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American Journal of Managed Care

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https://www.readbyqxmd.com/read/28978207/chemotherapy-induced-nausea-and-vomiting-roles-of-pharmacists-and-formulary-decision-makers
#1
Stacey W McCullough
Despite guidelines and medications available for the management of chemotherapy-induced nausea and vomiting (CINV), many patients with cancer are persistently affected by this dreadful adverse effect. It is not only physically and mentally draining, but financially strenuous as well. Along with these concerns, health-related consequences as dehydration, epigastric pain, and anorexia can arise. Therefore, compliance becomes a big issue in this patient population. It is important for healthcare professionals to educate patients and incorporate strategies by not only addressing but also individualizing treatment regimens and determining risk factors for potential CINV...
September 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28978206/overview-of-chemotherapy-induced-nausea-and-vomiting-and-evidence-based-therapies
#2
Nelly Adel
Among patients with cancer, chemotherapy-induced nausea and vomiting (CINV) is a common adverse effect that not only impacts quality of life, but also treatment outcomes. It is important to address these issues from both prevention and treatment standpoints so that patients remain adherent to their regimens. With CINV being classified into 5 different types, the primary medication options for prevention and treatment include 5-HT3 receptor antagonists, NK1 receptor antagonists, and corticosteroids. Other medications used, but to a lesser extent, include dopamine antagonists, benzodiazepines, cannabinoids, and olanzapine...
September 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28978218/overview-of-the-cardiovascular-benefit-with-diabetic-agents-and-novel-combination-products-for-type-2-diabetes
#3
Candis M Morello
Cardiovascular (CV) disease is commonly observed in individuals with type 2 diabetes (T2D) and is associated with significant morbidity and mortality. Diabetes medications can have substantial negative or beneficial CV effects in these patients. Thus far, specific glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors have been shown to have beneficial CV effects in persons with T2D. Clinical trials are ongoing to evaluate the CV effects of investigational and recently approved diabetes medications...
August 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28978217/strategies-for-addressing-the-cost-of-nonadherence-in-diabetes
#4
Candis M Morello, Jan D Hirsch
Diabetes accounts for the second largest amount of avoidable healthcare costs in the United States-an estimated $24.6 billion in wasteful and avoidable spending. Diabetes is a lifelong disease that is highly dependent on patient self-management. Unfortunately, studies demonstrate that almost 50% of patients with diabetes fail to reach the glycemic goal of glycated hemoglobin <7%. Patient nonadherence poses a significant barrier to effective management of diabetes and can place a significant burden on the patient and the healthcare system, resulting in even greater increases in costs, morbidity, and mortality...
August 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28978216/economic-impact-of-and-treatment-options-for-type-2-diabetes
#5
Jan D Hirsch, Candis M Morello
Diabetes and its various comorbidities are responsible for a substantial societal financial burden. Healthcare and managed care providers must take responsibility for and address the high healthcare costs attributed to diabetes care. They can work together to improve diabetes-related patient care and reduce costs. Newer therapeutic agents and those used as combination therapy may decrease direct costs by improving glycemic control and preventing negative outcomes associated with diabetes comorbidities. Additional diabetes education, increased time to review medication adherence and diabetes monitoring, and having affordable care are all necessary to improve the care of individuals with diabetes...
