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Prevalence of inappropriate prescribing of inhaled corticosteroids for respiratory tract infections in the Netherlands: a retrospective cohort study.

Teichert M, Schermer T, van den Nieuwenhof L, De Smet PA, Wensing M - NPJ Prim Care Respir Med (2014)

Bottom Line: These ICS were mainly prescribed by general practitioners, mostly during winter months, for elderly persons, after high dosages of oral corticosteroids, and in single-inhaler combinations with a long-acting β2-agonist.The extrapolated total annual expense for this ICS use was € 555,000.In the Netherlands one-off ICS dispensing in combination with oral antibiotics in subjects without chronic respiratory conditions was considerably lower than in Australia.

View Article: PubMed Central - PubMed

Affiliation: 1] Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboudumc, Nijmegen, The Netherlands [2] Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands.

ABSTRACT

Background: Inhaled corticosteroids (ICS) are recommended in prevailing guidelines for use in patients with persistent asthma or moderate-to-severe chronic obstructive pulmonary disease (COPD) and recurrent exacerbations. Recent data from Australia showed that 44% of patients with a single ICS dispensing and without other respiratory inhalation medications ('one-off ICS') were co-dispensed oral antibiotics. Evidence of the merit of ICS for treating respiratory infections in subjects without asthma or COPD is lacking.

Aims: The aims of the study were to describe the rate of one-off ICS dispensing in combination with oral antibiotics in subjects without chronic respiratory conditions in the Netherlands, and to compare this with the rate of one-off ICS dispensing in combination with oral antibiotics as reported earlier from Australia.

Methods: Dispensing data were obtained from the Dutch Foundation of Pharmaceutical Statistics. Additional information was available on patients' age, sex and prescriber. Patients with any ICS dispensing in 2011 were selected.

Results: Data were available from 1,725 Dutch community pharmacies (88%). Of 845,068 ICS users in 2011, 10% were dispensed one-off ICS, among which 13% had oral antibiotics co-dispensed. These ICS were mainly prescribed by general practitioners, mostly during winter months, for elderly persons, after high dosages of oral corticosteroids, and in single-inhaler combinations with a long-acting β2-agonist. The extrapolated total annual expense for this ICS use was € 555,000.

Conclusion: In the Netherlands one-off ICS dispensing in combination with oral antibiotics in subjects without chronic respiratory conditions was considerably lower than in Australia.

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Related in: MedlinePlus

Cohort of one-off inhaled corticosteroids (ICS) users in combination with oral antibiotics (based on data from 1,725 (89% of all) Dutch community pharmacies).
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fig1: Cohort of one-off inhaled corticosteroids (ICS) users in combination with oral antibiotics (based on data from 1,725 (89% of all) Dutch community pharmacies).

Mentions: Data were used from pharmacies that had delivered complete data for the whole calendar year from 2010 to 2012. All patients with at least one ICS dispensing during the calendar year 2011, either alone or in single-inhaler combination with long-acting β2-agonist (LABA; ATC codes: R03BA, R03AK06, R03AK07), were included in the study cohort. The calendar years 2010 and 2012 were used as prior and posterior measurement periods to determine earlier and later dispensings for patients of the cohort. To warrant complete data history for the patients included, patients were excluded who—besides dispensing of a one-off ICS—did not have a dispensing of any other medication in 2011 or 2012 (‘drop-in’ patients; Figure 1). Within the total group of ICS users, patients who had their first dispensing of an ICS in 2011 without a previous ICS dispensing during the preceding 12 months (‘first ICS’) were identified. Next, only those patients were selected who had no subsequent dispensing of an ICS in the following 12 months (‘single ICS’). Among these patients, those who had not received any other respiratory medication (ATC codes R03, except R03AK06 or R03AK07 or R03BA) in the 12 months prior to or after the single ICS dispensing in 2011 were labelled as ‘one-off ICS’ users. For these patients co-dispensing of antibiotics was defined as dispensing an oral antibiotic within the drug classes commonly used for respiratory tract infections, comparable to the selection made by Poulos et al.20 in their paper (tetracyclines, penicillines, sulphonamides in combination with trimethoprim, quinolones and combinations of these drugs; ATC-codes: J01A, J01C. J01E, J01F, J01M, J01R), within 7 days prior or past of the date of one-off ICS dispensing. As we did not consider information on the diagnosis, we only selected dispensings of these antibiotics for a prescribed period of use between 7 and 15 days according to the Dutch GP recommendations of antibiotic drug use for respiratory infections.26 Patients with a co-dispensed antibiotic for a shorter or longer period of time were not labelled as having ‘concomitant antibiotic use’. Usage of a course of high-dose oral corticosteroids was defined as a dispensing with ATC codes H02AB06 or H02AB07 in the 12 months prior to the one-off ICS dispensing. In order to differentiate between subjects with and those without allergies, one-off ICS users with antibiotics were stratified on the basis of having received or not received any dispensing of antiallergic medication (R01AC, R01AD, R03BC, R03DC, R03DX05, R06) between 2010 and 2012.


