Self-reported participant experience with desonide hydrogel in the treatment of mild to moderate atopic dermatitis.

The objective of this study was to evaluate patients' real-world experiences with desonide hydrogel for the treatment of mild to moderate atopic dermatitis (AD). Physicians who participated in this patient-experience program identified eligible participants (age range, < 3 months to 91 years) for treatment with desonide hydrogel 0.05%. The medication was prescribed by each participant's physician according to his/her practice guidelines and was provided to the participant at no charge. Patients (or their parents/guardians) voluntarily participated by providing consent and completing 2 surveys: one at baseline (pretreatment) and the other approximately 3 weeks after initiation of desonide hydrogel treatment (posttreatment). The pretreatment survey included questions about prior topical medication use for AD and satisfaction with prior treatments. The second survey assessed compliance with desonide hydrogel, satisfaction with treatment, characteristics of desonide hydrogel, intent to continue treatment, and willingness to recommend desonide hydrogel to others. A total of 1185 participants completed both the pretreatment and posttreatment surveys. Participant satisfaction with desonide hydrogel was 95% greater than satisfaction with prior topical medications for AD (P < .01). Adherence to treatment with desonide hydrogel was more than 80% based on reports from participants. Eighty-nine percent of participants reported that they would continue to use the medication for their condition if needed and 85% would recommend desonide hydrogel to others. Prescribing physicians received individual summaries of survey responses reported by each of his/her participating patients, which provided valuable feedback regarding participants' perceptions of treatment. Participants reported favorable experiences after treatment with desonide hydrogel compared with prior topical therapies. Desonide is widely prescribed for the treatment of AD.

Patient experience with darifenacin - results of a short-term community-based survey in managing overactive bladder.

OBJECTIVE: This community-based program evaluated patients' experiences with darifenacin over 3 weeks' treatment in a predominantly primary care clinical practice setting. METHODS: Physicians (n = 2117, 50% primary care physicians, 35% urologists, 10% obstetrician/gynecologist, 5% other) were asked to introduce the program to patients with overactive bladder (OAB). Patients received an enrollment kit including a 30-day darifenacin voucher, activated if patients registered for the program via telephone or online. Patients (≥ 18 years of age) completed a brief automated survey to evaluate frequency of urge urinary incontinence episodes (UUIEs), micturitions/24 hours, urge severity/24 hours (10 point scale: 0 = not at all severe; 10 = very severe), and treatment tolerability (10 point scale: 0 = very poorly tolerated; 10 = very well tolerated). Patients also completed a second survey 3 weeks after starting darifenacin. Statistical analyses were not prospectively planned or performed. RESULTS: A total of 2165 patients completed both surveys. At baseline, mean age of completers was 66 years, 76% were female, and 47% reported prior use of OAB medications. After 3 weeks' treatment, patients experienced reductions in UUIEs and micturitions. Urge severity was reduced by >30% after 3 weeks (mean scores: 6.7 at baseline vs. 4.6 after 3 weeks' treatment) and treatment was well tolerated (mean score: 7.7). Overall, 85% of patients who participated in the program did so due to physician influences. CONCLUSIONS: The results of this 3-week, self-reported community-based survey indicate that patients were generally satisfied with darifenacin treatment and experienced a reduction in OAB symptoms. Darifenacin was generally well tolerated.

Assessing effects of treatment with lisdexamfetamine dimesylate for pediatric ADHD using a parental survey.

INTRODUCTION: Lisdexamfetamine dimesylate (LDX) is a prodrug stimulant approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) in adults and children 6-12 years of age. Parent surveys provide valuable information regarding the impact of ADHD treatments. METHODS: Parents of children with ADHD beginning treatment with LDX voluntarily completed surveys through an automated telephone system or the Internet before and 6 weeks after LDX treatment initiation. Prescribing physicians received individual reports of the responses for each survey completed by their patients' parents. All patients whose parents completed both baseline and 6 week surveys were included in the analyses. Subgroup analyses were conducted for those previously treated with medications to treat ADHD, including mixed amphetamine salts-extended release. RESULTS: LDX treatment was associated with a significant decrease in ADHD symptom interference with school activities, family interactions, homework, and social interactions (P<.01; N=11,576). Parents rated satisfaction with LDX as significantly higher than with their child's previous treatment (P<.01). On average, global improvement, tolerability, convenience, and satisfaction with LDX were all highly rated. CONCLUSION: Patients treated with LDX showed significant symptom improvement and parents reported significantly greater satisfaction than with prior treatment.

Patient perceptions of insulin detemir as reported through patient telephone surveys.

