethoxazole Drug Combination (8064-90-2)
Language	English
Publishing date	2023-04-05
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	3019-3
ISSN	1537-6613 ; 0022-1899
ISSN (online)	1537-6613
ISSN	0022-1899
DOI	10.1093/infdis/jiad087
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Article ; Online: Antimicrobial resistance in

Datta, Rupak / Pirruccio, Gabrielle / Fried, Terri R / O'Leary, John R / Zullo, Andrew R / Cohen, Andrew

Infection control and hospital epidemiology

2023 , Page(s) 1–4

Abstract: Annual prevalences of antimicrobial resistance among urine isolates (3, ... ...

Abstract	Annual prevalences of antimicrobial resistance among urine isolates (3,913
Language	English
Publishing date	2023-05-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	639378-0
ISSN	1559-6834 ; 0195-9417 ; 0899-823X
ISSN (online)	1559-6834
ISSN	0195-9417 ; 0899-823X
DOI	10.1017/ice.2023.98
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Article ; Online: Capsule Commentary on McCoy Et al. Hospital Readmissions Among Commercially-Insured and Medicare Advantage Beneficiaries with Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events.

Zullo, Andrew R

Journal of general internal medicine

2017 Volume 32, Issue 10, Page(s) 1132

MeSH term(s)	Diabetes Mellitus ; Humans ; Hypoglycemic Agents ; Medicare Part C ; Patient Readmission ; United States
Chemical Substances	Hypoglycemic Agents
Language	English
Publishing date	2017-06-26
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-017-4109-8
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Article ; Online: Adoption of sodium-glucose cotransporter-2 inhibitors among prescribers caring for nursing home residents.

Hayes, Kaleen N / Berry, Sarah D / Munshi, Medha N / Zullo, Andrew R

Journal of the American Geriatrics Society

2023 Volume 71, Issue 8, Page(s) 2585–2592

Abstract: Background: Sodium-glucose cotransporter-2 inhibitor (SGLT2I) use has increased among community-dwelling populations, but little is known about how clinicians have prescribed them for US nursing home (NH) residents. We described the adoption of SGLT2Is ... ...

Abstract	Background: Sodium-glucose cotransporter-2 inhibitor (SGLT2I) use has increased among community-dwelling populations, but little is known about how clinicians have prescribed them for US nursing home (NH) residents. We described the adoption of SGLT2Is by prescribers caring for long-stay NH residents by clinician specialty and over time, compared with sulfonylureas, an older diabetes medication class. Methods: We conducted a retrospective cohort study of prescribers of SGLT2Is and sulfonylureas for all long-stay US NH residents aged 65 years or older (2017-2019). Using 100% of Medicare Part D claims linked to prescriber characteristics data, we identified all dispensings of SGLT2Is and sulfonylureas for long-stay NH residents and their associated prescribers. We described the distribution of prescriber specialties for each drug class over time as well as the number of NH residents prescribed SGLT2s versus sulfonylureas. We estimated the proportions of prescribers who prescribed both drug classes versus only sulfonylureas or only SGLT2Is. Results: We identified 36,427 unique prescribers (SGLT2I: N = 5811; sulfonylureas: N = 35,443) for 117,667 NH residents between 2017 and 2019. For both classes, family medicine and internal medicine physicians accounted for most prescriptions (75%-81%). Most clinicians (87%) prescribed only sulfonylureas, 2% prescribed SGLT2Is only, and 11% prescribed both. Geriatricians were least likely to prescribe only SGLT2Is. We observed an increase in the number of residents with SGLT2I use from n = 2344 in 2017 to n = 5748 in 2019. Conclusions: Among NH residents, most clinicians have not incorporated SGLT2Is into their prescribing for diabetes, but the extent of use is increasing. Family medicine and internal medicine physicians prescribed the majority of diabetes medications for NH residents, and geriatricians were the least likely to prescribe only SGLT2Is. Future research should explore provider concerns regarding SGLT2I prescribing, particularly adverse events.
MeSH term(s)	Aged ; Humans ; United States ; Diabetes Mellitus, Type 2/drug therapy ; Nursing Homes ; Retrospective Studies ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use ; Sulfonylurea Compounds/therapeutic use ; Medicare Part D ; Glucose/therapeutic use ; Sodium ; Hypoglycemic Agents/therapeutic use
Chemical Substances	Sodium-Glucose Transporter 2 Inhibitors ; Sulfonylurea Compounds ; Glucose (IY9XDZ35W2) ; Sodium (9NEZ333N27) ; Hypoglycemic Agents
Language	English
Publishing date	2023-04-20
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.18360
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Article ; Online: Comparative safety of tramadol and other opioids following total hip and knee arthroplasty.