August 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28978214/strategies-to-manage-costs-in-idiopathic-pulmonary-fibrosis
#6
Gary M Owens
Idiopathic pulmonary fibrosis (IPF) is a diagnostically challenging disease. Clinicians are faced with the need to exclude alternative diagnoses, limited treatment and management guidelines, and few treatment options. Patients with IPF have significantly increased healthcare usage compared with similar patients without the disease. Medicare estimates for this disease are as high as $3 billion, not including cost of treatment. The disease, characterized by worsening dyspnea, declining lung function, nonspecific respiratory symptoms, and a varied clinical course randomly punctuated by episodes of acute exacerbations, is also accompanied by a host of comorbid conditions that contribute significantly to increased healthcare usage and cost...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28978213/evaluating-new-treatment-options
#7
Steven D Nathan
Idiopathic pulmonary fibrosis (IPF) is the most prevalent type of idiopathic interstitial pneumonia, accounting for at least half of all diagnosed cases. Because it lacks a cure, the goal of treatment for IPF is to stabilize or reduce the rate of disease progression. Nonpharmacologic treatment options for IPF consist of long-term oxygen treatment, lung transplantation, and pulmonary rehabilitation. In the past, pharmacologic therapies for IPF included anticoagulants and anti-inflammatory or immunosuppressive agents...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28978212/overview-of-idiopathic-pulmonary-fibrosis-ipf-and-evidence-based-guidelines
#8
Roozbeh Sharif
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive form of interstitial lung disease (ILD), characterized by fibrosis and worsening lung function, that primarily occurs in those 50 years and older. Various causes including genetic susceptibility, environmental risk factors, and exposures have been suggested in the literature. All of these cause repetitive micro-injury to the lung tissue and vasculature, which triggers a cascade of inflammatory response and fibrosis. Symptoms are nonspecific and most patients present several years after the initial radiographic changes occur...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28850793/medication-adherence-and-improved-outcomes-among-patients-with-type-2-diabetes
#9
Sarah E Curtis, Kristina S Boye, Maureen J Lage, Luis-Emilio Garcia-Perez
OBJECTIVES: Examine the association between adherence to glucose-lowering agents (GLAs) and patient outcomes in an adult type 2 diabetes (T2D) population. STUDY DESIGN: Retrospective analysis. METHODS: Truven's Commercial Claims and Encounters database supplied data from July 1, 2009, to June 30, 2014. Patients 18 to 64 years with T2D were included if they received a GLA from July 1, 2010, through June 30, 2011. Multivariable analyses examined the relationships among 3-year patient outcomes and adherence, defined as proportion of days covered 80% or more...
July 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28850792/adaptation-of-an-asthma-management-program-to-a-small-clinic
#10
Kenny Yat-Choi Kwong, Nasser Redjal, Lyne Scott, Marilyn Li, Salima Thobani, Brian Yang
OBJECTIVES: Asthma management programs, such as the Breathmobile program, have been extremely effective in reducing asthma morbidity and increasing disease control; however, their high start-up costs may preclude their implementation in smaller health systems. In this study, we extended validated asthma disease management principles from the Breathmobile program to a smaller clinic system utilizing existing resources and compared clinical outcomes. STUDY DESIGN: Cox-regression analyses were conducted to determine the cumulative probability that a new patient entering the program would achieve improved clinical control of asthma with each subsequent visit to the program...
July 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28850791/twitter-accounts-followed-by-congressional-health-staff
#11
David Grande, Zachary F Meisel, Raina M Merchant, Jane Seymour, Sarah E Gollust
OBJECTIVES: Although health policy research should inform policy making, the communication gap between researchers and policy makers limits successful translation. Social media represents a new opportunity to connect researchers and policy makers. Our objective was to assess who Congressional health policy staff follow on a major social media platform. STUDY DESIGN: Cross-sectional study. METHODS: Our study measured Congressional health policy staff's use of Twitter and the types of individuals and organizations they follow...
July 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28850790/leveraging-ehrs-for-patient-engagement-perspectives-on-tailored-program-outreach
#12
Susan D Brown, Christina S Grijalva, Assiamira Ferrara
OBJECTIVES: Electronic health records (EHRs) present healthcare delivery systems with scalable, cost-effective opportunities to promote lifestyle programs among patients at high risk for type 2 diabetes, yet little consensus exists on strategies to enhance patient engagement. We explored patient perspectives on program outreach messages containing content tailored to EHR-derived diabetes risk factors-a theory-driven strategy to increase the persuasiveness of health communications. STUDY DESIGN: Convergent mixed methods...
July 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28850789/predicting-high-cost-privately-insured-patients-based-on-self-reported-health-and-utilization-data
#13
Peter J Cunningham
OBJECTIVES: To examine how well self-reported data on health, health behaviors, and healthcare utilization by a sample of privately insured patients predict whether they will incur high healthcare costs the following year. STUDY DESIGN: A 2012 mail survey of autoworkers from Chrysler, Ford, and General Motors, with 3983 survey respondents linked to their health insurance claims data for 2012 and 2013. METHODS: High healthcare costs are defined as being in the 75th percentile or higher of healthcare expenditures...
