THREAD: #Prescribers, how do YOU respond to Conflicts of Interest (COI)? 👀

1/8 This thread looks at the issues highlighted in our TI Therapeutics Letter on COI

👉🏼Full Letter: ti.ubc.ca/letter136

#ConflictofInterest #MedEd #MedicalEthics
2/8 Kirsten is a clinical pharmacist attending a primary care conference👩🏽‍⚕️

When a keynote speaker reports financial relationships💰with several drug companies, Kirsten takes note🤨

Find out why she prefers #MedEd free of commercial sponsorship: ti.ubc.ca/letter136
3/8 Key Opinion Leaders (KOLs)

It's common practice to cultivate “expert” KOLs who are crucial to market success💵of a new drug

Payments to KOLs are reported in USA but similar disclosure does NOT exist in Canada
go.nature.com/39XdVVq

#FinancialInterests #ConflictofInterest
4/8 Authors with #FinancialInterests are more likely to publish positive results

A @CochraneLibrary review of nearly 200 RCTs published in major journals found 68% had personal financial ties between principal investigators, drugmakers bit.ly/3MOhyv9

#PublicationBias
5/8 How a study is designed can shape packaging of takeaway messages to prescribers

Commercial influence on trial design can include:
✅Nature of the hypothesis
✅Choice of comparators
✅Outcome definitions
✅What results are ultimately reported (or not)

ti.ubc.ca/letter136
6/8 Professional healthcare groups often counsel members to identify and avoid actual, potential or perceived COIs

@CMA_Docs: Doctors have responsibility to ensure "collaboration with industry primarily serves the interests of their patients & the public" bit.ly/3sU3dFu
7/8 Therapeutics Initiative (TI) approach to COI

The TI is an independent org'n, separate from gov't, pharma, other vested interests

We believe independent evidence assessments of drug therapies are needed to ⚖️ industry-sponsored information sources
ti.ubc.ca/letter136
8/8 Back to Kirsten's conference

Post-presentation, she gives the organizers feedback: "Please aim for unconflicted speakers next time"

She also plans to seek high quality #prescribing information, primarily evidence from unconflicted systematic reviews ti.ubc.ca/letter136
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More from @Drug_Evidence

May 16
THREAD: Online Portraits for BC family physicians

1/7 UBC’s Therapeutics Initiative now has Online #PrescribingPortraits: ti.ubc.ca/portrait

✅ Timely evidence
✅ Personalized, confidential prescribing data
✅ Recommendations to support

#BetterPrescribing & #BetterHealth Image
2/7 Why have a #PrescribingPortrait?

"How do I prescribe compared to others or to evidence standards?"

✅Portrait does NOT tell individual doctors how to practice
✅Portrait DOES promote optimal prescribing based on best available evidence

More here: ti.ubc.ca/portrait Image
3/7 BC family physicians: How do you prescribe ACEIs and ARBs for #hypertension?

✅Register for your Online #PrescribingPortrait: ti.ubc.ca/portrait

✅View a sample portrait on prescribing of antihypertensives: ti.ubc.ca/2022/01/28/ace…

#BetterPrescribing #MedEd Image
Read 8 tweets
Mar 28
THREAD: How best to treat Urinary Tract Infections?

1/6 Our new TI Therapeutics Letter 135 describes the best approach for treating symptomatic, uncomplicated lower urinary tract infections (UTIs)

👉🏽ti.ubc.ca/letter135

#MedEd #FOAMed #UTIs #BetterPrescribing
2/6 Use symptoms, not tests to diagnose UTIs:

Uncomplicated lower UTI can be diagnosed with > 90% probability if pt has 2 or more of dysuria, urgency, and frequency, and no vaginal discharge.

This is less reliably predicted for older women.

