What quantifies good primary care in the United States? A review of algorithms and metrics using real-world data.

Primary care physicians (PCPs) play an indispensable role in providing comprehensive care and referring patients for specialty care and other medical services. As the COVID-19 outbreak disrupts patient access to care, understanding the quality of primary care is critical at this unprecedented moment to support patients with complex medical needs in the primary care setting and inform policymakers to redesign our primary care system. The traditional way of collecting information from patient surveys is time-consuming and costly, and novel data collection and analysis methods are needed. In this review paper, we describe the existing algorithms and metrics that use the real-world data to qualify and quantify primary care, including the identification of an individual's likely PCP (identification of plurality provider and major provider), assessment of process quality (for example, appropriate-care-model composite measures), and continuity and regularity of care index (including the interval index, variance index and relative variance index), and highlight the strength and limitation of real world data from electronic health records (EHRs) and claims data in determining the quality of PCP care. The EHR audits facilitate assessing the quality of the workflow process and clinical appropriateness of primary care practices. With extensive and diverse records, administrative claims data can provide reliable information as it assesses primary care quality through coded information from different providers or networks. The use of EHRs and administrative claims data may be a cost-effective analytic strategy for evaluating the quality of primary care.

Use of virtual games for interactive learning in a pharmacy curriculum.

BACKGROUND AND PURPOSE: To evaluate student pharmacists' attitudes and satisfaction toward playing educational virtual games in the classroom. EDUCATIONAL ACTIVITY AND SETTING: Virtual games were played in the classroom setting. First year student pharmacists participated in two Mimycx quests in the Healthcare Communication and the Psychiatry/Neurology courses. Students were randomly assigned into teams and worked together to complete the assigned quest games. Completion of the pre- and post-quest questionnaires via Qualtrics was voluntary. FINDINGS: A total of 79 student pharmacists played the Mimycx quests. Only 66 students completed both pre- and post-quest questionnaires. Students indicated their familiarity with game concepts related to the virtual environment and avatars used in the study. The change in their attitudes and satisfaction about the Mimycx virtual learning experience was significant between the two learning time points. SUMMARY: The use of virtual gaming technology could enhance student pharmacists' learning and engagement in the classroom. Students benefitted from increased familiarity with virtual, educational gaming concepts in their experiences with Mimycx, although no statistically significant differences were found regarding their attitudes toward communication and teamwork.

New combination antiviral for the treatment of hepatitis C.

PURPOSE: The pharmacology, pharmacokinetics, clinical efficacy, and safety of Viekira, as well as its place in hepatitis C virus (HCV) therapy, are reviewed. SUMMARY: Ombitasvir 25 mg-paritaprevir 150 mg-ritonavir 100 mg plus dasabuvir 250 mg (Viekira) is approved in the United States as a combination direct-acting antiviral agent for treatment-naive or treatment-experienced patients with HCV genotype 1 infection, including those with compensated cirrhosis. It is the first coformulated direct-acting antiviral that targets different stages of the virus's life cycle. Viekira is administered as an oral, interferon-free regimen. Phase III clinical trials demonstrated that Viekira administered with or without ribavirin can achieve sustained virological response rates of ≥90%. These results are notable because they show that high virological cure rates can be achieved without peginterferon and ribavirin. Viekira is also effective for special patient populations, such as individuals coinfected with HIV, liver transplant recipients, and those with advanced renal disease. The most frequently reported adverse effects among patients associated with Viekira without ribavirin were nausea, pruritus, and insomnia. During clinical trials, the most common adverse effects among patients receiving Viekira with ribavirin were fatigue, nausea, pruritus, insomnia, and weakness. CONCLUSION: Viekira, the first coformulated direct-acting antiviral that targets different stages of the HCV life cycle, is an interferon-free treatment for HCV genotype 1 infection. It is associated with a virological cure rate of ≥90% and treatment durations of 12 and 24 weeks. Viekira is also effective and safe for patients who have undergone liver transplantation, are coinfected with HIV, or have advanced kidney disease.

Boceprevir: a recently approved protease inhibitor for hepatitis C virus infection.

PURPOSE: The pharmacologic properties, clinical efficacy, and safety profile of the first oral protease inhibitor approved for the treatment of chronic infection with hepatitis C virus (HCV) genotype 1 are reviewed. SUMMARY: Boceprevir, approved by the Food and Drug Administration as an adjunct to the standard regimen for HCV genotype 1 infection (peginterferon alfa and ribavirin), is available in 200-mg capsules, to be administered thrice daily at seven-to nine-hour intervals (total daily dose, 2400 mg). In two Phase III clinical trials involving a total of nearly 1500 previously untreated patients who were not sufficiently responsive to or had relapsed after standard therapy, the adjunctive use of boceprevir was associated with significantly higher rates of sustained virologic response and a shorter cumulative duration of treatment. Adverse effects occurring significantly more often in clinical trial participants receiving boceprevir relative to control groups included anemia (47% versus 20%), dysgeusia (35% versus 16%), and neutropenia (25% versus 19%); these were generally not treatment-limiting effects. Due to the potential for serious or potentially life-threatening adverse events, boceprevir use is contraindicated in patients receiving any of a wide range of drugs whose clearance is highly dependent on cytochrome P-450 (CYP) isoenzymes 3A4/5 (e.g., cisapride, lovastatin, midazolam, sildenafil); boceprevir is also contraindicated for patients receiving potent CYP3A4/5 inducers such as carbamazepine, phenytoin, and rifampin, whose concurrent use can diminish boceprevir's virologic activity. Close monitoring is critical to ensure patient adherence to triple-drug therapy and, more broadly, to reduce the risk of the development and transmission of resistant HCV strains. CONCLUSION: Previously untreated patients with chronic HCV monoinfection, as well as patients who do not respond adequately to or relapse after standard dual therapy, may benefit from adjunctive boceprevir therapy. Careful selection and close monitoring of patients receiving boceprevir are essential to avoid drug-drug interactions, reduce adverse effects, and optimize treatment outcomes.