{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T15:48:26Z","timestamp":1747151306518,"version":"3.40.5"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,3,11]],"date-time":"2020-03-11T00:00:00Z","timestamp":1583884800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>This study aims to assess the implementation of published research, contraindications, and warnings on the prescription of dual renin\u2010angiotensin\u2010hormone system (RAS) blockade in ambulatory care in Germany.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cohort study based on health claims data of 6.7 million subjects from 2008 to 2015. Yearly prevalence and incidence for dual RAS blockade with (a) angiotensin\u2010converting enzyme inhibitors and angiotensin\u2010receptor blockers (ACEI\u2009+\u2009ARB) and (b) aliskiren and ACEI or ARB (aliskiren\u2009+\u2009ACEI\/ARB) were calculated. We assessed prescriber specialty and associations between discontinuing dual RAS blockade with specialist (internal medicine, cardiology, nephrology) visits and hospital discharge in the previous year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 2\u2009984 517 patients were included (age 51.4 \u00b1\u2009SD 18.4 y, 48.5% male). Prescription rates for ACEI\u2009+\u2009ARB decreased from 0.6% (n = 17\u2009907) to 0.4% (n = 12\u2009237) and for aliskiren\u2009+\u2009ACEI\/ARB from 0.23% (n = 6634) to 0.03% (n = 818). Incident prescriptions decreased from 0.23% (n = 6705) to 0.19% (n = 5055) (ACE\u2009+\u2009ARB) and from 0.1% (n = 2796) to 0.005% (n = 142) (aliskiren\u2009+\u2009ACE\/ARB); 59% of ACEI\u2009+\u2009ARB and 48% of aliskiren\u2009+\u2009ACE\/ARB combinations were prescribed only by one physician. Of those, 73% (ACEI\u2009+\u2009ARB) and 58% (aliskiren\u2009+\u2009ACE\/ARB) were primary care providers (PCPs). Discontinuing dual RAS blockade was associated with specialist care and hospital discharge in the previous year (specialist care: RR 1.4, 95% CI, 1.3\u20101.6; hospital visit: RR 1.5, 95% CI, 1.3\u20101.6).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our results suggest a delayed uptake of treatment recommendation for ACEI\u2009+\u2009ARB and a higher impact of Dear Doctor letters addressing PCPs directly compared with published research, contraindications, and warnings. Targeted continuous medical education, practice software alerts, and stronger involvement of pharmacists might improve the implementation of medication safety recommendations in ambulatory care.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.4965","type":"journal-article","created":{"date-parts":[[2020,3,12]],"date-time":"2020-03-12T05:20:27Z","timestamp":1583990427000},"page":"530-537","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Dual renin\u2010angiotensin\u2010aldosterone blockade: Implementation of published research and Dear Doctor letters in ambulatory care: A retrospective observational study using prescription data"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1027-231X","authenticated-orcid":false,"given":"Aniela","family":"Angelow","sequence":"first","affiliation":[{"name":"Department of General Practice, Institute for Community Medicine University Medicine Greifswald  Greifswald Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tina","family":"Ploner","sequence":"additional","affiliation":[{"name":"InGef\u2014Institute for Applied Health Research Berlin GmbH  Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Grimmsmann","sequence":"additional","affiliation":[{"name":"Health Insurance Medical Service (MDK) Mecklenburg\u2010Vorpommern  Schwerin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jochen","family":"Walker","sequence":"additional","affiliation":[{"name":"InGef\u2014Institute for Applied Health Research Berlin GmbH  Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean\u2010Fran\u00e7ois","family":"Chenot","sequence":"additional","affiliation":[{"name":"Department of General Practice, Institute for Community Medicine University Medicine Greifswald  Greifswald Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,3,11]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy339"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e3281fc975a"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.2003.00940.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-1755.2004.09226.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2006080922"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-148-1-200801010-00190"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0801317"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61236-2"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61124-6"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1208799"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1303154"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f360"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hps038"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/2042098615589905"},{"key":"e_1_2_8_16_1","unstructured":"Federal Institute for Drugs and Medical Devices (BfArM). 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Wichtige Informationen zu neuen Gegenanzeigen und Warnhinweisen bei der Anwendung Aliskiren\u2010haltiger Arzneimittel in Kombination mit Inhibitoren des Angiotensin konvertierenden Enzyms (ACE\u2010Hemmern) oder Angiotensin\u2010Rezeptor\u2010Blockern (ARB) [Important information on new contraindications and warnings for the use of aliskiren\u2010containing medicines in combination with inhibitors of the angiotensin converting enzyme (ACE\u2010inhibitors) or angiotensin receptor blockers (ARB)]www.bfarm.de\/SharedDocs\/Risikoinformationen\/Pharmakovigilanz\/DE\/RHB\/2012\/rhb-aliskiren2.pdf?__blob=publicationFile&amp;v=4. (last accessed December 13 2018)."},{"key":"e_1_2_8_18_1","unstructured":"European Medical Agency. 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