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1.
Medicine (Baltimore) ; 99(30): e21241, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791698

RESUMO

Financial crisis has forced health systems to seek alternatives to hospitalization-based healthcare. Quick diagnosis units (QDUs) are cost-effective compared to hospitalization, but the determinants of QDU costs have not been studied.We aimed at assessing the predictors of costs of a district hospital QDU (Hospital Plató, Barcelona) between 2009 and 2016.This study was a retrospective longitudinal single center study of 404 consecutive outpatients referred to the QDU of Hospital Plató. The referral reason was dichotomized into suggestive of malignancy vs other. The final diagnosis was dichotomized into organic vs nonorganic and malignancy vs nonmalignancy. All individual resource costs were obtained from the finance department to conduct a micro-costing analysis of the study period.Mean age was 62 ±â€Š20 years (women = 56%), and median time-to-diagnosis, 12 days. Total and partial costs were greater in cases with final diagnosis of organic vs nonorganic disorder, as it was in those with symptoms suggestive or a final diagnosis of cancer vs noncancer. Of all subcosts, imaging showed the stronger correlation with total cost. Time-to-diagnosis and imaging costs were significant predictors of total cost above the median in binary logistic regression, with imaging costs also being a significant predictor in multiple linear regression (with total cost as quantitative outcome).Predictors of QDU costs are partly nonmodifiable (i.e., cancer suspicion, actually one of the goals of QDUs). Yet, improved primary-care-to-hospital referral circuits reducing time to diagnosis as well as optimized imaging protocols might further increase the QDU cost-effectiveness process. Prospective studies (ideally with direct comparison to conventional hospitalization costs) are needed to explore this possibility.


Assuntos
Custos Hospitalares/estatística & dados numéricos , Hospitais Públicos/economia , Ambulatório Hospitalar/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Públicos/organização & administração , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Ambulatório Hospitalar/organização & administração , Ambulatório Hospitalar/estatística & dados numéricos , Encaminhamento e Consulta/economia , Estudos Retrospectivos , Espanha , Fatores de Tempo
2.
BMJ Open ; 10(8): e039177, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32819955

RESUMO

OBJECTIVE: COVID-19 started spreading widely in China in January 2020. Outpatient fever clinics (FCs), instituted during the SARS epidemic in 2003, were upgraded to serve for COVID-19 screening and prevention of disease transmission in large tertiary hospitals in China. FCs were hoped to relieve some of the healthcare burden from emergency departments (EDs). We aimed to evaluate the effect of upgrading the FC system on rates of nosocomial COVID-19 infection and ED patient attendance at Peking Union Medical College Hospital (PUMCH). DESIGN: A retrospective cohort study. PARTICIPANTS: A total of 6365 patients were screened in the FC. METHODS: The FC of PUMCH was upgraded on 20 January 2020. We performed a retrospective study of patients presenting to the FC between 12 December 2019 and 29 February 2020. The date when COVID-19 was declared an outbreak in Beijing was 20 January 2020. Two groups of data were collected and subsequently compared with each other: the first group of data was collected within 40 days before 20 January 2020; the second group of data was collected within 40 days after 20 January 2020. All necessary data, including patient baseline information, diagnosis, follow-up conditions and the transfer records between the FC and ED, were collected and analysed. RESULTS: 6365 patients were screened in the FC, among whom 2912 patients were screened before 21 January 2020, while 3453 were screened afterward. Screening results showed that upper respiratory infection was the major disease associated with fever. After the outbreak of COVID-19, the number of patients who were transferred from the FC to the ED decreased significantly (39.21% vs 15.75%, p<0.001), and patients generally spent more time in the FC (55 vs 203 min, p<0.001), compared with before the outbreak. For critically ill patients waiting for their screening results, the total length of stay in the FC was 22 min before the outbreak, compared with 442 min after the outbreak (p<0.001). The number of in-hospital deaths of critically ill patients in the FC was 9 out of 29 patients before the outbreak and 21 out of 38 after the outbreak (p<0.05). Nineteen cases of COVID-19 were confirmed in the FC during the period of this study. However, no other patients nor any healthcare providers were cross-infected. CONCLUSION: The workload of the FC increased significantly after the COVID-19 outbreak. New protocols regarding the use of FC likely helped prevent the spread of COVID-19 within the hospital. The upgraded FC also reduced the burden on the ED.


Assuntos
Infecções por Coronavirus/diagnóstico , Serviço Hospitalar de Emergência/organização & administração , Febre/virologia , Ambulatório Hospitalar/organização & administração , Pneumonia Viral/diagnóstico , Centros de Atenção Terciária/organização & administração , Carga de Trabalho , Adulto , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/estatística & dados numéricos , Pandemias , Transferência de Pacientes/estatística & dados numéricos , Pneumonia Viral/transmissão , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
3.
PLoS One ; 15(8): e0237781, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857798

RESUMO

BACKGROUND: Drug therapy problems (DTPs) are major concerns of healthcare and have been identified to contribute to negative clinical outcomes. The occurrence of DTPs in heart failure patients is associated with worsening of outcomes. The aim of this study was to assess DTPs, associated factors and patient satisfaction among ambulatory heart failure patients at Tikur Anbessa Specialized Hospital (TASH). METHODS: A hospital based prospective cross-sectional study was conducted on 423 heart failure patients on follow up at TASH. Data was collected through patient interview and chart review. Descriptive statistics, binary and multiple logistic regressions were used for analyses and P < 0.05 was used to declare association. RESULTS: Majority of the patients were in NYHA class III (55.6%) and 66% of them had preserved systolic function. DTPs were identified in 291(68.8%) patients, with an average number of 2.51±1.07.per patient. The most common DTPs were drug interaction (27.3%) followed by noncompliance (26.2%), and ineffective drug use (13.7%). ß blockers were the most frequent drug class involved in DTPs followed by angiotensin converting enzyme inhibitors. The global satisfaction was 78% and the overall mean score of treatment satisfaction was 60.5% (SD, 10.5). CONCLUSION: Prevalence of DTPs as well as non-adherence among heart failure patients on follow up is relatively high. Detection and prevention of DTPs along with identifying patients at risk can save lives, help to adopt efficient strategies to closely monitor patients at risk, enhance patient's quality of life and optimize healthcare costs.


