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Reason for discontinuation of newly prescribed antihypertensive medications: methods of a pilot study using
A P Suarez1, J A Staffa, P Fletcher
1The Degge Group Ltd, 1616 North Ft. Myer Drive, Suite 1430, Arlington, VA 22209, USA.
Insights
This pilot study explored using computerized medical records to identify patients and physicians for studying antihypertensive medication discontinuation. While patient participation was good, physician recruitment and recall of discontinued medications were challenges.
Area of Science:
- Primary Care Research
- Health Informatics
- Pharmacovigilance
Background:
- Medication non-adherence is a significant challenge in managing hypertension.
- Identifying reasons for antihypertensive medication discontinuation is crucial for improving patient outcomes.
- Computerized medical records offer a potential resource for studying medication adherence patterns.
Purpose of the Study:
- To assess the feasibility of using computerized medical records to identify patients and physicians for a study on antihypertensive medication discontinuation.
- To evaluate patient and physician participation rates in such a study.
- To examine the accuracy of computerized data compared to self-reported and physician-reported information.
Main Methods:
- A case-control pilot study utilizing the UKPCD (United Kingdom Primary Care Database) computerized medical records.
- Retrospective identification of patients newly prescribed antihypertensive medication and their physicians.
- Direct surveys of identified patients (discontinuers vs. continuers) and their physicians.
Main Results:
- Patient participation rate was 70%, while physician participation was low at 19%.
- Discontinuers had a higher non-response rate (37%) compared to continuers (27%).
- Self-reported treatment status showed good agreement with computerized data (kappa=0.67); physician agreement was moderate (kappa=0.53).
- Patients could provide detailed medication and symptom information, but discontinuers struggled to recall the specific medication.
Conclusions:
- Utilizing computerized medical records is feasible for identifying patients and physicians to study medication discontinuation in primary care.
- Methodological improvements are needed to enhance physician and patient participation and recall for larger studies.
- Maintaining patient and physician confidentiality is achievable using this approach.
Abstract:
Objective-The purpose of this pilot study was to examine the feasibility of using computerized medical records retrospectively to identify patients and their physicians for subsequent survey to examine discontinuation of a newly prescribed antihypertensive medication in primary care, while maintaining patient confidentiality.Design-A case - control study utilizing UKPCD (formerly MediPlus(R)), a large automated database of computerized medical records, and direct collection of information from patients and their physicians.Setting-Eight selected general practices in the United Kingdom.Participants-Thirty-two patients, identified with a newly prescribed antihypertensive (index) medication and classified by their treatment status (discontinuer vs continuer) and five physicians were surveyed.Results-The participation rate was low among physicians (19%), likely to be due to recruitment during the holiday season, but higher among eligible patients (70%). A higher proportion of discontinuers (37%) refused or failed to respond to the invitation to participate compared with continuers (27%). For most patients, self-reported treatment status matched the UKPCD-based classification of discontinuer or continuer (kappa = 0.67); agreement of UKPCD data with physicians was moderate (kappa = 0.53). The extent and accuracy of the information collected from patients demonstrated that they were able and willing to report detailed knowledge of their medications and recent symptoms. Discontinuers, however, had difficulty recalling the discontinued medication on their own, possibly due to the amount of time elapsed between the event and the questionnaire administration.Conclusion-This pilot study demonstrates the feasibility of examining medication discontinuation in an ambulatory setting by utilizing a large automated database of computerized records to identify and recruit eligible physicians and their hypertensive patients for study, while maintaining patient and physician privacy. Modifications to the methodology to increase physician and patient participation and recall, and to decrease the time between the index event and patient query would increase its utility in larger studies. Copyright (c) 2000 John Wiley & Sons, Ltd.
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