Patient Support Program and Healthcare Resource Utilization in Patients Using Clean Intermittent Catheterization for Bladder Management.

PURPOSE: The primary purpose of this study was to evaluate the impact of a patient-centered, chronic care self-management support program of clean intermittent catheterization (CIC) on emergency department (ED) visits and hospitalizations within the first 30 days of starting CIC. Secondary research objectives were to compare reuse of catheters, adherence to healthcare provider-instructed frequency of CIC, and reasons for nonadherence. DESIGN: A correlational survey design with 2 respondent groups. SUBJECTS AND SETTING: Four hundred forty-five respondents met inclusion criteria for this study; 321 respondents enrolled in an intermittent catheter manufacturer-supported CIC support program, and 124 respondents were not enrolled in a support program (comparison group). METHODS: Participants completed a 37-item online questionnaire designed for purposes of this study. Chi-square test was used to assess differences in the proportions of patients with ED visits and overnight hospital admissions comparing respondents enrolled in the patient support program to those not enrolled. Regression analyses were performed to estimate the effect of the CIC support program on ED visit events and on hospital overnight stays. RESULTS: Within the first month of CIC initiation, 16.1% and 10.2% of the respondents in the comparison group reported at least 1 ED visit and at least 1 overnight hospital stay, respectively. Respondents participating in the CIC support program experienced a 47% decrease in ED visits (adjusted rate ratio: 0.53; 95% confidence interval: 0.30-0.94, P = .036) and a 77% decrease (adjusted rate ratio: 0.24; 95% confidence interval: 0.10-0.62, P = .002) in hospital overnight stays within the first month of CIC initiation, while controlling for age, sex, education, duration of CIC use, region, health insurance status, and medical conditions necessitating CIC. Respondents in the CIC support program group reported an 8% higher adherence rate with the healthcare provider-instructed frequency of CIC usage compared to the comparison group (88% vs 80%, P = .039). CONCLUSIONS: The burden of CIC-related complications within the first month of CIC initiation is significant. A patient-centered, chronic care self-management program for CIC was associated with fewer ED visits and overnight hospital stays during the first month of CIC and improved adherence to prescribed frequency of CIC use.

Reducing potentially preventable health events among patients with asthma through multi-state, multi-center quality improvement program.

INTRODUCTION: Enhancing Care for Patients with Asthma is a multi-state, multi-center quality improvement program developed to augment guideline-based practice among health care providers through Plan-Do-Study-Act cycle. This study examined the association between the implementation of the guideline-based quality improvement program and subsequent changes in asthma-related emergency room visits and hospitalizations. METHODS: This retrospective, interrupted time-series study used administrative claims data from a private insurer that provided coverage to patients receiving care from participating health centers (15 centers in New Mexico, Oklahoma, Texas, and Illinois). The 12-month implementation period started in January 2013 for centers in Cohort 1 and October 2013 for centers in Cohort 2. The claims of 1,828 patients with asthma from January 2012 to May 2015 were analyzed. The data included 12-month pre-program implementation, 12-month program implementation, and 5-month post-program completion periods. RESULTS: The average number of asthma-related emergency room visits and hospitalizations decreased from 2.22 to 1.38 and 1.97 to 1.04 per 100 patients per month, respectively, in the 12-month pre-implementation period as compared to 12-month implementation period. The results of three-level generalized linear mixed models found that during the 12-month implementation period, patients had 37.7% and 47.1% lower rates of emergency room visits and hospitalizations, respectively, compared to the 12-month pre-implementation period (p < 0.001 in both comparisons). CONCLUSIONS: Enhancing Care for Patients with Asthma is an effective quality improvement program that was successfully executed in diverse geographical states and associated with reductions in potentially preventable health events. The findings support the widespread use of the program in other settings.

Enhancing guideline-based asthma care processes through a multi-state, multi-center quality improvement program.

