Impact of specialty drugs on the use of other medical services.
Ontology highlight
ABSTRACT:
SUBMITTER: Joyce GF
PROVIDER: S-EPMC3767569 | biostudies-literature | 2008 Dec
REPOSITORIES: biostudies-literature
Publications
Impact of specialty drugs on the use of other medical services.
Joyce Geoffrey F GF Goldman Dana P DP Karaca-Mandic Pinar P Lawless Grant D GD
The American journal of managed care 20081201 12
<h4>Objective</h4>To examine whether initiation of a biologic agent to treat 2 autoimmune disorders -- rheumatoid arthritis (RA) and multiple sclerosis (MS) -- affects use of other medical services.<h4>Study design</h4>Longitudinal analysis from 1997 to 2005 examining linked pharmacy and medical claims from large, private employers.<h4>Methods</h4>The study sample included 30,761 individuals newly diagnosed with RA (92,660 person-years) and 8961 unique individuals with MS (25,100 person-years). ...[more]
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Project description:BackgroundLittle is known about how delivery of primary care in the patient-centered medical home (PCMH) influences outpatient specialty care use.ObjectiveTo describe changes in outpatient specialty use among patients with treated hypertension during and after PCMH practice transformation.DesignOne-group, 48-month interrupted time series across baseline, PCMH implementation and post-implementation periods.PatientsAdults aged 18-85 years with treated hypertension.InterventionSystem-wide PCMH redesign implemented across 26 clinics in an integrated health care delivery system, beginning in January 2009.Main measuresResource Utilization Band variables from the Adjusted Clinical Groups case mix software characterized overall morbidity burden (low, medium, high). Negative binomial regression models described adjusted annual differences in total specialty care visits. Poisson regression models described adjusted annual differences in any use (yes/no) of selected medical and surgical specialties.Key resultsCompared to baseline, the study population averaged 7% fewer adjusted specialty visits during implementation (P?<?0.001) and 4% fewer adjusted specialty visits in the first post-implementation year (P?=?0.02). Patients were 12% less likely to have any cardiology visits during implementation and 13% less likely during the first post-implementation year (P?<?0.001). In interaction analysis, patients with low morbidity had at least 27% fewer specialty visits during each of 3 years following baseline (P?<?0.001); medium morbidity patients had 9% fewer specialty visits during implementation (P?<?0.001) and 5% fewer specialty visits during the first post-implementation year (P?=?0.007); high morbidity patients had 3% (P?=?0.05) and 5% (P?=?0.009) higher specialty use during the first and second post-implementation years, respectively.ConclusionsResults suggest that more comprehensive primary care in this PCMH redesign enabled primary care teams to deliver more hypertension care, and that many needs of low morbidity patients were within the scope of primary care practice. New approaches to care coordination between primary care teams and specialists should prioritize high morbidity, clinically complex patients.
| S-EPMC4000327 | biostudies-literature
Project description:ObjectiveTo estimate patients' elasticity of demand, willingness to pay, and consumer surplus for five high-cost specialty medications treating metastatic disease or hematologic malignancies.Data source/study settingClaims data from 71 private health plans from 1997 to 2005.Study designThis is a revealed preference analysis of the demand for specialty drugs among cancer patients. We exploit differences in plan generosity to examine how utilization of specialty oncology drugs varies with patient out-of-pocket costs.Data collection/extraction methodsWe extracted key variables from administrative health insurance claims records.Principal findingsA 25 percent reduction in out-of-pocket costs leads to a 5 percent increase in the probability that a patient initiates specialty cancer drug therapy. Among patients who initiate, a 25 percent reduction in out-of-pocket costs reduces the number of treatments (claims) by 1-3 percent, depending on the drug. On average, the value of these drugs to patients who use them is about four times the total cost paid by the patient and his or her insurer, although this ratio may be lower for oral specialty therapies.ConclusionsThe decision to initiate therapy with specialty oncology drugs is responsive to price, but not highly so. Among patients who initiate therapy, the amount of treatment is equally responsive. The drugs we examine are highly valued by patients in excess of their total costs, although oral agents warrant further scrutiny as copayments increase.
