1
|
Sinaiko AD, Sloan CE, Soto MJ, Zhao O, Lin CT, Goss FR. Clinician Response to Patient Medication Prices Displayed in the Electronic Health Record. JAMA Intern Med 2023; 183:1172-1175. [PMID: 37669058 PMCID: PMC10481319 DOI: 10.1001/jamainternmed.2023.3307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/15/2023] [Indexed: 09/06/2023]
Abstract
This cross-sectional study examines whether clinicians changed their medication orders after seeing the patient’s out-of-pocket drug costs in the electronic health record.
Collapse
Affiliation(s)
- Anna D. Sinaiko
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Mark J. Soto
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Olivia Zhao
- Harvard Business School, Boston, Massachusetts
| | - Chen-Tan Lin
- University of Colorado Hospital, Aurora
- University of Colorado School of Medicine, Aurora
| | - Foster R. Goss
- University of Colorado Hospital, Aurora
- University of Colorado School of Medicine, Aurora
| |
Collapse
|
2
|
Zhao DH, Cheung JMY, Smith L, Saini B. Exploring asthma in the workplace: A triangulation of perspectives from management, employees and people with asthma. J Asthma 2017; 55:859-867. [PMID: 28858530 DOI: 10.1080/02770903.2017.1369991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE People with asthma spend a significant amount of time in the workplace but little is known about the current state of disease management in such contexts. The aim of the current study is to explore the experiences, attitudes and perceptions of asthma across different stakeholders in the workplace to help inform potential recommendations for workplace asthma policies. METHOD Using purposive and convenience sampling methods, in-depth semi-structured interviews were conducted in Australia with 5 human resource personnel, 10 employees with asthma and 10 employees without asthma. Interviews were guided by a schedule of questions focusing on attitudes and experiences of people with asthma in the workplace, which were audio recorded, transcribed verbatim and thematically analysed. RESULTS Analysis of the qualitative dataset revealed three key themes: Beliefs and Attitudes about Asthma, Asthma Solutions in the Workplace and Workplace Obstacles. Findings suggest that employees with asthma experience problems managing their asthma at work and there is a lack of workplace support in relation to asthma emergency management. CONCLUSION Key recommendations for workplace asthma policies have been made to provide better support for employees with asthma. However, further investigation into the experience of managing asthma is required in a wider variety of occupations and work experiences to inform the development of a workplace asthma policy.
Collapse
Affiliation(s)
- Denise H Zhao
- a Faculty of Pharmacy , The University of Sydney , Sydney , NSW , Australia
| | - Janet M Y Cheung
- a Faculty of Pharmacy , The University of Sydney , Sydney , NSW , Australia.,b CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research , University of Sydney , NSW , Australia
| | - Lorraine Smith
- a Faculty of Pharmacy , The University of Sydney , Sydney , NSW , Australia
| | - Bandana Saini
- a Faculty of Pharmacy , The University of Sydney , Sydney , NSW , Australia.,b CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research , University of Sydney , NSW , Australia
| |
Collapse
|
3
|
Constantino Portela MDC, Campos Fernandes A. Medicines Compliance and Reimbursement Level in Portugal. Health Serv Res Manag Epidemiol 2015; 2:2333392815601972. [PMID: 28462263 PMCID: PMC5266445 DOI: 10.1177/2333392815601972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
During a severe financial crisis, it is a priority to use scientific evidence to identify factors that enable therapeutic compliance by patients. This study aimed to evaluate a possible association between the number of patients who attended a medical appointment and had medicine prescribed and the number of these same patients who purchased the prescribed medicine and whether the level of reimbursement was a deciding factor. We perform a correlation analysis at primary care centers in Portugal, between 2010 and 2012 (n = 96). We found a moderate to high positive association, which is statistical significant, between the number of the patients with medicines dispensing and medicines reimbursement levels. The correlation coefficient varies from .5 to .63 (P < .01). The compliance increases along with the increase in the reimbursement levels.
