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  • Patterns of Prescription Drug Use Before and After Fragility Fracture

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    JAMA Intern Med. 2016; 176(10):1531-1538. doi: 10.1001/jamainternmed.2016.4814

    This pharmacoepidemiology study uses Medicare Part D data to describe changes in use of prescription drugs associated with an increase in fracture risk before and after fragility fractures.

  • Pharmaceutical Industry–Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries

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    JAMA Intern Med. 2016; 176(8):1114-1122. doi: 10.1001/jamainternmed.2016.2765

    This study explores whether receipt of pharmaceutical industry-sponsored meals by physicians is associated with their prescribing the promoted brand-name drug at higher rates to Medicare beneficiaries.

  • JAMA Internal Medicine August 1, 2016

    Figure 1: Target Branded Drugs as a Percentage of All Filled Prescriptions in the Class in 2013, Across Days Receiving Target Drug–Sponsored Meals

    Filled prescriptions for each target branded drug are shown as a percentage of all prescriptions within the class, according to number of days receiving target drug-sponsored meals. A, Statins. B, Cardioselective β-blockers. C, Angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers (ACE inhibitors and ARBs). D, Selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs). Sample sizes for Figure 1 are shown in the last 5 rows of Table 2. Error bars indicate 95% confidence intervals.
  • JAMA Internal Medicine August 1, 2016

    Figure 2: Predicted Probabilities for Prescribing the Target Drug as a Percentage of All Prescriptions in the Class, According to the Number and Cost of Sponsored Meals Received by Each Physician

    The figure shows predicted probabilities for prescribing the target drug over alternatives within the treatment class, based on the cost and number of meals received promoting the target drug. Predicted probabilities are calculated for physicians with the highest-frequency values of all characteristics in Table 1 (male sex, internal medicine specialty, Southern region, urban location, group size ≥51, ≥20 years since medical school graduation, and mean values for prescribing volume, income in zip code, and percentage of low-income subsidy and Medicare Advantage Part D patients). A, Statins. B, Cardioselective β-blockers. C, Angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers (ACE inhibitors and ARBs). D, Selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs). Error bars indicate 95% confidence intervals.
  • Estimation of Potential Savings Through Therapeutic Substitution

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    JAMA Intern Med. 2016; 176(6):769-775. doi: 10.1001/jamainternmed.2016.1704

    This cross-sectional study estimates potential savings through therapeutic substitution in terms of both overall and out-of-pocket expenditures of branded drugs when a generic in the same class with the same indication was available.

  • Vasomotor Symptom Duration in Midlife Women—Research Overturns Dogma

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    JAMA Intern Med. 2015; 175(4):540-541. doi: 10.1001/jamainternmed.2014.8099
  • JAMA Internal Medicine November 1, 2014

    Figure: Evolution of Suicidal Ideation and HAD Scores During the Follow-up Period by Type and Dosage of Antidepressant at Treatment Onset

    A suicidal ideation is based on the score (>1) of item 9 of the Montgomery-Åsberg Depression Rating Scale. HAD indicates Hospital Anxiety and Depression Scale; SSRI, selective serotonin reuptake inhibitor.
  • Antidepressant Dosage and Suicidal Ideation

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    JAMA Intern Med. 2014; 174(11):1863-1865. doi: 10.1001/jamainternmed.2014.4509
  • Selective Serotonin Reuptake Inhibitors and Surgery: To Hold or Not to Hold, That Is the Question: Comment on “Perioperative Use of Selective Serotonin Reuptake Inhibitors and Risks for Adverse Outcomes of Surgery”

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    JAMA Intern Med. 2013; 173(12):1082-1083. doi: 10.1001/jamainternmed.2013.718
  • Perioperative Use of Selective Serotonin Reuptake Inhibitors and Risks for Adverse Outcomes of Surgery

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    JAMA Intern Med. 2013; 173(12):1075-1081. doi: 10.1001/jamainternmed.2013.714
    Auerbach et al examined the relationship between perioperative administration of selective serotonin reuptake inhibitors (SSRIs) and adverse outcomes of surgery (mortality, bleeding, length of stay, readmission, and ventricular arrhythmia). An invited commentary by Mrkobrada and Hackam follows.
  • JAMA Internal Medicine June 24, 2013

    Figure: Serotonin Reuptake Inhibitor Use, Depression, and Long-Term Outcomes After an Acute Coronary Syndrome: A Prospective Cohort Study

    Figure. Event-free survival for combined major adverse cardiac events and mortality in 3 medication groups. Vertical dotted line at 180 days indicates the longest follow-up duration (for adverse cardiac events) in current randomized clinical trials of selective serotonin reuptake inhibitors (SSRIs) in cardiac patients.
  • Serotonin Reuptake Inhibitor Use, Depression, and Long-Term Outcomes After an Acute Coronary Syndrome: A Prospective Cohort Study

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    JAMA Intern Med. 2013; 173(12):1150-1151. doi: 10.1001/jamainternmed.2013.910
  • JAMA Internal Medicine February 11, 2013

