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Despite recent therapeutic advances, diabetes remains the seventh leading cause of death in the United States. Clinicians caring for people with diabetes often find that low health literacy interferes with diabetes care. The aim of this cross-sectional study was to determine which diabetes-related misunderstandings or potentially maladaptive health beliefs were present among people at a low-income community clinic in Harris County, TX, and to determine the effect of such misconceptions on A1C values.
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Uncontrolled diabetes negatively affects millions of people in the United States and contributes to significant health burden. Many people with diabetes require high insulin doses to achieve glycemic control, but glycemia in this group has historically been difficult to manage. This retrospective, case-control study evaluated which therapeutic interventions and patient factors were associated with an improvement in A1C in people with type 2 diabetes using high-dose insulin at a county health system serving primarily low-income patients. Medication nonadherence was found to be the most influential factor affecting glycemic control in these individuals.
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Uncontrolled diabetes negatively affects millions of people in the United States and contributes to significant health burden. This retrospective case-control study evaluated which therapeutic interventions and patient factors were associated with improvement in A1C values from ≥9.0 to <9.0% in people with uncontrolled type 2 diabetes at a county health clinic serving primarily low-income, Hispanic patients. Medication adherence, high-dose insulin use, and clinical pharmacy specialist visits were found to be the most influential factors with regard to improving A1C.
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Background: Therapeutic interchange (TI) is the dispensing of an alternative medication within the same class as the original medication. TI often occurs in hospitals; however, failure to return patients to their original medications may increase the risk of adverse effects following hospital discharge. Objective: The purpose of this study was to evaluate the relationship between TI and discharge medication changes, hospital readmission rates, and emergency department visit rates following hospital discharge. Methods: Patient demographic and medication data were collected retrospectively for patients admitted to a nonprofit, acute care hospital. The primary outcome was the relationship between TI and the rate of discharge medication changes. Secondary outcomes included types of discharge medication changes and the relationship between TI and both hospital readmissions and emergency department visits following hospital discharge. Results: A total of 497 patients accounting for 1072 medications were included; 21.2% of home medications were interchanged following admission, and 21.8% of home medications were changed at discharge. TI increased the incidence of discharge medication changes by 70% (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.22-2.37, P = .0021). Cardiovascular agents were most likely to be changed at discharge (26%), and gastrointestinal agents were most likely to be interchanged (65%). Psychotropic agents were least likely to be changed at discharge (12%) or interchanged (7%). Neither TI nor discharge medication changes were predictive of 30-, 60-, or 90-day hospital readmission or emergency department visits following discharge. Conclusion and Relevance: This study was the first to examine the effects of TI on post-discharge outcomes. Despite being associated with an increased rate of discharge medication changes, the presence of TI did not correlate with hospital readmission or emergency department visit rates. This study supports the safety of TI.
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BACKGROUND: Claims data generally lack information on clinical outcomes. However, a validated claims-based algorithm for estimating the effectiveness of biologic agents in treating rheumatoid arthritis (RA) was recently developed and applied to various databases. OBJECTIVES: The objectives of the study were to implement a claims-based algorithm in a large nationwide database to estimate medication effectiveness and cost for patients with RA using biologic disease-modifying antirheumatic drugs (DMARDs) and to assess the effect of eliminating one criterion from the algorithm on results. METHODS: The DMARD groups included patients initiated on etanercept, adalimumab, abatacept, or infliximab. Patients were categorized as effectively treated if they met these six criteria: a medication possession ratio of 80% or greater; no escalation in biologic dose; no switch in biologics; no new nonbiologic DMARD; no new or increased oral glucocorticoid treatment; and no more than one glucocorticoid injection. In a follow-up analysis, the dose-escalation criterion was removed because an increase in dose for infliximab may be appropriate. Average costs for RA-related medications were calculated for each DMARD patient group and divided by the number of patients who met all six effectiveness criteria. RESULTS: A total of 1196 individuals were included in the analysis. Using the algorithm, the index biologic was categorized as effective for 25.4% of patients overall: 30.3% (102/337) of etanercept, 27.6% (104/377) of adalimumab, 32.7% (37/113) of abatacept, and 16.5% (61/369) of infliximab patients. Total costs for RA medication costs per effectively treated patient ranged from more than $80,000 for infliximab to ~$43,000-$46,000 for the other three groups. Removing the no dose-escalation criterion drastically reduced the cost per effectively treated patient in the infliximab group (to ~$42,000). CONCLUSIONS: Using the original six-criteria claims-based algorithm in a large claims database, infliximab was the least-effective biologic agent and had the highest medication cost per effectively treated patient. However, when a follow-up analysis removed the dose-escalation exclusion criterion, the four groups had similar effectiveness and medication costs per effectively treated patient with RA.