| S-EPMC2813440 | biostudies-literature
Project description:BackgroundA comprehensive picture of how the US population engages in specialty care use is lacking, even though redesign models focused on specialty care are becoming more popular.ObjectiveTo describe the type of provider, primary care or specialist, most often seen by individuals, to test associations between type of provider most often seen and insurance coverage, and to test associations between the number of generalist and specialist visits and insurance coverage.DesignCross-sectional analysis of 2013-2016 Medicaid Expenditure Panel Survey. Logistic and negative binomial models were used in multivariate regression modeling.ParticipantsDepending on the analysis, the study samples include between 71,402 and 79,518 US residents.Main measuresIndividuals' provider type most often seen, primary care visits, and specialist visits were reported.Key resultsMore than half of the sample (55%) predominantly visited primary care providers (or generalists), and 36% predominantly visited specialists. Among individuals primarily visiting generalists, 80% visited only one type of primary care provider, and 24% also visited one or more specialists. Among individuals primarily visiting specialists, 48% visited only one type of specialist, and 47% did not visit any generalists in the year. Among Medicare enrollees, 50% predominantly visited specialists, and 40% predominantly visited generalists. Medicare enrollment was associated with greater odds of predominantly visiting specialists (p < 0.05), and Medicare-Medicaid enrollment and having no insurance were associated with lower odds of predominantly visiting specialists (p < 0.05). Medicare enrollment was associated with 13% more generalist visits and 35% more specialist visits, and Medicare-Medicaid enrollment was associated with 38% more generalist visits and 15% more specialist visits (all p < 0.05).ConclusionsGiven the overall frequency of specialty care use and the reliance on multiple specialists in any given year, particularly among Medicare enrollees, public payers are uniquely positioned to promote specialty care redesign and champion improved coordination between specialists.
| S-EPMC7351893 | biostudies-literature
Project description:To examine the impact of benefit generosity and household health care financial burden on the demand for specialty drugs in the treatment of rheumatoid arthritis (RA).Enrollment, claims, and benefit design information for 35 large private employers during 2000-2005.We estimated multivariate models of the effects of benefit generosity and household financial burden on initiation and continuation of biologic therapies.We defined initiation of biologic therapy as first-time use of etanercept, adalimumab, or infliximab, and we constructed an index of plan generosity based on coverage of biologic therapies in each plan. We estimated the household's burden by summing up the annual out-of-pocket (OOP) expenses of other family members.Benefit generosity affected both the likelihood of initiating a biologic and continuing drug therapy, although the effects were stronger for initiation. Initiation of a biologic was lower in households where other family members incurred high OOP expenses.The use of biologic therapy for RA is sensitive to benefit generosity and household financial burden. The increasing use of coinsurance rates for specialty drugs (as under Medicare Part D) raises concern about adverse health consequences.
| S-EPMC2965502 | biostudies-other
Project description:BACKGROUND AND AIMS:Brief alcohol interventions in medical settings are efficacious in improving self-reported alcohol consumption among those with low-severity alcohol problems. Screening, Brief Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral-specific component, in increasing the utilization of alcohol-related care. METHODS:A systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health-care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post-treatment alcohol services utilization assessed by self-report or administrative data, which we compared across intervention and control groups. RESULTS:Thirteen RCTs met inclusion criteria and nine were meta-analyzed (n?=?993 and n?=?937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was?=?1.08, 95% confidence interval (CI)?=?0.92-1.28. Five studies compared referral-specific interventions with a control condition without such interventions (pooled RR?=?1.08, 95% CI?=?0.81-1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non-statistically significant results. CONCLUSIONS:There is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol-related services.
