Background: IMS Brogan (IMS) monitors ambulatory antibacterial (AB) consumption using the Xponent... more Background: IMS Brogan (IMS) monitors ambulatory antibacterial (AB) consumption using the Xponent®database, which samples ~60-70% of retail pharmacy dispensing records and estimates total use using a proprietary method. Many studies use IMS data for monitoring the effect of antimicrobial stewardship (AS) activities and identifying potetntial AS targets. Since 09-2007 Alberta pharmacies have submitted dispensing records to a provincial database; the Pharmacy Information Network (PIN). Our objective was to validate the IMS Brogan estimates for the province of Alberta using data from the PIN. Methods: Guidelines for reporting reliability and agreement studies (GRRAS) were followed. We obtained dispensing data from IMS and PIN for systemic AB [ATC J01] for 8 consecutive quarters from 07-2010 to 06-2012. Number of scripts were provided for all systemic ABs in 5 provincial health zones grouped by age (0-17, 18-64 and ≥65). Population estimates for each zone and each age group as of June 3...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2012
In Canada, treatment of children and adolescents with antipsychotics is almost always off label. ... more In Canada, treatment of children and adolescents with antipsychotics is almost always off label. A single atypical agent, aripiprazole, only recently received regulatory authorization for use in the group aged 15 to 17 years. This regulatory approval was restricted to treatment of schizophrenia. The objective of this review was to summarize pharmacoepidemiologic reports examining the frequency of use of these medications. A literature search was used to identify English-language studies examining the pharmacoepidemiology of antipsychotics in children and adolescents. The results of identified studies were summarized using narrative review methods. In countries where longitudinal data are available, increased antipsychotic use has been consistently observed. Generally, most or all of this increase can be attributed to second-generation antipsychotics (SGAs). Major international differences are evident in the literature. European studies describe lower overall frequencies of use than ...
ABSTRACT Introduction: Antimicrobial stewardship (AS) within acute care facilities is a requireme... more ABSTRACT Introduction: Antimicrobial stewardship (AS) within acute care facilities is a requirement for Accreditation Canada's Required Organisational Practices. In order to obtain a baseline evaluation of current AS processes, a focus group approach was used to qualitatively assess frontline pharmacy staff and leadership perspectives on AS resources. Methods: A semi-structured interview process was applied to focus groups comprised of Pharmacy Services employees throughout Alberta Health Services in Alberta, Canada. A thematic analysis of transcripts was done independently by two investigators, and consensus was reached on identified themes and topics. Codes were recorded for prevalence and total number of mentions. A combination of conventional and deductive approaches was used to identify themes. Results: A total of 200 (10%) pharmacy services staff members participated in the focus groups. Eight main themes were identified: antimicrobial resources, influences on antimicrobial utilisation, barriers to antimicrobial stewardship, establishing AS teams, education needs, improving communications, antimicrobial utilisation concerns, and enablers for improvement. Two hundred and six topics were identified to support the themes, with 1924 data points. Prominent topics included ubiquitous awareness of a provincial antimicrobial stewardship reference, prescriber preferences influencing antimicrobial utilisation, and desire to improve interprofessional teamwork, communication and educational opportunities. Conclusions: A broad description of the culture of antimicrobial use showed that the themes are interrelated. To successfully change practice, one must take into account the complexity of the relationship between these perceptions.
Canadian journal of psychiatry. Revue canadienne de psychiatrie
Current epidemiologic knowledge about bipolar disorder (BD) in Canada is inadequate. To date, onl... more Current epidemiologic knowledge about bipolar disorder (BD) in Canada is inadequate. To date, only 3 prevalence studies have been conducted: only 1 was based on a national sample, and none distinguished between BD I and II. The objective of this study was to estimate the prevalence of BD I and II in Canada in 2012. Data were obtained from the 2012 Canadian Community Health Survey: Mental Health and Well-being, a cross-sectional survey of a nationally representative sample of household residents ages 15 years and older (n = 25 113). The survey response rate was 68.9%. Interviews were based on the World Health Organization Composite International Diagnostic Interview (CIDI). Prevalence was estimated using generalized linear modelling. Prevalence of self-reported diagnosis of BD and use of lithium were also estimated. The estimated lifetime prevalence of BD I and II (based on the CIDI) in Canada in 2012 was 0.87% (95% CI 0.67% to 1.07%) and 0.57% (95% CI 0.44% to 0.71%), respectively. ...