Assuntos
Antagonistas Adrenérgicos beta/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Insuficiência Cardíaca/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Antagonistas Adrenérgicos beta/farmacocinética , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores da Enzima Conversora de Angiotensina/farmacocinética , Estudos Transversais , Interações Medicamentosas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/psicologia , Etiópia/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Ambulatório Hospitalar/estatística & dados numéricos , Prevalência , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
4.
J Orthop Surg Res ; 15(1): 279, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32703305

RESUMO

BACKGROUND: According to the required reorganization of all hospital activities, the recent COVID-19 pandemic had dramatic consequences on the orthopedic world. We think that informing the orthopedic community about the strategy that we adopted both in our hospital and in our Department of Orthopedics could be useful, particularly for those who are facing the pandemic later than Italy. METHODS: Changes were done in our hospital by medical direction to reallocate resources to COVID-19 patients. In the Orthopedic Department, a decrease in the number of beds and surgical activity was stabilized. Since March 13, it has been avoided to perform elective surgery, and since March 16, non-urgent outpatient consultations were abolished. This activity reduction was associated with careful evaluation of staff and patients: extensive periodical swab testing of all healthcare staff and swab testing of all surgical patients were applied. RESULTS: These restrictions determined an overall reduction of all our surgical activities of 30% compared to 2019. We also had a reduction in outpatient clinic activities and admissions to the orthopedic emergency unit. Extensive swab testing has proven successful: of more than 160 people tested in our building, only three COVID-19 positives were found, and of over more than 200 surgical procedures, only two positive patients were found. CONCLUSIONS: Extensive swab test of all people (even if asymptomatic) and proactive tracing and quarantining of potential COVID-19 positive patients may diminish the virus spread.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Ortopedia/organização & administração , Pneumonia Viral/epidemiologia , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Emergências , Reforma dos Serviços de Saúde/organização & administração , Hospitalização , Humanos , Controle de Infecções/organização & administração , Itália/epidemiologia , Procedimentos Ortopédicos/estatística & dados numéricos , Ambulatório Hospitalar/organização & administração , Ambulatório Hospitalar/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Centro Cirúrgico Hospitalar/organização & administração
5.
Cochrane Database Syst Rev ; 7: CD013665, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32633856

RESUMO

BACKGROUND: Some people with SARS-CoV-2 infection remain asymptomatic, whilst in others the infection can cause mild to moderate COVID-19 disease and COVID-19 pneumonia, leading some patients to require intensive care support and, in some cases, to death, especially in older adults. Symptoms such as fever or cough, and signs such as oxygen saturation or lung auscultation findings, are the first and most readily available diagnostic information. Such information could be used to either rule out COVID-19 disease, or select patients for further diagnostic testing. OBJECTIVES: To assess the diagnostic accuracy of signs and symptoms to determine if a person presenting in primary care or to hospital outpatient settings, such as the emergency department or dedicated COVID-19 clinics, has COVID-19 disease or COVID-19 pneumonia. SEARCH METHODS: On 27 April 2020, we undertook electronic searches in the Cochrane COVID-19 Study Register and the University of Bern living search database, which is updated daily with published articles from PubMed and Embase and with preprints from medRxiv and bioRxiv. In addition, we checked repositories of COVID-19 publications. We did not apply any language restrictions. SELECTION CRITERIA: Studies were eligible if they included patients with suspected COVID-19 disease, or if they recruited known cases with COVID-19 disease and controls without COVID-19. Studies were eligible when they recruited patients presenting to primary care or hospital outpatient settings. Studies including patients who contracted SARS-CoV-2 infection while admitted to hospital were not eligible. The minimum eligible sample size of studies was 10 participants. All signs and symptoms were eligible for this review, including individual signs and symptoms or combinations. We accepted a range of reference standards including reverse transcription polymerase chain reaction (RT-PCR), clinical expertise, imaging, serology tests and World Health Organization (WHO) or other definitions of COVID-19. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently selected all studies, at both title and abstract stage and full-text stage. They resolved any disagreements by discussion with a third review author. Two review authors independently extracted data and resolved disagreements by discussion with a third review author. Two review authors independently assessed risk of bias using the QUADAS-2 checklist. Analyses were descriptive, presenting sensitivity and specificity in paired forest plots, in ROC (receiver operating characteristic) space and in dumbbell plots. We did not attempt meta-analysis due to the small number of studies, heterogeneity across studies and the high risk of bias. MAIN RESULTS: We identified 16 studies including 7706 participants in total. Prevalence of COVID-19 disease varied from 5% to 38% with a median of 17%. There were no studies from primary care settings, although we did find seven studies in outpatient clinics (2172 participants), and four studies in the emergency department (1401 participants). We found data on 27 signs and symptoms, which fall into four different categories: systemic, respiratory, gastrointestinal and cardiovascular. No studies assessed combinations of different signs and symptoms and results were highly variable across studies. Most had very low sensitivity and high specificity; only six symptoms had a sensitivity of at least 50% in at least one study: cough, sore throat, fever, myalgia or arthralgia, fatigue, and headache. Of these, fever, myalgia or arthralgia, fatigue, and headache could be considered red flags (defined as having a positive likelihood ratio of at least 5) for COVID-19 as their specificity was above 90%, meaning that they substantially increase the likelihood of COVID-19 disease when present. Seven studies carried a high risk of bias for selection of participants because inclusion in the studies depended on the applicable testing and referral protocols, which included many of the signs and symptoms under study in this review. Five studies only included participants with pneumonia on imaging, suggesting that this is a highly selected population. In an additional four studies, we were unable to assess the risk for selection bias. These factors make it very difficult to determine the diagnostic properties of these signs and symptoms from the included studies. We also had concerns about the applicability of these results, since most studies included participants who were already admitted to hospital or presenting to hospital settings. This makes these findings less applicable to people presenting to primary care, who may have less severe illness and a lower prevalence of COVID-19 disease. None of the studies included any data on children, and only one focused specifically on older adults. We hope that future updates of this review will be able to provide more information about the diagnostic properties of signs and symptoms in different settings and age groups. AUTHORS' CONCLUSIONS: The individual signs and symptoms included in this review appear to have very poor diagnostic properties, although this should be interpreted in the context of selection bias and heterogeneity between studies. Based on currently available data, neither absence nor presence of signs or symptoms are accurate enough to rule in or rule out disease. Prospective studies in an unselected population presenting to primary care or hospital outpatient settings, examining combinations of signs and symptoms to evaluate the syndromic presentation of COVID-19 disease, are urgently needed. Results from such studies could inform subsequent management decisions such as self-isolation or selecting patients for further diagnostic testing. We also need data on potentially more specific symptoms such as loss of sense of smell. Studies in older adults are especially important.