| S-EPMC4753046 | biostudies-literature
Project description:INTRODUCTION:Effective smoking cessation medications are readily available but may be underutilized in hospital settings. In our large, tertiary care hospital, we aimed to (1) characterize patient tobacco use prevalence across medical specialties, (2) determine smoking cessation pharmacotherapy prescription variation across specialties, and (3) identify opportunities for improvement in practice. METHODS:Using electronic health records at Barnes Jewish Hospital, we gathered demographic data, admitting service, admission route, length of stay, self-reported tobacco use, and smoking cessation prescriptions over a 6-year period, from 2010 to 2016. We then compared tobacco use prevalence and smoking cessation prescriptions across medical specialties using a cross-sectional, retrospective design. RESULTS:Past 12-month tobacco use was reported by patients in 27.9% of inpatient admissions; prescriptions for smoking cessation pharmacotherapy were provided during 21.5% of these hospitalizations. The proportion of patients reporting tobacco use was highest in psychiatry (55.3%) and lowest in orthopedic surgery (17.1%). Psychiatric patients who reported tobacco use were most likely to receive pharmacotherapy (71.8% of admissions), and plastic surgery patients were least likely (4.7% of admissions). Compared with Caucasian tobacco users, African American patients who used tobacco products were less likely to receive smoking cessation medications (adjusted odds ratio [aOR] = 0.65; 95% confidence interval [CI] = 0.62 to 0.68). CONCLUSIONS:Among hospitalized tobacco users, safe and cost-effective pharmacotherapies are under-prescribed. We identified substantial variation in prescribing practices across different medical specialties and demographic groups, suggesting the need for an electronic medical record protocol that facilitates consistent tobacco use cessation pharmacotherapy treatment. IMPLICATIONS:Tobacco use cessation pharmacotherapy is underutilized during hospitalization, and prescription rates vary greatly across medical specialties and patient characteristics. Hospitals may benefit from implementing policies and practices that standardize and automate the offer of smoking pharmacotherapy for all hospitalized patients who use tobacco.
| S-EPMC6468129 | biostudies-literature
Project description:Background and aimsDrug checking services provide people who use drugs with chemical analysis results of their drug samples while simultaneously monitoring the unregulated drug market. We sought to identify and synthesize literature on the following domains: (a) the influence of drug checking services on the behaviour of people who use drugs; (b) monitoring of drug markets by drug checking services; and (c) outcomes related to models of drug checking services.MethodsSystematic review. A systematic literature search was conducted in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, Scopus, Web of Science and Dissertations and Theses Global. Eligible studies were peer-reviewed articles and conference abstracts or grey literature, published in any language since 1990 and including original data on the domains. We assessed risk of bias for quantitative peer-reviewed articles reporting on behaviour or models of drug checking services using National Institutes of Health tools.ResultsWe screened 2463 titles and abstracts and 156 full texts, with 90 studies meeting inclusion criteria. Most (n = 65, 72.2%) were from Europe and used cross-sectional designs (n = 79, 87.7%). Monitoring of drug markets by drug checking services (n = 63, 70%) was the most reported domain, followed by the influence of drug checking services on behaviour (n = 31, 34.4%), including intent to use, actual use and disposal of the drug, and outcomes related to models of drug checking services (n = 17, 18.9%). The most common outcome measures were detection of unexpected substances (n = 50, 55.6%), expected substances (n = 44, 48.9%), new psychoactive substances (n = 40, 44.4%) and drugs of concern (n = 32, 36.5%) by drug checking services.ConclusionsDrug checking services appear to influence behavioural intentions and the behaviour of people who use drugs, particularly when results from drug checking services are unexpected or drugs of concern. Monitoring of drug markets by drug checking services is well established in Europe, and increasingly in North America. Concerns about drug contents and negative health consequences facilitate the use of drug checking services; lack of concern; trust in drug sellers; lack of accessibility of drug checking services; and legal and privacy concerns are barriers to use.
| S-EPMC9299873 | biostudies-literature
Project description:To understand what medical students consider when choosing their specialty, prior to significant clinical exposure to develop strategies to provide adequate career counseling.A cross-sectional study was performed by distributing optional questionnaires to 165 first-year medical students at the University of Ottawa in their first month of training with a sample yield of 54.5% (n=90). Descriptive statistics, analysis of variance, Spearman's rank correlation, Cronbach's alpha coefficient, Kaiser-Meyer-Olkin Measure, and exploratory factor analyses were used to analyze the anonymized results."Job satisfaction", "lifestyle following training" and, "impact on the patient" were the three highest rated considerations when choosing a specialty. Fifty-two and seventeen percent (n=24) and 57.89% (n=22) of males and females ranked non-surgical specialties as their top choice. Student confidence in their specialty preferences was moderate, meaning their preference could likely change (mean=2.40/5.00, SD=1.23). ANOVA showed no significant differences between confidence and population size (F(2,86)=0.290, p=0.75) or marital status (F(2,85)=0.354, p=0.70) in both genders combined. Five underlying factors that explained 44.32% of the total variance were identified. Five themes were identified to enhance career counseling.Medical students in their first month of training have already considered their specialty preferences, despite limited exposure. However, students are not fixed in their specialty preference. Our findings further support previous results but expand what students consider when choosing their specialty early in their training. Medical educators and administrators who recognize and understand the importance of these considerations may further enhance career counseling and medical education curricula.
