Andrew M Naidech1, Jennifer Beaumont2, Babak Jahromi2, Shyam Prabhakaran2, Abel Kho2, Jane L Holl2. 1. From the Departments of Neurology (A.M.N., S.P.), Medical Social Sciences (J.B.), and Neurological Surgery (B.J.), and the Institute for Public Health and Medicine (A.K., J.L.H.), Center for Healthcare Studies, Northwestern Medicine, Chicago, IL. a-naidech@northwestern.edu. 2. From the Departments of Neurology (A.M.N., S.P.), Medical Social Sciences (J.B.), and Neurological Surgery (B.J.), and the Institute for Public Health and Medicine (A.K., J.L.H.), Center for Healthcare Studies, Northwestern Medicine, Chicago, IL.
Abstract
OBJECTIVE: Prophylactic medications can be a source of preventable harm, potentially affecting large numbers of patients. Few data exist about how clinicians change prescribing practices in response to new data and revisions to guidelines about preventable harm from a prophylactic medication. We sought to determine the changes in prescribing practice of seizure medications for patients with intracerebral hemorrhage (ICH) across a metropolitan area before and after new outcomes data and revised prescribing guidelines were published. METHODS: We conducted an observational study using electronic medical record data from 4 academic medical centers in a large US metropolitan area. RESULTS: A total of 3,422 patients with ICH, diagnosed between 2007 and 2012, were included. In 2009, after a publication found an association of phenytoin with higher odds of dependence or death, the use of phenytoin declined from 9.6% in 2009 to 2.2% in 2012 (p < 0.00001). Conversely, the use of levetiracetam more than doubled, from 15.1% in 2007 to 35% in 2012 (p < 0.00001). Use of levetiracetam varied among the 4 institutions from 6.7% to 29.8% (p < 0.00001). CONCLUSIONS: New data that led to revised prescribing guidelines for prophylactic seizure medications for patients with ICH were temporally associated with a significant decrease in use of the medication, potentially reducing adverse outcomes. However, a corresponding increase in the use of an alternative medication, levetiracetam, occurred despite limited knowledge about its potential effects on outcomes. Future guideline changes should anticipate and address alternatives.
OBJECTIVE: Prophylactic medications can be a source of preventable harm, potentially affecting large numbers of patients. Few data exist about how clinicians change prescribing practices in response to new data and revisions to guidelines about preventable harm from a prophylactic medication. We sought to determine the changes in prescribing practice of seizure medications for patients with intracerebral hemorrhage (ICH) across a metropolitan area before and after new outcomes data and revised prescribing guidelines were published. METHODS: We conducted an observational study using electronic medical record data from 4 academic medical centers in a large US metropolitan area. RESULTS: A total of 3,422 patients with ICH, diagnosed between 2007 and 2012, were included. In 2009, after a publication found an association of phenytoin with higher odds of dependence or death, the use of phenytoin declined from 9.6% in 2009 to 2.2% in 2012 (p < 0.00001). Conversely, the use of levetiracetam more than doubled, from 15.1% in 2007 to 35% in 2012 (p < 0.00001). Use of levetiracetam varied among the 4 institutions from 6.7% to 29.8% (p < 0.00001). CONCLUSIONS: New data that led to revised prescribing guidelines for prophylactic seizure medications for patients with ICH were temporally associated with a significant decrease in use of the medication, potentially reducing adverse outcomes. However, a corresponding increase in the use of an alternative medication, levetiracetam, occurred despite limited knowledge about its potential effects on outcomes. Future guideline changes should anticipate and address alternatives.
Authors: J P Broderick; H P Adams; W Barsan; W Feinberg; E Feldmann; J Grotta; C Kase; D Krieger; M Mayberg; B Tilley; J M Zabramski; M Zuccarello Journal: Stroke Date: 1999-04 Impact factor: 7.914
Authors: A Gray Ellrodt; Gregg C Fonarow; Lee H Schwamm; Nancy Albert; Deepak L Bhatt; Christopher P Cannon; Adrian F Hernandez; Mark A Hlatky; Russell V Luepker; Pamela N Peterson; Mathew Reeves; Eric Edward Smith Journal: Circulation Date: 2013-10-28 Impact factor: 29.690
Authors: Kevin N Sheth; Sharyl R Martini; Charles J Moomaw; Sebastian Koch; Mitchell S V Elkind; Gene Sung; Steven J Kittner; Michael Frankel; Jonathan Rosand; Carl D Langefeld; Mary E Comeau; Salina P Waddy; Jennifer Osborne; Daniel Woo Journal: Stroke Date: 2015-10-15 Impact factor: 7.914
Authors: Lewis B Morgenstern; J Claude Hemphill; Craig Anderson; Kyra Becker; Joseph P Broderick; E Sander Connolly; Steven M Greenberg; James N Huang; R Loch MacDonald; Steven R Messé; Pamela H Mitchell; Magdy Selim; Rafael J Tamargo Journal: Stroke Date: 2010-07-22 Impact factor: 7.914
Authors: Thomas W K Battey; Guido J Falcone; Alison M Ayres; Kristin Schwab; Anand Viswanathan; Kristen A McNamara; Zora Y DiPucchio; Steven M Greenberg; Kevin N Sheth; Joshua N Goldstein; Jonathan Rosand Journal: Neurocrit Care Date: 2012-12 Impact factor: 3.210
Authors: P M Vespa; K O'Phelan; M Shah; J Mirabelli; S Starkman; C Kidwell; J Saver; M R Nuwer; J G Frazee; D A McArthur; N A Martin Journal: Neurology Date: 2003-05-13 Impact factor: 9.910
Authors: Elena Haapaniemi; Daniel Strbian; Costanza Rossi; Jukka Putaala; Tuulia Sipi; Satu Mustanoja; Tiina Sairanen; Sami Curtze; Jarno Satopää; Reina Roivainen; Markku Kaste; Charlotte Cordonnier; Turgut Tatlisumak; Atte Meretoja Journal: Stroke Date: 2014-05-29 Impact factor: 7.914
Authors: Jacques E Rossouw; Garnet L Anderson; Ross L Prentice; Andrea Z LaCroix; Charles Kooperberg; Marcia L Stefanick; Rebecca D Jackson; Shirley A A Beresford; Barbara V Howard; Karen C Johnson; Jane Morley Kotchen; Judith Ockene Journal: JAMA Date: 2002-07-17 Impact factor: 56.272
Authors: Matthew B Maas; Neil F Rosenberg; Adam R Kosteva; Rebecca M Bauer; James C Guth; Eric M Liotta; Shyam Prabhakaran; Andrew M Naidech Journal: Neurology Date: 2013-06-05 Impact factor: 9.910
Authors: Andrew M Naidech; Jennifer Beaumont; Kathryn Muldoon; Eric M Liotta; Matthew B Maas; Matthew B Potts; Babak S Jahromi; David Cella; Shyam Prabhakaran; Jane L Holl Journal: Crit Care Med Date: 2018-09 Impact factor: 7.598