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ObjectiveTo examine whether physicians' use of information technology (IT) was associated with better knowledge of drug costs.Study design/methodsA 2007 statewide survey of 247 primary care physicians in Hawaii regarding IT use and self-reported knowledge of formularies, copayments, and retail prices.ResultsApproximately 8 in 10 physicians regularly used IT in clinical care: 60% Internet, 54% e-prescribing, 43% electronic health records (EHRs), and 37% personal digital assistants (PDAs). However, fewer than 1 in 5 often knew drug costs when prescribing, and more than 90% said lack of knowledge of formularies and copayments remained a barrier to considering drug costs for patients. In multivariate analyses adjusting for sex, practice size, years in practice, number of formularies, and use of clinical resources (eg, pharmacists), use of the Internet -- but not e-prescribing, EHRs, or PDAs -- was associated with physicians reporting slightly better knowledge of copayments (adjusted predicted percentage of 23% vs 11%; P = .04). No type of IT was associated with better knowledge of formularies or retail prices.ConclusionsDespite high rates of IT use, there was only a modest association between physicians' use of IT and better knowledge of drug costs. Future investments in health IT should consider how IT design can be improved to make it easier for physicians to access cost information at the point of care.

ObjectivesTo determine whether elderly patients with high drug expenditures want and receive providers' help in managing drug costs.DesignCross-sectional survey.SettingA Medicare managed care plan (>400,000 members) in one state in 2002.ParticipantsOne thousand one hundred six seniors (62% response rate) sampled so that half exceeded caps on their drug benefits the previous year, and all had total drug expenditures in the top quartile of members in their cap level.MeasurementsParticipants' preferences and experiences with providers discussing costs and participation in choosing medications.ResultsTwo-thirds reported difficulty paying for medications, and one-fourth decreased medication use because of cost. Most wanted providers to ask about medication affordability (81%), consider cost (86%), offer choices (70%), and to persuade them or decide for them which medication to use (88%), but few said providers asked about affordability (17%), usually or always discussed prices (19%), or offered choices (45%), although nearly all said providers chose their medications (93%). Sixty-two percent had asked providers for help with drug costs, although 34% who used less medication because of cost or had difficulty paying for medications had not asked for help.ConclusionProviders should be aware that elderly patients want their help in managing drug costs but do not always receive it or ask for help when they need it. Providers could improve communication by initiating conversations about cost and by asking patients about preferences when prescribing.

Objective. To describe the proportion, characteristics, and attitudes of pediatricians who want to allocate more time in primary care to children with special health care needs (CSHCN). Methods. Data from a national random sample mail survey of 1000 pediatricians were used to examine attitudes towards allocating more time to CSHCN, and associated preferences towards changes to primary care. Results. Sixty percent (n=502) of eligible subjects participated. Forty-five percent of pediatricians reported that, if they could redesign their practices to maximize efficiency and effectiveness, they would allocate more time to providing care to CSHCN. After multivariate adjustment, respondents who wanted to allocate more time to CSHCN were more likely to want to allocate more time to care coordination with staff (OR 3.6[1.7-7.4, p≤0.001]) and non-visit communication with parents (OR 3.0[1.7-5.5], p≤0.001), and were more likely to prefer delegation of well-child care services to non-physicians (OR 5.9[2.8-12.5], p≤0.001). Inadequate reimbursement was reported as the most important obstacle to implementing such changes in their practices. Conclusions. These findings suggest that a substantial number of pediatricians would ideally allocate more time in primary care to CSHCN. Systems of care that could support such a change should be investigated.

Objective. To describe the proportion, characteristics, and attitudes of pediatricians who want to allocate more time in primary care to children with special health care needs (CSHCN). Methods. Data from a national random sample mail survey of 1000 pediatricians were used to examine attitudes towards allocating more time to CSHCN, and associated preferences towards changes to primary care. Results. Sixty percent (n=502) of eligible subjects participated. Forty-five percent of pediatricians reported that, if they could redesign their practices to maximize efficiency and effectiveness, they would allocate more time to providing care to CSHCN. After multivariate adjustment, respondents who wanted to allocate more time to CSHCN were more likely to want to allocate more time to care coordination with staff (OR 3.6[1.7-7.4, p?0.001]) and non-visit communication with parents (OR 3.0[1.7-5.5], p?0.001), and were more likely to prefer delegation of well-child care services to non-physicians (OR 5.9[2.8-12.5], p?0.001). Inadequate reimbursement was reported as the most important obstacle to implementing such changes in their practices. Conclusions. These findings suggest that a substantial number of pediatricians would ideally allocate more time in primary care to CSHCN. Systems of care that could support such a change should be investigated.

