Analysis of a panel-based pharmacogenomics testing program among members of a commercial and Medicare client of a pharmacy benefits manager.

BACKGROUND: Although the field of pharmacogenomics (PGx) has existed for decades, use of pharmacogenomic information by providers to optimize medication therapy for patients has had relatively slow adoption. There are many factors that have contributed to the slow adoption of PGx testing, but it is partially due to a lack of coverage by payers. If PGx testing is covered by payers, frequently only testing of a specific gene is covered, rather than a panel of many genes. As a result, little is known about how coverage of a panel-based PGx test will affect a member's medication therapy. OBJECTIVES: To determine how giving providers specific medication optimization recommendations, based on results of a panel-based PGx test, impacted members' medication regimens. METHODS: Pharmacy claims data were retrospectively reviewed for this exploratory study. Members who participated in PGx testing were in the intervention group and members who chose not to participate in the PGx testing, but who were eligible to participate, were in the control group. PGx test results, including suggested medication changes, were mailed to providers. To determine if providers adopted the suggested medication changes, pharmacy claims data were analyzed retrospectively for the 4-month period preceding and following the date from which recommendations were provided to prescribers. RESULTS: Of the 101 members included in the analysis, 50 were in the intervention group and 51 were in the control group. In the intervention group, members were taking in a total of 352 medications; 165 of the medications had PGx guidance. Based on the PGx test results, 62 of these medications (37.6%) had recommendations. Of members who received PGx testing, 76% had at least 1 recommended change. When pharmacist recommendations were made, a change was made to the medication 27% of the time. There was a statistically significant difference between the number of medication changes in the PGx group and the control group (P = 0.024). CONCLUSIONS: Recommendations based on PGx testing can lead to changes in medications and an optimized medication regimen for members. DISCLOSURES: The authors have no conflicts to disclose that may present a potential conflict of interest.

Impact of a Combined Value-Based Insurance Design and Medication Therapy Management Program on Diabetes Medication Adherence.

BACKGROUND: Value-based insurance design (VBID) waives or reduces prescription copayments in order to decrease member cost barriers to refilling medications. Medication therapy management (MTM) is a member clinical intervention designed to reinforce members' knowledge of their medications, which addresses barriers to medication adherence. Both methods have been shown to increase adherence in members, particularly when used in combination. To date, studies of such combined programs have often been completed within integrated health systems but have rarely included control populations. OBJECTIVE: To determine the effect of a combined VBID and MTM program on key medication adherence metrics among diabetic members of a large employer group in the Midwest. METHODS: A retrospective pre/post longitudinal analysis of pharmacy claims data was performed for 77 participants in a combined VBID/MTM program and 77 eligible nonparticipants, matched by the baseline adherence metrics of proportion of days covered (PDC) and number of days without therapy, also known as gaps in therapy (GIT). Oral antidiabetic medication adherence and cost-related outcomes for all pharmacy claims were evaluated within and between groups over a 6-month period. Post hoc analyses were performed to investigate the effect of the intervention by gender and among a less adherent subpopulation of participants with a PDC of < 100% at baseline. RESULTS: Introduction of the intervention resulted in a nonsignificant increase in PDC from 92.9% to 95.4%, in contrast to a nonsignificant decrease from 92.8% to 91.7% in the comparison group. GIT underwent a nonsignificant decrease of 2.83 days during intervention, while nonsignificantly increasing 2.82 days in the comparators. Pharmacy claims costs paid by the plan per member per 6-month period significantly increased in the intervention group from $1,991.23 to $3,092.74, compared with a nonsignificant increase from $1,402.21 to $1,645.68 in the comparison group. Among the less-adherent subpopulation, PDC increased significantly after intervention from 84.7% to 93.1% compared with a nonsignificant increase from 84.6% to 89.0% among nonparticipants. A significant 10.69-day decrease in GIT was also observed among nonadherent participants compared with a nonsignificant 3.59-day decrease among nonparticipants. Female participants experienced a significant PDC increase from 91.5% to 96.8% and a GIT decrease of 7.32 days, while male participants did not change significantly. CONCLUSIONS: While statistically significant improvements to adherence were not observed among this population of members who were highly adherent at baseline, improvement trends and subgroup analyses demonstrated that the combined VBD/MTM program may have the potential to influence member behavior in employer groups. Larger, longer-term studies are needed to confirm this potential. Additional benefit may be realized by targeting members with lower adherence metrics at baseline and examining potential cost savings associated with medical outcomes. DISCLOSURES: Funding for this project was provided by Navitus Health Solutions. Peaslee, Wickizer, and Olson are employed by Navitus Health Solutions. Peaslee is a clinical staff pharmacist working in Formulary Services and a former PGY-1 Managed Care Clinical Pharmacy Resident at this location. Wickizer is the Associate Manager of Clinical Programs and Residency Programs. Olson is the Director of Clinical Programs and Product Development. Topp is the Patricia A. Chin Nursing Research Endowed Professor at the Hahn School of Nursing and Health Science at the University of San Diego specializing in statistics. Topp received consulting fees from Navitus Health Solutions for work on this project. Study concept and design were contributed by Peaslee, Wickizer, and Olson, with assistance from Topp. Peaslee took the lead in data collection, with assistance from Wickizer, and data interpretation was performed by Peaslee, Topp, Wickizer, and Olson. The manuscript was written primarily by Peaslee, with assistance from the other authors, and revised by Topp, Wickizer, and Olson, assisted by Peaslee.

