Rajender R Aparasu

University of Houston, Houston, Texas, United States

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Publications (174)472.84 Total impact

  • Vishal Bali, Pravin Shivaji Kamble, Rajender R Aparasu
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    ABSTRACT: Concomitant use of stimulants and atypical antipsychotics is common in pediatric attention deficit hyperactivity disorder (ADHD). However, little is known about the determinants of concomitant use and its utility in the management of pediatric ADHD. To (a) examine predictors of concomitant stimulant and atypical antipsychotic use and (b) evaluate the impact of concomitant atypical antipsychotic use on the persistence of stimulants in children and adolescents diagnosed with ADHD. The retrospective cohort study was conducted using 4 years (January 2004-December 2007) of IMS LifeLink claims data. The study population included children and adolescents aged 6-16 years with a diagnosis of ADHD and those who initiated long-acting stimulants (LAS) from July 2004 to December 2006. Patients were followed for 1 year after index stimulant use. Concomitant use was defined as the concurrent prescription for LAS and atypical antipsychotic agents with at least 14 days overlap after the index LAS claim. Persistence was measured by summing the total number of days a patient remained on the index LAS from the index prescription date with an allowable gap of no more than 30 days. Multiple logistic regression within the conceptual framework of the Andersen Behavioral Model was performed to determine the predictors of concomitant stimulant and atypical antipsychotic use. Multivariate Cox proportional hazards regression within the conceptual framework of the Andersen Behavioral Model was used to examine the impact of concomitant atypical antipsychotic use on persistence of stimulants. The study cohort consisted of 39,981 children who initiated LAS treatment. Most (96.10%) received LAS monotherapy, and 3.90% received LAS and atypical antipsychotic concomitantly. The multiple logistic regression analysis found that gender, health insurance, region, year of cohort entry, season, physician specialty, coexisting mental health conditions, and general mental health status influenced the concomitant use of LAS and atypical antipsychotic agents. Bivariate analyses revealed that concomitant users had longer persistence (by 71 days) than the stimulant-alone users. Cox proportional hazards regression revealed that concomitant atypical antipsychotic was associated with improvement in LAS persistence by 15% (HR = 0.85, 95% CI = 0.76-0.94) in comparison with the LAS recipients who did not use atypical antipsychotic concomitantly. Other factors such as age, region, season, coexisting mental health conditions, use of comedications, and general mental health status influenced the LAS treatment persistence among children and adolescents. Various predisposing, enabling, and need factors were associated with the concomitant stimulant and atypical antipsychotic use. Concomitant use of atypical antipsychotics was associated with improved LAS treatment persistence in children and adolescents with ADHD.
    06/2015; 21(6):486-98.
  • Value in Health 05/2015; 18(3):A13. DOI:10.1016/j.jval.2015.03.085
  • F. Chekani, Bali, R.R. Aparasu
    Value in Health 05/2015; 18(3):A288. DOI:10.1016/j.jval.2015.03.1678
  • Value in Health 05/2015; 18(3):A116. DOI:10.1016/j.jval.2015.03.683
  • Value in Health 05/2015; 18(3):A248. DOI:10.1016/j.jval.2015.03.1443
  • N Kachru, S Chatterjee, R Aparasu
    Value in Health 05/2015; 18(3):A104. DOI:10.1016/j.jval.2015.03.612
  • P. Rane, Bali, R.R. Aparasu
    Value in Health 05/2015; 18(3):A131. DOI:10.1016/j.jval.2015.03.763
  • Value in Health 05/2015; 18(3):A114-A115. DOI:10.1016/j.jval.2015.03.674
  • Value in Health 05/2015; 18(3):A133. DOI:10.1016/j.jval.2015.03.776
  • P. Rane, R.R. Aparasu, S. Guha
    Value in Health 05/2015; 18(3):A265. DOI:10.1016/j.jval.2015.03.1543
  • Value in Health 05/2015; 18(3):A128-A129. DOI:10.1016/j.jval.2015.03.749
  • Sneha D Sura, Ryan M Carnahan, Hua Chen, Rajender R Aparasu
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    ABSTRACT: To examine the association between the use of anticholinergic drugs and the health-related quality of life (HRQoL) among community-dwelling older adults with dementia. This was a retrospective, longitudinal, cohort study of older adults aged 65 years and above diagnosed with dementia using Medical Expenditure Panel Survey data. Anticholinergic drug exposure was measured using the Anticholinergic Drug Scale. The HRQoL measures of interest were Physical Component Score (PCS) and Mental Component Score (MCS). Two separate unweighted multiple linear regression analyses were performed to determine the association of anticholinergic drugs with PCS and MCS, while adjusting for other factors and baseline HRQoL measures. The study included 112 patients with dementia; 15.18% of whom used anticholinergic drugs. The majority of the patients were between the ages of 65 and 79 years (53%), women (57%), and had poor or low family income (65%). After controlling for other factors and baseline HRQoL, anticholinergic drug use was associated with 7.48 unit reductions in PCS (P <0.01), whereas no association was found between anticholinergic drug use and MCS. Baseline HRQoL measures were found to be significant in both models. Anticholinergic drugs are associated with reduced PCS of HRQoL in older adults with dementia. The study findings suggest the need for carefully monitoring the health status of elderly patients when prescribing anticholinergic agents in this vulnerable population.