Assuntos
Assistência Ambulatorial , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Atenção Primária à Saúde , Avaliação de Sintomas , Artralgia/diagnóstico , Artralgia/etiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Fadiga/diagnóstico , Fadiga/etiologia , Febre/diagnóstico , Febre/etiologia , Cefaleia/diagnóstico , Humanos , Mialgia/diagnóstico , Mialgia/etiologia , Ambulatório Hospitalar/estatística & dados numéricos , Pandemias , Exame Físico , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Viés de Seleção , Avaliação de Sintomas/classificação , Avaliação de Sintomas/estatística & dados numéricos
6.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32616629

RESUMO

OBJECTIVES: To compare the frequency of opioid and corticosteroid prescriptions dispensed for children with pneumonia or sinusitis visits on the basis of location of care. METHODS: We evaluated 2016 South Carolina Medicaid claims data for 5 to 18 years olds with pneumonia or sinusitis. Visits were associated with 1 of 3 locations: the emergency department (ED), urgent care, or the ambulatory setting. RESULTS: Inclusion criteria were met by 31 838 children. Pneumonia visits were more often linked to an opioid prescription in the ED (34 of 542 [6.3%]) than in ambulatory settings (24 of 1590 [1.5%]; P ≤ .0001) and were more frequently linked to a steroid prescription in the ED (106 of 542 [19.6%]) than in ambulatory settings (196 of 1590 [12.3%]; P ≤ .0001). Sinusitis visits were more often linked to an opioid prescription in the ED (202 of 2705 [7.5%]) than in ambulatory settings (568 of 26 866 [2.1%]; P ≤ .0001) and were more frequently linked to a steroid prescription in the ED (510 of 2705 [18.9%]) than in ambulatory settings (1922 of 26 866 [7.2%]; P ≤ .0001). In logistic regression for children with pneumonia, the ED setting was associated with increased odds of receiving an opioid (adjusted odds ratio [aOR] 4.69) or steroid (aOR 1.67). Similarly, patients with sinusitis were more likely to be prescribed opioids (aOR 4.02) or steroids (aOR 3.05) in the ED than in ambulatory sites. CONCLUSIONS: School-aged children received opioid and steroid prescriptions for pneumonia or sinusitis at a higher frequency in the ED versus the ambulatory setting.


Assuntos
Corticosteroides/uso terapêutico , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Analgésicos Opioides/uso terapêutico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Ambulatório Hospitalar/estatística & dados numéricos , Pneumonia/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Sinusite/tratamento farmacológico , Adolescente , Assistência Ambulatorial , Criança , Pré-Escolar , Serviços Médicos de Emergência , Feminino , Fidelidade a Diretrizes , Humanos , Modelos Logísticos , Masculino , Medicaid , Guias de Prática Clínica como Assunto , South Carolina , Estados Unidos
7.
Plast Reconstr Surg ; 145(6): 1541-1551, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459783