    Figure: Opioid Dose and Risk of Road Trauma in Canada: A Population-Based Study

    Figure 3. Association between opioid dose and road trauma, adjusted for age, past (3 years) hospitalization for alcoholism, past (1 year) emergency department (ED) visit for alcoholism, duration of opioid treatment, medication use in past 180 days (ie, selective serotonin reuptake inhibitors, other antidepressants, antipsychotics, benzodiazepines and other depressants of the central nervous system, separately), number of drugs dispensed in the past 180 days, and numbers of physician and ED visits in the past 1 year. For all comparisons, the reference group includes those who received an opioid dose of 1 to 19 mg of morphine or equivalent (MEQ). *Includes 5300 cases and controls. †Includes 2428 cases and controls. ‡Includes 840 cases and controls.
  • Antidepressant Use and Risk of Incident Cardiovascular Morbidity and Mortality Among Postmenopausal Women in the Women's Health Initiative Study

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    Arch Intern Med. 2009; 169(22):2128-2139. doi: 10.1001/archinternmed.2009.436
  • JAMA Internal Medicine December 14, 2009

    Figure 1: Antidepressant Use and Risk of Incident Cardiovascular Morbidity and Mortality Among Postmenopausal Women in the Women's Health Initiative Study

    Diagram depicting derivation of analytic cohort. AD indicates antidepressant; CT, clinical trial; DM, diabetes mellitus; HT, hypertension; OS, observational study; SSRI, selective serotonin reuptake inhibitor; and TCA, tricyclic antidepressant.
  • JAMA Internal Medicine April 27, 2009

    Figure 2: Prior Authorization for Antidepressants in Medicaid: Effects Among Disabled Dual Enrollees

    Rates of antidepressant therapy initiation (Michigan, n = 28 798, solid boxes; Indiana, n = 21 769, gray diamonds) (A) and switching among established selective serotonin reuptake inhibitor/serotonin norepinephrine reuptake inhibitor users (Michigan, n = 14 638; Indiana, n = 10 398) (B). PA indicates prior authorization.
  • JAMA Internal Medicine April 27, 2009

    Figure 1: Prior Authorization for Antidepressants in Medicaid: Effects Among Disabled Dual Enrollees

    Prevalence of use by type of antidepressant (Michigan, n = 28 798 [A]; Indiana, n = 21 769 [B]). PA indicates prior authorization; gray triangles, all antidepressants; gray diamonds, other antidepressants; open boxes, nonpreferred selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors (SSRIs/SNRIs); solid boxes, preferred SSRIs/SNRIs.
  • Prior Authorization for Antidepressants in Medicaid: Effects Among Disabled Dual Enrollees

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    Arch Intern Med. 2009; 169(8):750-756. doi: 10.1001/archinternmed.2009.39
  • Antidepressant Use, Depression, and Survival in Patients With Heart Failure

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    Arch Intern Med. 2008; 168(20):2232-2237. doi: 10.1001/archinte.168.20.2232
  • JAMA Internal Medicine July 14, 2008

    Figure: Prevalence of Low Sexual Desire and Hypoactive Sexual Desire Disorder in a Nationally Representative Sample of US Women

    A directed acyclic graph (DAG) we constructed shows the anticipated relationships between menopausal status, low sexual desire/hypoactive sexual desire disorder (HSDD), and the other variables being evaluated in this analysis. The direction of the arrows between any 2 variables indicates the known (as indicated by the literature) or assumed directionality of the relationship. We considered body mass index (BMI) as a confounder because there is evidence suggesting an association between menopausal status and BMI. Heavier women tend to go through the menopausal transition at a later age, perhaps due to a relationship between adiposity and hormonal production. In addition, women with a higher BMI may have lower self-image, which may result in low sexual desire or HSDD. Although the mechanism is not always apparent, smoking status was included in this DAG because of its relationship with menopausal status. The age at natural menopause is influenced by whether and how much a woman currently smokes and may be associated with low sexual desire and HSDD either causally or because of its associations with other health outcomes or risky behaviors. Depression was included in the DAG based on a review by West et al suggesting that women with psychiatric comorbidities, especially depression and anxiety, are at higher risk of sexual dysfunction. There is also literature suggesting menopause may lead to depression, perhaps because of hormonal fluctuations. Similarly, antidepressants were included in the DAG because the most popular type, the selective serotonin reuptake inhibitors, are known to have sexual dysfunction as a critical adverse effect, and they are used for the treatment of depression and menopausal hot flashes. Note that the directionality of the arrows indicates that depression, antidepressants, and exogenous hormones are potential intermediates along the causal pathway between menopause and low sexual desire or HSDD and cannot be confounders of this relationship. The directionality of the smoking status and depression association is unclear because some studies indicate that depression leads to smoking and other studies indicate that smoking leads to depression, perhaps through some unmeasured confounders. Also, the age at which smoking begins may affect the directionality of its relationship with depression.