    Journal of the American Pharmacists Association 04/2015; 55(3):e305-e310. DOI:10.1331/JAPhA.2015.14068
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    ABSTRACT: Inappropriate medications are often used in older adults despite their unfavourable risk-to-benefit profile. Although many of the medications in the American Geriatrics Society (AGS) Beers list are potentially inappropriate because of their anticholinergic properties, little is known regarding the nature and extent of potentially inappropriate anticholinergic medication use in older adults. To determine the prevalence of, and factors associated with, potentially inappropriate anticholinergic medication use in the older population. A retrospective, cross-sectional study was conducted, involving older adults (aged 65 years and older), using 2009-2010 Medical Expenditure Panel Survey (MEPS) data. The 2012 AGS Beers Criteria were used to define potentially inappropriate anticholinergic medications on the basis of the list of medications to avoid using in older adults irrespective of the diagnosis. Descriptive analyses were used to examine the nature and extent of potentially inappropriate anticholinergic medication use. Multivariable logistic regression within the conceptual framework of the Andersen Behavioral Model was used to identify the factors associated with potentially inappropriate anticholinergic use in older adults. According to the MEPS, there were 78.60 million older adults in the USA; an estimated 7.51 million (9.56 %) of these older adults used potentially inappropriate anticholinergic medications in 2009-2010. The most frequently used potentially inappropriate anticholinergics were cyclobenzaprine, promethazine, amitriptyline, hydroxyzine and dicyclomine. Multivariable regression analyses revealed that female sex, residing in the South and the presence of anxiety disorder increased the likelihood of receiving potentially inappropriate anticholinergic medications, whereas older adults aged 75-84 or ≥85 years, and those with over 15 years of education, had a decreased likelihood of receiving potentially inappropriate anticholinergic medications. The study found that approximately one in ten older adults used potentially inappropriate anticholinergic medications. Several predisposing, enabling and need factors were associated with the use of potentially inappropriate anticholinergic medications. Concerted efforts are needed to optimize potentially inappropriate anticholinergic medication use in older adults.
    Drugs & Aging 04/2015; 32(5). DOI:10.1007/s40266-015-0257-x
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    ABSTRACT: This study examined the prevalence of and factors associated with concurrent use of long-acting stimulants (LAS) and second-generation antipsychotic agents among children and adolescents with attention-deficit hyperactivity disorder (ADHD). The study involved retrospective longitudinal analysis of 2003-2007 Medicaid data from four states for children and adolescents between the ages of six and 17 years who were diagnosed as having ADHD and initiated LAS treatment. Concurrent use of LAS and second-generation antipsychotic medications was defined as simultaneous receipt of both medications for at least 14 days. On the basis of the conceptual framework of the Andersen behavioral model, multivariable logistic regression analysis was used to examine predisposing, enabling, and need factors associated with concurrent use. Among the 61,793 children who initiated LAS treatment for ADHD, 11,866 (19.2%) received LAS and second-generation antipsychotics concurrently for at least 14 days. Overall, the average length of concurrent use was 130±98 days. Multivariable logistic regression revealed that concurrent use was higher among boys, blacks, and foster care children compared with their respective counterparts. Comorbid psychiatric conditions, including disorders that are not approved indications for second-generation antipsychotic use, were associated with concurrent use of LAS and second-generation antipsychotics. Almost one in five children and adolescents who initiated LAS also received second-generation antipsychotics concurrently for at least 14 days. Approved and nonapproved indications of second-generation antipsychotics influenced concurrent use in pediatric ADHD.
    Psychiatric services (Washington, D.C.) 04/2015; 66(4):404-10. DOI:10.1176/appi.ps.201300391
  • Gastroenterology 04/2015; 148(4):S-95-S-96. DOI:10.1016/S0016-5085(15)30329-2