RESUMO

BACKGROUND: Health insurance reimbursement structure has evolved, with patients becoming increasingly responsible for their health care costs through rising out-of-pocket expenses. High levels of cost sharing can lead to delays in access to care, influence treatment decisions, and cause financial distress for patients. METHODS: Patients undergoing the most common outpatient reconstructive plastic surgery operations were identified using Truven MarketScan databases from 2009 to 2017. Total cost of the surgery paid to the insurer and out-of-pocket expenses, including deductible, copayment, and coinsurance, were calculated. Multivariable generalized linear modeling with log link and gamma distribution was used to predict adjusted total and out-of-pocket expenses. All costs were inflation-adjusted to 2017 dollars. RESULTS: The authors evaluated 3,165,913 outpatient plastic and reconstructive surgical procedures between 2009 and 2017. From 2009 to 2017, total costs had a significant increase of 25 percent, and out-of-pocket expenses had a significant increase of 54 percent. Using generalized linear modeling, procedures performed in outpatient hospitals conferred an additional $1999 in total costs (95 percent CI, $1978 to $2020) and $259 in out-of-pocket expenses (95 percent CI, $254 to $264) compared with office procedures. Ambulatory surgical center procedures conferred an additional $1698 in total costs (95 percent CI, $1677 to $1718) and $279 in out-of-pocket expenses (95 percent CI, $273 to $285) compared with office procedures. CONCLUSIONS: For outpatient plastic surgery procedures, out-of-pocket expenses are increasing at a faster rate than total costs, which may have implications for access to care and timing of surgery. Providers should realize the increasing burden of out-of-pocket expenses and the effect of surgical location on patients' costs when possible.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/economia , Custo Compartilhado de Seguro/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Reembolso de Seguro de Saúde/economia , Procedimentos Cirúrgicos Reconstrutivos/economia , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Redução de Custos/economia , Redução de Custos/legislação & jurisprudência , Custo Compartilhado de Seguro/economia , Custo Compartilhado de Seguro/legislação & jurisprudência , Custo Compartilhado de Seguro/tendências , Bases de Dados Factuais/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/economia , Planos de Pagamento por Serviço Prestado/legislação & jurisprudência , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/tendências , Feminino , Gastos em Saúde/legislação & jurisprudência , Gastos em Saúde/tendências , Preços Hospitalares/estatística & dados numéricos , Preços Hospitalares/tendências , Humanos , Reembolso de Seguro de Saúde/legislação & jurisprudência , Reembolso de Seguro de Saúde/tendências , Masculino , Programas de Assistência Gerenciada/economia , Programas de Assistência Gerenciada/legislação & jurisprudência , Programas de Assistência Gerenciada/estatística & dados numéricos , Programas de Assistência Gerenciada/tendências , Medicare/economia , Medicare/legislação & jurisprudência , Medicare/estatística & dados numéricos , Medicare/tendências , Pessoa de Meia-Idade , Ambulatório Hospitalar/economia , Ambulatório Hospitalar/estatística & dados numéricos , Políticas , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
8.
Value Health ; 23(4): 481-486, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32327165

RESUMO

OBJECTIVES: To examine the uptake of filgrastim-sndz (Zarxio), the first biosimilar to launch in the United States, in the Medicare Part B fee-for-service program from its launch in September 2015 to December 2017 and compare characteristics of patients and facilities that used filgrastim-sndz or originator filgrastim (Neupogen). METHODS: The 20% sample of Medicare Part B fee-for-service administrative claims data was used to extract information on claims for any filgrastim product between January 1, 2015 and December 31, 2017. RESULTS: The utilization of filgrastim-sndz in Medicare Part B increased sharply between January and August 2016, surpassing filgrastim by November 2017, contributing to a 30% decrease in overall spending on this drug since 2015. Uptake was faster and larger in physician practices compared with hospital outpatient departments. About 77% of patients receiving filgrastim-sndz were new users. Utilization patterns indicated that product selection occurred at the facility level, rather than being at the discretion of the prescribing physician or driven by patient characteristics. CONCLUSION: Uptake of biosimilar filgrastim in the Medicare Part B program occurred despite multiple challenges to the adoption of biosimilars in the US market, suggesting that substantial potential savings could be generated by improving biosimilar uptake. Our findings indicated that physician practices and hospital outpatient departments have distinctive biosimilar uptake patterns. Thus policy makers aiming to contain Medicare Part B spending might consider focusing on incentivizing biosimilar uptake among hospital outpatient departments.


Assuntos
Medicamentos Biossimilares/administração & dosagem , Filgrastim/administração & dosagem , Fármacos Hematológicos/administração & dosagem , Medicare Part B/economia , Medicamentos Biossimilares/economia , Redução de Custos , Planos de Pagamento por Serviço Prestado/economia , Filgrastim/economia , Fármacos Hematológicos/economia , Humanos , Medicare Part B/estatística & dados numéricos , Ambulatório Hospitalar/estatística & dados numéricos , Pacientes Ambulatoriais , Padrões de Prática Médica/estatística & dados numéricos , Estados Unidos
10.
Ann R Coll Surg Engl ; 102(6): 412-417, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32306742

RESUMO

INTRODUCTION: The national reconfiguration of vascular surgery means that arterial centres serve larger populations with increased demand on resources. Emergency general surgery ambulatory clinics facilitate timely review and intervention, avoiding admission; a critical limb ischaemia (CLI) 'hot clinic' (HC) was implemented to achieve similar for vascular patients. The aim of the study was to determine HC efficacy. METHODS: This was a prospective cohort study comparing HC patients with emergency admission (EA) patients between 1 May and 1 December 2017. Age, sex, comorbidities, CLI severity and smoking status were noted. HC patients were provided with satisfaction surveys. Primary outcome measures were freedom from reintervention and major amputation. Secondary outcome measures included time to procedure, length of stay, returns to theatre and 30-day readmission. RESULTS: A total of 147 patients (72 HC, 75 EA) were enrolled in the study. No statistical difference was found in age, sex, smoking status, severity of CLI or prevalence of comorbidities between the groups except that diabetes was more prevalent in EA patients (p=0.028). The median length of stay for the HC cohort was shorter (3 days vs 17 days, p<0.001), with no difference between time to procedure, return to theatre or 30-day readmission. HC patients were nearly 6 times more likely to experience freedom from reintervention (odds ratio: 5.824, p<0.001) and 2.5 times less likely to undergo amputation (odds ratio: 2.616, p=0.043). HC utilisation saved a total of 441 bed days. Over 90% of attendees responded with 100% positive feedback. CONCLUSIONS: A vascular HC facilitates urgent review and revascularisation. It provides comparable in-hospital outcomes and better long-term outcomes, with greater efficiency than hospital admission, demonstrating its value in treating CLI.


