Latest news with #MerativeMarketScan
Medscape
2 days ago
- Health
- Medscape
Urgent Care Linked to High Prescribing Rates
TOPLINE: Urgent care visits frequently result in inappropriate prescribing, with 12.4% leading to antibiotic fills, 9.1% to glucocorticoid fills, and 1.3% to opioid fills. Analysis of over 22.4 million urgent care visits revealed concerning patterns, including 40.8% of acute bronchitis visits resulting in inappropriate glucocorticoid prescriptions. METHODOLOGY: Researchers conducted a cross-sectional study analyzing urgent care visits from January 1, 2018, to December 31, 2022, using Merative MarketScan Commercial and Medicare Supplemental databases representing over 270 million Americans and 12.9 million Medicare supplemental beneficiaries. Analysis included 10,773,218 patients with a median age of 34 years (interquartile range, 20-49 years), with 56.6% (n = 8,640,819) being women, from a total of 22,426,546 urgent care visits. Primary diagnosis codes were grouped into Clinical Classifications Software Refined (CCSR) categories, with visits containing missing or multiple primary diagnostic codes excluded to ensure accurate assessment of prescription appropriateness. Patients could contribute multiple visits only when separated by more than 3 days to allow accurate prescription attribution, with researchers examining inappropriate oral antibiotic, glucocorticoid, and opioid prescription fills for the 10 most common CCSR categories. TAKEAWAY: Analysis revealed that out of 22,426,546 urgent care visits, 2,783,924 (12.4%) led to antibiotic prescription fills, 2,038,506 (9.1%) to glucocorticoid fills, and 299,210 (1.3%) to opioid prescription fills. Researchers found that antibiotics were always appropriate for 58.2% (n = 169,782) of upper respiratory infections and 63.9% (n = 325,632) of urinary tract infections, while being frequently filled for never-appropriate indications including otitis media (30.66%, n = 33,001). Glucocorticoid prescriptions were commonly prescribed, though generally inappropriate for upper respiratory infections (11.9%, n = 306,658), sinusitis (23.9%, n = 253,513), and acute bronchitis (40.8%, n = 190,302). According to the findings, opioid prescriptions, while generally inappropriate, were common for nonback musculoskeletal pain (4.6%, n = 28,048), abdominal pain and digestive symptoms (6.3%, n = 26,143), and sprains and strains (4.0%, n = 18,806). IN PRACTICE: 'Inappropriate prescribing in urgent care is influenced by clinician knowledge, patient demands, and lack of decision support. Antibiotic, glucocorticoid, and opioid stewardship programs are needed to reduce inappropriate urgent care prescribing and support long-term glucocorticoid and opioid deprescribing efforts,' wrote the authors of the study. SOURCE: The study was led by Shirley Cohen-Mekelburg, MD, MS, Division of Gastroenterology and Hepatology and Institute for Healthcare Policy and Innovation, University of Michigan in Ann Arbor, Michigan. It was published online on July 21 in Annals of Internal Medicine. LIMITATIONS: The study population was limited to insured patients, which may affect the generalizability of the findings. The analysis was restricted to the most common CCSR categories associated with each drug type, potentially underestimating the extent of inappropriate prescribing. Additionally, the researchers noted that the limitations of administrative data prevented them from elucidating demographic, clinician, or facility details or confirming medication administration. DISCLOSURES: The University of Michigan Institutional Review Board (HUM00127665) deemed this study exempt. Disclosure forms are available with the article online. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
15-05-2025
- Health
- Medscape
Multiple Naloxone Administrations Rise in EDs
TOPLINE: The proportion of emergency department (ED) patients requiring multiple naloxone administrations increased from 10.1% in 2016 to 17.4% in 2022 in the MarketScan database and from 3.0% in 2016 to 7.3% in 2022 in the National Emergency Department Sample (NEDS) database, indicating an increasing trend. METHODOLOGY: Researchers conducted a retrospective claims-based cohort study using data from the Merative MarketScan and NEDS databases in the United States between 2016 and 2022. The MarketScan data included 335,846 patients with ED claims for opioid overdose (mean age, 41 years), of whom 27,742 (mean age, 39 years) received naloxone during at least one ED encounter. The NEDS data encompassed 2,087,492 ED visits for opioid overdose (mean age, 46 years), with naloxone administered during 50,791 (mean age, 41 years) of these visits. The primary outcome in MarketScan was the percentage of patients who received multiple naloxone administrations during their first ED visit. The primary outcome in NEDS was the percentage of ED visits with multiple naloxone administrations, among ED visits in which naloxone was administered at least once. TAKEAWAY: Among patients from the MarketScan database who received naloxone, 14.7% received multiple administrations, increasing from 10.1% in 2016 to 17.4% in 2022 ꟷ a 72.8% increase (P < .01 for trend). Among NEDS ED visits during which naloxone was administered, multiple administrations were recorded during 6.3% of these visits, which increased by 146.7%, from 3.0% in 2016 to 7.3% in 2021 (P < .01 for trend). The likelihood of receiving multiple naloxone administrations in the ED increased by 10% (adjusted odds ratio [aOR], 1.10; 95% CI, 1.09-1.12) in MarketScan and 13% (aOR, 1.13; 95% CI, 1.11-1.16) in NEDS each year. The proportion of patients from MarketScan who received naloxone at their first ED visit increased by 60.5%, from 5.8% in 2016 to 9.3% in 2022, and NEDS ED visits with naloxone administration increased by 49.9%, from 1.9% to 2.9%. IN PRACTICE: "Increases in fatal and nonfatal opioid toxicities involving fentanyl have been accompanied by increased use of naloxone in the ED. While a single naloxone administration appears to address the needs of most ED patients, a small but growing percentage of ED patients require multiple naloxone administrations," the authors wrote. SOURCE: The study was led by Rachael Rzasa Lynn, MD, Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado. It was published online on May 8, 2025, in The Journal of Emergency Medicine. LIMITATIONS: Claims data did not include complete information on prehospital naloxone administration or the precise timing of administrations within the ED, making it difficult to distinguish between multiple administrations due to insufficient initial dosing and those due to extended opioid toxicity. Additionally, claims data lacked information on naloxone dose strengths or routes of administration or continuous intravenous infusion details. Additionally, the cross-sectional dataset may not have been fully representative of EDs across the United States. DISCLOSURES: The study was funded by Purdue Pharma. One author reported being a former employee of Genesis Research, which was paid by Purdue. Another author reported being an employee of Purdue. Some authors declared receiving grants or having other ties with various sources. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
