Are Financial Payments From the Pharmaceutical Industry Associated With Physician Prescribing? A Systematic Review

Mitchell AP, Trivedi NU, Gennarelli RL, Chimonas S, Tabatabai SM, Goldberg J, Diaz LA Jr, Korenstein D. Ann Intern Med. 2020 Nov 24. [CrossRef] [PubMed]

Financial payments from the drug industry to U.S. physicians are common and may influence physicians' clinical decision making and drug prescribing. The authors searched MEDLINE (Ovid), Embase, the Cochrane Library, Web of Science, and EconLit for studies examining an association between receipt of industry payments (exposure) and prescribing (outcome). Thirty-six studies comprising 101 analyses were included. Most studies (n = 30) identified a positive association between payments and prescribing in all analyses; the remainder (n = 6) had a mix of positive and null findings. No study had only null findings. Of 101 individual analyses, 89 identified a positive association. Payments were associated with increased prescribing of the paying company's drug, increased prescribing costs, and increased prescribing of branded drugs. Nine studies assessed and found evidence of a temporal association; 25 assessed and found evidence of a dose–response relationship.

Sixty-Day Outcomes Among Patients Hospitalized With COVID-19

Chopra V, Flanders SA, O'Malley M, Malani AN, Prescott HC.  Ann Intern Med. 2020 Nov 11. Epub ahead of print. [CrossRef] [PubMed]

Although characteristics and in-hospital outcomes for persons with coronavirus disease 2019 (COVID-19) have been well described, less is known about the longer-term outcomes of hospitalized patients. This observational cohort study looked at patients hospitalized with COVID-19 (discharged between 16 March and 1 July 2020) at 38 hospitals participating in the MI-COVID19 initiative. Of 1648 patients with COVID-19 admitted to 38 hospitals, 398 (24.2%) died during hospitalization and 1250 (75.8%) survived. Of 1250 patients discharged alive, 975 (78.0%) went home whereas 158 (12.6%) were discharged to a skilled nursing or rehabilitation facility. By 60 days after discharge, an additional 84 patients (6.7% of hospital survivors and 10.4% of intensive care unit [ICU]-treated hospital survivors) had died, bringing the overall mortality rate for the cohort to 29.2%, and 63.5% for the 405 patients who received treatment in an ICU. Within 60 days of discharge, 189 patients (15.1% of hospital survivors) were rehospitalized. Cardiopulmonary symptoms (such as cough and dyspnea) were reported by 159 patients, including 92 with new or worsening symptoms and 65 with persistent loss of taste or smell. Fifty-eight patients reported new or worsening difficulty completing activities of daily living. Among 195 patients who were employed before hospitalization, 117 had returned to work whereas 78 could not because of ongoing health issues or job loss. Of the 117 patients who returned to work, 30 reported reduced hours or modified duties due to health reasons. Although postdischarge chart review was completed for all patients, telephone contact occurred in fewer than half. Despite these limitations, our study indicates that adverse events after COVID-19 hospitalization are common.

Association of Peer Comparison Emails with Electronic Health Record Documentation of Cancer Stage by Oncologists

Sinaiko AD, Barnett ML, Gaye M, Soriano M, Mulvey T, Hochberg E. JAMA Netw Open. 2020 Oct 1;3(10):e2015935. [CrossRef] [PubMed]

In a randomized pilot study of 56 oncologists at the Massachusetts General Hospital, the authors sent emails with peer comparison data on the proportion of an oncologist’s patients with cancer stage documentation in the machine-readable structured fields in electronic health records (EHRs). Sending these emails were associated with increased documentation of patients’ stage in the EHR by 9.0 percentage points, a relative increase of 69%. The association was observed among oncologists’ new, but not established, patients. The findings suggest interventions using peer comparisons could change physician performance on the EHR among oncologists.

Modeling COVID-19 scenarios for the United States

IHME COVID-19 Forecasting Team. Nat Med. 2020 Oct 23. Epub ahead of print. [CrossRef] [PubMed]

We use COVID-19 case and mortality data from 1 February 2020 to 21 September 2020 and a deterministic SEIR (susceptible, exposed, infectious and recovered) compartmental framework to model possible trajectories of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and the effects of non-pharmaceutical interventions in the United States at the state level from 22 September 2020 through 28 February 2021. Using this SEIR model, and projections of critical driving covariates (pneumonia seasonality, mobility, testing rates and mask use per capita), we assessed scenarios of social distancing mandates and levels of mask use. Projections of current non-pharmaceutical intervention strategies by state-with social distancing mandates reinstated when a threshold of 8 deaths per million population is exceeded (reference scenario)-suggest that, cumulatively, 511,373 (469,578-578,347) lives could be lost to COVID-19 across the United States by 28 February 2021. We find that achieving universal mask use (95% mask use in public) could be sufficient to ameliorate the worst effects of epidemic resurgences in many states. Universal mask use could save an additional 129,574 (85,284-170,867) lives from September 22, 2020 through the end of February 2021, or an additional 95,814 (60,731-133,077) lives assuming a lesser adoption of mask wearing (85%), when compared to the reference scenario.

Modeling COVID-19 scenarios for the United States

IHME COVID-19 Forecasting Team. Nat Med. 2020 Oct 23. Epub ahead of print. [CrossRef] [PubMed]

We use COVID-19 case and mortality data from 1 February 2020 to 21 September 2020 and a deterministic SEIR (susceptible, exposed, infectious and recovered) compartmental framework to model possible trajectories of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and the effects of non-pharmaceutical interventions in the United States at the state level from 22 September 2020 through 28 February 2021. Using this SEIR model, and projections of critical driving covariates (pneumonia seasonality, mobility, testing rates and mask use per capita), we assessed scenarios of social distancing mandates and levels of mask use. Projections of current non-pharmaceutical intervention strategies by state-with social distancing mandates reinstated when a threshold of 8 deaths per million population is exceeded (reference scenario)-suggest that, cumulatively, 511,373 (469,578-578,347) lives could be lost to COVID-19 across the United States by 28 February 2021. We find that achieving universal mask use (95% mask use in public) could be sufficient to ameliorate the worst effects of epidemic resurgences in many states. Universal mask use could save an additional 129,574 (85,284-170,867) lives from September 22, 2020 through the end of February 2021, or an additional 95,814 (60,731-133,077) lives assuming a lesser adoption of mask wearing (85%), when compared to the reference scenario.