ABSTRACT
Objective: To evaluate real-world treatment patterns for patients initiating benztropine and to understand treatment approaches in patients with drug-induced movement disorders from a health care provider perspective.Methods: A retrospective claims analysis was conducted among patients with evidence of benztropine initiation from January 2017 through March 2020 to assess treatment patterns and patient health care resource utilization. Subsequently, a 30-minute, United States-based online survey fielded from December 2021 to January 2022 was sent to physicians, nurse practitioners, and physician assistants who reported a primary care or psychiatry specialty currently treating drug-induced movement disorders and prescribed benztropine.Results: The health care claims analysis included 112,542 patients. Polypharmacy and multiple comorbidities were frequent characteristics in this population; 54.1% of patients had ≥ 2 comorbidities at baseline, and 59.1% had claims for > 10 medications. Benztropine was used for > 3 months in > 50% of the population. Health care costs and resource utilization were high, with mean all-cause pharmacy and outpatient costs totaling $11,755. Survey results from 349 primary care or psychiatry health care providers indicated that benztropine is often used in non-tardive dyskinesia drug-induced movement disorders but frequently continued for > 3 months or used in tardive dyskinesia. In this study, psychiatry providers prescribed benztropine in line with guideline recommendations more often than primary care providers; however, < 40% indicated familiarity with 2020 American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia.Conclusions: These complementary analyses suggest that benztropine is used long-term in non-tardive dyskinesia drug-induced movement disorders and in tardive dyskinesia despite risks of worsening tardive dyskinesia or adverse effects.Prim Care Companion CNS Disord 2023;25(4):22m03472. Author affiliations are listed at the end of this article.
Subject(s)
Movement Disorders , Tardive Dyskinesia , Humans , Benztropine , Insurance Claim Review , Retrospective Studies , Health PersonnelABSTRACT
Este artículo pretende explorar el concepto de antifragilidad en el adulto mayor, dado el cambio demográfico en el mundo, con evidencia del aumento de personas mayores, que exige a los profesionales vinculados a su atención implementar modelos de intervención acordes con sus necesidades, relacionadas con su capacidad funcional y promoción de una cultura de antifragilidad. La construcción teórica de lo que significa ser adulto mayor antifrágil, en una sociedad que asimila el envejecimiento con fragilidad, enfermedad y discapacidad, es una oportunidad para presentar una mirada positiva de la salud en la vejez, a partir de las adaptaciones al estrés en diferentes dimensiones que influencian la vida de este grupo poblacional, en el que el capital físico, psicológico y social se integran e influencian, en un proceso que se relaciona con la antifragilidad y el envejecer como un continuo de la vida, con ganancias y pérdidas; el estudio de esta relación permitirá contar con políticas inclusivas adecuadas en cada etapa de la vida.
This article intends to explore the concept of anti-fragility in the elderly, given the demographic change in the world, with evidence of the increase in the number of elderly people, which requires professionals linked to their care, to implement intervention models in accordance with their needs, related to their functional capacity and promotion of a culture of antifragility. The theoretical construction of what it means to be an anti-fragile older adult, in a society that assimilates aging with frailty, illness and disability, is an opportunity to present a positive view of health in old age, based on the adaptations to stress in different dimensions that influence the life of this population group, in which physical, psychological and social capital are integrated and influenced, in a process that is related to anti-fragility and aging as a continuum of life, with gains and losses; the study of this relationship will make it possible to have appropriate inclusive policies at each stage of life.
ABSTRACT
Dengue continues to be the most important viral vector-borne disease in the world, particularly in Asia and Latin America, and is significantly affected by climate variability. The influence of climate in an endemic region of Colombia, from 2010 to 2011, was assessed. Epidemiological surveillance data (weekly cases) were collected, and incidence rates were calculated. Poisson regression models were used to assess the influence of the macroclimatic variable ONI (Oscillation Niño Index) and the microclimatic variable pluviometry (mm of rain for Risaralda) on the dengue incidence rate, adjusting by year and week. During the study period, 13,650 cases were reported. In 2010, the rates ranged from 8.6 cases/100,000 pop. up to a peak of 75.3 cases/100,000 pop. for a cumulative rate of 456.2 cases/100,000 pop. in that week. The climate variability in 2010 was higher (ONI 1.6, El Niño to -1.5, La Niña) than in 2011 (ONI -1.4, La Niña to -0.2, Neutral). The mean pluviometry was 248.45mm (min 135.9-max 432.84). During El Niño, cases were significantly higher (mean 433.81) than during the climate neutral period (142.48) and during the La Niña (52.80) phases (ANOVA F=66.59; p<0.001). Regression models showed that the ONI (coefficient 0.329; 95%CI 0.209-0.450) and pluviometry (coefficient 0.003; 95%CI 0.002-0.004) were highly significant independent variables associated with dengue incidence rate, after adjusting by year and week (p<0.001, pseudo r(2)=0.6913). El Niño significantly affected the incidence of dengue in Risaralda. This association with climate change and variability should be considered in the elements influencing disease epidemiology. In addition, predictive models should be developed further with more available data from disease surveillance.