👉🏽ti.ubc.ca/letter135

#MedEd
3/6 No need to culture:

✅Fewer than 2% of urine cultures meaningfully impact choice of treatment or need for follow-up
✅Most guidelines recommend against culture for
symptomatic uncomplicated #UTIs

👉🏽ti.ubc.ca/letter135

#MedEd #BetterPrescribing #BetterHealth
Read 7 tweets
Feb 28
THREAD: Bring it down safely! ↘️💊

1/6 6⃣tweets about our new TI Therapeutics Letter 134: Finding the lowest effective dose for non-opioid #analgesics

👉🏾 Full Letter: ti.ubc.ca/letter134

#MedEd #medsafety #prescribing #BetterPrescribing Image
2/6 Consistent evidence that minority of pts get clinically meaningful pain relief from any dose of:
#Cyclobenzaprine (at best 1/4)
#Duloxetine (at best 1/6)
#Gabapentin / #Pregabalin (at best 1/6)

👉🏾ti.ubc.ca/letter134

#MedEd #ptsafety #BetterPrescribing #prescribing Image
3/6 Gabapentin, pregabalin, duloxetine:

A 2021 Canadian systematic review found NNT (numbers needed to treat) of 6-7 for "clinically meaningful benefit" (defined as ≥30% reduction in pain or pain & function)

👉🏾ti.ubc.ca/letter134

#MedEd #BetterPrescribing #deprescribing Image
Read 7 tweets
Feb 2
THREAD: Primary #hypertension therapy: after thiazides, an ACEI or an ARB?

1/8 Nearly 650,000 British Columbians took an ACEI or ARB in 2021

Our new TI Therapeutics Letter reiterates evidence for one of the most common primary care tx choices: ti.ubc.ca/letter133

#MedEd
2/8 Lower #BloodPressure not the Main Goal

#Antihypertensives lower various measures of blood pressure (BP) 💊

But... not all BP lowering drugs are proven to reduce both morbidity & mortality

👉🏾ti.ubc.ca/letter133

#MedEd #prescribing #hypertension
3/8 The importance of clinical outcomes

Basing decisions on which drug lowers #BloodPressure the best cannot guarantee the best clinical outcomes

Read our Therapeutics Letter on optimal 1st and 2nd line treatments: ti.ubc.ca/letter133

#MedEd #prescribing #hypertension
Read 9 tweets
Jan 21
THREAD: #ExercisePrescriptions

1/5 The TI’s Dr. Josh Levin asks:

Clinicians, can you help your patients be more active? 🏃🏾‍♀️🏊🏾‍♂️ 🚶🏾‍♂️

👉🏾Watch Dr. Levin’s recent presentation: bit.ly/3nLCEje 👨🏾‍💻

#Exercise #prescribing #twitterRx
2/5 #ExercisePrescriptions: How much activity should people get? It depends on their age.

👉🏾See the Canadian Society for Exercise Physiology activity guidelines for different age groups: csepguidelines.ca 🏊🏾‍♂️🏃🏾‍♀️🚶🏾

#Exercise #prescribing #twitterRx #BetterHealth
3/5 Below is an example of an #ExercisePrescription 🏊🏾‍♂️🏃🏾‍♀️🚶🏾‍♂️

#Exercise #prescribing #twitterRx #BetterPrescribing
Read 6 tweets
Nov 27, 2021
THREAD: SGLT2 inhibitors for #diabetes

1/5 Dr. Jamie Falk @jamisonfalk presented "A Deep Dive into #SGLT2i: What Comes to the Surface for Individuals with Diabetes"

👉🏽Watch the presentation here: bit.ly/3FRCEoM 🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd
2/5 #AdverseEffects for #SGLT2i to be aware of: genital infections, hypovolemia, DKA, amputations

✅Check out the image ⬇️ for the risk estimates
✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd #diabetes #ptsafety
3/5 Evidence to date for #SGLT2i:

The first of the two new classes of medications for type II diabetes to reduce ↘️ risk of CV #AdverseEvents and mortality

✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd #diabetes
Read 6 tweets

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