Bosco, Elliott / Riester, Melissa R / Beaudoin, Francesca L / Schoenfeld, Andrew J / Gravenstein, Stefan / Mor, Vincent / Zullo, Andrew R

BMC geriatrics

2024 Volume 24, Issue 1, Page(s) 319

Abstract: Background: Tramadol is increasingly used to treat acute postoperative pain among older adults following total hip and knee arthroplasty (THA/TKA). However, tramadol has a complex pharmacology and may be no safer than full opioid agonists. We compared ... ...

Abstract	Background: Tramadol is increasingly used to treat acute postoperative pain among older adults following total hip and knee arthroplasty (THA/TKA). However, tramadol has a complex pharmacology and may be no safer than full opioid agonists. We compared the safety of tramadol, oxycodone, and hydrocodone among opioid-naïve older adults following elective THA/TKA. Methods: This retrospective cohort included Medicare Fee-for-Service beneficiaries ≥ 65 years with elective THA/TKA between January 1, 2010 and September 30, 2015, 12 months of continuous Parts A and B enrollment, 6 months of continuous Part D enrollment, and no opioid use in the 6 months prior to THA/TKA. Participants initiated single-opioid therapy with tramadol, oxycodone, or hydrocodone within 7 days of discharge from THA/TKA hospitalization, regardless of concurrently administered nonopioid analgesics. Outcomes of interest included all-cause hospitalizations or emergency department visits (serious adverse events (SAEs)) and a composite of 10 surgical- and opioid-related SAEs within 90-days of THA/TKA. The intention-to-treat (ITT) and per-protocol (PP) hazard ratios (HRs) for tramadol versus other opioids were estimated using inverse-probability-of-treatment-weighted pooled logistic regression models. Results: The study population included 2,697 tramadol, 11,407 oxycodone, and 14,665 hydrocodone initiators. Compared to oxycodone, tramadol increased the rate of all-cause SAEs in ITT analyses only (ITT HR 1.19, 95%CLs, 1.02, 1.41; PP HR 1.05, 95%CLs, 0.86, 1.29). Rates of composite SAEs were not significant across comparisons. Compared to hydrocodone, tramadol increased the rate of all-cause SAEs in the ITT and PP analyses (ITT HR 1.40, 95%CLs, 1.10, 1.76; PP HR 1.34, 95%CLs, 1.03, 1.75), but rates of composite SAEs were not significant across comparisons. Conclusions: Postoperative tramadol was associated with increased rates of all-cause SAEs, but not composite SAEs, compared to oxycodone and hydrocodone. Tramadol does not appear to have a superior safety profile and should not be preferentially prescribed to opioid-naïve older adults following THA/TKA.
MeSH term(s)	Humans ; Aged ; United States/epidemiology ; Analgesics, Opioid/adverse effects ; Tramadol/adverse effects ; Oxycodone/adverse effects ; Arthroplasty, Replacement, Knee/adverse effects ; Hydrocodone ; Retrospective Studies ; Arthroplasty, Replacement, Hip/adverse effects ; Medicare
Chemical Substances	Analgesics, Opioid ; Tramadol (39J1LGJ30J) ; Oxycodone (CD35PMG570) ; Hydrocodone (6YKS4Y3WQ7)
Language	English
Publishing date	2024-04-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2059865-8
ISSN	1471-2318 ; 1471-2318
ISSN (online)	1471-2318
ISSN	1471-2318
DOI	10.1186/s12877-024-04933-2
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Article: Electronic Health Records to Rapidly Assess Biosimilar Uptake: An Example Using Insulin Glargine in a Large U.S. Nursing Home Cohort.

Hayes, Kaleen N / Mor, Vincent / Zullo, Andrew R

Frontiers in pharmacology

2022 Volume 13, Page(s) 855598

Abstract: Large healthcare administrative databases, like Medicare claims, are a common means to evaluate drug policies. However, administrative data often have a lag time of months to years before they are available to researchers and decision-makers. Therefore, ... ...

Abstract	Large healthcare administrative databases, like Medicare claims, are a common means to evaluate drug policies. However, administrative data often have a lag time of months to years before they are available to researchers and decision-makers. Therefore, administrative data are not always ideal for timely policy evaluations. Other sources of data are needed to rapidly evaluate policy changes and inform subsequent studies that utilize large administrative data once available. An emerging area of interest in both pharmacoepidemiology and drug policy research that can benefit from rapid data availability is biosimilar uptake, due to the potential for substantial cost savings. To respond to the need for such a data source, we established a public-private partnership to create a near-real-time database of over 1,000 nursing homes' electronic health records to describe and quantify the effects of recent policies related to COVID-19 and medications. In this article, we first describe the components and infrastructure used to create our EHR database. Then, we provide an example that illustrates the use of this database by describing the uptake of insulin glargine-yfgn, a new exchangeable biosimilar for insulin glargine, in US nursing homes. We also examine the uptake of all biosimilars in nursing homes before and after the onset of the COVID-19 pandemic. We conclude with potential directions for future research and database infrastructure.
Language	English
Publishing date	2022-05-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2587355-6
ISSN	1663-9812
ISSN	1663-9812
DOI	10.3389/fphar.2022.855598
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