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1.
J Thromb Thrombolysis ; 49(2): 287-293, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31598931

RESUMEN

Recent guidelines recommend direct acting oral anticoagulants (DOAC) over vitamin-k antagonist (VKA) for acute venous thromboembolism (VTE). Non-adherence to anticoagulation has been associated with increased frequency of VTE or stroke. This study evaluated 90 day persistence among patients prescribed rivaroxaban or warfarin for the treatment of acute VTE at an academic safety net hospital. We conducted a single center, retrospective cohort study of 314 consecutive patients newly prescribed rivaroxaban or warfarin for acute VTE between January 2016 and July 2017. Primary outcome was 90 day persistence, and secondary outcomes included 90 day readmission and/or ED visit, time to 90 m day readmission and/or ED visits, and attendance of direct oral anticoagulant education class. Of 314 patients, 78 were prescribed warfarin and 236 rivaroxaban. Patients had a mean age of 52 years, 62% were men, and 96% were diagnosed with deep vein thrombosis and/or pulmonary embolism. Persistence at 90 days was 52.6% among patients prescribed warfarin compared to 45.3% for patients prescribed rivaroxaban (p = 0.2678). Persistencewas associated with decreased 90 day hospital or ED readmission. Among patients prescribed rivaroxaban, attending a pharmacist led educational class was associated with a 2.5 fold increase in persistence (p < 0.0001). Among patients with new onset venous thromboembolism, 90 day persistence with anticoagulation was similarly low with either rivaroxaban or warfarin therapy. Participation in a pharmacist led DOAC class was associated with a 2.5-fold increase in persistence on rivaroxaban.

2.
Am J Pharm Educ ; 83(8): 7037, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31831895

RESUMEN

Objective. To design and implement an elective course on pharmaceutical industry practice and assess its impact on student pharmacists' knowledge and perceptions. Methods. This was a two-credit hour, elective course offered to second- and third-year student pharmacists during the 2015 and 2016 spring semesters. The goal of this course was to provide instruction regarding skills and competencies for pharmaceutical industry practice. Curricular content included didactic instruction, assigned readings, weekly quizzes, classroom discussion of industry-based functions and responsibilities, and three application projects. A 65-item survey instrument was developed to assess changes in student pharmacists' perceptions and understanding of pharmaceutical industry practice. Results. Forty-four students enrolled in the elective course over the two offerings. The average rating on the course evaluation was 4.7 out of 5. Average scores on graded quizzes were 90%, and grades on the application projects ranged from 92% to 99%. There was an increase in the number of students who perceived that they understood various functions and roles in the pharmaceutical industry, and who rated themselves confident in completing unique tasks associated with pharmaceutical industry practice. Furthermore, there was an increase in the number of students who reported improved perceptions regarding the trustworthiness of the pharmaceutical industry, costs of prescription medications, and promotional advertising for branded prescription medication. Conclusion. Student pharmacists' perceptions of the course were positive, and overall perceptions and understanding of the pharmaceutical industry improved. Active collaboration between colleges and pharmaceutical companies can lead to positive educational opportunities for students interested in pharmaceutical industry careers.

3.
Am J Pharm Educ ; 83(9): 7365, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31871358

RESUMEN

Objective. To develop and implement a multimodal structured approach to intentional interprofessional experiential education at a non-academic community hospital, and to evaluate students' perceptions of the program. Methods. A multimodal structured approach to intentional interprofessional experiential education was designed that consisted of medical and pharmacy students participating together in daily pre-rounds, daily teaching rounds, and once or twice weekly lunch-and-learn sessions at a non-academic community hospital. Pre- and post-experience surveys were administered to assess students' perceptions of physician and pharmacist collaboration in interprofessional education (IPE). The survey instrument included the Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education, Version 2 (SPICE-2) survey. Results. Thirty-nine students, including 18 fourth-year student pharmacists from Mercer University College of Pharmacy and 21 third-year medical students from three medical schools in the Caribbean, provided informed consent and were enrolled in the eight-month study. Students' perceptions of items related to the Interprofessional Education Collaborative (IPEC) competencies, including values/ethics for interprofessional practice, roles/responsibilities, and teams and teamwork, significantly improved from the pre- to the post-experience survey. Conclusion. A multimodal structured approach to intentional interprofessional experiential education had positive effects on students' perceptions of interprofessional clinical education targeting key components of the (IPEC) competencies. This approach may be a useful tool for implementing intentional IPE in the experiential setting.

