Dörks, Michael

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Dörks, Michael
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Dörks, Michael
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    Routinedatenbasierte Untersuchungen zum Off-Label-Use in der ambulanten Versorgung
    (2013-11-01)
    Dörks, Michael
    ;
    Hoffmann, Falk
    ;
    Zeeb, Hajo
    ;
    Garbe, Edeltraut
    In many medical disciplines, particularly in paediatrics, psychiatry and oncology, drugs are often prescribed off-label. An off-label use is defined as the practice of prescribing drugs outside the terms of the product license, especially prescribed for an unapproved indication or age group. One problem is the impact of off-label use on drug safety in terms of adverse drug reactions associated with these drugs. In Germany, only limited data investigating the extent of off-label use in ambulatory care exist. Over the years, the use of secondary data from large administrative healthcare databases for pharmacoepidemiological and health service research increased. Drug utilisation studies based on these population-based data are valuable to explore patterns of drug use including off-label use. This thesis investigates the ambulatory off-label use of antidepressant and antiepileptic drugs in paediatric patients and the ambulatory off-label use of lenalidomide in oncology patients based on claims data of statutory health insurances. Drug utilisation studies to evaluate off-label use are closing a gap in the ascertainment of drug safety after approval. As physician's prescription behaviour is not influenced, claims data of statutory health insurances are an important data source to study off-label use, particularly in patients that are often underrepresented in clinical trials.
    doctoral thesis
      370  187
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    Climate- conscious prescription of inhaled medications : DEGAM S1-Guideline
    (2022-08-29)
    Schmiemann, Guido
    ;
    Dörks, Michael
    The health care system is responsible for about 5 % of carbon dioxide (CO2) emis- sions. The biggest contributor to the carbon footprint caused by ambulatory primary care is the prescription of medications, followed by emissions from transportation (of patients and staff) and heating. Medication for chronic obstructive airway diseases (inhalers) is of special importance regarding the carbon footprint of the health care sector. The extent to which these inhalers contribute to climate changes varies depending on their method of functioning. The two main categories of inhalers are dry powder inhalers and metered-dose inhalers. Dry powder inhalers (DPIs) contain an active substance in powder form. The active ingre- dient is released and distributed by inhalation, requiring a sufficiently strong inhale to ensure effective therapy. In contrast, metered dose inhalers (MDIs) use propellants to transport the active substance into the deep sections of the lungs. The chlorofluorocarbons (CFCs) that were used as propellants for MDIs in the past have been largely banned due to their impact on the ozone layer and have been replaced by hydrofluoroalkanes (fluranes). While these do not damage the ozone layer, they are pow - erful greenhouse gases. Compared with DPIs, MDIs therefore have more potential to damage the atmosphere (global warming potential - GWP). This guideline aims to support a shift in prescribing patterns of inhalers to reduce the carbon footprint of the health care system. It addresses those involved in prescribing inhalers and counselling patients with asthma/COPD. This includes doctors and their practice teams as well as pharmacists and other health professionals. The guideline supports climate-conscious prescription of inhalers by n summarising existing evidence on the decision between DPIs and MDIs and explicitly addressing the climate damage caused by propellants.
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