EMRs as a Research Tool: Evaluating Topiramate Use at a Headache Center
EMRs as a Research Tool: Evaluating Topiramate Use at a Headache Center
Background.—Electronic medical records (EMRs) are used in large healthcare centers to increase efficiency and accuracy of documentation. These databases may be utilized for clinical research or to describe clinical practices such as medication usage.
Methods.—We conducted a retrospective analysis of EMR data from a headache clinic to evaluate clinician prescription use and dosing patterns of topiramate. The study cohort comprised 4833 unique de-identified records, which were used to determine topiramate dose and persistence of treatment.
Results.—Within the cohort, migraine was the most common headache diagnosis (n = 3753, 77.7%), followed by tension-type headache (n = 338, 7.0%) and cluster or trigeminal autonomic cephalalgias (n = 287, 5.9%). Physicians prescribed topiramate more often for subjects with migraine and idiopathic intracranial hypertension (P < .0001) than for those with other conditions, and more often for subjects with coexisting conditions including obesity, bipolar disorder, and depression. The most common maintenance dose of topiramate was 100 mg/day; however, approximately 15% of subjects received either less than 100 mg/day or more than 200 mg/day. More than a third of subjects were prescribed topiramate for more than 1 year, and subjects with a diagnosis of migraine were prescribed topiramate for a longer period of time than those without migraine.
Conclusions.—Findings from our study using EMR demonstrate that physicians use topiramate at many different doses and for many off-label indications. This analysis provided important insight into our patient populations and treatment patterns.
Electronic medical records (EMRs) have the potential to improve clinical efficiency and documentation. Recently, healthcare providers have begun using EMRs for clinical research. Most large-scale retrospective observational studies conducted to date have been based on insurance claims data (eg, prescriptions filled to determine commonly prescribed doses of a medication). EMRs vary widely in their structure, capacity, and extent of data capture. Analysis is most successful in evaluating objective data, such as lab results. Subjective or complex variables can be more challenging to measure and document. Results from clinical practice may vary tremendously compared with the results of clinical trials. EMRs do not solve all issues with documentation; they can help standardize documentation but do not prevent inaccuracies. Most EMRs in clinical practice are designed to increase the accuracy of billing, eliminate the need for dictation, improve communication of health information between clinicians, and prevent errors rather than for use as a research tool.
Retrospective EMR analyses have yielded important findings that can affect clinical care, such as studies showing increased cardiovascular event rates with the use of rofecoxib. Other EMR studies have documented prevention of medication errors and demonstrated trends in treatment response that may lead to better practice. For instance, a recent EMR analysis demonstrated that anti-epileptic usage in elderly patients has not changed significantly despite changes in clinical guidelines. EMR studies can also help determine compliance with treatment guidelines and may demonstrate cost savings. The goal of this pilot study was to explore the utility of EMR as a clinical research tool through an evaluation of patient demographics, diagnoses, and topiramate use in a cohort of patients treated at a university-based headache specialty clinic.
Abstract and Introduction
Abstract
Background.—Electronic medical records (EMRs) are used in large healthcare centers to increase efficiency and accuracy of documentation. These databases may be utilized for clinical research or to describe clinical practices such as medication usage.
Methods.—We conducted a retrospective analysis of EMR data from a headache clinic to evaluate clinician prescription use and dosing patterns of topiramate. The study cohort comprised 4833 unique de-identified records, which were used to determine topiramate dose and persistence of treatment.
Results.—Within the cohort, migraine was the most common headache diagnosis (n = 3753, 77.7%), followed by tension-type headache (n = 338, 7.0%) and cluster or trigeminal autonomic cephalalgias (n = 287, 5.9%). Physicians prescribed topiramate more often for subjects with migraine and idiopathic intracranial hypertension (P < .0001) than for those with other conditions, and more often for subjects with coexisting conditions including obesity, bipolar disorder, and depression. The most common maintenance dose of topiramate was 100 mg/day; however, approximately 15% of subjects received either less than 100 mg/day or more than 200 mg/day. More than a third of subjects were prescribed topiramate for more than 1 year, and subjects with a diagnosis of migraine were prescribed topiramate for a longer period of time than those without migraine.
Conclusions.—Findings from our study using EMR demonstrate that physicians use topiramate at many different doses and for many off-label indications. This analysis provided important insight into our patient populations and treatment patterns.
Introduction
Electronic medical records (EMRs) have the potential to improve clinical efficiency and documentation. Recently, healthcare providers have begun using EMRs for clinical research. Most large-scale retrospective observational studies conducted to date have been based on insurance claims data (eg, prescriptions filled to determine commonly prescribed doses of a medication). EMRs vary widely in their structure, capacity, and extent of data capture. Analysis is most successful in evaluating objective data, such as lab results. Subjective or complex variables can be more challenging to measure and document. Results from clinical practice may vary tremendously compared with the results of clinical trials. EMRs do not solve all issues with documentation; they can help standardize documentation but do not prevent inaccuracies. Most EMRs in clinical practice are designed to increase the accuracy of billing, eliminate the need for dictation, improve communication of health information between clinicians, and prevent errors rather than for use as a research tool.
Retrospective EMR analyses have yielded important findings that can affect clinical care, such as studies showing increased cardiovascular event rates with the use of rofecoxib. Other EMR studies have documented prevention of medication errors and demonstrated trends in treatment response that may lead to better practice. For instance, a recent EMR analysis demonstrated that anti-epileptic usage in elderly patients has not changed significantly despite changes in clinical guidelines. EMR studies can also help determine compliance with treatment guidelines and may demonstrate cost savings. The goal of this pilot study was to explore the utility of EMR as a clinical research tool through an evaluation of patient demographics, diagnoses, and topiramate use in a cohort of patients treated at a university-based headache specialty clinic.
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