Prevalence of inappropriate prescribing of inhaled corticosteroids for respiratory tract infections in the Netherlands: a retrospective cohort study.

Teichert M, Schermer T, van den Nieuwenhof L, De Smet PA, Wensing M - NPJ Prim Care Respir Med (2014)

Cohort of one-off inhaled corticosteroids (ICS) users in combination with oral antibiotics (based on data from 1,725 (89% of all) Dutch community pharmacies).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4373501&req=5

fig1: Cohort of one-off inhaled corticosteroids (ICS) users in combination with oral antibiotics (based on data from 1,725 (89% of all) Dutch community pharmacies).
Mentions: Data were used from pharmacies that had delivered complete data for the whole calendar year from 2010 to 2012. All patients with at least one ICS dispensing during the calendar year 2011, either alone or in single-inhaler combination with long-acting β2-agonist (LABA; ATC codes: R03BA, R03AK06, R03AK07), were included in the study cohort. The calendar years 2010 and 2012 were used as prior and posterior measurement periods to determine earlier and later dispensings for patients of the cohort. To warrant complete data history for the patients included, patients were excluded who—besides dispensing of a one-off ICS—did not have a dispensing of any other medication in 2011 or 2012 (‘drop-in’ patients; Figure 1). Within the total group of ICS users, patients who had their first dispensing of an ICS in 2011 without a previous ICS dispensing during the preceding 12 months (‘first ICS’) were identified. Next, only those patients were selected who had no subsequent dispensing of an ICS in the following 12 months (‘single ICS’). Among these patients, those who had not received any other respiratory medication (ATC codes R03, except R03AK06 or R03AK07 or R03BA) in the 12 months prior to or after the single ICS dispensing in 2011 were labelled as ‘one-off ICS’ users. For these patients co-dispensing of antibiotics was defined as dispensing an oral antibiotic within the drug classes commonly used for respiratory tract infections, comparable to the selection made by Poulos et al.20 in their paper (tetracyclines, penicillines, sulphonamides in combination with trimethoprim, quinolones and combinations of these drugs; ATC-codes: J01A, J01C. J01E, J01F, J01M, J01R), within 7 days prior or past of the date of one-off ICS dispensing. As we did not consider information on the diagnosis, we only selected dispensings of these antibiotics for a prescribed period of use between 7 and 15 days according to the Dutch GP recommendations of antibiotic drug use for respiratory infections.26 Patients with a co-dispensed antibiotic for a shorter or longer period of time were not labelled as having ‘concomitant antibiotic use’. Usage of a course of high-dose oral corticosteroids was defined as a dispensing with ATC codes H02AB06 or H02AB07 in the 12 months prior to the one-off ICS dispensing. In order to differentiate between subjects with and those without allergies, one-off ICS users with antibiotics were stratified on the basis of having received or not received any dispensing of antiallergic medication (R01AC, R01AD, R03BC, R03DC, R03DX05, R06) between 2010 and 2012.

Bottom Line: These ICS were mainly prescribed by general practitioners, mostly during winter months, for elderly persons, after high dosages of oral corticosteroids, and in single-inhaler combinations with a long-acting β2-agonist.The extrapolated total annual expense for this ICS use was € 555,000.In the Netherlands one-off ICS dispensing in combination with oral antibiotics in subjects without chronic respiratory conditions was considerably lower than in Australia.

View Article: PubMed Central - PubMed

Affiliation: 1] Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboudumc, Nijmegen, The Netherlands [2] Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands.

ABSTRACT

Background: Inhaled corticosteroids (ICS) are recommended in prevailing guidelines for use in patients with persistent asthma or moderate-to-severe chronic obstructive pulmonary disease (COPD) and recurrent exacerbations. Recent data from Australia showed that 44% of patients with a single ICS dispensing and without other respiratory inhalation medications ('one-off ICS') were co-dispensed oral antibiotics. Evidence of the merit of ICS for treating respiratory infections in subjects without asthma or COPD is lacking.

Aims: The aims of the study were to describe the rate of one-off ICS dispensing in combination with oral antibiotics in subjects without chronic respiratory conditions in the Netherlands, and to compare this with the rate of one-off ICS dispensing in combination with oral antibiotics as reported earlier from Australia.

Methods: Dispensing data were obtained from the Dutch Foundation of Pharmaceutical Statistics. Additional information was available on patients' age, sex and prescriber. Patients with any ICS dispensing in 2011 were selected.

Results: Data were available from 1,725 Dutch community pharmacies (88%). Of 845,068 ICS users in 2011, 10% were dispensed one-off ICS, among which 13% had oral antibiotics co-dispensed. These ICS were mainly prescribed by general practitioners, mostly during winter months, for elderly persons, after high dosages of oral corticosteroids, and in single-inhaler combinations with a long-acting β2-agonist. The extrapolated total annual expense for this ICS use was € 555,000.

Conclusion: In the Netherlands one-off ICS dispensing in combination with oral antibiotics in subjects without chronic respiratory conditions was considerably lower than in Australia.

Show MeSH
Related in: MedlinePlus