Background: Appropriate baseline quantification of antibacterial (AB) use is essential to antimic... more Background: Appropriate baseline quantification of antibacterial (AB) use is essential to antimicrobial stewardship (AS). As a result, we aimed to quantify and analyze trends in AB use Alberta, Canada (population: ~4 million). Health care is administered through 5 zones in Alberta; Calgary and Edmonton zones are urban cities with populations > 1 million residents, and South, Central and North zones are regions of small urban centres and rural areas. Methods: We used data from the IMS Brogan Xponent® database to estimate the use of systemic AB for 8 quarters (Jul 2010 - Jun 2012). The population of each zone was obtained from the Alberta Health Care Insurance Plan (AHCIP) for each year. Estimation of end of quarter population was calculated based on a linear population change model anchored to AHCIP data. Number of prescriptions per 1000 inhabitant-days (PrID) and defined daily doses per 1000 inhabitant-days (DID) were calculated for the zones, stratified by ages 0-17 (pediatrics)...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2015
Current epidemiologic knowledge about bipolar disorder (BD) in Canada is inadequate. To date, onl... more Current epidemiologic knowledge about bipolar disorder (BD) in Canada is inadequate. To date, only 3 prevalence studies have been conducted: only 1 was based on a national sample, and none distinguished between BD I and II. The objective of this study was to estimate the prevalence of BD I and II in Canada in 2012. Data were obtained from the 2012 Canadian Community Health Survey: Mental Health and Well-being, a cross-sectional survey of a nationally representative sample of household residents ages 15 years and older (n = 25 113). The survey response rate was 68.9%. Interviews were based on the World Health Organization Composite International Diagnostic Interview (CIDI). Prevalence was estimated using generalized linear modelling. Prevalence of self-reported diagnosis of BD and use of lithium were also estimated. The estimated lifetime prevalence of BD I and II (based on the CIDI) in Canada in 2012 was 0.87% (95% CI 0.67% to 1.07%) and 0.57% (95% CI 0.44% to 0.71%), respectively. ...
Medication administration omissions (MAO) are usually considered medication errors but not all MA... more Medication administration omissions (MAO) are usually considered medication errors but not all MAO are clinically relevant. We determined the frequency of clinically relevant MAO of antimicrobial drugs in adult hospitals in Calgary, Alberta, Canada based on electronic medication administration record (eMAR). We examined 2011 data from eMAR records on medical wards and developed a reproducible assessment scheme to categorize and determine clinical relevance of MAO. We applied this scheme to records from 2012 in a retrospective cohort study to quantify clinically relevant MAO. Significant predictors of clinically relevant MAO were identified. A total of 294,718 dose records were assessed of which 10,282 (3.49%) were for doses not administered. Among these 4903 (1.66% of total); 47.68% of MAO were considered clinically relevant. Significant positive predictors of clinically relevant MAO included inhaled (OR 4.90, 95% CI 3.54-6.94) and liquid oral (OR 1.32, 95% CI 1.18-1.47) route of me...
OBJECTIVE To compare antimicrobial utilization data derived from pharmacy dispensing records and ... more OBJECTIVE To compare antimicrobial utilization data derived from pharmacy dispensing records and nursing administration record data by 2 commonly used units of measure. DESIGN, PARTICIPANTS, AND METHODS Data from nursing administration records and pharmacy dispensing records were obtained for 32 medical wards. From nursing and pharmacy data, defined daily doses (DDD) were calculated, and from the nursing data, days of therapy were derived. Direct comparison of total antimicrobial use was performed by graphical analysis and linear regression. Slope of trend line was used to quantify the difference between pairs of measures. Bland-Altman plots were constructed to determine constant and proportional bias. At the level of individual agents, difference between pairs of measures was calculated and presented graphically and the average (95% CI) for the difference between measures was determined. RESULTS Nursing administration record–derived DDD were on average 23% lower than corresponding ...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 8, 2014
Morbidity due to cardiovascular disease is high among First Nations people. The extent to which t... more Morbidity due to cardiovascular disease is high among First Nations people. The extent to which this may be related to the likelihood of coronary angiography is unclear. We examined the likelihood of coronary angiography after acute myocardial infarction (MI) among First Nations and non-First Nations patients. Our study included adults with incident acute MI between 1997 and 2008 in Alberta. We determined the likelihood of angiography among First Nations and non-First Nations patients, adjusted for important confounders, using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. Of the 46,764 people with acute MI, 1043 (2.2%) were First Nations. First Nations patients were less likely to receive angiography within 1 day after acute MI (adjusted odds ratio [OR] 0.73, 95% confidence interval [CI] 0.62-0.87). Among First Nations and non-First Nations patients who underwent angiography (64.9%), there was no difference in the likelihood of ...