Collaborating With Businesses to Support and Sustain Research.

Financial assistance is necessary for sustaining research at universities. Business collaborations are a potential means for obtaining these funds. To secure funding, understanding the process for obtaining these business funds is important for nursing faculty members. Although faculty rarely request funding from businesses, they are often in a position to solicit financial support due to existing relationships with clinical agency administrators, staff, and community leaders. The economic support received from businesses provides outcomes in nursing research, research education, academic-service partnerships, and client health care. This article describes the steps and processes involved in successfully obtaining research funding from businesses. In addition, case examples for securing and maintaining funding from health care agencies (evidence-based practice services) and from a health manufacturing company (product evaluation) are used to demonstrate the process.

Conducting Research With Community Groups.

Nurse scientists are increasingly recognizing the necessity of conducting research with community groups to effectively address complex health problems and successfully translate scientific advancements into the community. Although several barriers to conducting research with community groups exist, community-based participatory research (CBPR) has the potential to mitigate these barriers. CBPR has been employed in programs of research that respond in culturally sensitive ways to identify community needs and thereby address current health disparities. This article presents case studies that demonstrate how CBPR principles guided the development of (a) a healthy body weight program for urban, underserved African American women; (b) a reproductive health educational intervention for urban, low-income, underserved, ethnically diverse women; and (c) a pilot anxiety/depression intervention for urban, low-income, underserved, ethnically diverse women. These case studies illustrate the potential of CBPR as an orientation to research that can be employed effectively in non-research-intensive academic environments.

Science on a Shoestring: Building Nursing Knowledge With Limited Funding.

Building the science for nursing practice has never been more important. However, shrunken federal and state research budgets mean that investigators must find alternative sources of financial support and develop projects that are less costly to carry out. New investigators often build beginning programs of research with limited funding. This article provides an overview of some cost-effective research approaches and gives suggestions for finding other sources of funding. Examples of more cost-effective research approaches include adding complementary questions to existing funded research projects; conducting primary analysis of electronic patient records and social media content; conducting secondary analysis of data from completed studies; reviewing and synthesizing previously completed research; implementing community-based participatory research; participating in collaborative research efforts such as inter-campus team research, practice-based research networks (PBRNs), and involving undergraduate and doctoral students in research efforts. Instead of relying on funding from the National Institutes of Health (NIH) and other government agencies, nurse researchers may be able to find support for research from local sources such as businesses, organizations, or clinical agencies. Investigators will increasingly have to rely on these and other creative approaches to fund and implement their research programs if granting agency budgets do not significantly expand.

Community perceptions of mental health needs in an underserved minority neighborhood.

Accurate information is needed to facilitate health equity in underserved communities. This community-based participatory study asked residents about the meaning of mental health, their perceptions of community mental health needs, barriers to accessing mental health care, and acceptability of mental health services that are integrated in primary health clinics. Forty-five primarily African-American residents from urban communities participated in focus groups. Findings revealed high prevalence of substance abuse, depression, crime, and stigma about mental illness, with multiple access barriers. Participants were receptive to mental health care integrated in primary care, if others did not know they were receiving mental health care.

Including African Americans in health care research.

The inclusion of minority populations, particularly African Americans (AAs), in health care research has been and continues to be challenging. Including AAs in health care research will address the health disparities observed between Caucasian and AA populations and may reduce the disparities in disease incidence and prevalence between these groups. To include more AAs in health care research, the research team must strive to build relationships, linkages, and mutual respect with the target AA community they wish to study.

Methodological issues in identifying sexuality for research.

Sexuality is a complex concept that can be measured based on various aspects. Depending on the variable of interest, investigators may wish to focus on sexual behavior (activity), sexual orientation (attraction to a particular gender), or sexual identity (self-identification with a particular group of people). Further complicating the process is the fact that these aspects of sexuality are not always congruent with one another. Lesbian, gay, and bisexuals (LGB) are sexual minorities that have been identified as one of several groups that experience health disparities. For researchers working with the LGB population, properly identifying and defining which aspect of sexuality is of interest to the investigator is paramount in obtaining accurate outcomes.

How to develop a budget for a research proposal.

Novice investigators may be intimidated by the task of proposal budget preparation. Often a basic understanding of the mechanics of budgeting, paired with a good working relationship with the institution's sponsored programs office, can alleviate much of the stress investigators encounter in developing budgets. Careful attention to the detailed inclusive costs of conducting the proposed study combined with awareness of university and agency budget requirements is essential. This article describes strategies for developing a budget for a research proposal.