Assuntos
Tratamento de Emergência/estatística & dados numéricos , Isquemia/cirurgia , Salvamento de Membro/estatística & dados numéricos , Ambulatório Hospitalar/organização & administração , Doença Arterial Periférica/cirurgia , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Idoso , Amputação/estatística & dados numéricos , Estado Terminal/terapia , Eficiência Organizacional , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/efeitos adversos , Feminino , Humanos , Isquemia/diagnóstico , Perna (Membro)/irrigação sanguínea , Tempo de Internação/estatística & dados numéricos , Salvamento de Membro/efeitos adversos , Masculino , Ambulatório Hospitalar/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Doença Arterial Periférica/diagnóstico , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento , Reino Unido , Procedimentos Cirúrgicos Vasculares/efeitos adversos
11.
Ann R Coll Surg Engl ; 102(6): 418-421, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32326744

RESUMO

INTRODUCTION: Guidelines for nasal injury state that assessment should be at 7-10 days post-injury and manipulation within 14 days. We performed a plan, do, study, act improvement cycle to assess whether a dedicated nasal fracture service led to better outcomes. MATERIALS AND METHODS: A retrospective study was carried out of all patients undergoing manipulation under anaesthesia for nasal trauma between February 2013 and December 2016 in a district general hospital. A dedicated nasal fracture clinic providing manipulation under local anaesthesia was implemented followed by a prospective study of all patients presenting to the clinic between February and November 2017. Main outcome measures included time from injury to otolaryngology assessment, time from injury to manipulation and incidence of secondary septorhinoplasty. RESULTS: The retrospective series involved 525 patients including 381 males (72.6%) and 144 females (27.4%). Mean time from injury to assessment was 10 days. Mean time from injury to surgery was 14.5 days. Mean time from assessment to surgery was five days. The incidence of septorhinoplasty was 2.3%. The prospective series involved 119 patients including 78 males (65.5%) and 41 females (34.5%). Following implementation of a nasal fracture clinic, mean time from injury to assessment and manipulation was 6.1 days and 5.4% of patients underwent septorhinoplasty for secondary deformity. DISCUSSION: Implementation of a nasal fracture clinic providing reduction under local anaesthesia reduced the time to assessment and manipulation. The incidence of septorhinoplasty is low following reduction under general or local anaesthesia. Assessment earlier than seven days is feasible and advice for referral can be changed accordingly.


Assuntos
Anestesia Local , Osso Nasal/lesões , Deformidades Adquiridas Nasais/cirurgia , Rinoplastia/métodos , Fraturas Cranianas/cirurgia , Adulto , Feminino , Implementação de Plano de Saúde , Humanos , Masculino , Osso Nasal/cirurgia , Septo Nasal/lesões , Septo Nasal/cirurgia , Ambulatório Hospitalar/organização & administração , Ambulatório Hospitalar/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Estudos Retrospectivos , Rinoplastia/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Reino Unido
12.
Plast Reconstr Surg ; 145(4): 769e-778e, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221217

RESUMO

BACKGROUND: Peroneal neuropathy with an overt foot drop is a known risk factor for falling. Subclinical peroneal neuropathy caused by compression at the fibular neck is subtler and does not have foot drop. A previous study found subclinical peroneal neuropathy in 31 percent of hospitalized patients. This was associated with having fallen. The purpose of this study was to determine the prevalence of subclinical peroneal neuropathy in ambulatory adults and investigate if it is associated with falling. METHODS: A cross-sectional study of 397 ambulatory adults presenting to outpatient clinics at a large academic hospital was conducted from 2016 to 2017. Patients were examined for dorsiflexion weakness and signs of localizing peroneal nerve compression to the fibular neck. Fall risk was assessed with the Activities-Specific Balance Confidence Scale and self-reported history of falling. Multivariate logistic regression was used to correlate subclinical peroneal neuropathy with fall risk and a history of falls. RESULTS: The mean patient age was 54 ± 15 years and 248 patients (62 percent) were women. Thirteen patients (3.3 percent) were found to have subclinical peroneal neuropathy. After controlling for various factors known to increase fall risk, patients with subclinical peroneal neuropathy were 3.74 times (95 percent CI, 1.06 to 13.14) (p = 0.04) more likely to report having fallen multiple times in the past year than patients without subclinical peroneal neuropathy. Similarly, patients with subclinical peroneal neuropathy were 7.22 times (95 percent CI, 1.48 to 35.30) (p = 0.02) more likely to have an elevated fall risk on the Activities-Specific Balance Confidence fall risk scale. CONCLUSION: Subclinical peroneal neuropathy affects 3.3 percent of adult outpatients and may predispose them to falling. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Vida Independente/estatística & dados numéricos , Ambulatório Hospitalar/estatística & dados numéricos , Neuropatias Fibulares/epidemiologia , Acidentes por Quedas/prevenção & controle , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neuropatias Fibulares/complicações , Neuropatias Fibulares/diagnóstico , Prevalência , Estudos Prospectivos , Fatores de Risco
13.
Sci Rep ; 10(1): 1146, 2020 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-31980729

RESUMO

Headache is a common problem with great effect both on the individual and on the society. Recent studies raised the possibility of increasing rate of specialty referrals, inappropiate treatment and advanced imaging for simple headache. The aim of our study was to analyze the characteritics of patients (including duration of symptoms, headache type, brain imaging, treatment) referred to our specialized headache clinic between 01/01/2014 and 01/01/2015 by their general practitioners and primary care neurologists due to chronic/treatment-resistant headache syndromes. 202 patients (mean age 53.6 ± 17.6 years) were evaluated in our clinic (102 females, mean age 50.14 ± 16.11 years and 100 males, mean age 57 ± 18.1 years). Migraine (84/202) and tension-type (76/202) were the most common syndromes. 202 plain brain CT, 60 contrast-enhanced CT and 128 MRI were carried out by their general practitioners or other healthcare professioners including neurologists before referral to our headache centre. Despite of extensive brain imaging appropiate treatment was started less than 1/3 of all patients and significant proportion received benzodiazepines or opioid therapy. Furthermore, more than 10% of referred patients presented with secondary headache including one meningitis. The management of headache is still a challenge for primary care physicians leading to medical overuse. Vast majority of our patients should not be referred to our specialized headache clinic as they had uncomplicated headache or other underlying conditions than pain.


