Restocking the sample closet: results of a trial to alter medication prescribing

BACKGROUND: Although medication costs make up a large and growing portion of health care costs, few interventions have successfully encouraged physicians to alter prescribing patterns. METHODS: To promote the use of an open formulary, we altered the contents of the sample closets of five primary care practices in eastern Massachusetts. In these practices, we removed all nonformulary drugs in five drug classes and restocked with purchased generic samples. We performed a time series analysis of formulary compliance, before and during an 8-month intervention, with five concurrent control practices for comparison. RESULTS: Although providers in both the intervention and control practices complied well with the formulary, we found no incremental effect of the sample closet intervention on absolute formulary compliance (P = .46) or on the secular trend in formulary compliance (P = .60). We also found no effect on these measures in any of the individual drug classes studied. CONCLUSIONS: This sample closet intervention did not appear to improve further the good formulary compliance in these practices. In such settings, better ways are needed to guide prescribing behavior.     

Association of Fetuin‐A With Incident Fractures in Community‐Dwelling Older Adults: The Cardiovascular Health Study

Fetuin‐A, a serum protein that regulates calcium mineralization, has been associated with bone mineral density (BMD) in several cross‐sectional human studies, suggesting a possible beneficial effect on clinically important measures of bone health. Fetuin‐A and incidence of subsequent fracture was assessed in 4714 men and women ≥65 years of age. Proportional hazards models were used to estimate risk of incident hip (hospital discharge ICD‐9 codes) and composite fracture (hip, pelvis, humerus, or proximal forearm; hospital discharge ICD‐9 codes and Medicare claims data). A total of 576 participants had an incident hip fracture (median follow‐up 11.2 years) and 768 had an incident composite fracture (median follow‐up 6.9 years). In unadjusted analyses, there was no association between fetuin‐A (per SD increase) and risk of hip fracture (hazard ratio [HR], 0.96; 95% CI, 0.88 to 1.05) or composite fracture (HR, 0.99; 95% CI, 0.92 to 1.06). Results were not significantly changed after adjustment for potential confounding variables. Analyses modeling fetuin‐A in quartiles or within a subset with available BMD measures also showed no statistically significant association with risk of hip or composite fracture. Though fetuin‐A was positively associated with areal BMD in partially adjusted models (total hip: β, 0.013 g/cm²; 95% CI, 0.005 to 0.021; femoral neck: β, 0.011 g/cm²; 95% CI, 0.004 to 0.018; and lumbar spine: β, 0.007 g/cm²; 95% CI, 0.001 to 0.028), these associations were no longer significant after further adjustment for BMI and in final multivariate models. In this large sample of community‐dwelling older adults, a small positive association between fetuin‐A and areal BMD appeared attributable to confounding variables and we found no evidence of an association between fetuin‐A and risk of clinical fracture. © 2015 American Society for Bone and Mineral Research © 2015 American Society for Bone and Mineral Research.