| S-EPMC5694695 | biostudies-other
Project description:ObjectivesFentanyl is a highly potent opioid and has, until recently, been considered an unwanted contaminant in the street drug supply among people who use drugs (PWUD). However, it has become a drug of choice for an increasing number of individuals. This systematic review evaluated intentional non-medical fentanyl use among PWUD, specifically by summarizing demographic variance, reasons for use, and resulting patterns of use.MethodsThe search strategy was developed with a combination of free text keywords and MeSH and non-MeSH keywords, and adapted with database-specific filters to Ovid MEDLINE, Embase, Web of Science, and PsychINFO. Studies included were human studies with intentional use of non-medical fentanyl or analogues in individuals older than 13. Only peer-reviewed original articles available in English were included.ResultsThe search resulted in 4437 studies after de-duplication, of which 132 were selected for full-text review. Out of 41 papers included, it was found that individuals who use fentanyl intentionally were more likely to be young, male, and White. They were also more likely to have experienced overdoses, and report injection drug use. There is evidence that fentanyl seeking behaviours are motivated by greater potency, delay of withdrawal, lower cost, and greater availability.ConclusionsAmong PWUD, individuals who intentionally use fentanyl have severe substance use patterns, precarious living situations, and extensive overdose history. In response to the increasing number of individuals who use fentanyl, alternative treatment approaches need to be developed for more effective management of withdrawal and opioid use disorder.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42021272111.
| S-EPMC10896833 | biostudies-literature
Project description:Background: Fluctuations in emergency medical services (EMS) responses can have a substantial impact on the ability of agencies to meet resource needs within an EMS system. We aimed to identify weather characteristics as potentially predictable factors associated with EMS responses. Methods: We reviewed hourly counts of scene responses documented by 24 EMS agencies in Western Pennsylvania from January 1, 2014 to December 31, 2017 and compared rates of responses to weather characteristics. Responses to counties nonadjacent to the studied weather reporting station and interfacility/scheduled transports were excluded. We identified the mean temperature, meters visibility, dew point, wind speed, total millimeters of precipitation, and presence of rain or snow in 6-hour windows prior to dispatch, in addition to temporal factors of time of day and weekend vs. weekday. Analysis was performed using multivariable linear regression of a negative binomial distribution, reporting incidence rate ratios (IRR) with 95% confidence intervals (CI). Secondary analyses were performed for transports to the hospital and cases involving transports for traumatic complaints and pediatric patients (age <18?years). Results: We included 529,058 responses (54.8% female, mean age 57.2?±?SD 24.7?years). In our multivariable model, responses were associated with (IRR, 95% CI) rain (1.10, 1.08-1.11) snow (1.07, 1.05-1.09), and both rain and snow (1.15, 1.11-1.19). A lower incidence of responses occurred on weekends (0.84, 0.83-0.85) and at night (0.62, 0.61-0.62). Increasing temperature in 5?°C increments was associated with an increase in responses across seasons with an effect that varied between 1.16 (1.15-1.17) in winter to 1.31 (1.28-1.33) in summer. Windy weather was associated with increased responses from light breeze (1.10, 1.09-1.11) to fresh breeze or greater (1.23, 1.16-1.30). Transports occurred in a similar pattern to responses. Trauma transports (n?=?64,235) occurred more during weekends (1.04, 1.02-1.06). Pediatric transports (n?=?21,880) were not significantly associated with precipitation or season. Conclusion: EMS responses increased with rising temperature and following rain and snow. These findings may assist in planning by EMS agencies and emergency departments to identify periods of greatest resource utilization.
| S-EPMC7266083 | biostudies-literature