OBJECTIVES: To examine patient-reported perceptions of insulin detemir (Levemirt) as treatment for diabetes and report information back to prescribing physicians. METHODS: This cross-sectional survey with a convenience population involves physicians identifying patients appropriate for this treatment and providing them with study information. Patients voluntarily responded to a baseline survey prior to medication use and surveys at approximately 30 and 60 days following treatment initiation using interactive voice response (IVR) technology. Questions were designed by the medical group on the study team to measure patients' perceptions regarding blood sugar control, confidence in avoiding symptoms and medication satisfaction with insulin detemir. Questions were not drawn from a tested survey instrument, but do maintain face validity. Prescribing physicians received an individual report summarizing the patient's responses. RESULTS: In total, 586 adults completed the study. Average age was 59 years; 64% female. After an average of 35 days and 72 days using insulin detemir, patients could more easily judge blood sugar levels (n = 586; average 6.6 and 7.0 out of 10 (10 = much easier) at each follow-up, respectively) and keep good blood sugar control (n = 586; 6.7 and 7.0). With insulin detemir, patients who used a prior insulin (n = 414) felt more confident about avoiding symptoms of hypoglycemia with an average rating of 6.8 out of 10 after the first month and 7.1 out of 10 (10 = much more confident) after the second month. They (n = 414) also felt more confident in avoiding low blood sugars at night with average ratings of 7.3 after both the first and second months with insulin detemir. Thirty-one percent of the prior insulin users (n = 414) also reported weight loss, 58% reported no change, 11% gained weight after the second month with insulin detemir. Satisfaction with insulin detemir among all patients (n = 586) averaged 7.9 out of 10 at both months 1 and 2. CONCLUSIONS: With insulin detemir, patients felt more confident about managing blood sugar levels, tended not to gain weight, and were quite satisfied. The authors recognize that the results are not generalizable to or representative of all patients using insulin detemir due to potential patient selection bias. In addition, the results reflect patients' self-reported impressions which were not confirmed through any objective clinical measures. However, the individual patient data collected through the surveys can help physicians monitor patients' perceptions and promote discussions about treatment with patients.

Management of chronic obstructive pulmonary disease associated with chronic bronchitis with inhaled fluticasone propionate/salmeterol (ADVAIR DISKUS) 250/50: results of a patient experience trial.

CONTEXT: Chronic obstructive pulmonary disease (COPD) is recognized as a major healthcare problem in the United States and around the world. OBJECTIVE: This survey regarding initial experience in patients with COPD collected feedback about newly initiated therapy with fluticasone propionate/salmeterol (FSC; ADVAIR DISKUS). DESIGN: Three telephone surveys were conducted; Survey 1 prior to initiating therapy with FSC 250/50, and Surveys 2 and 3 at 2 weeks and 30 days after initiating therapy with FSC 250/50, respectively. SETTING: One thousand primary care physicians recruited outpatients into the trial. PATIENTS: Patients were either newly diagnosed with COPD associated with chronic bronchitis or were still experiencing breathing difficulties on an anticholinergic medication. INTERVENTIONS: Patients initiated FSC 250/50 and received a 1-month supply of FSC 250/50 with an albuterol inhaler for rescue use. MAIN OUTCOME MEASURES: Outcome measures were patient perceptions of satisfaction, compliance, and convenience and changes in breathing on 1 (negative) to 9 (positive) point scales. RESULTS: Five hundred sixteen patients completed all 3 surveys. The mean age was 61 years, 63% were female, and 62% had been diagnosed with COPD associated with chronic bronchitis for 3 years or less (Table 1). CONCLUSION: Patients reported high satisfaction, compliance, and convenience with FSC 250/50 within 2 weeks of initiating therapy, all maintained over the trial period. Additionally, patients had positive changes in breathing, including improvements in the ability to breathe upon awakening in the morning.

Self-reported compliance with topical cyclosporine emulsion 0.05% and onset of the effects of increased tear production as assessed through patient surveys.