OBJECTIVE: This study investigated the effectiveness of Enhancing Care for Patients with Asthma (ECPA)-a collaborative quality improvement program implemented in 65 community health centers that serve asthma patients in four states-on clinic-based asthma performance measures consistent with national guidelines. METHODS: This study utilized a pretest-posttest quasi-experimental design. Six clinic-based performance measures of each center were collected from a retrospective chart review at time points: before the ECPA implementation; at the end of the 12-month long ECPA program; and 6 months after program completion. The effectiveness of the ECPA was assessed using generalized linear mixed models with a Poisson distribution and log link by evaluating the change in each measure from baseline to program completion, from baseline to 6-month post-program completion and from program completion to 6-month post-program completion. RESULTS: The ECPA implementation was positively associated with improvement in all measures from baseline to program completion: documentation of asthma severity (rate ratio (RR) 1.314; 95% confidence interval (CI) 1.206, 1.432); Asthma Control Test (RR 3.625; 95% CI 3.185, 4.124); pulmonary function testing (RR 1.771; 95% CI 1.527, 2.054), asthma education (RR 2.246; 95% CI 2.018, 2.501), asthma action plan (RR 2.335; 95% CI 2.070, 2.634) and controller medication (RR 1.961; 95% CI 1.504,2.556). Improvement was sustained for all six measures at the 6-month post-program completion time point. CONCLUSION: This study demonstrated the favorable effect of the ECPA program on evidence-based asthma quality measures. This program could be considered a model worth replication on a broader scale.

Occupational Health Survey of Cosmetologists in Minnesota.

Cosmetologists face a variety of occupational health and safety challenges. To gather information on respiratory issues related to work as a cosmetologist, licensed cosmetologists were invited by e-mail to participate in a short online survey. The survey collected demographic data, work history, respiratory symptoms, product usage, and health and safety training. Results revealed that while 57% of cosmetologists reported having received training on customer or consumer safety, only 10.5% had received training on worker health such as work-related asthma and/or breathing issues. Respiratory symptoms were reported by 46% of respondents. Length of employment and the use of glues or adhesives were associated with a diagnosis of asthma.

Machine Versus Man: Can Robotic Mops Clean to Lead Safety Standards?

This study compared the effectiveness of using a commercially available robotic mop versus hand mopping as the second step of the U.S. Department of Housing and Urban Development's recommended three-step vacuum­mop­vacuum process to remove lead dust debris from residential floors. A total of 1,703 floors were cleaned using the robotic mop. Lead dust wipe tests from these floors were compared with 995 lead dust wipe tests for floors cleaned with hand mopping. Analysis of the dust wipes showed that cleaning floors with a robotic mop resulted in a clearance failure rate significantly lower than that obtained by cleaning floors by hand (4.8% versus 10.0%; p < .05). The use of newer technologies like robotic mops can help improve the efficiency and thoroughness of floor-cleaning efforts, as well as decrease costs associated with re-cleaning floors following regulated renovations.

Disparities in SGLT2 Inhibitor or Glucagon-Like Peptide 1 Receptor Agonist Initiation Among Medicare-Insured Adults With CKD in the United States.

Rationale & Objective: Information regarding disparities in initiating sodium/glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) in patients with chronic kidney disease (CKD) is limited. We examined sociodemographic and clinical factors associated with the initiation of SGLT2i, GLP-1RA, or second-generation sulfonylureas in a Medicare Fee-For-Service patient population with CKD and type 2 diabetes. Study Design: Retrospective cohort study. Setting & Participants: The 20% random sample of Medicare Fee-For-Service claims, 2012-2018. Exposures: Patients' sociodemographic and clinical factors. Outcomes: Use of SGLT2i, GLP-1RA, or sulfonylureas. Analytical Approach: Patients with a newly initiated prescription of SGLT2i, GLP-1RA, or second-generation sulfonylureas from January 1, 2013, to December 31, 2018, were identified. Multinomial logistic regression model was used to evaluate demographic and clinical factors associated with the initiation of SGLT2i, GLP-1RA, or second-generation sulfonylureas. Results: The study cohort comprised 53,029 adults (aged greater than or equal to 18 years) with CKD and type 2 diabetes, of whom 10.0%, 17.4%, and 72.6% had a first prescription for SGLT2i, GLP-1RA, and sulfonylurea, respectively. Patients aged greater than or equal to 75 years versus those aged 65-74 years had lower odds to start SGLT2i or GLP-1RA compared with sulfonylureas. Black patients were associated with lower odds of initiation of SGLT2i (OR, 0.67; 95% CI, 0.61-0.74) and GLP-1RA (OR, 0.73; 95% CI, 0.68-0.79), compared with White patients. Hispanic and Asian patients had lower odds of initiation of GLP-1RA. Patients with cardiovascular disease or hyperlipidemia had higher odds to start SGLT2i or GLP-1RA. Limitations: CKD and type 2 diabetes diagnosis; CKD stage; and patient clinical status were identified with diagnosis or procedure codes. There is potential for residual confounding with the use of retrospective data. Conclusions: The results of this study identified disparities in the use of SGLT2i and GLP-1RA in patients with CKD. Black and older patients were significantly less likely to be initiated on SGLT2i or GLP-1RA than on second-generation sulfonylureas.

