Antiviral completion rates and sustained viral response in hepatitis C patients with and without preexisting major depressive disorder.

Background: Despite evidence suggesting that the majority of patients with hepatitis C virus (HCV) have psychiatric and substance use disorders, patients with these comorbidities have historically been excluded from antiviral therapy for HCV.

Objective: The authors compared antiviral completion and sustained virologic response (SVR) rates between hepatitis C (HCV) patients with versus those without preexisting major depressive disorder (MDD).

Method: The authors performed a chart review of HCV patients (30 with MDD and 25 control subjects) who attended an optional HCV education class and signed informed consent allowing collection of clinical data.

The cognitive effects of hepatitis C in the presence and absence of a history of substance use disorder.

The aim of the study was to determine whether infection with the hepatitis C virus (HCV) is associated with cognitive impairment beyond the effects of prevalent comorbidities and a history of substance use disorder (SUD). Adult veterans were recruited from the Portland Veterans Affairs Medical Center into three groups: (1) HCV+/SUD+ (n = 39), (2) HCV+/SUD- (n = 24), and (3) HCV-/SUD- (n = 56). SUD+ participants were in remission for > or =90 days, while SUD- participants had no history of SUD.

Pharmacist care plans and documentation of follow-up before the Iowa Pharmaceutical Case Management program.

Objectives: To document drug therapy problems and their causes and assess pharmacist follow-up of patients with identified drug therapy problems.

Design: Cross-sectional analysis.

Setting: Iowa.

Interpretation of drug risk and benefit: individual and population perspectives.

Objective: To provide pharmacists with the necessary nomenclature and tools to interpret the medical literature on drug risks and benefits.

Data Sources: Primary articles were identified by MEDLINE search (1990-December 2003) and through secondary sources.

Study Selection And Data Extraction: All of the articles identified from the data sources were evaluated, and all information from secondary sources deemed relevant was included.

The use of ACE inhibitors as renoprotective agents in Medicaid patients with diabetes.

Objective: To establish a relationship between angiotensin-converting enzyme (ACE) inhibitor therapy and renal outcomes in Medicaid patients with diabetes, and compare the use of ACE inhibitors between 1994 and 1998.

Methods: One thousand patients with either type 1 or type 2 diabetes were randomly selected from the Iowa Medicaid database and followed retrospectively from 1994 through 1998. Data on medication use (insulin, oral antidiabetic agents, or both) and medical services were collected from prescription claims and diagnostic codes.

Treatment of Medicaid patients with asthma: comparison with treatment guidelines using disease-based drug utilization review methodology.

Objective: To compare asthma drug therapy in the Iowa Medicaid population with international treatment guideline recommendations and relate differences to patient outcomes.

Methods: Data on asthma drug therapy and respiratory-related medical services (clinic visits, emergency visits, hospital admissions) were abstracted from prescription claims and diagnostic codes of adult Iowa Medicaid patients with asthma (n = 1029).

Results: About two-thirds of the population received a prescription for a short-acting beta 2-agonist during the study period.

Pharmacoepidemiology of urinary tract infections in Iowa Medicaid patients in urban long-term-care facilities.

Objective: To describe the therapeutic management of Medicaid patients with urinary tract infections (UTIs) in urban long-term-care facilities (LTCFs) and to link individual therapies to patient outcomes.

Design: Retrospective review of medical records in LTCFs of patients who had documented UTIs.

Methods: Patient data were collected from 17 LTCFs in the Des Moines, IA, metropolitan area during a 1-year period starting January 1, 1995.

Assessment of methods and outcomes: using modified inpatient ciprofloxacin criteria in community-based drug use evaluation.

Objective: To determine if published drug use evaluation (DUE) criteria for inpatients could be modified to describe and evaluate drug therapy in outpatients.

Design: Retrospective review of drug profiles and diagnostic codes in outpatients included in the Iowa Medicaid Management Information System database.

Methods: Criteria specifying clinical indication, process indicators, complications, and outcomes were modified from existing inpatient DUE criteria for ciprofloxacin.

Effect of pharmacists on health care outcomes in hospitalized patients.

The cost-effectiveness of pharmacists and their effect on inpatient health care outcomes were evaluated. For one year, data were collected on all patients receiving care from general medicine and general surgery teams at Walter Reed Army Medical Center, Washington, D.C.

Prolonged recurrence of pentamidine-induced torsades de pointes.