4.
J Pharm Pract ; : 897190019857409, 2019 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-31238785

RESUMEN

OBJECTIVE: To evaluate the effectiveness of a student pharmacist-led telephone follow-up intervention to improve hemoglobin A1c (HbA1c) in diabetic patients. METHODS: This was a prospective, randomized, pilot study to implement a telephone follow-up intervention for diabetic patients with HbA1c ≥7%. Patients were recruited and randomized into intervention and control groups. All patients received standard of care. Patients in the intervention group additionally received weekly phone calls from a student pharmacist for 12 weeks to encourage medication adherence. HbA1c at baseline and end of study were measured and the data were analyzed using SAS version 9.4. Analysis included descriptive statistics and a multiple regression model to assess the association between the end of study and baseline HbA1c while controlling for demographics. RESULTS: Seventy-eight patients participated and the average age was 62 (±11) years. Baseline HbA1c was 8.2% (±1.4%) in the intervention group and 7.9% (±1.3%) in the control group. HbA1c decreased by 0.35% in the intervention group (P = .027) and increased by 0.338% in the control group (P = .013). The end of study HbA1c were higher in the control group even after controlling for baseline HbA1cs (0.5547, P value .002) in the regression model. CONCLUSION: Incorporating student pharmacists in physician offices to provide clinical care services could lead to improved patient outcomes and students' clinical and research skills.

5.
Hosp Pharm ; 54(3): 197-202, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31205332

RESUMEN

Purpose: Hypoglycemia is a common adverse event associated with insulin during treatment of hyperkalemia in hospitalized patients; however, limited data exist regarding hypoglycemia incidence and appropriate dosing strategies for treatment of patients in the emergency department. The study objective was to determine the incidence of hypoglycemia associated with insulin use during treatment of hyperkalemia among patients seen in the emergency department. Methods: This was an Institutional Review Board (IRB)-approved retrospective, chart-review study. All adult patients who received intravenous regular insulin as a result of an order from the emergency department hyperkalemia order set were eligible for inclusion. The main clinical outcomes were incidence of hypoglycemia (blood glucose <70 mg/dL) and severe hypoglycemia (blood glucose <40 mg/dL). Blood glucose was checked within 24 hours of insulin administration. Results: A total of 172 patients were included. The incidence of hypoglycemia was 19.8% (n = 34) and the incidence of severe hypoglycemia was 5.2% (n = 9). Hypoglycemic patients had a significantly lower median blood glucose at baseline compared to those who did not develop hypoglycemia (83.5 [72.0-112.0] mg/dL vs 123.0 [96.0-167.0] mg/dL, P < .0001); however, no difference was noted between groups in the average insulin dose administered (0.11 ± 0.04 units/kg vs 0.12 ± 0.05 units/kg, P = .6175). Conclusion: There is a concerning risk of hypoglycemia associated with insulin use during treatment of hyperkalemia in the emergency department. Standard insulin doses may not be appropriate in some cases like patients with lower baseline blood glucose. Further research is warranted to develop safer hyperkalemia treatment protocols that mitigate this high risk of hypoglycemia associated with insulin use.