Cost-Effectiveness Analysis of a Medial Meniscus Replacement Prosthesis for the Treatment of Patients with Medial Compartment Pain in the United Kingdom.

BACKGROUND: The most common intra-articular knee injury is a meniscal tear, which commonly occurs secondary to trauma following twisting or hyperflexion. Treatment options for meniscal tears can either be surgical or non-surgical, and range from rest, exercise, bracing and physical therapy to surgical intervention, including meniscal repair and partial meniscectomy. In patients with persistent pain following loss of meniscus tissue, treatment can include partial replacement or meniscal allograft transplantation. The NUsurface® prosthesis has been developed as a treatment option for patients experiencing persistent knee pain post medial meniscus (MM) surgery. OBJECTIVE: The aim of this study was to assess the cost effectiveness of MM replacement using NUsurface for the treatment of patients with medial compartment pain following previous partial medial meniscectomy, from a UK health service perspective. METHODS: An economic decision-analytic model was developed to assess the cost per quality-adjusted life-year (QALY) gained associated with the introduction of MM replacement using NUsurface compared with non-surgical standard of care, over a lifetime time horizon. The model structure was primarily informed by a previous clinical trial (VENUS) and was developed based on the clinical pathways typically followed by patients with this condition, with treatment pathways and probabilities of clinical progression adjusted depending on whether patients were receiving the intervention or undergoing current practice. A hypothetical cohort of adult patients (mean age of 50 years) was modelled, with clinical data sourced from the VENUS study as well as relevant UK literature. Both deterministic and probabilistic sensitivity analyses were carried out to explore uncertainty in the model results. RESULTS: The base-case probabilistic results indicate that MM replacement using NUsurface is likely to be cost effective across a range of willingness-to-pay (WTP) thresholds (95% probability of being cost effective at the National Institute for Health and Care Excellence (NICE)-recommended £20,000 WTP threshold). Although per-patient costs increase, QALYs are also gained, with the incremental cost per QALY (probabilistic value = £5011) being below £20,000. Deterministic sensitivity analyses indicate that the parameters that have the greatest impact on results are the failure rate in the control group (current practice), utility scores, and the cost of undergoing MM replacement using NUsurface. CONCLUSIONS: Based on the analysis presented, MM replacement with the NUsurface prosthetic implant is likely to be a cost-effective use of UK health care service resources compared with current standard care.

Hypoglycemia Risk With SGLT2 Inhibitors or Glucagon-Like Peptide 1 Receptor Agonists Versus Sulfonylureas Among Medicare Insured Adults With CKD in the United States.

