Showing papers in "Managed care (Langhorne, Pa.) in 2008"

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.

RSV disease in the pediatric population: epidemiology, seasonal variability, and long-term outcomes.

Abstract: Infants younger than 1 year, and especially premature infants, are susceptible to severe RSV disease, which accounts for up to 126,000 hospitalizations each year. In the United States, the RSV season generally extends from November though March, but varies considerably both temporally and geographically. Studies, such as the one we have conducted in Colorado, indicate that the RSV season can even vary among local communities. In addition to seasonal variability, other independent risk factors also have to be taken into consideration when considering RSV immunoprophylaxis. Among these are a GA of less than 33 weeks, infants with CLD or CHD or who are immunosuppressed, male sex, household crowding, and daycare attendance. Exposure to indoor tobacco smoke and abbreviated breast feeding (less than 2 months) also may be pertinent risk factors. The Colorado studies show that high altitude also increases the risk of RSV hospitalization. Although hospitalization is a major outcome of severe RSV infections in infants, the development of wheezing and physician-diagnosed asthma later in life may be a long-term outcome that should be considered.

Nausea and vomiting of pregnancy: cost effective pharmacologic treatments.

Abstract: Nausea and vomiting of pregnancy (NVP) can range from morning sickness to moderate NVP to hyperemesis gravidarum (HG). If it is left unmanaged, health plans may pay for expensive unproven outpatient therapies that are not necessary for treatment of simple morning sickness or moderate NVP. Meanwhile, patients with serious hyperemesis gravidarum whose treatment is delayed may suffer needlessly, ending up with multiple hospitalizations or emergency room (ER) visits. Two expensive, heavily marketed outpatient therapies with scant supportive evidence in the treatment of NVP have recently emerged and some health plans are providing coverage without a thorough review of the medical evidence or cost implications. Health plans may have an opportunity to save a significant amount and to improve member satisfaction by utilizing evidence-based knowledge of pharmacologic interventions that are driven, in order, by known safety, proven efficacy, and cost effectiveness.

Evaluation of a continuous glucose monitoring system for home-use conditions.

Abstract: Objective: To evaluate the safety and effectiveness of the FreeStyle Navigator Continuous Glucose Monitoring System when used by adult patients with type 1 or 2 diabetes requiring insulin in the home environment. Research design and methods: Multicenter, prospective study enrolling 137 subjects. This was a two-phase study consisting of 20 days of use (“masked period”) without access to continuous glucose readings followed by 21 days of use (‘”unmasked period”) with access to continuous glucose readings and glucose alarms. At the conclusion of the study, all subjects were asked to complete a User’s Questionnaire. Results: A total of 11,487 paired continuous glucose sensor and blood glucose reference results from 961 sensors were evaluated; 77.2 percent were in Clarke error grid zone A and 19.6 percent were in zone B. Only 13.1 percent of the hypoglycemic and 0.5 percent of the hyperglycemic threshold alarms were false alerts. Subjects with type 1 diabetes demonstrated a 55 percent reduction in time spent with significant hypoglycemia (below 55 mg/dL) (P<.0001) from masked to unmasked periods. Their average number of hypoglycemic episodes (below 70 mg/dL) per day fell from 1.1 to 0.8 (P<.0001). Results from patient questionnaires demonstrated high levels of subject satisfaction and the ability to use and understand the system. Conclusions: FreeStyle Navigator Continuous Glucose Monitoring System is safe and effective, and results in a high level of subject satisfaction while used in the home setting. Utilization of continuous glucose monitors with alerts may result in cost offsets by reducing the number and severity of clinically significant events and assisting in the maintenance of optimal glycemic control.

RSV infection in the adult population.

