The safety and efficacy of vortioxetine for acute treatment of major depressive disorder: a systematic review and meta-analysis.

Background: Vortioxetine is the first mixed serotonin agonist and antagonist antidepressant approved in the US. We sought to evaluate all published and unpublished data available to determine the efficacy and harms of vortioxetine in adults with major depressive disorder.

Methods: We used a predefined search strategy of MEDLINE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.

Use of administrative data to identify off-label use of second-generation antipsychotics in a Medicaid population.

OBJECTIVE The use of second-generation antipsychotics for conditions not approved by the U.S. Food and Drug Administration (FDA) is a prevalent phenomenon with important implications.

One practice's experiment in refusing detail rep visits.

Purpose: The physician-pharmaceutical industry relationship has come under increasing scrutiny. Little guidance exists concerning how smaller practices should manage this relationship.In 2006, Madras Medical Group, a small family practice in rural Oregon, implemented a policy prohibiting visits from representatives of the pharmaceutical industry and the acceptance of drug samples.

Effect of drug sample removal on prescribing in a family practice clinic.

Purpose: Little is known about the impact of recent restrictions on pharmaceutical industry detailing and sampling on prescribing behavior, particularly within smaller, independent practices. The objective of this study was to evaluate the effect of a policy prohibiting prescription drug samples and pharmaceutical industry interaction on prescribing patterns in a rural family practice clinic in central Oregon.

Methods: Segmented linear regression models were used to evaluate trends in prescribing using locally obtained pharmacy claims.

Antimicrobial prescribing for upper respiratory infections and its effect on return visits.

Background And Objectives: Antibiotic resistance is a growing problem that complicates the treatment of various illnesses. This study analyzes Medicaid encounter data to (1) determine antibiotic prescribing rates for common respiratory tract infections in Oregon and (2) assess the effect of receiving an antibiotic at an index visit on whether there was a return visit within 30 days.

Methods: Subjects included in this study were Medicaid patients in Oregon between 2001--2003 who were enrolled in Medicaid for a full year and were diagnosed with an upper respiratory tract infection, including bronchitis, sinusitis, acute otitis media (AOM), pharyngitis, and upper respiratory infections (URIs).

Patterns of atypical antipsychotic subtherapeutic dosing among Oregon Medicaid patients.

Objective: To examine a cohort of Medicaid patients with new prescriptions for atypical antipsychotic medication to determine the prevalence of subtherapeutic atypical antipsychotic medication use and to identify patient and prescribing provider characteristics associated with occurrence of subtherapeutic use.

Method: This observational cohort study examined Medicaid administrative claims data for patients aged 20 to 64 years with a new prescription for an atypical antipsychotic medication (clozapine, olanzapine, quetiapine, risperidone, ziprasidone) between January 1, 2004, and December 31, 2004. Patient diagnostic information was identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes on submitted medical claims.

Impact of a Medicaid copayment policy on prescription drug and health services utilization in a fee-for-service Medicaid population.

Background: Copayments (copays) for prescription drugs are a common policy among state Medicaid programs. Research exploring the effects of copays on pharmacy and health care utilization in Medicaid patients is limited, especially among patients with chronic disease.

Objectives: The goal of this research was to quantify the impact of a copay policy for prescription drugs on medication and health services utilization overall and among subjects with several common chronic diseases enrolled in a state Medicaid program.

How expensive is antipsychotic polypharmacy? Experience from five US state Medicaid programs.

Objective: To characterize healthcare costs associated with antipsychotic polypharmacy and to investigate predictors of high-cost patients.

Methods: A retrospective cohort study using Medicaid claims data from California, Nebraska, Oregon, Utah, and Wyoming evaluated 55 383 fee-for-service patients with antipsychotic prescriptions between 1998 and 2002. Polypharmacy was defined as initiating multiple antipsychotic drugs or concomitant antipsychotic therapy (>or=60 days).

Rates of adverse events of long-acting opioids in a state Medicaid program.

Background: Despite widespread use and emerging safety concerns, data on the comparative safety and effectiveness of long-acting opioid (LAO) analgesics are weak.

Objective: To compare rates of adverse events among patients newly prescribed an LAO.

Methods: A retrospective observational cohort study using Medicaid administrative claims data was conducted examining time until first adverse outcome among patients with new prescriptions for methadone, extended-release (ER) oxycodone, ER morphine, or transdermal fentanyl.

Prevalence, utilization patterns, and predictors of antipsychotic polypharmacy: experience in a multistate Medicaid population, 1998-2003.

Objectives: This study was conducted to estimate the prevalence of antipsychotic polypharmacy among fee-for service state Medicaid beneficiaries initiating antipsychotic drug therapy and to investigate psychiatric and demographic predictors of such polypharmacy.

Methods: This was a retrospective cohort study employing Medicaid claims data from California, Nebraska, Oregon, Utah, and Wyoming for patients who filled >1 antipsychotic prescription between 1998 and 2003 and who were continuously eligible for benefits from 180 days before to 1 year after the index antipsychotic claim. Antipsychotic Polypharmacy was defined as initiation of multiple antipsychotic medications or at least 60 consecutive days of concomitant antipsychotic medication overlapping the index antipsychotic prescription at any time during the 365 days after the index drug claim.

An evaluation of Oregon's evidence-based Practitioner-Managed Prescription Drug Plan.

This paper describes Oregon's implementation of its publicly developed, evidence-based, Practitioner-Managed Prescription Drug Plan (PMPDP). Oregon's PMPDP was initially self-enforced with a dispense as written (DAW) exception process, followed by an educational prior authorization (soft PA) method, and finally no active enforcement. Market-share trends indicate that the educational prior authorization process was most effective at increasing the use of preferred agents.

Initial results of the use of prescription order change forms to achieve dose form optimization (consolidation and tablet splitting) of SSRI antidepressants in a state Medicaid program.

Background: One method to reduce drug costs is to promote dose form optimization strategies that take advantage of the flat pricing of some drugs, i.e., the same or nearly the same price for a 100 mg tablet and a 50 mg tablet of the same drug.

Risk of hospitalization for heart failure associated with thiazolidinedione therapy: a medicaid claims-based case-control study.

Study Objectives: To determine, in patients with type 2 diabetes mellitus, whether an association exists between thiazolidinedione therapy or other diabetes therapies and hospital admission for heart failure.

Design: Retrospective case-control study.

Data Source: Oregon Medicaid claims database.

Effects of a prior-authorization policy for celecoxib on medical service and prescription drug use in a managed care Medicaid population.

Background: Prior authorization (PA) is a poorly studied but commonly employed policy used by health care payers to manage the rising costs of pharmacy benefits.

Objective: The aim of this study was to evaluate the intended and unintended effects of a PA policy for celecoxib on pharmacy and medical-service utilization in a Medicaid managed-care organization.

Methods: This was a retrospective, interrupted time-series analysis of 22 monthly health-related utilization rates from January 1, 1999, to October 31, 2000.

Gabapentin use in a managed medicaid population.

Objective: The use of gabapentin, an antiepileptic agent, in a primary care setting was evaluated to determine (a) the conditions being treated, (b) specialties of the prescribers, (c) dose ranges, and (d) the extent of documentation and follow-up.

Methods: A retrospective review of both claims data and patient charts was performed by a clinical pharmacist. Patients were identified from CareOregon and Oregon Medicaid fee-for-service drug claim databases.