Managed care (Langhorne, Pa.) 

About: Managed care (Langhorne, Pa.) is an academic journal. The journal publishes majorly in the area(s): Health care & MEDLINE. It has an ISSN identifier of 1062-3388. Over the lifetime, 1032 publications have been published receiving 4900 citations.

A retrospective study of persistence with single-pill combination therapy vs. concurrent two-pill therapy in patients with hypertension.

Abstract: CONTEXT Patients with hypertension often fail to control their blood pressure because they do not comply with pharmacologic therapy. It was hypothesized that a greater percentage of patients receiving a single pill combining an ACE inhibitor and a diuretic would persist with therapy than patients receiving both drugs as separate pills. METHODS Prescription data were obtained from a large commercial pharmacy benefit manager (PBM). The records of presumably newly diagnosed hypertensive patients for whom lisinopril combined with hydrochlorothiazide in a single pill (lisinopril/HCTZ) was prescribed (n = 1,644) were compared with those of patients for whom lisinopril and a diuretic were prescribed concurrently (n = 624). Likewise, the records of patients for whom enalapril maleate combined with hydrochlorothiazide in a single pill (enalapril/HCTZ) was prescribed (n = 969) were compared with those of patients for whom enalapril maleate and a diuretic were prescribed concurrently (n = 705). Patients were regarded as persisting if they renewed their prescription within three times the number of days supplied by the previous prescription. Patients were followed for one year from the date of the initial prescription. RESULTS At 12 months, the percentages of patients persisting with lisinopril/HCTZ (68.7 percent) and enalapril/HCTZ (70.0 percent) therapy were 18.8 percent and 21.7 percent greater, respectively, than the percentages of patients persisting with lisinopril plus concurrent diuretic therapy (57.8 percent) or enalapril maleate plus concurrent diuretic therapy (57.5 percent). Statistical significance (p < 0.05) was demonstrated at 6 and 12 months for both comparisons. CONCLUSION The simplification of a drug regimen by using combination therapy in a single pill for hypertension resulted in significant increases in persistence with prescribed therapy.

An evidence-based evaluation of percutaneous vertebroplasty.

Abstract: Background information Percutaneous vertebroplasty is a therapeutic, interventional radiologic procedure that involves injection of bone cement into a cervical, thoracic, or lumbar vertebral body lesion for the relief of pain and the strengthening of bone. This procedure only recently has been introduced, and is being used for patients with lytic lesions due to bone metastases, aggressive hemangiomas, or multiple myeloma, and for patients who have medically intractable debilitating pain resulting from osteoporotic vertebral collapse. Findings Results from two uncontrolled prospective studies and several case series reports, including one with 187 patients, indicate that percutaneous vertebroplasty can produce significant pain relief and increase mobility in 70 percent to 80 percent of patients with osteolytic lesions in the vertebrae from hemangiomas, metastases, or myeloma, or with osteoporotic compression fractures. In these reports, pain relief was apparent within one to two days after injection, and persisted for at least several months up to several years. While experimental studies and preliminary clinical results suggest that percutaneous vertebroplasty can also strengthen the vertebral bodies and increase mobility, it remains to be proven whether this procedure can prevent additional fractures in the injected vertebrae. In addition, the duration of effect is not known; there were no long-term follow-up data on most of these patients, and these data may be difficult to obtain and interpret in patients with an underlying malignant process, because disease progression may confound evaluation of the treatment effect. Complications were relatively rare, although some studies reported a high incidence of clinically insignificant leakage of bone cement into the paravertebral tissues. In a few cases, the leakage of polymer caused compression of spinal nerve roots or neuralgia. Several instances of pulmonary embolism were also reported. Although patient selection criteria have not been definitely established, percutaneous vertebroplasty is considered appropriate treatment for patients with vertebral lesions resulting from osteolytic metastasis and myeloma, hemangioma, and painful osteoporotic compression fractures if the following criteria have been met: o Severe debilitating pain or loss of mobility that cannot be relieved by correct medical therapy. o Other causes of pain, such as herniated intervertebral disk have been ruled out by computed tomography or magnetic resonance imaging. o The affected vertebra has not been extensively destroyed and is at least one third of its original height. o Radiation therapy or concurrent surgical interventions, such as laminectomy, may also be required in patients with compression of the spinal cord due to ingrowth of a tumor. Conclusions Percutaneous vertebroplasty has only recently been introduced as a treatment for osteolytic lesions and osteoporotic compression fractures of the vertebrae, but early results are promising. Up to 80 percent of patients with pain unresponsive to correct medical treatment experience a significant degree of pain relief, and few serious complications have been reported. However, relatively few patients have undergone this procedure, and there are no data from controlled clinical trials or from studies with long-term follow-up. At the present time this procedure is still in the investigational stages, but may be appropriate for patients with no other reasonable options for medical treatment.

Persistence with drug therapy: a practical approach using administrative claims data.

Abstract: For the purposes of this paper, compliance refers to how well a patient follows physician orders within a designated timeframe (number of days supplied/observable period) while persistence addresses how long a patient remains on therapy. Persistence introduces chronology into the assessment while compliance does not. Both compliance and persistence are viewed here as components of overall adherence. The Estimated Level of Persistence with Therapy (ELPT) approach that will be discussed here makes efficient use of valuable information that is already available within administrative pharmaceutical-claims databases. The ELPT provides an inexpensive, unobtrusive way to determine the extent to which patients are filling their prescriptions for long-term therapies

In chronic disease, nationwide data show poor adherence by patients to medication and by physicians to guidelines.

Abstract: Purpose It is widely acknowledged in small studies that provider variation from evidence-based care guidelines and patient medication nonadherence lead to less than optimal health outcomes, increasing costs, and higher utilization. The research presented here aims to determine the prevalence of patient adherence to a medication regimen and provider adherence to guidelines for a variety of chronic conditions, using nationally representative data. Design A retrospective analysis of administrative claims data from a large national insurer was conducted. Methodology The study examined multiple quality indicators exemplifying evidence-based medicine and medication adherence for several chronic conditions. Medication possession ratio (MPR) determined patient adherence. Using EBM Connect software created by Ingenix, we measured adherence to guidelines by applying a series of clinical rules and algorithms. Principal findings Adherence to the evidence-based practice guidelines examined in this study averaged approximately 59 percent, while patient medication nonadherence rates for all the conditions studied averaged 26.2 percent, with a range of 11 percent to 42 percent. Physician adherence to guidelines was highest in the prescribing of inhaled corticosteroids for persistent asthma. Ironically, medication adherence rates for inhaled corticosteroids were the worst identified. The best medication adherence rate was observed in patients with hypertension. Conclusion Like earlier studies, this analysis finds that poor adherence is common across the nation and across common chronic conditions.