Collapse
|
4
|
Weber C. Challenges in funding diabetes care: a health economic perspective. Expert Rev Pharmacoecon Outcomes Res 2014; 10:517-24. [DOI: 10.1586/erp.10.48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
5
|
Cisneros C, Quiralte J, Capel M, Casado MÁ, Mellstrom C. Análisis coste-efectividad de budesonida/formoterol en el tratamiento de mantenimiento y a demanda (Symbicort SMART®) frente a salmeterol/fluticasona más terbutalina, en el tratamiento del asma persistente en España. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03321485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
6
|
Impact of medication adherence on absenteeism and short-term disability for five chronic diseases. J Occup Environ Med 2012; 54:792-805. [PMID: 22796923 DOI: 10.1097/jom.0b013e31825463e9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To estimate the impact of medication adherence on absenteeism and short-term disability among employees with chronic disease. METHODS Cross-sectional analysis of administrative health care claims, absenteeism, and short-term disability data using multivariate regression and instrumental variable models for five cohorts of employees: diabetes, hypertension, congestive heart failure, dyslipidemia, and asthma/chronic obstructive pulmonary disease. Adherence was defined as possessing medication on at least 80% of days during follow-up. RESULTS Adherent employees with diabetes, hypertension, dyslipidemia, and asthma/chronic obstructive pulmonary disease realized between 1.7 and 7.1 fewer days absent from work and between 1.1 and 5.0 fewer days on short-term disability. Absenteeism and short-term disability days by adherent employees with congestive heart failure were not significantly different from nonadherent employees with the condition in most specifications. CONCLUSIONS Appropriate management of chronic conditions can help employers minimize losses due to missed work.
Collapse
|
7
|
Limat S, Demesmay K, Fagnoni P, Voillat L, Bernard Y, Deconinck E, Brion A, Arveux P, Cahn JY, Woronoff-Lemsi MC. Cost Effectiveness of Cardioprotective Strategies in Patients with Aggressive Non-Hodgkin's Lymphoma. Clin Drug Investig 2012; 25:719-29. [PMID: 17532718 DOI: 10.2165/00044011-200525110-00005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The cardiotoxicity of anthracyclines remains a key problem in patients with aggressive non-Hodgkin's lymphoma (NHL). With regard to the actual long-term prognosis of aggressive NHL, the development of cardioprotective strategies is mandatory for these patients. A cost-effectiveness analysis was carried out to determine the potential economic profile of dexrazoxane or liposome-encapsulated doxorubicin in patients with aggressive NHL treated with a CHOP regimen (cyclophosphamide, doxorubicin, vincristine, prednisone) as first-line therapy. METHODS A decision-analysis model described clinical events and economic consequences for theoretical patients who were to receive eight consecutive cycles of a CHOP regimen containing 50 mg/m(2) of doxorubicin as first-line chemotherapy. The timeframe of the model was the patient's lifetime. The probabilities were related to the cumulative dose of doxorubicin and age. The study was carried out from the perspective of the French healthcare system. Patients entered the model at 'choose' node: no cardioprotection versus cardioprotection with dexrazoxane or liposome-encapsulated doxorubicin. The model was based on a retrospective epidemiological study and on published data. The clinical end-point was life expectancy. Direct medical costs related to the cardioprotection and the treatment of congestive heart failure were considered. Monetary values for French prices in the year 2002 were used. Several univariate sensitivity analyses were carried out with varying clinical and economic parameters. RESULTS Per 100 patients, the two cardioprotective strategies provided similar benefits that were estimated as 24.5 and 13.4 life-years in 60- and 40-year-old patients, respectively. The cost per life-year saved with dexrazoxane was estimated as euro6931 and euro15 599 in 60- and 40-year-old patients, respectively, and euro22 940 and euro44 982, respectively, with liposome-encapsulated doxorubicin. Several sensitivity analyses showed the robustness of the model. CONCLUSION The results suggest the potential clinical and economic usefulness of cardioprotective therapies in patients with aggressive NHL. Prospective studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Samuel Limat
