An Effectiveness Evaluation of a Primary Care-Embedded Clinical Pharmacist-Led Intervention Among Blacks with Diabetes.

BACKGROUND: Black individuals with type 2 diabetes suffer disproportionate morbidity and mortality relative to whites with type 2 diabetes, irrespective of health insurance coverage. OBJECTIVE: Examine the impact of a primary care-embedded clinical pharmacist-led intervention (UCMyRx) on cardiovascular risk factor control among blacks with type 2 diabetes in a large healthcare system. DESIGN: We used data extracted from the electronic health records (EHR) system and a difference-in-differences study design with a propensity-matched comparison group to evaluate the impact of UCMyRx on HbA1c and systolic blood pressure (SBP) among black patients with type 2 diabetes, relative to usual care. PARTICIPANTS: Individuals with type 2 diabetes identified as either black or African American in the EHR that were ≥ 18 years of age that had the following observations during the study window (03/02/2013-12/31/18: (1) HbA1C ≥ 8%, at least once, anywhere between 365 days before and 14 days after the UCMyRx visit and a follow-up HbA1c measure within 120 to 365 days after the visit and/or (2) SBP ≥ 140 mmHg at least once between 365 days before and 14 days after the UCMyRx visit that had a follow-up SBP measure within 120 to 450 days after the visit. INTERVENTION: UCMyRx pharmacists review labs and vital signs, perform medication reconciliation, use a standardized survey to assess barriers to medication adherence, and develop tailored interventions to improve medication adherence. MAIN MEASURES: Change in HbA1c and change in SBP from before to after the first UCMyRx visit. KEY RESULTS: Having at least one visit with a UCMyRx clinical pharmacist was associated with a significant reduction in HbA1c (- 0.4%, p value = .01); however, there was no significant impact on SBP (- .051 mmHg, p value = 0.74). CONCLUSIONS: The UCMyRx intervention is a useful strategy for improving HbA1c control among blacks with type 2 diabetes.

Prevalence of Ophthalmologic Diagnoses in Children With Autism Spectrum Disorder Using the Optum Dataset: APopulation-Based Study.

PURPOSE: Autism spectrum disorder (ASD) affects an estimated 1.85% of children in the United States and is increasing in prevalence. Any relationship between ophthalmologic disorders and ASD is poorly understood. The purpose of this study was to calculate the prevalence of ophthalmologic disorders in children with ASD. DESIGN: Population-based retrospective cohort study. METHODS: Setting: claims data from Optum Labs Data Warehouse, a longitudinal real-world data asset with de-identified administrative claims and electronic health records data. StudyPopulation: children ≤18 years of age at the time of first claim between 2007 and 2013. OBSERVATION: diagnosis of pervasive developmental disorder (PDD) or autistic disorder (AD) according to International Classification of Disease-9th edition (ICD-9) codes. MainOutcomeMeasurements: prevalence of an ophthalmologic diagnosis (amblyopia, strabismus, optic neuropathy, nystagmus, or retinopathy of prematurity) by ICD-9 codes in typically developing (TD) controls and children with PDD and AD. Adjusted odds ratios (OR) for each diagnosis were calculated using multivariate logistic regression models. RESULTS: Claims from more than 10 million children were included. The prevalence of any ophthalmologic diagnosis considered in this study was 3.5% in TD controls, 12.5% in children with PDD (adjusted OR, 3.22; 95% confidence interval [CI, ], 3.16-3.29; P < .001), and 13.5% in children with AD (adjusted OR, 3.23; 95% CI, 3.15-3.31; P < .001). CONCLUSIONS: Population-based data suggested an increased risk of ophthalmologic diagnoses in children with ASD. Future research is necessary to further clarify the relationship between ophthalmologic disorders and autistic symptoms and severity.

Risk of physical injuries in children and teens with ophthalmic diagnoses in the OptumLabs Data Warehouse.

BACKGROUND: To evaluate how eye diseases affect the risk of injuries (fractures, musculoskeletal, head and eye injuries) in children and teens. METHODS: Claims from the OptumLabs Data Warehouse, a longitudinal deidentified commercial insurance claims database, were analyzed. Eligible subjects were aged <19 years at the time of their eye disease diagnosis, enrolled in the health plan between 2007 and 2018, and had >1 visit for >1 significant eye disease (strabismus, amblyopia, nystagmus, structural diseases), based on ICD9/10 codes. Controls were children in the same database who had no eye disease codes reported. Demographics and injury claims (fractures, musculoskeletal injuries, head injuries and eye injuries) were compared. RESULTS: The overall incidence of any subsequent physical injury (even into adulthood) was 29% in eye disease patients and 23% in controls (P < 0.001). After accounting for covariates, the hazard ratio for injury with any type of eye disease was 1.14 (95% CI, 1.13-1.15), 1.17 (95% CI, 1.16-1.18), 0.97 (95% CI, 0.96-0.98), and 1.63 (95% CI, 1.60-1.66) for musculoskeletal injuries, fractures, head injuries, and eye injuries, respectively. The eye disease with the highest adjusted injury risk was nystagmus (HR = 1.26; 95% CI, 1.23-1.28), followed by optic neuritis and pseudotumor cerebri (HR = 1.25). The eye diseases with the lowest risk included amblyopia, esotropia, and glaucoma (HR ≤ 1.06). CONCLUSIONS: There was an increased long-term risk of physical injury among children and teens with eye disease. The clinical significance of these small differences is unclear.