BACKGROUND: Keratoconjunctivitis sicca is a common eye condition characterized by itchiness, redness, and dryness due to a lack of tear production or abnormalities in the tear film. Cyclosporine works to increase the production of natural tears, which contain nutrients and proteins not found in artificial tears. OBJECTIVE: The purpose of this report was to assess the association between self-reported compliance with topical cyclosporine 0.05% emulsion and the onset of effects of increased tear production in patients with dry eye. METHODS: Practicing physicians were asked to identify patients for whom treatment with cyclosporine was appropriate and who were willing to participate in the study. Patients who agreed to participate were given medication samples and study materials. The participants were asked to respond to automated survey questions before they used cyclosporine and 30 and 60 days after initiating cyclosporine. Participants were asked how frequently they used the medication, how rapidly their symptoms were relieved, and whether they intended to continue using cyclosporine. RESULTS: Of the 5367 patients initially enrolled in the study, 3145 (59%) patients completed the baseline and 60-day follow-up surveys. The mean age of the participants was 60 years; 2677 (85%) of them were women, and 468 (15%) were men. Compliance with cyclosporine therapy was reported as follows: 2477 (79%) participants said they used cyclosporine twice daily as prescribed by their physicians, 468 (15%) reported missing some doses of cyclosporine, and 189 (6%) reported missing -50% or > or = 50% of the doses. The effects of increased tear production were reported to occur significantly sooner in participants who complied with cyclosporine treatment as prescribed than in those who did not comply with treatment (P < 0.01). Among those who complied with treatment, 1822 (73%) participants reported experiencing the effects of increased tear production in < 5 weeks compared with 468 (70%) participants who did not comply with treatment. Overall, the mean rate of satisfaction with cyclosporine was 7.5 on a scale from 0 (not at all satisfied) to 10 (very satisfied). Participants who reported using cyclosporine twice daily as prescribed gave satisfaction with cyclosporine a mean rating of 7.7 compared with 7.3 given by those who missed some doses and 5.3 from those who missed approximately 50% or > or = 50% of the doses (P < 0.01). An intention to continue using cyclosporine was reported by 2611 (83%) participants. CONCLUSION: The results of this study in participants using cyclosporine for dry eye in an actual-practice setting suggest an association between patient-reported compliance with medication and more rapid onset of the effects of increased tear production.

The impact of topical cyclosporine A emulsion 0.05% on the outcomes of patients with keratoconjunctivitis sicca.

OBJECTIVE: To assess patients' experiences with topical cyclosporine A (tCSA) 0.05% ophthalmic emulsion (Restasis) to treat keratoconjunctivitis sicca (KCS) in a real-world setting. METHODS: A total of 4504 ophthalmologists, optometrists and primary care physicians from throughout the United States participated in the study. Individual physicians identified patients from their practice who were appropriate candidates for treatment with tCSA and provided them with free sample medication and study materials. Patients voluntarily enrolled in the program by following the instructions provided in the study materials. Data for this study were obtained from patient surveys that included questions related to patients' experiences using topical cyclosporine A 0.05% ophthalmic emulsion (tCSA). Using automated surveys at baseline, 30-days and 60-days post-medication initiation, patients rated symptom severity, symptom impact on daily activities, and use of artificial tears pre- and post-treatment with study medication. Participants also reported on the rapidity of symptom relief and satisfaction with tCSA. RESULTS: A total of 5884 patients completed the study. The vast majority (84%) was female; average age was 63 years. Patients who completed the study (n = 5884) achieved significant reductions (p < 0.001) of 30% in symptom severity and 31%-36% in activity impairments relative to baseline. A positive association (p < 0.001) was observed between number of years with dry eye and the average ratings for symptom severity and impact on everyday activities. Onset of relief was noted within 1 week by 32% of patients and within 3 weeks by 73%. More than 60% reported decreased use of artificial tears at both 30 days and 60 days post-treatment initiation. CONCLUSIONS: Results suggest that in a real-world setting tCSA is an effective treatment for patients suffering from KCS. Onset of relief may be more rapid than in previously published reports.

The outcomes and costs of acute myeloid leukemia among the elderly.

BACKGROUND: The incidence of acute myeloid leukemia (AML) among the elderly can be expected to grow as the population continues to age. However, data on current treatment practices and costs for this form of cancer are sparse. METHODS: We used a retrospective inception cohort design and data from a linkage between 11 Surveillance, Epidemiology, and End Results cancer registries and Medicare administrative claims. We evaluated survival, use of health care resources, use of chemotherapy, and Medicare payments among adults 65 years and older with an initial diagnosis of AML between January 1, 1991, and December 31, 1996. RESULTS: A total of 2657 elderly patients with AML and complete Medicare claims data were identified. The prognosis for these patients was poor, with median survival estimated to be 2 months and a 2-year survival rate of 6%. Mean +/- SE total Medicare payments were $41,594 +/- $870 (in 1998 US dollars), 84% of which was attributed to inpatient payments. In the 2 years after the AML diagnosis, 790 patients (30%) underwent chemotherapy treatment. These patients had costs almost 3 times higher than those of other patients, and their median survival was 6 months longer. The use of hospice care was rare (17% of patients). CONCLUSIONS: Among the elderly, AML is associated with a poor prognosis and substantial costs during the relatively few remaining months of life. Moreover, most patients do not receive active treatment with chemotherapy or hospice services. Further work is needed to characterize this disease and the patient-related factors that influence treatment decisions and associated health outcomes.