Rationale & Objective: Information on safety issues of newer glucose-lowering medications from a large population perspective in chronic kidney disease (CKD) patients with type 2 diabetes is limited. Our study aimed to examine hypoglycemia risk associated with sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) versus second-generation sulfonylureas in a general population of older patients with CKD and type 2 diabetes, across race, age, sex, and socioeconomic subgroups. Study Design: Retrospective cohort. Setting & Participants: The 20% random sample of Medicare fee-for-service claims, 2012-2018. Exposures: Use of SGLT2is, GLP-1RAs, or sulfonylureas. Outcomes: Hypoglycemic events resulting in health care utilization. Analytical Approach: Cox proportional hazard model evaluated the 90-day risk of hypoglycemia associated with SGLT2is or GLP-1RAs versus sulfonylureas. Results: A total of 18,567 adults (mean age: 73 years) with CKD and type 2 diabetes was included; 14.0% (n = 2,528) had a prescription for a SGLT2i or GLP-1RA, and 86.0% (n = 16,039) with a sulfonylurea. Compared with sulfonylureas, use of SGLT2is or GLP-1RAs was associated with a significantly lower risk of hypoglycemia (adjusted HR, 0.30; 95% CI, 0.14-0.65). Black individuals had higher risk of developing hypoglycemia than White individuals (adjusted HR, 1.55; 95% CI, 1.07-2.26). Low-income subsidy compared to no low-income subsidy status was associated with higher risk of hypoglycemic events. The risk of hypoglycemia also increased with higher comorbid condition score. Limitations: CKD and type 2 diabetes diagnosis, CKD stage, and patient clinical status were identified with diagnosis or procedure codes. There is potential for residual confounding with use of retrospective data. Conclusions: Use of SGLT2is or GLP-1RAs compared with sulfonylureas was associated with a lower risk of hypoglycemia among patients with CKD and type 2 diabetes. Black race was not only associated with lower use of newer agents with demonstrated cardiovascular and kidney benefits and lower hypoglycemia risk, but also with a higher rate of hypoglycemic events as compared with White individuals.

Population-based assessment of asthma symptom burden in children.

The Minneapolis and St. Paul Controlling Asthma in American Cities Project (CAACP) used a school-based symptom survey to inform community-based programming and provide an intermediate outcome measure of progress toward reducing the burden of asthma. In collaboration with the two school districts, the project mailed the Child Asthma Short Form, a validated health-related quality of life instrument to parents of children in grades K-8 every other school year from 2003 to 2007. The survey was mailed to a randomly selected sample in four languages (English, Spanish, Hmong, and Somali). The overall response rate was 47%, 41%, and 32% for years 1, 3, and 5, respectively. Two out of three children for whom surveys were completed were children of minority populations; more than 50% were eligible for free or reduced-price meals. The changes in scores from the first round (2003-2004) to the third round (2007-2008) were statistically significant for daytime symptom burden (p < 0.05). Improvements were noted, but not statistically significant, for nighttime symptoms and functional limitations. Children of some racial/ethnic minority groups and children eligible for free or reduced-price meals had the highest symptom burden. Findings were used to guide CAACP's program development and delivery to populations in greatest need. CAACP's experience in Minneapolis and St. Paul demonstrates the feasibility of administering a symptom burden survey at low cost and in compliance with school system and institutional review board requirements to maintain confidentiality. The symptom-based survey may be a useful tool to track trends and changes in health disparities at a community and population level.

Glucose-Lowering Medication Use in CKD: Analysis of US Medicare Beneficiaries Between 2007 and 2016.

BACKGROUND: Information regarding the use of glucose-lowering medications in patients with chronic kidney disease (CKD) is limited. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Medicare 5% random sample of patients with CKD with type 2 diabetes, 2007 to 2016. PREDICTORS: Study year, CKD stage, low-income subsidy status, and demographic characteristics (age, sex, and race/ethnicity). OUTCOMES: Trends in use of glucose-lowering medications. ANALYTICAL APPROACH: Yearly cohorts of patients with CKD and type 2 diabetes were created. Descriptive statistics were used to report proportions of patients using glucose-lowering medications. To test overall trends in glucose-lowering medication classes, linear probability models with adjustment for age, sex, race/ethnicity, CKD stage, and low-income subsidy status were used. RESULTS: Metformin use increased significantly from 32.7% in 2007 to 48.7% in 2016. Use of newer classes of glucose-lowering medications increased significantly, including dipeptidyl peptidase 4 inhibitors (5.6%, 2007; 21.7%, 2016), glucagon-like peptide 1 receptor agonists (2.3%, 2007; 6.1%, 2016), and sodium-glucose cotransporter 2 inhibitors (0.2%, 2013; 3.3%, 2016). Newer insulin analogue use increased from 37.2% in 2007 to 46.3% in 2013 and then remained steady. Use of sulfonylureas, thiazolidinediones, older insulins (human regular and neutral protamine Hagedorn), α-glucosidase inhibitors, amylin mimetics, and meglitinides decreased significantly. Insulin was the most highly used single medication class. Insulin use was higher among low-income subsidy than among non-low-income subsidy patients. Combination therapy was less common as CKD stage increased. LIMITATIONS: Patients with CKD and type 2 diabetes and the CKD stages were identified with diagnosis codes and could not be verified through medical record review. Our results may not be generalizable to younger patients with CKD with type 2 diabetes. CONCLUSIONS: Use of metformin and newer glucose-lowering medication classes is increasing in patients with CKD with type 2 diabetes. We anticipate that percentages of patients with CKD using these newer agents will increase.