6.
PLoS One ; 14(4): e0213499, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31034485

RESUMEN

BACKGROUND: Although influenza vaccination has been shown to reduce the incidence of major adverse cardiac events (MACE) among those with existing cardiovascular disease (CVD), in the 2015-16 season, coverage for persons with heart disease was only 48% in the US. METHODS: We built a Monte Carlo (probabilistic) spreadsheet-based decision tree in 2018 to estimate the cost-effectiveness of increased influenza vaccination to prevent MACE readmissions. We based our model on current US influenza vaccination coverage of the estimated 493,750 US acute coronary syndrome (ACS) patients from the healthcare payer perspective. We excluded outpatient costs and time lost from work and included only hospitalization and vaccination costs. We also estimated the incremental cost/MACE case averted and incremental cost/QALY gained (ICER) if 75% hospitalized ACS patients were vaccinated by discharge and estimated the impact of increasing vaccination coverage incrementally by 5% up to 95% in a sensitivity analysis, among hospitalized adults aged ≥ 65 years and 18-64 years, and varying vaccine effectiveness from 30-40%. RESULT: At 75% vaccination coverage by discharge, vaccination was cost-saving from the healthcare payer perspective in adults ≥ 65 years and the ICER was $12,680/QALY (95% CI: 6,273-20,264) in adults 18-64 years and $2,400 (95% CI: -1,992-7,398) in all adults 18 + years. These resulted in ~ 500 (95% CI: 439-625) additional averted MACEs/year for all adult patients aged ≥18 years and added ~700 (95% CI: 578-825) QALYs. In the sensitivity analysis, vaccination becomes cost-saving in adults 18+years after about 80% vaccination rate. To achieve 75% vaccination rate in all adults aged ≥ 18 years will require an additional cost of $3 million. The effectiveness of the vaccine, cost of vaccination, and vaccination coverage rate had the most impact on the results. CONCLUSION: Increasing vaccination rate among hospitalized ACS patients has a favorable cost-effectiveness profile and becomes cost-saving when at least 80% are vaccinated.


Asunto(s)
Análisis Costo-Beneficio , Vacunas contra la Influenza/economía , Gripe Humana/prevención & control , Vacunación/economía , Adolescente , Adulto , Femenino , Hospitalización/economía , Humanos , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/economía , Gripe Humana/epidemiología , Masculino , Persona de Mediana Edad , Modelos Económicos , Readmisión del Paciente , Cobertura de Vacunación/economía , Adulto Joven
7.
J Pharm Pract ; 32(6): 617-624, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29618283

RESUMEN

Hospital readmissions remain a public health concern despite progress in reducing and preventing its occurrence. Among strategies that have been implemented to reduce readmission most involves medication management. Our objective was to evaluate the effectiveness of interventions involving pharmacists to reduce hospital readmissions. PubMed and Google Scholar were searched for primary literature from January 1990 to July 2016 with search terms such as "hospital readmission," and "Pharmacist," or "Pharmacy," or "medications." Studies with an abstract in English which highlighted a pharmacist involvement based on the type of intervention, country of origin, type of study, and findings were summarized. The outcomes of these interventions to reduce hospital readmissions were mixed. Of the 29 studies, 16 (55%) showed a statistically significant reduction in readmissions ranging from 3.3% to 30%. Most of the interventions focused mainly on patient education postdischarge (8) or in addition to medication reconciliation predischarge (9). There were no studies from Africa or Asia but mainly from the United States (72%). Although multiple factors contribute to hospital readmission, this review highlights the important role pharmacists can play singularly and as part of interdisciplinary teams. Most effective interventions often involved medication review and patient education postdischarge.