Assuntos
Transtornos da Cefaleia/epidemiologia , Ambulatório Hospitalar , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Benzodiazepinas/uso terapêutico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Comorbidade , Feminino , Clínicos Gerais , Transtornos da Cefaleia/diagnóstico por imagem , Transtornos da Cefaleia/tratamento farmacológico , Transtornos da Cefaleia/etiologia , Humanos , Hungria/epidemiologia , Imagem por Ressonância Magnética , Masculino , Sobremedicalização , Meningite/complicações , Pessoa de Meia-Idade , Neuroimagem/estatística & dados numéricos , Neurologistas , Ambulatório Hospitalar/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Tomografia Computadorizada por Raios X , Triptaminas/uso terapêutico
14.
Ann Saudi Med ; 39(6): 373-381, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31804138

RESUMO

BACKGROUND: No-shows, a major issue for healthcare centers, can be quite costly and disruptive. Capacity is wasted and expensive resources are underutilized. Numerous studies have shown that reducing uncancelled missed appointments can have a tremendous impact, improving efficiency, reducing costs and improving patient outcomes. Strategies involving machine learning and artificial intelligence could provide a solution. OBJECTIVE: Use artificial intelligence to build a model that predicts no-shows for individual appointments. DESIGN: Predictive modeling. SETTING: Major tertiary care center. PATIENTS AND METHODS: All historic outpatient clinic scheduling data in the electronic medical record for a one-year period between 01 January 2014 and 31 December 2014 were used to independently build predictive models with JRip and Hoeffding tree algorithms. MAIN OUTCOME MEASURES: No show appointments. SAMPLE SIZE: 1 087 979 outpatient clinic appointments. RESULTS: The no show rate was 11.3% (123 299). The most important information-gain ranking for predicting no-shows in descending order were history of no shows (0.3596), appointment location (0.0323), and specialty (0.025). The following had very low information-gain ranking: age, day of the week, slot description, time of appointment, gender and nationality. Both JRip and Hoeffding algorithms yielded a reasonable degrees of accuracy 76.44% and 77.13%, respectively, with area under the curve indices at acceptable discrimination power for JRip at 0.776 and at 0.861 with excellent discrimination for Hoeffding trees. CONCLUSION: Appointments having high risk of no-shows can be predicted in real-time to set appropriate proactive interventions that reduce the negative impact of no-shows. LIMITATIONS: Single center. Only one year of data. CONFLICT OF INTEREST: None.


Assuntos
Inteligência Artificial , Pacientes não Comparecentes/estatística & dados numéricos , Fatores Etários , Idoso , Algoritmos , Agendamento de Consultas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Ambulatório Hospitalar/organização & administração , Ambulatório Hospitalar/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais
15.
Artigo em Inglês | MEDLINE | ID: mdl-31835589

RESUMO

This study intends to inspect the sex differences in proportion of hospital outpatient department (OPD) visits in overall outpatient (OP) visits using national panel data and to explore factors that influence the proportions by sex. This study analyzed data of the 2009-2016 Korea Health Panel Survey. Fractional logit regression was applied to analyze factors that affect proportion of hospital visits among outpatient visits. Analysis of related factors was carried out first for all analysis subjects and then by sex. The study data were provided by 7470 women (52.2%) and 6846 men (47.8%). The overall average number of OP visits was 13.0, and women showed a much higher frequency of visits (15.8) than men (9.9). The average proportion of hospital OPD visits among overall OP visits was 21.9%, and men showed a higher rate (25.1%) than women (19.5%). The analysis model including sociodemographic factors, economic factors, and health-related factors confirmed that men showed a higher rate of hospital usage than women. Type of medical security, household income, participation in economic activities, disability, and serious illnesses were significant variables for both sexes. Age, education level, marital status, and subscription to voluntary private health insurance were significant only for women, whereas region of residence was significant only for men. This study confirmed that there is a sex difference in proportion of hospital OPD visits and in the factors that affect the proportion of hospital OPD visits. Universal health coverage is provided through social health insurance, but there is a sex difference in hospital OPD visits, and factors related to socioeconomic status have a significant effect, especially on women's selection of health care institutions. More attention should be given to sex differences in factors affecting health care utilization.