Translational Effect of Provider-Focused, Multi-State, Multi-Clinic Asthma Care Quality Improvement Program on Patient-Level Health Care Costs.

INTRODUCTION/OBJECTIVES: Enhancing Care for Patients with Asthma (ECPA), a year-long provider-focused, multi-state, multi-clinic quality improvement program, decreased avoidable utilizations among patients with asthma, but its effects on health care expenditures were not determined. This study examined the translational and sustainable effects of improved care through ECPA on individual-level total health care costs due to asthma. METHODS: We conducted a retrospective pretest-posttest quasi-experimental study in which attributed 1683 patients in a 12-month pre-ECPA implementation period served as their own control. We constructed the total annual asthma-related health care costs per patient occurred during pre-ECPA implementation, ECPA implementation, and post-ECPA completion. We used 3-level generalized linear mixed models (GLMMs) to estimate the ECPA effect on the annual health care costs and account for correlation between the repeated outcome measures for each patient and nested clinic. All costs were adjusted for inflation to 2014 U.S. dollars, the last year of program observation. RESULTS: Total asthma-related health care costs among the 1683 included patients decreased from an average of $7033 to $3237 per person-year (pre-ECPA implementation vs implementation). Using the cost data from the 12-month pre-ECPA implementation period as a reference, GLMMs found that the ECPA implementation was associated with a reduction in total annual asthma-related health care costs by 56.4% (95% CI -60.7%, -51.8%). During the 12-months after ECPA completion period, health care costs were also found to be significantly lower, experiencing a 57.3% reduction. CONCLUSIONS: The economic benefits of ECPA provide a justification to adopt this quality improvement initiative to more primary care clinics at a national level.

Optimal care for diabetes and vascular disease: lessons from the field.

Minnesota has led the nation in development of evidence-based guidelines and in public reporting of performance on quality measures. A recent qualitative study explored what 21 Minnesota clinics and their affiliated medical groups are doing to provide patients with optimal diabetes and vascular care. This article reports the practices medical directors and administrators identified as contributing to the successful management of patients with these conditions.

Athletes and asthma.

Many Minnesotans with asthma participate in recreational and competitive sports. If asthma is undiagnosed or if it is poorly controlled, its symptoms can compromise health, impair athletic performance, and limit sports participation. It can even lead to death. Asthma-related deaths during sports participation, while not common, have occurred in Minnesota. Having asthma should not limit an athlete's ability to compete and win at the highest levels of competition. This article briefly reviews asthma and exercise-induced bronchoconstriction, discusses the impact of asthma on sports participation and outlines asthma management strategies for team physicians, coaches, and athletic trainers.

Survivorship Care Plans: Health Actions Taken and Satisfaction After Use.

OBJECTIVES: To examine the use of and assess patient satisfaction with survivorship care plans (SCPs). SAMPLE & SETTING: 189 cancer survivors recruited from five cancer treatment center locations (Avera Cancer Institute in Aberdeen, Mitchell, Sioux Falls, and Yankton; Sanford Cancer Center in Sioux Falls) and one auxiliary specialty center (Urology Specialists in Sioux Falls), all in South Dakota. METHODS & VARIABLES: A written survey was completed by participants before and three months after receiving an SCP. Associations between demographics and cancer-related characteristics and use of the SCP were evaluated using chi-square tests. Logistic regression was used to determine factors associated with any use of the SCP, health actions attributable to the SCP, and satisfaction with the SCP. RESULTS: The most frequently reported uses of the SCP were to share with spouse or partner, inform about symptoms, and ask physician or nurse about concerns. SCP use, health actions taken, and satisfaction with the SCP were associated with gender, marital status, and main cancer type. IMPLICATIONS FOR NURSING: Nurses should promote SCPs because they are valued and used by survivors for follow-up care.