Asunto(s)
Readmisión del Paciente , Farmacéuticos/organización & administración , Anciano , Humanos , Conciliación de Medicamentos , Alta del Paciente , Estados Unidos
8.
J Pharm Pract ; 32(2): 126-131, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29162021

RESUMEN

OBJECTIVE: To compare the time taken and steps completed by nurses in the process of insulin preparation and administration using the pen device compared to the vial and syringe method. METHODS: Observational and exploratory study utilizing a time-motion analysis of nurses' administration of insulin using the pen versus vial and syringe delivery methods. Nurses were observed, video-recorded, and timed during insulin preparation and administration using each delivery method. The steps performed by nurses were observed against recommended processes for preparing and administering insulin, and the percentage of nurses completing each step was noted. RESULTS: A total of 137 (94%) nurses participated. Nurses took less time preparing and administering insulin with the pen device compared with the vial and syringe method (79 ± 18 seconds vs 88 ± 20 seconds, respectively, P < .001). The overall average completion rate of steps with the pen device was 90% ± 7% compared to 88% ± 7% with the vial and syringe method. CONCLUSION: The time taken by nurses to prepare and administer insulin was lower with the pen device compared with vial and syringe. Furthermore, areas were identified for potential nursing education to enhance safe and appropriate use of insulin with both delivery methods.


Asunto(s)
Sistemas de Liberación de Medicamentos/enfermería , Insulina/administración & dosificación , Estudios de Tiempo y Movimiento , Sistemas de Liberación de Medicamentos/métodos , Humanos , Inyecciones Subcutáneas/enfermería , Pacientes Internos , Enfermeras y Enfermeros , Entrenamiento Simulado , Jeringas
9.
Curr Pharm Teach Learn ; 9(3): 433-440, 2017 05.
Artículo en Inglés | MEDLINE | ID: mdl-29233282

RESUMEN

BACKGROUND AND PURPOSE: To describe the use of debates, and to evaluate student performance and perceptions, when student debates are incorporated as an active learning tool in a required pharmacy healthcare delivery course. EDUCATIONAL ACTIVITY AND SETTING: Student live debates replaced 15% of a traditional lecture-based course. Twelve healthcare controversies were debated by student teams each year. Student perception of debate utility and opinion on topics, pre- and post-debate, were measured via a voluntary survey. Both peer and instructor's assessments of team performances, as well as individual student performance on the debate-based questions on course exams, contributed to course grade. FINDINGS: The average survey response rates were 76% (2014) and 86% (2015). Fifteen-54% of student respondents changed their opinion on individual debate topics due to the debates. Although exam performance on debate-based questions was no better than on lecture-based questions, respondents who found the debates useful or very useful in mastering course material increased by 19% post versus pre-debate surveys. SUMMARY: Debates are an effective active learning tool for engaging students in controversial subjects. Assessment of student performance should include student and instructor evaluations, and can be incorporated into the course grade.


Asunto(s)
Educación en Farmacia/métodos , Aprendizaje Basado en Problemas , Estudiantes de Farmacia , Rendimiento Académico , Adulto , Actitud , Prestación de Atención de Salud , Femenino , Humanos , Masculino , Percepción , Facultades de Farmacia , Encuestas y Cuestionarios , Adulto Joven
10.
Health Serv Res ; 52 Suppl 2: 2307-2330, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-29130266

RESUMEN

OBJECTIVE: To estimate the societal economic and health impacts of Maine's school-based influenza vaccination (SIV) program during the 2009 A(H1N1) influenza pandemic. DATA SOURCES: Primary and secondary data covering the 2008-09 and 2009-10 influenza seasons. STUDY DESIGN: We estimated weekly monovalent influenza vaccine uptake in Maine and 15 other states, using difference-in-difference-in-differences analysis to assess the program's impact on immunization among six age groups. We also developed a health and economic Markov microsimulation model and conducted Monte Carlo sensitivity analysis. DATA COLLECTION: We used national survey data to estimate the impact of the SIV program on vaccine coverage. We used primary data and published studies to develop the microsimulation model. PRINCIPAL FINDINGS: The program was associated with higher immunization among children and lower immunization among adults aged 18-49 years and 65 and older. The program prevented 4,600 influenza infections and generated $4.9 million in net economic benefits. Cost savings from lower adult vaccination accounted for 54 percent of the economic gain. Economic benefits were positive in 98 percent of Monte Carlo simulations. CONCLUSIONS: SIV may be a cost-beneficial approach to increase immunization during pandemics, but programs should be designed to prevent lower immunization among nontargeted groups.