PurposeTo compare the prevalence of cardiovascular risk factors (CV-RF) and disease (CV-D) and he... more PurposeTo compare the prevalence of cardiovascular risk factors (CV-RF) and disease (CV-D) and health care use in people with and without schizophrenia.Subjects/materials and methodsData from the Canadian Community Health Survey (CCHS), cycle 3.1, were used. Prevalence of CV-RF, CV-D, and health care use were compared in those with and without schizophrenia using logistic regression analysis. Sampling weights and bootstrap variance estimates were used to account for survey design.ResultsA total of 399 (0.3%) people with schizophrenia were identified and compared to 120,044 (97.7%) people without. Individuals with schizophrenia were significantly more likely to be obese (34.8% vs. 15.6%) and report diabetes (11.9% vs. 5.3%). After accounting for sociodemographic variables, schizophrenia was not independently associated with diabetes (adjusted odds ratio [aOR]: 0.86; 0.49–1.51). Individuals with schizophrenia were more likely to be hospitalized (21.9% vs. 8.0%; aOR: 2.37; 95% CI: 1.51...
The purpose of this study was to assess the history of previous depression in people with inciden... more The purpose of this study was to assess the history of previous depression in people with incident diabetes compared with people without diabetes. We conducted a population-based nested case-control study using the administrative databases of Saskatchewan Health to assess the study objective. We identified cases of type 2 diabetes based on diagnostics codes and prescription records for individuals over the age of 20 years. For each case subject, two control subjects were randomly selected from the nondiabetic population during the same index year. History of depression, based on diagnostic codes and antidepressant prescription, was ascertained up to 3 years before index date. Simple and multivariate logistic regression analysis was used to estimate the odds ratio (OR) and 95% CIs, after adjusting for age, sex, and frequency of physician visits. Individuals with newly diagnosed diabetes (1,622 of 33,257; 4.9%) were 30% more likely to have had a previous history of depression compared with people without diabetes (2,279 of 59,420; 3.8%). This increased risk remained after controlling for sex and number of physician visits but was limited to subjects 20-50 years of age (adjusted OR 1.23 [95% CI 1.10-1.37]) and not in those aged > or =51 years (0.92 [0.84-1.00]). Depression appears to increase the risk of developing diabetes by approximately 23% in younger adults. This provides information regarding the temporality of the relationship between diabetes and depression.
Background: IMS Brogan (IMS) monitors ambulatory antibacterial (AB) consumption using the Xponent... more Background: IMS Brogan (IMS) monitors ambulatory antibacterial (AB) consumption using the Xponent®database, which samples ~60-70% of retail pharmacy dispensing records and estimates total use using a proprietary method. Many studies use IMS data for monitoring the effect of antimicrobial stewardship (AS) activities and identifying potetntial AS targets. Since 09-2007 Alberta pharmacies have submitted dispensing records to a provincial database; the Pharmacy Information Network (PIN). Our objective was to validate the IMS Brogan estimates for the province of Alberta using data from the PIN. Methods: Guidelines for reporting reliability and agreement studies (GRRAS) were followed. We obtained dispensing data from IMS and PIN for systemic AB [ATC J01] for 8 consecutive quarters from 07-2010 to 06-2012. Number of scripts were provided for all systemic ABs in 5 provincial health zones grouped by age (0-17, 18-64 and ≥65). Population estimates for each zone and each age group as of June 3...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2012
In Canada, treatment of children and adolescents with antipsychotics is almost always off label. ... more In Canada, treatment of children and adolescents with antipsychotics is almost always off label. A single atypical agent, aripiprazole, only recently received regulatory authorization for use in the group aged 15 to 17 years. This regulatory approval was restricted to treatment of schizophrenia. The objective of this review was to summarize pharmacoepidemiologic reports examining the frequency of use of these medications. A literature search was used to identify English-language studies examining the pharmacoepidemiology of antipsychotics in children and adolescents. The results of identified studies were summarized using narrative review methods. In countries where longitudinal data are available, increased antipsychotic use has been consistently observed. Generally, most or all of this increase can be attributed to second-generation antipsychotics (SGAs). Major international differences are evident in the literature. European studies describe lower overall frequencies of use than ...