Assuntos
Nível de Saúde , Ambulatório Hospitalar/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , República da Coreia , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
16.
PLoS One ; 14(11): e0211306, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31689292

RESUMO

BACKGROUND: Low utilization of health facilities for delivery by pregnant women poses a public health challenge in Nigeria. AIM: To determine the factors that influence the choice of birth place among antenatal clinic attendees. METHODOLOGY: This was a cross-sectional study of the eligible antenatal clinic attendees recruited at Mater Misericordiae Hospital, Afikpo and Saint Vincent Hospital, Ndubia in Ebonyi State from February 1, 2016 to June 30, 2016. Analysis was done using EPI Info 7.21 software (CDC Atlanta Georgia). RESULTS: A total of 397(99.3%) completely filled questionnaires were collated and analysed. Approximately 71% of the health facilities closest to the respondents had maternity services. It took at least 1 hour for 80.9% of the respondents to access health facilities with maternity services. Most (60.2%) of the respondents had at least one antenatal clinic attendance and majority of them did so at public hospitals. Approximately 43.8% of the respondents were delivered by the skilled birth attendants. The respondents' age and the couple's educational level, history of antenatal clinic attendance, distance of the health facility and availability of transport fare had a significant effect on delivery by skilled birth attendants. The common determinants of birth place were nearness of the health facilities, familiarity of healthcare providers, improved services, sudden labour onset and cost. Also 61.7% of the respondents chose to deliver in public health facilities due to favourable reasons but this could be hampered by the rudeness of some healthcare providers at such facilities. A significant proportion of private health facilities had unskilled manpower and shortage of drugs. CONCLUSION: A greater proportion of women will prefer to deliver in health facilities. However there are barriers to utilization of these facilities hence the need to address such barriers.


Assuntos
Entorno do Parto/estatística & dados numéricos , Ambulatório Hospitalar , Preferência do Paciente , Gestantes , Cuidado Pré-Natal , Adolescente , Adulto , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Rurais , Humanos , Recém-Nascido , Nigéria , Ambulatório Hospitalar/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/estatística & dados numéricos , Características de Residência , Inquéritos e Questionários , Adulto Jovem
17.
BMC Public Health ; 19(1): 1366, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651288

RESUMO

BACKGROUND: Many studies have reported the impact of air pollution on cardiovascular disease (CVD), but few of these studies were conducted in severe haze-fog areas. The present study focuses on the impact of different air pollutant concentrations on daily CVD outpatient visits in a severe haze-fog city. METHODS: Data regarding daily air pollutants and outpatient visits for CVD in 2013 were collected, and the association between six pollutants and CVD outpatient visits was explored using the least squares mean (LSmeans) and logistic regression. Adjustments were made for days of the week, months, air temperature and relative humidity. RESULTS: The daily CVD outpatient visits for particulate matter (PM10 and PM2.5), sulphur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) in the 90th-quantile group were increased by 30.01, 29.42, 17.68, 14.98, 29.34%, and - 19.87%, respectively, compared to those in the <10th-quantile group. Odds ratios (ORs) and 95% confidence intervals (CIs) for the increase in daily CVD outpatient visits in PM10 300- and 500-µg/m3, PM2.5 100- and 300-µg/m3 and CO 3-mg/m3 groups were 2.538 (1.070-6.020), 7.781 (1.681-36.024), 3.298 (1.559-6.976), 8.72 (1.523-49.934), and 5.808 (1.016-33.217), respectively, and their corresponding attributable risk percentages (AR%) were 60.6, 87.15, 69.68, 88.53 and 82.78%, respectively. The strongest associations for PM10, PM2.5 and CO were found only in lag 0 and lag 1. The ORs for the increase in CVD outpatient visits per increase in different units of the six pollutants were also analysed. CONCLUSIONS: All five air pollutants except O3 were positively associated with the increase in daily CVD outpatient visits in lag 0. The high concentrations of PM10, PM2.5 and CO heightened not only the percentage but also the risk of increased daily CVD outpatient visits. PM10, PM2.5 and CO may be the main factors of CVD outpatient visits.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Doenças Cardiovasculares/terapia , Ambulatório Hospitalar/estatística & dados numéricos , Adulto , Idoso , Monóxido de Carbono/efeitos adversos , Monóxido de Carbono/análise , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Cidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dióxido de Nitrogênio/efeitos adversos , Dióxido de Nitrogênio/análise , Ozônio/efeitos adversos , Ozônio/análise , Material Particulado/efeitos adversos , Material Particulado/análise , Dióxido de Enxofre/efeitos adversos , Dióxido de Enxofre/análise , Adulto Jovem
18.
West Afr J Med ; 36(3): 246-252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622487

RESUMO

BACKGROUND AND OBJECTIVE: Disclosure of human immuno-deficiency virus (HIV) sero-status is a difficult process that involves communication of information about a potentially stigmatizing and transmissible illness. Despite this, it is important for preventing HIV infection and mitigating its impacts. This study aimed to assess the rate and determinants of self-disclosure of HIV sero-status among people living with HIV/AIDS (PLHIV) attending an Antiretroviral Therapy (ART) Clinic in North Central Nigeria with a view to promoting self- disclosure as an intervention for secondary prevention of HIV/AIDS. METHODS: It was a cross-sectional study involving 325 consenting adults aged 18 to 65 years PLHIV attending ART clinic who were recruited using systematic random sampling method. Data collected from the participants include socio-demographic data and medical history. The rate and factors affecting self-disclosure of HIV sero-status were obtained by using a structured interviewer-administered questionnaire. Data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0 Results: Most of the participants (66.2%) were females. 96% of the participants had disclosed their HIV sero-status. Self-disclosure of HIV sero-status had statistically significant association with age (c2 = 12.614; p = 0.027) and gender (c2 = 4.638; p = 0.031). CONCLUSION: Self-disclosure of HIV sero-status was high among the participants. Being female and within 15-44 year age group were statistically significant factors associated with disclosure of HIV sero-status. Multiple counselling sessions are needed to improve disclosure particularly in males and older PLHIV as self-disclosure of HIV sero-status is a process that requires ongoing support and encouragement.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Soropositividade para HIV/psicologia , Revelação da Verdade , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/psicologia , Idoso , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Soropositividade para HIV/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Ambulatório Hospitalar/estatística & dados numéricos , Parceiros Sexuais , Centros de Atenção Terciária , Adulto Jovem
19.
J Manag Care Spec Pharm ; 25(11): 1282-1288, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31663457