Asunto(s)
Programas de Inmunización/economía , Vacunas contra la Influenza/economía , Gripe Humana/economía , Gripe Humana/prevención & control , Servicios de Salud Escolar/economía , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Preescolar , Costo de Enfermedad , Análisis Costo-Beneficio , Femenino , Humanos , Programas de Inmunización/organización & administración , Lactante , Subtipo H1N1 del Virus de la Influenza A , Maine/epidemiología , Masculino , Persona de Mediana Edad , Modelos Económicos , Método de Montecarlo , Pandemias , Servicios de Salud Escolar/organización & administración , Adulto Joven
11.
Hosp Pharm ; 52(5): 367-373, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28804154

RESUMEN

Objective: The objective of this study was to assess the association between liposomal bupivacaine use in patients undergoing knee or hip arthroplasty and concurrent pain control, length of hospitalization, and physical therapy milestones. Methods: This was a retrospective chart review. Patients receiving liposomal bupivacaine during a 1-year period (study group) were compared with patients seen by the same surgeon in the previous year who did not receive liposomal bupivacaine (control group). Clinical outcomes included concurrent opioid use, average pain scores, length of stay, ambulation, and range of motion. Results: A total of 357 patients were included in the study. Knee study group patients received lower amounts of opioid (209 vs 248 mg; P = .02) and had a delayed time to first rescue medication (6.3 ± 4.7 vs 5.0 ± 4.4 hours; P = .02). Hip study group patients had a delay in time to first rescue medication (7.1 ± 6.3 vs 4.9 ± 4.0 hours; P = .046). Both knee and hip study group patients had higher average pain score during the 72-hour postoperative period (6.38 vs 6.06; P = .01, and 6.32 vs 5.80; P = .02, respectively) but decreased median length of stay (2.0 vs 3.0 days; P < .0001, and 2.0 vs 3.0 days; P = .04, respectively). Conclusions: Use of liposomal bupivacaine produced a modest decrease in opioid use among knee patients and a decreased length of stay in both knee and hip patients; however, this was accompanied by a non-clinically significant increase in pain scores for knee and hip patients suggesting limited utility for orthopedic procedures.

12.
Pharmacotherapy ; 36(6): 623-30, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-27138730

RESUMEN

STUDY OBJECTIVE: To evaluate the success of an initial tobramycin dosing regimen to achieve target peak and trough concentrations in adult patients with pulmonary exacerbations of cystic fibrosis (CF). DESIGN: Retrospective single-center medical record review. SETTING: Large tertiary care academic medical center. PATIENTS: A total of 186 patient encounters where 112 patients with CF were treated for acute pulmonary exacerbations with 10 mg/kg/day of tobramycin between January 1, 2009, and December 5, 2014. MEASUREMENTS AND MAIN RESULTS: Baseline demographics, clinical characteristics, tobramycin data, and pharmacokinetic variables were collected. The primary outcome evaluated the success of the initial tobramycin dosing regimen in attaining the target peak concentration. Secondary end points were achievement of the target trough concentration, achievement of combined peak and trough targets, and incidence of nephrotoxicity. Bivariate and multivariate analyses were performed to evaluate factors associated with achieving target concentrations. Of the 186 patient encounters, 41% achieved the target peak with the first dosing regimen, 62% achieved a target trough, and 23% achieved the target peak and trough. Nephrotoxicity occurred in 10% of patient encounters. A body mass index (BMI) of 18.5-24.9 kg/m(2) was associated with higher odds of meeting the target peak compared with a BMI lower than 18.5 kg/m(2) (odds ratio [OR] 24.5; 95% confidence interval [CI] 5.2-117.2). Conversely, a BMI of 18.5-24.9 kg/m(2) was associated with lower odds of attaining the target trough compared with a BMI lower than 18.5 kg/m(2) (OR 0.16; 95% CI 0.05-0.56). Higher volume of distribution and elimination rate constants (Kel ) were associated with significantly lower odds of achieving the target peak. In addition, higher Kel values were associated with significantly higher odds of achieving the target trough. CONCLUSIONS: The current initial tobramycin regimen did not achieve target serum tobramycin concentrations reliably. Optimization of the initial CF tobramycin dosing regimen is warranted.


