Browsing by Author "Novak, Suzanne"
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Item An analysis of the long-term cost-effectiveness of intensive lifestyle intervention for Type 2 diabetes mellitus prevention(2005) Novak, Suzanne; Lawson, Kenneth Allen, 1952-Item Medication use patterns of antiepileptics and epileptic events(2012-08) Shcherbakova, Natalia G., 1982-; Rascati, Karen L.; Brown, Carolyn; Lawson, Kenneth; Novak, Suzanne; Richards, Kristin; Yoder, LindaThe purpose of this study was to identify clinical and demographic predictors of seizure recurrence in medically-treated patients with epilepsy. Innovus Invision™ Data Mart insurance claims from January 1, 2007 to September 30, 2010 were retrospectively analyzed. Patients aged 18-64 years with a primary or secondary diagnosis of epilepsy and >1 prescription claim for an antiepileptic drug (AED) pre-index were included. The primary outcome was incidence of seizures defined as an occurrence of an emergency room visit, ambulance service use or hospitalization with a primary or secondary diagnosis of epilepsy during the 1-year follow-up period. Predictor variables included antiepileptic drug (AED) adherence (Proportion of Days Covered ≥ 80 %), general comorbidity (Charlson’s Comorbidity Index ≥ 1), any mental health comorbidity, evidence of a prior seizure, type of epilepsy diagnosis (intractable versus non-intractable), presence of AED-interacting medications and any bioequivalent AED switch. The covariates included age, gender and geographic region of residence. The overall incidence of post-index seizures in the 1-year follow-up period for all four monotherapy cohorts combined was 5.3 % (n=166/3140), but was higher for the Keppra®/levetiracetam cohort (7.9%; n=88/1114) compared to the other cohorts [Lamictal®/lamotrigine (3.9%; n=45/1143), Trileptal®/oxcarbazepine (4.0%; n=18/456) and Topamax®/topiramate (3.5%; n=15/427)]. The combined cohort analysis demonstrated that pre-index seizures (odds ratio [OR] = 4.28; 95% CI, 2.81-6.53), any mental health comorbidity ([OR] = 3.41; 95% CI, 2.10-5.54), Charlson comorbidity Index ≥1 ([OR] = 2.88; 95% CI, 1.96-4.24) and monotherapy with Keppra®/levetiracetam ([OR] = 1.54; 95% CI, 1.03-2.31) were significant predictors of seizure recurrence. Among covariates, only geographic region was a significant predictor, with patients residing in the Northeast U.S. having higher odds of post-index seizure ([OR] = 1.92; 95% CI, 1.19-3.10), while controlling for clinical, medication and demographic characteristics. A bioequivalent AED switch, type of epilepsy diagnosis, AED adherence and the presence of interacting medications were not significant predictors of seizure recurrence in the combined cohort (p>0.05). Results indicate that epilepsy patients with comorbid conditions (both mental and somatic diseases), as well as patients who may have initially been unstable (with previous seizure occurrences) were more likely to experience seizures during the follow-up period.Item Use of statins and the development of incident diabetes mellitus : a retrospective cohort study(2015-05) Olotu, Busuyi Sunday; Shepherd, Marvin D.; Lawson, Kenneth A; Wilson, James P; Richards, Kristin M; Novak, SuzanneStatins are pharmaceutical agents used in lowering blood cholesterols levels. Several landmark statin trials have demonstrated the beneficial effects of statins in both primary and secondary prevention of cardiovascular disease. Although statins are generally safe and well tolerated, several studies have suggested that statins are associated with a moderate increase in risk of new-onset diabetes. These observations prompted the FDA to revise statin labels to now include a warning of an increased risk of incident diabetes mellitus as a result of increases in glycosylated hemoglobin (A1C) and fasting plasma glucose (FPG). However, few studies have used US-based data to investigate this statin-associated increased risk of diabetes. Thus, the purpose of this study was to evaluate whether statin use was associated with an increased risk of new-onset diabetes. In addition, this study evaluated whether diabetes risk was increased when patients received intensive statin doses. This study was a retrospective cohort analysis that utilized data from the Thomson Reuters MarketScan® Commercial Claims Database for the period of 2003 - 2004. The study population included new statin users who were aged 20 - 63 years at index and who do not have a history of diabetes. Among the study population (N=116,224), 6.5% (or N=7,593) had incident diabetes. Compared to no statin use, statin use was significantly associated with increased risk of incident diabetes (HR=2.752; 99% C.I.=2.535 - 2.987; p<0.0001). In addition, each statin type (i.e., atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin) was associated with about a two-fold increase in risk of diabetes. Diabetes risk was highest among lovastatin users and lowest among rosuvastatin users. Furthermore, diabetes risk was higher among intensive-dose statin users compared to moderate-dose statin users (HR=1.540; 99% C.I.=1.393 – 1.704; p<0.0001). Because of the proven benefits of statins in both primary and secondary prevention of cardiovascular disease, and because the potential for diabetogenicity differs among statins, health care professionals should individualize statin therapy by identifying patients who would benefit from less diabetogenic statin types. This could help optimize treatment by providing the highest benefit achievable while reducing the number of patients developing diabetes under statin therapy.Item Using the theory of planned behavior to examine Texas community pharmacists’ intentions to utilize a prescription drug monitoring program(2012-08) Fleming, Marc L., 1971-; Barner, Jamie C.; Brown, Carolyn M.; Shepherd, Marvin D.; Strassels, Scott A.; Novak, SuzanneThe purpose of this study was to determine the predictive utility of the theory of planned behavior (TPB) in predicting and explaining pharmacists’ intention to utilize a prescription drug monitoring program (PDMP) database, when the validity of the prescription/patient need is in question. The study tested the significance of each TPB model construct variable (attitude [A], subjective norm [SN], and perceived behavioral control [PBC]) in predicting pharmacists’ high intention, compared to non-high intention (dichotomous variable). In addition, the study examined the additional contribution of pharmacists’ perception of prescription (PPDA) drug abuse and perceived obligation (PO) to the TPB model. Demographic and practice characteristics were also explored in relation to the TPB model predictors, A, SN and PBC. A mail questionnaire was sent to a random sample of 998 Texas community pharmacists with active licenses. Three focus groups were conducted to collect information regarding pharmacists’ beliefs toward PDMP database utilization. The usable survey response rate was 26.2%. Due to data that were not normally distributed, intention was dichotomized into high intention and non-high intention. The TPB constructs were significant predictors of pharmacists’ high intention. Pharmacists with positive attitudes were almost twice as likely to have high intention (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.2 – 2.8). However, SN was the strongest predictor of pharmacists’ high intention (OR = 2.2, 95% CI = 1.4 – 3.3). Pharmacists who reported substantial PBC were also twice as likely to have high intention (OR = 1.9, 95% CI = 1.2 – 3.0). PPDA was not significantly related to pharmacists’ high intention. However, pharmacists’ PO was shown to predict high intention above that explained by the TPB model (OR = 1.8, 95% CI = 1.0 – 3.1). The results of this study support the utility of the TPB model with PO in predicting pharmacists’ high intention to utilize a PDMP database. Interventions that address pharmacists’ A, SN, PBC, and PO may be necessary to increase pharmacists’ high intention to utilize a PDMP database when it becomes available. Future studies using intention as a predictor of pharmacists’ behavior are needed to assess the influence of intention on PDMP utilization.