- Department of Pharmacy, Besançon University Hospital, Besançon, FranceINSERM EPI 106, Dijon, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Tai T, Bame SI. Cost-benefit analysis of childhood asthma management through school-based clinic programs. J Community Health 2011; 36:253-60. [PMID: 20803167 DOI: 10.1007/s10900-010-9305-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Asthma is a leading chronic illness among American children. School-based health clinics (SBHCs) reduced expensive ER visits and hospitalizations through better healthcare access and monitoring in select case studies. The purpose of this study was to examine the cost-benefit of SBHC programs in managing childhood asthma nationwide for reduction in medical costs of ER, hospital and outpatient physician care and savings in opportunity social costs of lowing absenteeism and work loss and of future earnings due to premature deaths. Eight public data sources were used to compare costs of delivering primary and preventive care for childhood asthma in the US via SBHC programs, including direct medical and indirect opportunity costs for children and their parents. The costs of nurse staffing for a nationwide SBHC program were estimated at $4.55 billion compared to the estimated medical savings of $1.69 billion, including ER, hospital, and outpatient care. In contrast, estimated total savings for opportunity costs of work loss and premature death were $23.13 billion. Medical savings alone would not offset the expense of implementing a SBHC program for prevention and monitoring childhood asthma. However, even modest estimates of reducing opportunity costs of parents' work loss would be far greater than the expense of this program. Although SBHC programs would not be expected to affect the increasing prevalence of childhood asthma, these programs would be designed to reduce the severity of asthma condition with ongoing monitoring, disease prevention and patient compliance.
Collapse
Affiliation(s)
- Teresa Tai
- Department of Management, Quinnipiac University, 275 Mount Carmel Avenue, Hamden, CT 06518, USA.
| | | |
Collapse
|
9
|
Coole C, Drummond A, Watson PJ, Radford K. What concerns workers with low back pain? Findings of a qualitative study of patients referred for rehabilitation. JOURNAL OF OCCUPATIONAL REHABILITATION 2010; 20:472-80. [PMID: 20373135 PMCID: PMC2980634 DOI: 10.1007/s10926-010-9237-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Health and workplace strategies to address work loss and sickness absence due to low back pain are urgently required. A better understanding of the experiences of those struggling to stay at work with back pain may help clinicians and employers with their treatment and management approaches. METHODS A qualitative approach using thematic analysis was used. Individual semi-structured interviews were conducted with a convenience sample of 25 low back pain patients who had been referred for multidisciplinary back pain rehabilitation. All were in employment and concerned about their ability to work due to low back pain. Initial codes were identified and refined through constant comparison of the transcribed interview scripts as data collection proceeded. Themes were finally identified and analysed by repeated study of the scripts and discussion with the research team. FINDINGS Five main themes were identified: justifying back pain at work; concern about future ability to retain work; coping with flare-ups; reluctance to use medication; concern about sickness records. CONCLUSIONS In this study, workers with low back pain remained uncertain of how best to manage their condition in the workplace despite previous healthcare interventions and they were also concerned about the impact back pain might have on their job security and future work capacity. They were concerned about how back pain was viewed by their employers and co-workers and felt the need to justify their condition with a medical diagnosis and evidence. Clinicians and employers may need to address these issues in order to enable people to continue to work more confidently with back pain.