ABSTRACT Introduction: Antimicrobial stewardship (AS) within acute care facilities is a requireme... more ABSTRACT Introduction: Antimicrobial stewardship (AS) within acute care facilities is a requirement for Accreditation Canada's Required Organisational Practices. In order to obtain a baseline evaluation of current AS processes, a focus group approach was used to qualitatively assess frontline pharmacy staff and leadership perspectives on AS resources. Methods: A semi-structured interview process was applied to focus groups comprised of Pharmacy Services employees throughout Alberta Health Services in Alberta, Canada. A thematic analysis of transcripts was done independently by two investigators, and consensus was reached on identified themes and topics. Codes were recorded for prevalence and total number of mentions. A combination of conventional and deductive approaches was used to identify themes. Results: A total of 200 (10%) pharmacy services staff members participated in the focus groups. Eight main themes were identified: antimicrobial resources, influences on antimicrobial utilisation, barriers to antimicrobial stewardship, establishing AS teams, education needs, improving communications, antimicrobial utilisation concerns, and enablers for improvement. Two hundred and six topics were identified to support the themes, with 1924 data points. Prominent topics included ubiquitous awareness of a provincial antimicrobial stewardship reference, prescriber preferences influencing antimicrobial utilisation, and desire to improve interprofessional teamwork, communication and educational opportunities. Conclusions: A broad description of the culture of antimicrobial use showed that the themes are interrelated. To successfully change practice, one must take into account the complexity of the relationship between these perceptions.
Canadian journal of psychiatry. Revue canadienne de psychiatrie
Current epidemiologic knowledge about bipolar disorder (BD) in Canada is inadequate. To date, onl... more Current epidemiologic knowledge about bipolar disorder (BD) in Canada is inadequate. To date, only 3 prevalence studies have been conducted: only 1 was based on a national sample, and none distinguished between BD I and II. The objective of this study was to estimate the prevalence of BD I and II in Canada in 2012. Data were obtained from the 2012 Canadian Community Health Survey: Mental Health and Well-being, a cross-sectional survey of a nationally representative sample of household residents ages 15 years and older (n = 25 113). The survey response rate was 68.9%. Interviews were based on the World Health Organization Composite International Diagnostic Interview (CIDI). Prevalence was estimated using generalized linear modelling. Prevalence of self-reported diagnosis of BD and use of lithium were also estimated. The estimated lifetime prevalence of BD I and II (based on the CIDI) in Canada in 2012 was 0.87% (95% CI 0.67% to 1.07%) and 0.57% (95% CI 0.44% to 0.71%), respectively. ...
Background: Appropriate baseline quantification of antibacterial (AB) use is essential to antimic... more Background: Appropriate baseline quantification of antibacterial (AB) use is essential to antimicrobial stewardship (AS). As a result, we aimed to quantify and analyze trends in AB use Alberta, Canada (population: ~4 million). Health care is administered through 5 zones in Alberta; Calgary and Edmonton zones are urban cities with populations > 1 million residents, and South, Central and North zones are regions of small urban centres and rural areas. Methods: We used data from the IMS Brogan Xponent® database to estimate the use of systemic AB for 8 quarters (Jul 2010 - Jun 2012). The population of each zone was obtained from the Alberta Health Care Insurance Plan (AHCIP) for each year. Estimation of end of quarter population was calculated based on a linear population change model anchored to AHCIP data. Number of prescriptions per 1000 inhabitant-days (PrID) and defined daily doses per 1000 inhabitant-days (DID) were calculated for the zones, stratified by ages 0-17 (pediatrics)...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2015
Current epidemiologic knowledge about bipolar disorder (BD) in Canada is inadequate. To date, onl... more Current epidemiologic knowledge about bipolar disorder (BD) in Canada is inadequate. To date, only 3 prevalence studies have been conducted: only 1 was based on a national sample, and none distinguished between BD I and II. The objective of this study was to estimate the prevalence of BD I and II in Canada in 2012. Data were obtained from the 2012 Canadian Community Health Survey: Mental Health and Well-being, a cross-sectional survey of a nationally representative sample of household residents ages 15 years and older (n = 25 113). The survey response rate was 68.9%. Interviews were based on the World Health Organization Composite International Diagnostic Interview (CIDI). Prevalence was estimated using generalized linear modelling. Prevalence of self-reported diagnosis of BD and use of lithium were also estimated. The estimated lifetime prevalence of BD I and II (based on the CIDI) in Canada in 2012 was 0.87% (95% CI 0.67% to 1.07%) and 0.57% (95% CI 0.44% to 0.71%), respectively. ...
Medication administration omissions (MAO) are usually considered medication errors but not all MA... more Medication administration omissions (MAO) are usually considered medication errors but not all MAO are clinically relevant. We determined the frequency of clinically relevant MAO of antimicrobial drugs in adult hospitals in Calgary, Alberta, Canada based on electronic medication administration record (eMAR). We examined 2011 data from eMAR records on medical wards and developed a reproducible assessment scheme to categorize and determine clinical relevance of MAO. We applied this scheme to records from 2012 in a retrospective cohort study to quantify clinically relevant MAO. Significant predictors of clinically relevant MAO were identified. A total of 294,718 dose records were assessed of which 10,282 (3.49%) were for doses not administered. Among these 4903 (1.66% of total); 47.68% of MAO were considered clinically relevant. Significant positive predictors of clinically relevant MAO included inhaled (OR 4.90, 95% CI 3.54-6.94) and liquid oral (OR 1.32, 95% CI 1.18-1.47) route of me...