Asunto(s)
Fibrosis Quística/tratamiento farmacológico , Tobramicina/farmacocinética , Adulto , Antibacterianos/efectos adversos , Antibacterianos/sangre , Antibacterianos/farmacocinética , Antibacterianos/orina , Índice de Masa Corporal , Creatinina/orina , Fibrosis Quística/sangre , Fibrosis Quística/complicaciones , Fibrosis Quística/orina , Femenino , Georgia/epidemiología , Humanos , Enfermedades Renales/inducido químicamente , Enfermedades Renales/complicaciones , Enfermedades Renales/epidemiología , Masculino , Estudios Retrospectivos , Tobramicina/efectos adversos , Tobramicina/sangre , Tobramicina/orina , Adulto Joven
13.
BMC Public Health ; 15: 330, 2015 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-25880910

RESUMEN

BACKGROUND: Despite the high mortality and morbidity resulting from acute respiratory infections (ARI) globally, there are few data from low-income countries on costs of ARI to inform public health policy decisions We conducted a prospective survey to assess costs of ARI episodes in selected primary, secondary, and tertiary healthcare facilities in north India where no respiratory pathogen vaccine is routinely recommended. METHODS: Face-to-face interviews were conducted among a purposive sample of patients with ARI from healthcare facilities. Data were collected on out-of-pocket costs of hospitalization, medical consultations, medications, diagnostics, transportation, lodging, and missed work days. Telephone surveys were conducted two weeks after medical encounters to ask about subsequent missed work and costs incurred. Costs of prescriptions and diagnostics in public facilities were supplemented with WHO-CHOICE estimates of hospital bed costs. Missed work days were assigned cost based on the national annual per capita income (US$1,104). Non-medically attended ARI cases were identified from an ongoing community-based ARI surveillance project in Faridabad. RESULTS: During September 2012-March 2013, 1766 patients with ARI were enrolled, including 451 hospitalized patients, 1056 outpatients, and 259 non-medically attended patients. The total direct cost of an ARI episode requiring outpatient care was US$4- $6 for public and $3-$10 for private institutions based on age groups. The total direct cost of an ARI episode requiring hospitalized care was $54-$120 in public and $135-$355 in private institutions. The cost of ARI among those hospitalized was highest among persons aged > = 65 years and lowest among children aged < 5 years. Indirect costs due to missed work days were 16-25% of total costs. The direct out-of-pocket cost of hospitalized ARI was 34% of annual per capita income. CONCLUSIONS: The cost of hospitalized ARI episodes in India is high relative to median per capita income. Data from this study can inform evaluations of the cost effectiveness of proven ARI prevention strategies such as vaccination.


Asunto(s)
Gastos en Salud/estadística & datos numéricos , Instituciones de Salud/estadística & datos numéricos , Infecciones del Sistema Respiratorio/economía , Absentismo , Enfermedad Aguda , Adolescente , Adulto , Anciano , Atención Ambulatoria/economía , Niño , Preescolar , Costos y Análisis de Costo , Femenino , Financiación Personal/estadística & datos numéricos , Hospitalización/economía , Humanos , India , Lactante , Masculino , Persona de Mediana Edad , Propiedad , Pobreza , Estudios Prospectivos , Transportes/economía , Adulto Joven
14.
Vaccine ; 31(46): 5339-48, 2013 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-24055351