Collapse
Affiliation(s)
- Carol Coole
- Division of Rehabilitation and Ageing, School of Community Health Sciences, Faculty of Medicine, University of Nottingham, Nottingham, UK
- Division of Rehabilitation and Ageing, B Floor, Medical School, Queens Medical Centre, Nottingham, NG7 2UH UK
| | - Avril Drummond
- Division of Rehabilitation and Ageing, School of Community Health Sciences, Faculty of Medicine, University of Nottingham, Nottingham, UK
| | - Paul J. Watson
- Department of Health Sciences, Academic Unit, University of Leicester, Leicester, UK
| | - Kathryn Radford
- Clinical Practice Research Unit, Faculty of Health, University of Central Lancashire, Preston, UK
| |
Collapse
|
10
|
Devine S, Vlahiotis A, Sundar H. A comparison of diabetes medication adherence and healthcare costs in patients using mail order pharmacy and retail pharmacy. J Med Econ 2010; 13:203-11. [PMID: 20345227 DOI: 10.3111/13696991003741801] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare long-term diabetes medication adherence and healthcare costs in patients using mail order pharmacy versus retail pharmacy. METHODS The MarketScan database was used to identify patients who filled prescriptions for oral anti-diabetes medications in a retail pharmacy for at least 6 months before switching to mail order pharmacy for at least 12 months. These patients were matched to others who used retail pharmacy continuously for at least 18 months. A propensity score was used to create matched groups of patients comparable on probability of switching to mail order, weighted Poisson regression was used to analyze differences in medication adherence, and Tobit regression was used to compare costs. RESULTS A total of 14,600 patients who switched to mail order were matched to 43,800 patients who used retail pharmacy continuously. The average adjusted adherence in retail pharmacy was 63.4% compared to 84.8% after switching to mail order. Per-member-per-month total healthcare and total medical costs were on average $34.32 and $37.54 lower in the mail order group, respectively. Diabetes-related medical costs were on average $19.14 lower in the mail order group, while pharmacy costs were $14.13 higher. LIMITATIONS Limitations include a patient population under the age of 65, no information on pharmacy benefit design, and limited follow-up time relative to that necessary to identify long-term diabetes complications. CONCLUSIONS After adjusting for measured confounders of medication adherence and disease severity, individuals who switched to mail order pharmacy had higher medication possession ratios and trended toward lower total and diabetes-related medical costs over time.
Collapse
|
11
|
Simpson RJ, Signorovitch J, Birnbaum H, Ivanova J, Connolly C, Kidolezi Y, Kuznik A. Cardiovascular and economic outcomes after initiation of lipid-lowering therapy with atorvastatin vs simvastatin in an employed population. Mayo Clin Proc 2009; 84:1065-72. [PMID: 19955243 PMCID: PMC2787392 DOI: 10.4065/mcp.2009.0298] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To compare the risk of cardiovascular-related hospitalization, statin adherence, and direct (medical and drug) and indirect (disability and medically related absenteeism) costs in US employees in whom atorvastatin or simvastatin was newly prescribed. PATIENTS AND METHODS Active employees aged 18 to 64 years with a new atorvastatin or simvastatin prescription were identified from a deidentified claims database for 23 privately insured US companies from January 1, 1999, through December 31, 2006. Employees given atorvastatin were matched to those given simvastatin according to propensity scores based on patient characteristics, index statin dose, preindex cardiovascular events, and wage. Outcomes were compared between matched cohorts during the 2-year postindex period, including the risk of cardiovascular-related hospitalization, adherence to the index statin, use of other lipid-lowering drugs, direct medical costs for third-party payers, and indirect costs to employers. Indirect costs were computed as follows: Disability Payments + Daily Wage x Days of Medically Related Absenteeism. Atorvastatin and simvastatin drug costs were imputed using recent pricing to account for the availability of lower-cost generic simvastatin after the study period. RESULTS Among 13,584 matched pairs, treatment with atorvastatin vs simvastatin was associated with a reduced risk of cardiovascular-related hospitalization, higher adherence, and less use of other lipid-lowering drugs. The increase in statin costs associated with atorvastatin vs simvastatin therapy was almost completely offset by reductions in medical service and indirect costs. CONCLUSION In this study, treatment with atorvastatin compared with simvastatin was associated with a reduced risk of cardiovascular events, reduced indirect costs, and a minimal difference in total costs to employers.