RESUMO

BACKGROUND: Adherence to specialty and nonspecialty medications is often calculated using pharmacy claims data. However, specialty medication regimens are complex and may require periods of intentional gaps in therapy. Common adherence calculations are insufficient in identifying reasons for gaps in therapy. Because adherence reporting is a growing measure of quality care for specialty pharmacy accreditation and payer and manufacturer contracts, a better understanding of the rates and reasons for nonadherence within a specialty population is needed. OBJECTIVE: To identify rates and reasons for misidentified and true nonadherence in patients who are prescribed specialty medications. METHODS: A single center, retrospective cohort study was conducted using pharmacy claims data between March 2017 and February 2018. Medication adherence was calculated using proportion of days covered (PDC). Electronic medical records of a random 10% sample of nonadherent patients (PDC < 80%) were manually reviewed to identify reasons for nonadherence. Patients were then classified as either (a) misidentified as nonadherent (i.e., a provider-directed discontinuation or disruption of treatment that varies from the prescribed administration schedule or transfer of the prescription to an external pharmacy) or (b) truly nonadherent (discontinuation or disruption of treatment that varies from the prescribed administration instruction that is not directed or recommended by the provider or health care team). RESULTS: Of the 7,488 included prescription records from 18 specialty areas, 1,059 met criteria for nonadherence. 105 prescription records (representing 105 unique patients) were manually reviewed; most of these patients (58%) were truly nonadherent, driven by inability to contact patients for refills (59%). However, 40% were misidentified as nonadherent, most due to provider-directed medication holding (69%). Two percent of patients were nonadherent for unknown reasons. CONCLUSIONS: Many patients classified as nonadherent based on pharmacy claims experienced gaps in therapy due to medically appropriate reasons. Methods to better measure and identify true nonadherence are needed to efficiently and adequately affect specialty medication adherence behavior. DISCLOSURES: This study received funding support from CTSA Award No. UL1 TR002243 from the National Center for Advancing Translational Sciences. Study findings and conclusions are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health. Zuckerman reports research support from Sanofi and Gilead Sciences, unrelated to this study. The other authors have nothing to disclose. A poster based on the data from this study was presented at AMCP Nexus 2018 on October 24, 2018, in Orlando, FL.


Assuntos
Adesão à Medicação/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Ambulatório Hospitalar/estatística & dados numéricos , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Adulto , Idoso , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Infecções por HIV/tratamento farmacológico , Hepatite C/tratamento farmacológico , Humanos , Masculino , Conduta do Tratamento Medicamentoso/organização & administração , Pessoa de Meia-Idade , Ambulatório Hospitalar/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Hipertensão Arterial Pulmonar/tratamento farmacológico , Estudos Retrospectivos , Estados Unidos
20.
J Manag Care Spec Pharm ; 25(11): 1290-1296, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31663460

RESUMO

BACKGROUND: Adherence to treatment is correlated with treatment success in chronic myeloid leukemia (CML). CVS Specialty explored novel methods to improve adherence in this population to ensure optimal adherence and lower the risk of unsuccessful treatment. One novel program explored involved an interactive 2-way clinical messaging technology that coaches patients with adherence and knowledge about taking their treatment and managing their conditions. Clinical secure messaging is a 2-way messaging program distinct from the 1-way refill reminders and order status messages that patients were receiving if opted into the messaging program. OBJECTIVE: To assess the effect on adherence of 2-way clinical messaging in a CML population treated with tyrosine kinase inhibitors (TKIs) compared with patients enrolled in 1-way refill reminders. METHODS: A retrospective cohort study was conducted using prescription claims data. Patients new to TKI therapy and enrolled in at least 1-way messaging were identified and divided into control and study cohorts based on clinical messaging enrollment status. Participants were followed for 365 days after their first fill. Adherence outcomes were defined by medication possession ratio (MPR), length of therapy, first fill drop-off rate, and gap days between refills. Optimal adherence was defined as an MPR ≥ 85%. RESULTS: Patients receiving clinical messaging had on average a 7.64% higher MPR score (MPR: 73.94% vs. 66.30%) compared with the control arm (P = 0.0063). This translates to 22% more patients being optimally adherent while exposed to clinical messaging (P = 0.022). Patients in the exposed group had a mean 32-day increase in average length of therapy compared with the control group (243 days vs. 275 days, P = 0.0043), potentially driving an increase in adherence. Additional drivers included a 5.4 percentage point reduction in first fill drop-off rates (4.66% vs. 10.04%, P = 0.0149). Persistency after 12 months was similar between the study arms (41%). CONCLUSIONS: Two-way clinical messaging positively affected adherence outcomes in a CML population. This effect was in addition to 1-way refill reminders and order status messages. The nature of the clinical content encourages further investigation into this novel execution of adherence coaching and counseling through a digital platform. DISCLOSURES: Funding for this research was provided by CVS Health. The sponsor was involved at all stages of the study's conduct and reporting. Sawicki and Friend are employed by CVS Health. The other authors were employed by CVS at the time of this study. The authors have nothing more to disclose. Posters based on this work were presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2016; April 19-22, 2016; San Francisco, CA, and AMCP Nexus 2016; October 3-6, 2016; National Harbor, MD.


Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/organização & administração , Sistemas de Alerta/estatística & dados numéricos , Envio de Mensagens de Texto/estatística & dados numéricos , Adulto , Idoso , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Pessoa de Meia-Idade , Ambulatório Hospitalar/organização & administração , Ambulatório Hospitalar/estatística & dados numéricos , Serviço de Farmácia Hospitalar/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Pontuação de Propensão , Estudos Retrospectivos
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