Biomedical subjects

J Ross Maclean

Publications and source records attributed to J Ross Maclean.

4 recordsLinked to original sources

PubMed2006

Acute myocardial infarction and kidney transplantation.

Although the risk for acute myocardial infarction (AMI) is lower after transplantation than on the waiting list, this risk may vary by patient population and may be different early versus late after transplantation. Risk factors for AMI were examined among 53,297 Medicare beneficiaries who were placed on the deceased-donor waiting list in 1995 to 2002. Early ( 3 mo) effects of receiving a deceased- or living-donor kidney transplant were examined using time-dependent covariates in Cox nonproportional hazards analysis. Overall, transplantation was associated with a 17% lower adjusted risk for AMI (0.83; 95% confidence interval [CI] 0.77 to 0.90) versus the waiting list. However, the relative risk (versus the waiting list) for AMI was greater for deceased- compared to living-donor transplants, with both being much greater early (deceased-donor 3.57 [95% CI 3.21 to 3.96] compared to living-donor 2.81 [95% CI 2.31 to 3.42]) than late (deceased-donor 0.45 [95% CI 0.41 to 0.50] compared to living-donor 0.39 [95% CI 0.33 to 0.47]) posttransplantation. Individuals who were >or=65 yr of age had a much higher risk (versus 18- to 34-yr-olds) for AMI early posttransplantation (8.01; 95% CI 5.12 to 12.53) compared with the waiting list (3.68; 95% CI 3.98 to 4.54) or late posttransplantation (4.37; 95% CI 3.07 to 6.20). Black patients had less reduction in AMI risk (versus white patients) late posttransplantation (0.78; 95% CI 0.64 to 0.95) compared with early posttransplantation (0.60; 95% CI 0.48 to 0.74) or on the waiting list (0.62; 95% CI 0.56 to 0.68). The AMI risk that was associated with chronic kidney disease from diabetes (versus glomerulonephritis) was relatively greater on the waiting list (1.64; 95% CI 1.45 to 1.85) compared with early (1.34; 95% CI 1.08 to 1.68) and late (1.39; 95% CI 1.12 to 1.72) posttransplantation. Thus the risk reduction for AMI with transplantation versus the waiting list varies by patient population and time after transplantation.

Adolescent↗

PubMed2004

A randomized study to decrease the use of potentially inappropriate medications among community-dwelling older adults in a southeastern managed care organization.

BACKGROUND: Despite progress in describing the problem of potentially inappropriate medication (PIM) use, there have been few prospective studies demonstrating that interventions with specific medication criteria can make a difference in decreasing the use of problematic drugs in older adults. OBJECTIVE: To design an intervention study to change physician behavior regarding PIM prescribing to older patients. STUDY DESIGN AND METHODS: A prospective randomized block design was used during an 18-month period from January 2001 to June 2002. The study population was primary care physicians (n = 355) in the Medicare + Choice product line of a southeastern managed care organization and their patients 65 years and older. There were 170 physicians in the treatment group and 185 in the control group. Physicians were assigned to the treatment or usual-care, groups using a randomization table, and each group included physicians who had and had not prescribed a PIM. RESULTS: Approximately 71% (84/118) of the physicians in the intervention group who prescribed a PIM completed and faxed back at least 1 potentially inappropriate medication form to the managed care organization. On 15.4% (260/1692) of the medication forms, physicians made some change regarding PIM use. CONCLUSIONS: Although many studies have addressed medication use among older adults, intervention studies aimed at influencing physician prescribing in this population are limited. This study describes a low-cost, replicable method to contact and educate physicians on drug therapy issues in older adults.

Academic Medical Centers↗

PubMed2002

Comparison of 2 systems for clinical practice profiling in diabetic care: medical records versus claims and administrative data.

OBJECTIVES: To (1) describe the rate of glycosylated hemoglobin (HbA1c) testing and control in a primary care clinic at an academic medical center; (2) compare academic medical center and health maintenance organization (HMO) data for a subgroup of the same patients; and (3) discuss the challenges to accurate clinical practice profiling. STUDY DESIGN: Retrospective analysis of medical records and claims and administrative data. PATIENTS AND METHODS: We reviewed the medical records of 300 patients with diabetes mellitus from the Primary Care practice at an academic medical center (AMC). The HMO and AMC were in the southeastern United States. The study adhered to the National Committee for Quality Assurance's Health Plan Employer Data and Information Set 3.0 (1998) guidelines for collection of the numerator and denominator data. RESULTS: Overall, 275 (91.7%) of 300 patients underwent a documented HbA1c test (range, 77.8%-98.0% across the 5 Primary Care Associates clinic physicians). Of these 275 patients, 206 (74.9%; range, 52.4%-84.7%) were under "good control" (defined by the National Committee for Quality Assurance as an HbA1c level of < or = 9.5%). The mean (SD) HbA1c level was 8.45% (1.98%). Data from the HMO documented a rate of HbA1c testing of 36.3% (45/124) compared with 92.7% (115/124) based on case note review at the academic medical center. CONCLUSIONS: Current administrative and claims-based information systems have inherent weaknesses if used for performance measurement. Reliance solely on medical record review is time and cost prohibitive. To ensure complete reporting of mandated "quality measures" will necessitate the tracking of data across different healthcare systems.

Academic Medical Centers↗

PubMedDate not supplied

Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.

BACKGROUND: Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults and economically affect the health care system. The purpose of this initiative was to revise and update the Beers criteria for potentially inappropriate medication use in adults 65 years and older in the United States. METHODS: This study used a modified Delphi method, a set of procedures and methods for formulating a group judgment for a subject matter in which precise information is lacking. The criteria reviewed covered 2 types of statements: (1) medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available and (2) medications that should not be used in older persons known to have specific medical conditions. RESULTS: This study identified 48 individual medications or classes of medications to avoid in older adults and their potential concerns and 20 diseases/conditions and medications to be avoided in older adults with these conditions. Of these potentially inappropriate drugs, 66 were considered by the panel to have adverse outcomes of high severity. CONCLUSIONS: This study is an important update of previously established criteria that have been widely used and cited. The application of the Beers criteria and other tools for identifying potentially inappropriate medication use will continue to enable providers to plan interventions for decreasing both drug-related costs and overall costs and thus minimize drug-related problems.

Aged↗