The Medical Home Model and Pediatric Asthma Symptom Severity: Evidence from a National Health Survey.

The objective was to investigate the association between receiving care under the medical home model and parental assessment of the severity of asthma symptoms. It was hypothesized that parents of children who received care under the medical home model reported less severe asthma symptoms compared with their counterparts, whose care did not meet the medical home criteria. Secondary analyses were conducted using cross-sectional data from the 2011-2012 National Survey of Children's Health. Children with asthma aged 0-17 years were included and classified as receiving care from the medical home if their care contained 5 components: a personal doctor, a usual source of sick care, family-centered care, no problems getting referrals, and effective care coordination. Ordinal logistic regression was used to examine the relationship between parent-rated severity of asthma symptoms (mild, moderate, and severe symptoms) and the medical home. Approximately 52% of 8229 children who reported having asthma received care from the medical home. Only 30.8% of children with severe asthma symptoms received care that met the medical home criteria, compared to 55.7% of children with mild symptoms. After accounting for confounding factors, obtaining care under the medical home model decreased the odds of parent-reported severe asthma symptoms by 31% (adjusted odds ratio 0.69; 95% CI, 0.56-0.85). Study results suggest that the medical home model can reduce parent-rated severity of asthma symptoms. The findings highlight the importance of providing medical home care to children with asthma to improve the outcomes that matter most to children and their families.

Pharmacy Practice in the South Dakota Correctional System: Discovery of an Unconventional Experiential Practice Site.

Pharmacists must be prepared to care for populations where health disparities are greatest and their services can best impact public health needs. Such preparation requires that students have access to practice experiences in underserved environments where pharmacy practice, cultural competence and knowledge of population health are experienced simultaneously. The correctional facility is such a place. The American Society of Health-System Pharmacists recommends that students receive preceptorship opportunities within the correctional system. The occasional collaboration or experiential opportunity, like Kingston's early model, has occurred between health professional schools and correctional facilities. However, to date, the correctional facility-experiential site remains an untapped opportunity, at least in a complete, coordinated, pharmaceutical care, patient management framework. Consequently, a short research study asked: To what extent is there potential for correctional facilities to serve as experiential practice sites for pharmacy students? The research objective was to identify pharmaceutical practices within South Dakota correctional system and compare those practices to the guidelines established by the Association of American College of Pharmacy's as optimal for student training. To understand medical and pharmaceutical practices in SDPS, three South Dakota Adult prison facilities were included in the exploratory study. Data was collected through a mixed methods approach designed to obtain perspectives about the SDPS health care system from individuals representing the numerous job levels and roles that exist within the health care continuum. Interviews and a web-based surveys were used to collect data. A review of a 36-page transcript along with 498 freeform survey comments revealed that while exact themes from the Exemplary Practice Framework may not have been evident, related words or synonyms for patient-centered care, informatics, public health, medication therapy management, and quality improvement appeared with great frequency.

Relationship of the magnitude of member cost-share and medication persistence with newly initiated renin angiotensin system blockers.

