Suchergebnisse

The Military Health System (MHS), with 9.7 million beneficiaries, represents an enormous pool of potential travelers requiring malaria prevention measures. A systematic search of the MHS electronic pharmacy record was performed for prescriptions of atovaquone-proguanil (AP), chloroquine (CQ), doxycycline (DC), mefloquine (MQ), primaquine (PQ) to adult patients from 2007 through 2011. Over 1,000,000 were identified, including 161,341 primary prophylaxis prescriptions originating from civilian facilities. Military facility prescription volume rose from 50,128 (PQ < 1%, AP 4%, CQ 6%, DC 53%, MQ 36%) in 2007 to 166,649 (PQ < 1%, AP 3%, CQ < 1%, DC 94%, MQ 2%) in 2011. Mefloquine use diminished in all clinics over time. The majority of military facility prescriptions originated from primary care clinics (83%); primary care clinics predominantly and increasingly prescribed DC, whereas specialty travel clinics predominantly and increasingly prescribed AP. Prescribing patterns in the MHS varied by time, practice setting, beneficiary status, and provider specialty. These changes, including among non-active duty military patients, are temporally associated with policy changes intended for the active duty force.

BACKGROUND: Recent price increases in medications used to treat helminth infections have had demonstrated impacts on Medicaid and immigrant patient populations. Helminth infections are common within the US military; however, anthelmintic prescribing patterns and costs have not yet been investigated in this patient population. METHODS: We conducted a retrospective analysis of pharmaceutical data from the Military Health System Data Repository between fiscal years 2012 and 2019. Prescription information, including costs and demographics, were abstracted for all anthelmintic medications as well as associated helminth diagnostic codes within 30 days of the prescription dispensing date. RESULTS: On average, there were 10( )871 anthelmintic medications prescribed per year, for a total of 86( )697 during the study period. Ivermectin and albendazole were each prescribed >34( )000 times. There were 15( )498 mebendazole prescriptions and 1327 praziquantel prescriptions. The total cost of all anthelmintic prescriptions was $16( )018( )381. Annual costs for anthelmintic medications increased 16-fold during the study period, up to nearly $5( )000( )000 in fiscal year 2019, primarily driven by price increases in albendazole and mebendazole. Albendazole prescriptions accounted for $12( )282( )891 of total costs (76.7%), though only 39.1% of total prescriptions. The most common diagnosis associated with albendazole and mebendazole prescriptions was enterobiasis. CONCLUSIONS: Price increases in anthelmintic medications have significantly impacted the costs borne by the US government for treating parasitic infections. There are a substantial number of anthelmintic prescriptions in the US military health care system annually, suggesting a higher number of helminth infections than previously thought.

The Deployment and Travel Medicine Knowledge, Attitudes, Practices, and Outcomes Study (KAPOS) examines the integrated relationship between provider and patient inputs and health outcomes associated with travel and deployments. This study describes malaria chemoprophylaxis prescribing patterns by medical providers within the U.S. Department of Defense's Military Health System and its network of civilian healthcare providers during a 5-year period. Chemoprophylaxis varied by practice setting, beneficiary status, and providers' travel medicine expertise. Whereas both civilian and military facilities prescribe an increasing proportion of atovaquone-proguanil, doxycycline remains the most prevalent antimalarial at military facility based practices. Civilian providers dispense higher rates of mefloquine than their military counterparts. Within military treatment facilities, travel medicine specialists vary their prescribing pattern based on service member versus beneficiary status of the patient, both in regards to primary prophylaxis, and use of presumptive anti-relapse therapy (PQ-PART). By contrast, nonspecialists appear to carry over practice patterns developed under force health protection (FHP) policy for service members, into the care of beneficiaries, particularly in high rates of prescribing doxycycline and PQ-PART compared with both military travel medicine specialists and civilian comparators. Force health protection policy plays an important role in standardizing and improving the quality of care for deployed service members, but this may not be the perfect solution outside of the deployment context. Solutions that broaden both utilization of decision support tools and travel medicine specialty care are necessary.

We evaluated differences in pretravel care, exposures, and illnesses among pediatric and adult travelers, using a prospective, observational cohort. Eighty-one pediatric travelers were matched 1:1 with adult military dependents by travel region, destination's malaria risk, and travel duration. Pediatric travelers were more likely to have coverage for hepatitis A and B (90% versus 67% of adults; 85% versus 44%), visit friends and relatives (36% versus 16%), report mosquito bites (69% versus 44%), and have close contact with wild or domesticated animals (40% versus 20%) than adults (P < 0.05). Subjects < 10 years of age were less likely to be prescribed antibiotics (28% versus 95%; RR = 0.63; 95% CI: 0.46–0.85) and antidiarrheals (9% versus 100%; RR = 0.10; 95% CI: 0.03–0.29) for travelers' diarrhea (TD) self-treatment than adults. Travel medicine providers should emphasize strategies for vector avoidance, prevention of animal bites and scratches, and TD self-treatment in pediatric pretravel consultations.