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ND4 COMPARISON OF TRINETX ELECTRONIC MEDICAL RECORD DATABASE AND NATIONAL AMBULATORY MEDICAL CARE SURVEY: FINDINGS ON THE INAPPROPRIATE MEDICATIONS USE IN PARKINSON'S DISEASE IN THE UNITED STATES

      Objectives

      To evaluate and compare inappropriate medication use in Parkinson’s Disease (PD) using the TriNetX Electronic Medical Record (EMR) database and the National Ambulatory Medical Care Surveys (NAMCS).

      Methods

      Data from the NAMCS and the TriNetX EMR from 2011-2015 were analyzed. The study sample included elderly patients aged ≥ 65 years with a diagnosis of PD based on the (ICD-9-CM and ICD-10-CM). Inappropriate medications were defined based on the 2015 American Geriatric Society Beers’ criteria and included anti-psychotics and anti-emetics. Descriptive analyses of the NAMCS data involving appropriate weights were conducted using SAS 9.4 whereas analyses of the EMR data were performed using the in-built analytics platform.

      Results

      Analyses of the NAMCS data revealed about 6.63 million outpatient visits (95% CI, 5.78 -7.54) for PD during 2011-2015. Inappropriate anti-psychotic and anti-emetic drugs accounted for 0.30% (and 0.25% of the office visits, respectively. Promethazine was the most commonly prescribed inappropriate anti-emetic (0.30%); olanzapine (0.21%), haloperidol (0.20%), risperidone (0.20%) and lurasidone (0.30%) were the most commonly prescribed inappropriate anti-psychotics. The EMR data analyses found 58,833 patients with PD during 2011-2015. Inappropriate antipsychotic and antiemetic drugs were prescribed in 13% and 19% of PD patients, respectively. Among inappropriate anti-emetics, promethazine (8%), metoclopramide (6%) and prochlorperazine (5%) were the most commonly prescribed. The most commonly prescribed inappropriate anti-psychotics were olanzapine (3%), haloperidol (5%) and risperidone (3%). Hypertension as a co-morbidity was recorded in 54% PD patients in TriNetX compared to 13% visits in NAMCS. Similarly, depression (34% vs 8.47%), Type 2 diabetes mellitus (21% vs 5%) and sleep disorders (28% vs 8%) were captured in higher proportions in TriNetX.

      Conclusions

      While the patient-level findings from TriNetX EMR data are not directly comparable to the visit-level estimates from NAMCS, the study findings suggest that EMR data sources can provide strong study samples for outcomes research.