RESUMEN

Every year, approximately 10-20% of the world's population is infected with influenza viruses, resulting in a significant number of outpatient and hospital visits and substantial economic burden both on health care systems and society. With recently updated WHO recommendations on influenza vaccination and broadening vaccine production, policy makers in middle- and low-income countries will need data on the cost of influenza disease and the cost effectiveness of vaccination. We reviewed the published literature to summarize estimates of cost and cost-effectiveness of influenza vaccination. We searched PUBMED (MEDLINE), EMBASE, WEB of KNOWLEDGE, and IGOOGLE using the key words 'influenza', 'economic cost', 'cost effectiveness', and 'economic burden'. We identified 140 studies which estimated either cost associated with seasonal influenza or cost effectiveness/cost-benefit of influenza vaccination. 118 of these studies were conducted in World Bank-defined high income, 22 in upper-middle income, and no studies in low and lower-middle income countries. The per capita cost of a case of influenza illness ranged from $30 to $64. 22 studies reported that influenza vaccination was cost-saving; reported cost-effectiveness ratios were $10,000/outcome in 13 studies, $10,000 to $50,000 in 13 studies, and ≥$50,000 in 3 studies. There were no studies from low income countries and few studies among pregnant women. Substantial differences in methodology limited the generalization of results. Decision makers in lower income countries lack economic data to support influenza vaccine policy decisions, especially of pregnant women. Standardized cost-effectiveness studies of influenza vaccination of WHO-recommended risk groups' methods are urgently needed.


Asunto(s)
Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/economía , Gripe Humana/economía , Gripe Humana/prevención & control , Vacunación/economía , Vacunación/métodos , Análisis Costo-Beneficio , Salud Global , Humanos , Gripe Humana/epidemiología
15.
Artículo en Inglés | MEDLINE | ID: mdl-24753974

RESUMEN

BACKGROUND: Medicare ceased payment for some hospital-acquired infections beginning October 1, 2008, following provisions in the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005. OBJECTIVE: We examined the association of this policy with declines in rates of vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infection (CAUTI). DATA: Discharge data from the Florida Agency for Healthcare Administration from 2007 to 2011. STUDY DESIGN: We compared rates of hospital-acquired vascular catheter-associated infections (HA-VCAI) and catheter-associated urinary tract infections (HA-CAUTI) before and after implementation of the new policy (January 2007 to September 2008 vs. October 2008 to September 2011). This pre-post, retrospective, interrupted time series study was further analyzed with a generalized hierarchical logistic regression, by estimating the probability of a patient acquiring these infections in the hospital, post-policy compared to pre-policy. PRINCIPAL FINDINGS: Pre-policy, 0.12% of admitted patients were diagnosed with CAUTI; of these, 32% were HA-CAUTI. Similarly, 0.24% of admissions were diagnosed as VCAI; of these, 60% were HA-VCAI. Post-policy, 0.16% of admissions were CAUTIs; of these, 31% were HA-CAUTI. Similarly, 0.3% of admissions were VCAIs and, of these, 45% were HA-VCAI. There was a statistically significant decrease in HA-VCAIs (OR: 0.571 (p < 0.0001)) post-policy, but the reduction in HA-CAUTI (OR: 0.968 (p < 0.4484)) was not statistically significant. CONCLUSIONS: The results suggest Medicare non payment policy is associated with both a decline in the rate of hospital-acquired VCAI (HA-VCAI) per quarter, and the probability of acquiring HA-VCAI post- policy. The strength of the association could be overestimated, because of concurrent ongoing infection control interventions.


Asunto(s)
Infección Hospitalaria/epidemiología , Medicare/organización & administración , Anciano , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Periférico/efectos adversos , Femenino , Política de Salud/legislación & jurisprudencia , Humanos , Masculino , Medicare/legislación & jurisprudencia , Persona de Mediana Edad , Estados Unidos/epidemiología , Cateterismo Urinario/efectos adversos , Infecciones Urinarias/epidemiología
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