July 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817783/the-association-between-insurance-type-and-cost-related-delay-in-care-a-survey
#14
Sora Al Rowas, Michael B Rothberg, Benjamin Johnson, Joel Miller, Mohanad AlMahmoud, Jennifer Friderici, Sarah L Goff, Tara Lagu
OBJECTIVES: Massachusetts has insurance rates similar to those projected under the Affordable Care Act, but many of the state's patients are insured through private insurance plans with high out-of-pocket costs. We aimed to explore the relationship between insurance type (private vs public) and delays in care due to cost, stratified by income. STUDY DESIGN: Cross-sectional study. METHODS: We conducted a study of English-speaking adults recruited from the waiting rooms of the emergency department or outpatient clinics of a large healthcare system in western Massachusetts...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817782/cost-effectiveness-of-a-patient-navigation-program-to-improve-cervical-cancer-screening
#15
Yan Li, Erin Carlson, Roberto Villarreal, Leah Meraz, José A Pagán
OBJECTIVES: To assess the cost-effectiveness of a community-based patient navigation program to improve cervical cancer screening among Hispanic women 18 or older in San Antonio, Texas. STUDY DESIGN: We used a microsimulation model of cervical cancer to project the long-term cost-effectiveness of a community-based patient navigation program compared with current practice. METHODS: We used program data from 2012 to 2015 and published data from the existing literature as model input...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817781/availability-and-variation-of-publicly-reported-prescription-drug-prices
#16
Jeffrey T Kullgren, Joel E Segel, Timothy A Peterson, A Mark Fendrick, Simone Singh
OBJECTIVES: To examine how often retail prices for prescription drugs are available on state public reporting websites, the variability of these reported prices, and zip code characteristics associated with greater price variation. STUDY DESIGN: Searches of state government-operated websites in Michigan, Missouri, New York, and Pennsylvania for retail prices for Advair Diskus (250/50 fluticasone propionate/salmeterol), Lyrica (pregabalin 50 mg), Nasonex (mometasone 50 mcg nasal spray), Spiriva (tiotropium 18 mcg cp-handihaler), Zetia (ezetimibe 10 mg), atorvastatin 20 mg, and metoprolol 50 mg...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817780/us-internists-awareness-and-use-of-overtreatment-guidelines-a-national-survey
#17
Kira L Ryskina, Eric S Holmboe, Elizabeth Bernabeo, Rachel M Werner, Judy A Shea, Judith A Long
OBJECTIVES: To assess physician views and perceived adoption of overtreatment guidelines and measure whether adoption of these guidelines influenced the recommendation of a targeted service. STUDY DESIGN: A cross-sectional survey mailed from July 2014 to January 2015 to 902 internists who completed residency between 2003 and 2013, randomly selected from the American Medical Association Masterfile. METHODS: Poisson regression was used to model the rate of recommending a targeted service included in the guidelines, based on the level of guideline adoption...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817779/the-price-may-not-be-right-the-value-of-comparison-shopping-for-prescription-drugs
#18
Sanjay Arora, Neeraj Sood, Sophie Terp, Geoffrey Joyce
OBJECTIVES: To measure variations in drug prices across and within zip codes that may reveal simple strategies to improve patients' access to prescribed medications. STUDY DESIGN: We compared drug prices at different types of pharmacies across and within local markets. In-store prices were compared with a Web-based service providing discount coupons for prescription medications. Prices were collected for 2 generic antibiotics because most patients have limited experience with them and are less likely to know the price ranges for them...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28727476/options-for-addressing-exocrine-pancreatic-insufficiency-in-patients-receiving-enteral-nutrition-supplementation
#19
Steven D Freedman
Patients with exocrine pancreatic insufficiency (EPI) have suboptimal secretion of pancreatic digestive enzymes and experience a range of clinical symptoms related to the malabsorption of fat. In patients with EPI unable to meet their nutritional requirements, enteral nutrition (EN) support is used to augment nutritional status. In addition to protein and carbohydrate, EN formulas contain fats as a calorie source, as well as vitamins and minerals to help prevent nutritional deficiencies related to malabsorption...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28727475/guidance-for-supplemental-enteral-nutrition-across-patient-populations
#20
Douglas L Nguyen
Enteral nutrition is preferred over parenteral nutrition as a result of the greater safety of enteral nutrition therapy and comparative convenience. A wide variety of enteral nutrition products have been developed, including disease-specific products to help manage the nutritional needs of patients with kidney failure, liver failure, lung disease, diabetes, and other conditions. An assessment of each patient's nutritional needs and digestive function should be conducted prior to initiation of enteral nutrition therapy...
July 2017: American Journal of Managed Care
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