The strength of evidence for specific ambulatory care prescribing cascades, in which a marker drug is used to treat an adverse event caused by an index drug, has not been well characterized. To perform a structured, systematic, and transparent review of the evidence supporting ambulatory care prescribing cascades. Ninety‐four potential prescribing cascades identified through a previously published systematic review. Systematic search of the literature to further characterize prescribing cascades. (1) Grading of evidence based on observational studies investigating associations between index and marker drugs, including: Level I—strong evidence [i.e. multiple high‐quality studies]; Level II—moderate evidence [i.e. single high‐quality study]; Level III—fair evidence [no high‐quality studies but one or more moderate‐quality studies]; and Level IV—poor evidence [other]. (2) Listing of the adverse event associated with the index drug in the product's United States Food and Drug Administration (FDA) label. (3) Synthesis of the evidence supporting mechanisms linking index drugs and associated adverse events. Of 99 potential cascades, 94 were supported by one or more confirmatory observational studies and were therefore included in this review. The 94 cascades related to 30 types of adverse drug reactions affecting 10 different anatomic/physiologic systems and were investigated by a total of 88 confirmatory studies, including prescription sequential symmetry analysis (n = 51), cohort (n = 30), and case–control (n = 7) studies. Overall, the evidence from observational studies was strong for 18 (19.1%) prescribing cascades, moderate for 61 (64.9%), fair for 13 (13.8%), and poor for 2 (2.1%). Although the evidence supporting mechanisms that link index drugs and associated adverse events was variable, FDA labels included information about the adverse event associated with the index drug for most (n = 86) but not all of the 94 prescribing cascades. Although we identified 18 of 94 prescribing cascades supported by strong clinical evidence and most adverse events associated with index drugs are included in FDA label, the evidentiary basis for prescribing cascades varies, with many requiring further evidence of clinical relevance. [ABSTRACT FROM AUTHOR]

Study Objective: To estimate the prevalence of potential moderate to severe drug–drug interactions (DDIs) involving nirmatrelvir/ritonavir, identify interacting medications, and evaluate risk factors associated with potential DDIs. Design: Cross‐sectional study. Data Source: Electronic health records from the National COVID Cohort Collaborative Enclave, one of the largest COVID‐19 data resources in the United States. Patients: Outpatients aged ≥18 years and started nirmatrelvir/ritonavir between December 23, 2021 and March 31, 2022. Intervention: Nirmatrelvir/ritonavir. Measurements: The outcome is potential moderate to severe DDIs, defined as starting interacting medications reported by National Institutes of Health 30 days before or 10 days after starting nirmatrelvir/ritonavir. Main Results: Of 3214 outpatients who started nirmatrelvir/ritonavir, the mean age was 56.8 ± 17.1 years, 39.5% were male, and 65.8% were non‐Hispanic white. Overall, 521 (16.2%) were potentially exposed to at least one moderate to severe DDI, most commonly to atorvastatin (19.2% of all DDIs), hydrocodone (14.0%), or oxycodone (14.0%). After adjustment for covariates, potential DDIs were more likely among individuals who were older (odds ratio [OR] 1.16 per 10‐year increase, 95% confidence interval [CI] 1.08–1.25), male (OR 1.36, CI 1.09–1.71), smokers (OR 1.38, CI 1.10–1.73), on more co‐medications (OR 1.35, CI 1.31–1.39), and with a history of solid organ transplant (OR 3.63, CI 2.05–6.45). Conclusions: One in six of individuals receiving nirmatrelvir/ritonavir were at risk of a potential moderate or severe DDI, underscoring the importance of clinical and pharmacy systems to mitigate such risks. [ABSTRACT FROM AUTHOR]