Collapse
Affiliation(s)
- Ross J Simpson
- Division of Cardiology, University of North Carolina, CB #7075, 6th Floor, 099 Manning Dr, Chapel Hill, NC 27599-7075, USA.
| | | | | | | | | | | | | |
Collapse
|
12
|
Slover R, Coy J, Davids HR. Advances in the management of pain in children: acute pain. Adv Pediatr 2009; 56:341-58. [PMID: 19968955 DOI: 10.1016/j.yapd.2009.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robin Slover
- The Children's Hospital, Chronic Pain Clinic, Aurora, CO, USA.
| | | | | |
Collapse
|
13
|
Canino G, Koinis-Mitchell D, Ortega AN, McQuaid EL, Fritz GK, Alegría M. Asthma disparities in the prevalence, morbidity, and treatment of Latino children. Soc Sci Med 2006; 63:2926-37. [PMID: 16956704 DOI: 10.1016/j.socscimed.2006.07.017] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Indexed: 10/24/2022]
Abstract
The paper reviews the existing research related to asthma disparities and frames the results of this research within a conceptual model modified from the Institute of Medicine model in order to explain asthma health disparities in Latino children in the USA. The model of pediatric asthma disparity presented is based on the conceptualization of health disparities as the result of a complex interaction of factors related to four main domains: the individual and family, the environment or context in which the child lives, the health-care system, and provider characteristics. Asthma disparities are discussed as they are reflected in the process of care (access and quality of treatment) and outcome (prevalence, morbidity, severity) experienced by Latino children. The potential mechanisms that may account for the asthma disparities documented as reflected by the conceptual model proposed are discussed. Finally, several suggestions for future research examining determinants that account for asthma disparities are examined.
Collapse
Affiliation(s)
- Glorisa Canino
- University of Puerto Rico, Medical School San Juan, Puerto Rica.
| | | | | | | | | | | |
Collapse
|
14
|
Simonella L, Marks G, Sanderson K, Andrews G. Cost-effectiveness of current and optimal treatment for adult asthma. Intern Med J 2006; 36:244-50. [PMID: 16640742 DOI: 10.1111/j.1445-5994.2006.01054.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND This article is part of a project to determine the cost-effectiveness of averting the burden of disease. We used population data to investigate the costs and benefits of allocating resources to optimal treatment for asthma in adults, using a burden of disease framework. METHODS We calculated the population burden of asthma in the absence of any treatment as years lived with disability (YLD), ignoring the years of life lost. We then estimated the proportion of burden averted with current interventions, the proportion that could be averted with optimally implemented current evidence-based guidelines and the direct treatment cost-effectiveness ratio in dollarA per YLD averted for both current and optimal treatment. RESULTS The direct treatment cost of current treatment of adult asthma in Australia was dollar A452 million and averted 25% of the burden with a cost-effectiveness ratio of dollar A14 000/YLD averted. Optimal treatment and optimal compliance would cost dollar A627 million and avert 69% of the burden with a cost-effectiveness ratio of dollar A7000/YLD averted. CONCLUSION Implementation of optimal treatment for asthma is affordable, will be more cost-effective and will significantly decrease disability.
