Potential impact of pharmacist interventions to reduce cost for Medicare Part D beneficiaries.

The objective was to determine the impact of simulated pharmacist interventions on out-of-pocket cost, time to coverage gap, and cost per patient to the Medicare Part D program using actual patient cases from an adult general medicine clinic. Medication profiles of 100 randomly selected Medicare-eligible patients from a university-affiliated general internal medicine clinic were reviewed by a pharmacist to identify opportunities to cost-maximize the patients' therapies based on the plan. An online Part-D calculator, Aetna Medicare Rx Essentials, was used as the standard plan to determine medication cost and time to gap. The primary analysis was comparison of the patients' pre-review and post-review out-of-pocket cost, time to coverage gap, and cost to Medicare. A total of 65 patients had at least 1 simulated pharmacist cost intervention. The most common intervention was substituting for a less costly generic, followed by substituting a generic for a brand name. Projected patient cost savings was $476 per year. The average time to coverage gap was increased by 0.7 ±1.2 months. This study illustrates that the pharmacists may be able to reduce cost to some patients as well as to the Medicare Part D program.

Efficacy of gait training with real-time biofeedback in correcting knee hyperextension patterns in young women.

STUDY DESIGN: Single cohort study. OBJECTIVES: To investigate the efficacy of real-time biofeedback provided during treadmill gait training to correct knee hyperextension in asymptomatic females while walking. BACKGROUND: Knee hyperextension is associated with increased stress to the posterior capsule of the knee joint, anterior cruciate ligament, and the anterior compartment of the tibiofemoral joint. Previous methods aimed at correcting knee hyperextension have shown limited success. METHODS: Ten women, ages 18 to 39 years, with asymptomatic knee hyperextension during ambulation, were provided with 6 sessions of real-time feedback of kinematic data (Visual 3D) during treadmill training. Gait evaluations were performed pretraining, posttraining, and 1 month after the last training session. RESULTS: Participants showed improved control of knee hyperextension during overground walking at 1.3 m/s at posttraining and at 1 month posttraining. CONCLUSION: The present study demonstrated that knee sagittal plane kinematics may be influenced by gait retraining using real-time biofeedback.