The American journal of managed care
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Pharmacokinetic drug-drug interactions (DDIs) involving opioid analgesics can be problematic. Opioids are widely used, have a narrow therapeutic index, and can be associated with severe toxicity. ⋯ Opioids metabolized by the drug metabolizing enzymes of the cytochrome P450 (CYP450) system (codeine, oxycodone, hydrocodone, fentanyl, tramadol, and methadone) are associated with numerous DDIs that can result in either a reduction in opioid effect or excess opioid effects. Conversely, opioids that are not metabolized by that system (morphine, oxymorphone, and hydromorphone) tend to be involved in fewer CYP450-associated pharmacokinetic DDIs.
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To evaluate the effect of medical comanagement on outcomes of hospitalized surgical patients who had postoperative complications. ⋯ Comanagement of patients who had perioperative complications was associated with lower mortality, suggesting that comanagement may facilitate effective rescue among medically complex surgical patients.
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To study risk factors for and likelihood of unplanned hospital admission and readmission in persons aged >65 years in Catalonia, Spain. ⋯ Aged persons and those who used more hospital services in previous years had a higher probability of hospital admission and readmission.
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To evaluate patient and physician characteristics associated with the purchase of antidepressant medication for at least 6 months. ⋯ The findings suggest that in a managed care setting, there is high uniformity among physicians. Although physician characteristics explain little of the variability associated with adherence, certain patient characteristics as determined by their physicians (eg, antidepressant drug class, psychiatric diagnosis) do play a role in adherence.
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To investigate compliance, persistence, and switching patterns for angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). ⋯ Although residual confounding and indication bias cannot be ruled out, this study showed that compliance, persistence, and switching behavior varied between specific ACE inhibitors but not between specific ARBs. These results support prescribing of cheap generic ARBs as opposed to expensive ARBs. Apart from factors leading to therapy switches, compliance and persistence were similar between ACE inhibitors and ARBs.