  • Source
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    ABSTRACT: Background Antipsychotic use is associated with serious adverse events in the elderly, and consequently can lead to further healthcare utilization such as nursing home admission. Objective To evaluate the risk of nursing home admission associated with typical versus atypical antipsychotic use among the US community-dwelling elderly population. Methods A retrospective cohort design was conducted using Medicare and Medicaid Analytical eXtract (MAX) data from four US states. The cohort included all dual-eligible beneficiaries (aged ≥65 years) who initiated antipsychotic treatment during July 2001-December 2003. The risk of nursing home admission during the 6-month follow-up period was evaluated using Cox proportional hazards regression model and extended Cox model stratified on matched pairs based on propensity score, using atypical agents as the reference category. Results The average risk of nursing home admission was similar among atypical antipsychotic users compared to typical users (hazard ratio [HR] 0.91; 95 % confidence interval [CI] 0.81-1.01]) However, the results of extended Cox regression revealed that the effect varied with time; typical users had a moderately lower risk of nursing home admission within the initial 90 days of therapy [HR 0.87; 95 % CI 0.77-0.97] but substantial risk was observed for 90-180 days of typical antipsychotic exposure [HR 1.58; 95 % CI 1.08-2.12]. Conclusion The study found that, among elderly beneficiaries, typical antipsychotic use was associated with a time-dependent increase in risk of nursing home admission. Given the safety concerns with atypical antipsychotics and their extensive use in the elderly, there is a need to be cautious while prescribing antipsychotics in the vulnerable elderly population.
    Drugs - Real World Outcomes 02/2015; 2(1). DOI:10.1007/s40801-015-0013-x
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    ABSTRACT: Individual comparisons of the performance of risk-adjustment indices have been widely conducted. Few reviews have been conducted to summarize the performance of different risk-adjustment indices. A 30-day mortality rate is widely used to evaluate the quality of care in hospitals by federal agencies like the Centers for Medicare and Medicaid Services. This study examined relative performance of risk-adjustment indices that predict 30-day mortality. Databases including Medline, PubMed and PsycINFO were searched for studies that compared risk-adjustment indices. The search protocol included comparative studies in which the performance of risk-adjustment indices were compared across any defined cohort to compare 30-day mortality, including mortality within 30 days and intensive care unit mortality, which lasts less than 30 days. Data were extracted using a structured form and abstract data included author and publication year, population studied (including location, sample size, study time period), comparison indices, outcome studied, results and conclusions from the results. A meta-analytical approach was used to summarize all the studies. Scaled ranking score was used to estimate the relative superiority of any given risk-adjustment indices. A hypergeometric test was carried out to evaluate the performance of risk-adjustment measures. Out of 2805 studies identified, 23 studies met the eligibility criteria. Main risk-adjustment indices used for comparison included Acute Physiology and Chronic Health Evaluation, Sequential Organ Failure Assessment score, Charlson co-morbidity index, Model for End-Stage Liver Disease score and Simplified Acute Physiology Score (SAPS). Based on scaled ranking score, SAPS performed best (score 0.510) among all the risk-adjustment indices. However, based on hypergeometric test, the five measures performed equally well. Although all the selected risk-adjustment indices perform equally well, SAPS seems better than other indices for short-term mortality based on scaled ranking score. © 2015 John Wiley & Sons, Ltd.
    Journal of Evaluation in Clinical Practice 02/2015; 21(2). DOI:10.1111/jep.12307
  • Journal of Child and Adolescent Psychopharmacology 12/2014;
  • Value in Health 05/2014; 17(3):A154-A155. DOI:10.1016/j.jval.2014.03.901
  • Value in Health 05/2014; 17(3):A211-A212. DOI:10.1016/j.jval.2014.03.1239

Publication Stats

1k Citations
472.84 Total Impact Points

Institutions

  • 2006–2015
    • University of Houston
      • • Department of Clinical Sciences & Administration
      • • College of Pharmacy
      Houston, Texas, United States
  • 2010
    • University of Texas Health Science Center at Houston
      Houston, Texas, United States
  • 2008
    • Texas Medical Center
      Houston, Texas, United States
  • 1996–2005
    • South Dakota State University
      • College of Pharmacy
      Brookings, South Dakota, United States
  • 1999
    • Dakota State University
      Brookings, South Dakota, United States
  • 1996–1997
    • University of Louisiana at Monroe
      Louisiana, United States