OBJECTIVE To compare antimicrobial utilization data derived from pharmacy dispensing records and ... more OBJECTIVE To compare antimicrobial utilization data derived from pharmacy dispensing records and nursing administration record data by 2 commonly used units of measure. DESIGN, PARTICIPANTS, AND METHODS Data from nursing administration records and pharmacy dispensing records were obtained for 32 medical wards. From nursing and pharmacy data, defined daily doses (DDD) were calculated, and from the nursing data, days of therapy were derived. Direct comparison of total antimicrobial use was performed by graphical analysis and linear regression. Slope of trend line was used to quantify the difference between pairs of measures. Bland-Altman plots were constructed to determine constant and proportional bias. At the level of individual agents, difference between pairs of measures was calculated and presented graphically and the average (95% CI) for the difference between measures was determined. RESULTS Nursing administration record–derived DDD were on average 23% lower than corresponding ...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 8, 2014
Morbidity due to cardiovascular disease is high among First Nations people. The extent to which t... more Morbidity due to cardiovascular disease is high among First Nations people. The extent to which this may be related to the likelihood of coronary angiography is unclear. We examined the likelihood of coronary angiography after acute myocardial infarction (MI) among First Nations and non-First Nations patients. Our study included adults with incident acute MI between 1997 and 2008 in Alberta. We determined the likelihood of angiography among First Nations and non-First Nations patients, adjusted for important confounders, using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. Of the 46,764 people with acute MI, 1043 (2.2%) were First Nations. First Nations patients were less likely to receive angiography within 1 day after acute MI (adjusted odds ratio [OR] 0.73, 95% confidence interval [CI] 0.62-0.87). Among First Nations and non-First Nations patients who underwent angiography (64.9%), there was no difference in the likelihood of ...
PurposeTo compare the prevalence of cardiovascular risk factors (CV-RF) and disease (CV-D) and he... more PurposeTo compare the prevalence of cardiovascular risk factors (CV-RF) and disease (CV-D) and health care use in people with and without schizophrenia.Subjects/materials and methodsData from the Canadian Community Health Survey (CCHS), cycle 3.1, were used. Prevalence of CV-RF, CV-D, and health care use were compared in those with and without schizophrenia using logistic regression analysis. Sampling weights and bootstrap variance estimates were used to account for survey design.ResultsA total of 399 (0.3%) people with schizophrenia were identified and compared to 120,044 (97.7%) people without. Individuals with schizophrenia were significantly more likely to be obese (34.8% vs. 15.6%) and report diabetes (11.9% vs. 5.3%). After accounting for sociodemographic variables, schizophrenia was not independently associated with diabetes (adjusted odds ratio [aOR]: 0.86; 0.49–1.51). Individuals with schizophrenia were more likely to be hospitalized (21.9% vs. 8.0%; aOR: 2.37; 95% CI: 1.51...
The purpose of this study was to assess the history of previous depression in people with inciden... more The purpose of this study was to assess the history of previous depression in people with incident diabetes compared with people without diabetes. We conducted a population-based nested case-control study using the administrative databases of Saskatchewan Health to assess the study objective. We identified cases of type 2 diabetes based on diagnostics codes and prescription records for individuals over the age of 20 years. For each case subject, two control subjects were randomly selected from the nondiabetic population during the same index year. History of depression, based on diagnostic codes and antidepressant prescription, was ascertained up to 3 years before index date. Simple and multivariate logistic regression analysis was used to estimate the odds ratio (OR) and 95% CIs, after adjusting for age, sex, and frequency of physician visits. Individuals with newly diagnosed diabetes (1,622 of 33,257; 4.9%) were 30% more likely to have had a previous history of depression compared with people without diabetes (2,279 of 59,420; 3.8%). This increased risk remained after controlling for sex and number of physician visits but was limited to subjects 20-50 years of age (adjusted OR 1.23 [95% CI 1.10-1.37]) and not in those aged > or =51 years (0.92 [0.84-1.00]). Depression appears to increase the risk of developing diabetes by approximately 23% in younger adults. This provides information regarding the temporality of the relationship between diabetes and depression.
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Papers by Lauren Bresee