BACKGROUND: Effective treatment for chronic diseases often requires medication refill persistence. Health plans have frequently increased the amount of member cost-sharing by implementing tier-copayment pharmacy benefit designs and raising copayments. However, increased member costshare may present a barrier to the management of chronic conditions. Little is known about the relationship between the magnitude of member cost-sharing and antihypertensive persistence among members newly initiating therapy. OBJECTIVE: To investigate and quantify the relationship between amount of prescription cost-sharing and medication refill persistence among members newly initiating therapy with a single-agent angiotensin system blocker--either an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB). METHODS: This was an observational cohort study of pharmacy and medical claims data for 29 employers with approximately 310,000 beneficiaries that did not have a change in pharmacy benefits including the amount of member cost-share in 2004. The claims data were supplemented with census data for household income and race at the Zip Code level. Selected patients were new users of single-agent ACEIs or ARBs (i.e., excluding ACEI or ARB in combination with hydrochlorothiazide or amlopdipine) between January 1 and June 30, 2004, without a pharmacy claim for an ACEI or an ARB in the 6 months prior to the index claim for either drug type. Medication refill persistence was measured in 3 ways: (1) total number of days without ACEIs or ARBs during 6 months follow-up, (2) proportion of days covered (PDC) with less than 80% defined as nonpersistent during 6 months follow-up, and (3) number of days to the first gap of more than 30 days in medication coverage from the index date to end of 2004 (mean [SD] follow-up=9.2 [1.8] months). Three statistical models were fit: Tobit model, examining the association between cost-sharing and total number of medication gap days; logistic regression, testing the association between cost-sharing and odds of being nonpersistent; and Cox proportional hazards model, assessing the association between cost-sharing and time to a 30-day gap. RESULTS: Among the eligible population, a study cohort of 1,351 members newly initiating a single-agent ACEI or ARB was identified. These members were 41.8% female and had a mean age of 55.9 (SD=13.1) years. On average, their member cost-share was $12.42 (SD=$8.50) per 30-day supply. Each $1 increment in per 30-day cost-share was associated with a 1.9% increase in total gap (beta=0.019, 95% confidence interval [CI], 0.007-0.030, P=0.001), a 2.8% increase in the odds of being nonpersistent (odds ratio [OR]=1.028, 95% CI,1.011-1.045, P=0.001), and a 1.0% increase in the risk of having a gap of more than 30 days (hazard ratio [HR]=1.010, 95% CI, 1.001-1.019, P=0.034). Following transformation of the cost-sharing coefficient in each model, a $10 increment in cost-share had a consistent negative influence; 18.9% greater total gap days (beta=0.189, 95% CI, 0.073-0.304), 31.9% greater odds of being nonpersistent (OR=1.319, 95% CI, 1.120-1.553), and 10.2% larger hazard of having a gap of more than 30 days (HR=1.102, 95% CI, 1.007-1.205). CONCLUSION: For members newly initiating single-agent angiotensin system blocking medication, the amount of prescription cost-sharing was associated with a negative impact on refill persistence.

Measurement of persistence and adherence to regimens of IOP-lowering glaucoma medications using pharmacy claims data.

PURPOSE: Determine persistence and adherence of glaucoma patients to therapeutic regimens of prostaglandin/prostamide-class IOP-lowering medications. DESIGN: Retrospective, population-based study. METHODS: Glaucoma patients in the IMS Health LifeLink database with a pharmacy claim for latanoprost (n = 1567), travoprost (n = 381), or bimatoprost (n = 476) between September, 2001 and March, 2002 who had no claims for IOP-lowering medication in the previous 180 days, and who were persistent during the first 90 days of therapy. Values reported in the quantity dispensed and days supply fields of the database were used in an algorithm that corrected anomalous data and adjusted days supply to calculate the main outcome measures, persistence, and adherence to therapy. RESULTS: The percentage of patients persistent for the 12-month observation period was 69.4% (1087/1567) for those prescribed latanoprost, 70.6% (269/381) for those prescribed travoprost, and 68.1% (324/467) for those prescribed bimatoprost. Mean adherence for patients prescribed latanoprost was 75.4% of the year, for those prescribed travoprost, 77.1% of the year, and for those prescribed bimatoprost, 78.2% of the year. The mean number of days adherent for bimatoprost-treated patients (291.2 days) was significantly greater than for latanoprost-treated patients (281.0 days), and not remarkably different from travoprost-treated patients (287.0 days). CONCLUSIONS: Overall, patients in this study who were taking IOP-lowering prostaglandin/prostamide medications had a mean adherence rate of 76% on average, suggesting that opportunities remain for improvement of adherence to therapeutic regimens for glaucoma treatment with prostamides and prostaglandins.