The following are examples of ongoing topics currently being investigated by members of the Pharmacoepidemiologic and Pharmacoeconomic Research Unit.

The rapid increase in bacterial resistance to antibiotics is an alarming problem at medical centers across the country. This burden will continue to grow as the number of drug-resistant illnesses increase. A primary focus of the Pharmacoepidemiologic and Pharmacoeconomics Research Unit is to provide useful knowledge that has been lacking in the efforts to understand the use and potential misuse of antibiotics related to control of bacterial resistance in medical centers.

Extensive or predominant utilization of individual antibiotics has been associated with hospital outbreaks of resistant organisms, particularly in intensive care or long-term care units, and in rising rates of bacterial resistance. It follows that an increasingly complex and aging population with increased risk or frequency of infection will drive increased antibiotic use. This, in turn, will drive the risk for increased resistance in response to the patterns of antibiotic management of community and nosocomial infections. Patients infected with drug-resistant organisms are more likely to require hospitalizations, remain in the hospital for long periods of time, and face poor prognoses. Multiple initiatives are currently in place to evaluate this important issue.

Proper adherence to medications is another important topic for the Pharmacoepidemiologic and Pharmacoeconomic Research Unit. For example, type 2 diabetes is a chronic debilitating condition that is associated with significant morbidity, mortality, and health care costs. Effective control often requires treatment with multiple agents. Medication adherence is critical to achieve recommended glycemic, blood pressure, and lipid goals.

Several studies in persons with diabetes have shown a high correlation between medication adherence and metabolic control. However, a recent systematic review showed poor oral diabetes medication adherence in persons with diabetes. It is unclear whether medication adherence differs significantly by race/ethnicity among elderly adults with type 2 diabetes. The relationship between medication adherence and multiple diabetes outcomes including glycemic control, blood pressure control, and lipid control in elderly people with diabetes is poorly understood and there is little data on whether the effect of medication adherence on cost differs significantly by race/ethnicity. In collaboration with the MUSC Center for Health Disparities Research (CHDR), an initiative to assess racial differences of medical adherence by type 2 diabetics is currently being launched.

Present funding of members is through the National Institutes of Health, Department of Veterans Affairs, and the pharmaceutical industry.

Recent Publications Related to Pharmacoepidemiology and Pharmacoeconomics:

Cotton, PB, Durkalski VL, Pineau BC, Palesch YY, Mauldin, PD, et al. “Virtual colonoscopy (CT colonography. A multicenter comparison with standard colonoscopy for detection of mass lesions.” JAMA, 2004; 291(14): 1713-1719.

Gillanders WE, Mikhitarian K, Hebert R, Mauldin PD, Palesch YY, et al. “Molecular detection of micrometastatic breast cancer in histopathology-negative axillary lymph nodes correlates with traditional predictors of prognosis: An interim analysis of a prospective multi-institutional cohort study.” Annals of Surgery, 2004; 239(6): 828‑840.

Jeong J, Becker ER, Mauldin PD, and WS Weintraub. “A Comparison of Self-Selectivity Corrections in Economic Evaluations and Outcomes Research.” Value in Health 2005; 8(6): 656-666.

Mikhitarian K, Martin R, Mitas M, Mauldin PD, et al. “Molecular analysis improves the sensitivity of breast sentinel lymph node biopsy: results of a multi-institutional prospective cohort study.” Surgery, 2005; 138(3):474-81.

Chumney E, Mauldin PD, and K Simpson. “Charges for Hospital Admissions Attributable to Health Disparities for African American Patients in South Carolina During 1998-2002.”  J National Medical Association 2006; 98(5): 690-694.

Bosso JA, PD Mauldin. “Assessment of Effects of Fluoroquinolone Formulary Changes on Gram-negative Susceptibility and MRSA isolation rates Using Interrupted Time Series Analysis.”  Forthcoming in Antimicrobial Agents and Chemotherapy.