Abstract: RSV is a significant and unrecognized cause of seasonal RTIs in adults, accounting for as much as 25 percent of excess wintertime mortality usually attributed to influenza. Nearly 80 percent of RSV-associated underlying respiratory and circulatory deaths occur among the elderly, and RSV is estimated to account for about 180,000 hospital admissions each year at a cost exceeding $1 billion. RSV also is recognized as an important cause of viral pneumonia in adults. Preventive measures, such as hand washing, are paramount, especially in hospitals and nursing homes where many immunocompromised patients reside. When RSV is circulating, it is advisable to minimize contact between high-risk patients and children.

Societal and economic consequences of influenza.

Abstract: High rates of vaccination coverage for preschool and school-aged children can reduce morbidity and mortality related to influenza outbreak. More focused and effective influenza prevention strategies are necessary to improve quality of life and to limit the burden of flu complications.

Optimizing the use of 17P in pregnant managed Medicaid members.

Abstract: OBJECTIVE: To evaluate the effect of 17 alpha-hydroxyprogesterone caproate (17P) on reducing the rate of neonatal intensive care unit (NICU) admissions and premature births in a managed Medicaid population that has a history of preterm delivery. Specifically, to measure the effect of initiating 17P treatment during the recommended time frame of 16-21 weeks gestation versus after 21 weeks gestation. DESIGN: A 2004-2007 observational, causal comparative study reviewed birth outcomes in 104 pregnant women with a confirmed history of preterm delivery. Women whose 17P treatment was initiated during the recommended time frame of 16-21 weeks gestation were compared to those whose treatment was initiated after 21 weeks gestation. METHODOLOGY: Intervention included offering 17P as a benefit to pregnant women who had a history of preterm delivery and who were deemed to be appropriate candidates for this treatment by their physician. RESULTS: No significant changes in birth outcomes were noted when comparing those members whose treatment was initiated during the recommended time frame of 16-21 weeks versus those whose treatment began after 21 weeks gestation. Members who received therapy of at least five injections of 17P, as opposed to those receiving fewer than five injections, experienced a statistically significant reduction in NICU admissions and in preterm birth at fewer than 37 weeks and at fewer than 32 weeks. CONCLUSION: The number of injections and not the time frame, which had been indicated by previous research, the initiation of 17P therapy is the factor in reducing preterm birth and decreasing NICU admissions for pregnant women with a history of preterm birth in a managed Medicaid population.

Myelodysplastic syndromes: disease overview and therapy options.

Abstract: The increase in new cases of myelodysplastic syndromes is likely attributable to both an aging population and a greater number of cancer survivors who have received chemotherapy. A detailed diagnostic history is critical in order to place a patient in the proper treatment category.

Multiple myeloma: epidemiology and therapeutic options.

Abstract: Myeloma remains an incurable disease, but its management has significantly improved with the introduction of novel treatment agents. Variations in both disease manifestation and patient response to treatment have personalized approaches to care.

An introduction to influenza: lessons from the past in epidemiology, prevention, and treatment.

Abstract: Better understanding of viral biology and the origins of influenza epidemics and pandemics may improve diagnosis and disease control. Advances to stop the spread of disease, including live-attenuated and inactivated vaccines and new antiviral agents, promise to reduce disease burden, mortality, and morbidity.

In the trenches: a pediatrician's perspective on prevention and treatment strategies for RSV disease.

Abstract: Pharmacologic options in the treatment of RSV infection have no or minimal effectiveness. Therefore, for infants at high risk of RSV infection, proper hand hygiene, limiting exposure to infection, and immunoprophylaxis with palivizumab is paramount. The first injection of palivizumab must be given prior to the start of the local RSV season and subsequent injections should be administered every 30 days to provide protective levels until the end of the RSV season. Pediatricians should anticipate the start of the RSV season and attend to reimbursement issues and obtain all necessary approvals well in advance of the time when the first injections will be given. Compliance is the key to providing protection for high-risk infants. Compliance has a positive association with decreasing RSV hospitalization rates; however, it is difficult for pediatricians to achieve optimal compliance on their own. A collaborative effort involving the hospital and NICU, pediatrician, parent, home care provider, and insurer is necessary to achieve optimal compliance.