Objective: To report a case of recurrent pentamidine-induced torsades de pointes (TdP) and to review previously reported cases in the literature.

Data Sources: Medical records of the subject patient, case reports, and relevant studies identified by MEDLINE.

Data Extraction: Data were abstracted from pertinent published sources by one author and reviewed by the remaining authors.

Aerosolized pentamidine and Pneumocystis carinii pneumonia: patient compliance and outcomes.

Objective: The study objectives were to compare compliance between every-two-week and every-four-week aerosolized pentamidine regimens, and to determine if patients who were more compliant with the use of aerosolized pentamidine were at decreased risk for developing Pneumocystis carinii pneumonia (PCP).

Design: Nonrandomized observational study of patients receiving aerosolized pentamidine for PCP prophylaxis using the hospital pharmacy computer system to document aerosolized pentamidine use and compliance, and the Patient Administration Division's computer to document cases of PCP.

Setting: Tertiary care, US Army medical center.

Pharmacoepidemiology and military medical automation: opportunity for excellence.

Fielding of the Composite Health Care System (CHCS) brings an unparalleled opportunity for medical research. This sophisticated automated medical record system promises pharmacoepidemiologic research of a quality and quantity never before possible. Pharmacoepidemiology provides answers about the validity of beneficial and adverse drug events and aids in individualizing drug therapy.

The relationship between outpatient drug costs and disease progression in the human immunodeficiency virus-infected population. The Military Medical Consortium for Applied Retroviral Research.

As the focus of the management of human immunodeficiency virus (HIV) infection turns from the treatment of AIDS to the entire continuum of the disease, projection of long-term healthcare costs becomes increasingly important. Rather than a fulminant disease treated primarily inside the hospital, HIV infection will become a chronic condition requiring years of outpatient monitoring and pharmacologic intervention with attending increases in pharmacy costs. The objective of this study was to characterize outpatient drug costs by Walter Reed (WR) disease stage in order to estimate the association of disease progression and outpatient prescription drug costs.

Impact of a drug-use review program intervention on prescribing after publication of a randomized clinical trial.

The effect of a drug-use review (DUR) program intervention on physician prescribing after the results of a randomized clinical trial were published was studied. A Veterans Administration (VA) cooperative study published in June 1986 showed that congestive heart failure (CHF) patients who had hydralazine and isosorbide added to their drug therapy had less mortality than patients given digoxin and diuretics with or without prazosin. Physicians with at least one CHF patient who was receiving the less effective therapy were randomly assigned to intervention and control groups.

Prescription drug use patterns of human immunodeficiency virus-infected patients taking zidovudine. Walter Reed Retrovirus Research Group.

Prescription drug profiles of 116 human immunodeficiency virus (HIV)-infected patients taking zidovudine in 1988 were surveyed. Patients received the drug an average of 236 days. About one-third (32 percent) required reduced dosage presumably because of hematologic toxicity and this was associated with length of time on the drug.

Impact of HIV infection on pharmaceutical services at Walter Reed Army Medical Center.

Services developed by the pharmacy department at Walter Reed Army Medical Center (WRAMC) relating to the treatment and study of patients infected with the human immunodeficiency virus (HIV) are described. The WRAMC pharmacy department closely monitored use of azidothymidine (renamed zidovudine) before and after its approval by FDA. It has also done pharmaceutical cost studies for HIV-infected patients by disease stage according to the Walter Reed Classification System.

Career patterns of pioneer clinical pharmacists.

The career paths of some early clinical pharmacists from their first positions during the years 1965-1974 to their current positions were studied. In August 1985 a group of pharmacists was surveyed to determine (1) the extent to which they had maintained a clinical practice (defined as direct patient contact, including evaluating and planning drug regimens), (2) the number of job-function changes, and (3) the degree of the pharmacists' commitment to public service, as measured by Hall's Belief in Public Service and Allport-Vernon-Lindzey Personality Values. The response rate for the 337 questionnaires was 73.

Drug utilization study methodologies: national and international perspectives.

This paper in the series on pharmacoepidemiology describes the history, development, and present status of drug utilization activities. The various methodologies employed in drug utilization studies are evaluated and presented along with a listing of the principal drug databases available for drug utilization research. An analysis is presented comparing the validity of drug consumption rates based on individual patient usage or drug cost data as adopted in North America and the defined daily dose unit as developed in Europe.