Collapse
Affiliation(s)
- L Simonella
- School of Psychiatry, University of New South Wales. Australia
| | | | | | | |
Collapse
|
15
|
Crawford AG, Fuhr JP, Clarke J, Hubbs B. Comparative effectiveness of total population versus disease-specific neural network models in predicting medical costs. ACTA ACUST UNITED AC 2006; 8:277-87. [PMID: 16212513 DOI: 10.1089/dis.2005.8.277] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of this research was to compare the accuracy of two types of neural networks in identifying individuals at risk for high medical costs for three chronic conditions. Two neural network models-a population model and three disease-specific models-were compared regarding effectiveness predicting high costs. Subjects included 33,908 health plan members with diabetes, 19,264 with asthma, and 2,605 with cardiac conditions. For model development/ testing, only members with 24 months of continuous enrollment were included. Models were developed to predict probability of high costs in 2000 (top 15% of distribution) based on 1999 claims factors. After validation, models were applied to 2000 claims factors to predict probability of high 2001 costs. Each member received two scores-population model score applied to cohort and disease model score. Receiver Operating Characteristic (ROC) curves compared sensitivity, specificity, and total performance of population model and three disease models. Diabetes-specific model accuracy, C = 0.786 (95%CI = 0.779-0.794), was greater than that of population model applied to diabetic cohort, C = 0.767 (0.759-0.775). Asthma-specific model accuracy, C = 0.835 (0.825-0.844), was no different from that of population model applied to asthma cohort, C = 0.844 (0.835-0.853). Cardiac-specific model accuracy, C = 0.651 (0.620-0.683), was lower than that of population model applied to cardiac cohort, C = 0.726 (0.697-0.756). The population model predictive power, compared to the disease model predictive power, varied by disease; in general, the larger the cohort, the greater the advantage in predictive power of the disease model compared to the population model. Given these findings, disease management program staff should test multiple approaches before implementing predictive models.
Collapse
Affiliation(s)
- Albert G Crawford
- Department of Health Policy, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
| | | | | | | |
Collapse
|
16
|
Root M, Smith T. Prescribe by Risk: The Utility of a Biomarker-Based Risk Calculation in Disease Management to Prevent Heart Disease. ACTA ACUST UNITED AC 2005; 8:106-13. [PMID: 15815159 DOI: 10.1089/dis.2005.8.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Preventive treatment for those most at risk of heart disease rather than those with the highest blood pressure or cholesterol values may be a more efficacious strategy for disease management. This depends on accurate biomarker-based risk assessment tools. An evidence-based model of heart disease risk was developed using the Framingham model with an additional five risk factors, including three of the newer blood biomarkers. This was applied to the adult population of the 3rd National Health and Nutrition Examination Survey cohort. Additionally, the selection criteria for therapeutic intervention from the Adult Treatment Panel III guidelines (for hyperlipidemia) and the 7th Report of the Joint National Committee (for hypertension) were applied to the same subjects. Of this cohort 54% qualified for at least one of these medications while 18% qualified for both. Using this 18% cutoff, the 18% of the subjects with the highest calculated heart disease risk were also identified using the developed risk model. We applied established therapeutic reductions in heart disease probability to those identified by guidelines and to those identified by risk. Applying both drugs to the high-risk group (one third the size of the guidelines group) achieved the same reduction in population risk (about one fourth) as applying the drugs to the guideline groups and required only half as many prescriptions. Intermediate results were found when an intervention group was identified by a combination of both high risk and high levels of risk factors. In this simulation, identifying patients by heart disease risk level resulted in substantially fewer people being treated with fewer drugs and achieving a similar reduction in disease risk.
Collapse
Affiliation(s)
- Martin Root
- BioSignia, Inc., Durham, North Carolina, USA.
| | | |
Collapse
|
17
|
Lynch WD, Riedel JE, Hymel PA, Loeppke RR, Nelson RW, Ashenfelter JW. Factors Affecting the Frequency of Value-Focused Health Activities and Policies by Employers. J Occup Environ Med 2004; 46:1103-14. [PMID: 15534497 DOI: 10.1097/01.jom.0000147156.30071.c0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to gather employer perspectives about value-focused activities (VFAs), intentions to make decisions based on value, and other factors affecting decisions. METHODS Health decision-makers (n = 174), both American College of Occupational and Environmental Medicine members and corporate HR/benefits directors, responded to an Internet-based questionnaire. RESULTS Of a total of 32 listed VFAs, companies reported, on average, performing 5.2 activities currently and considering 2.6. Twenty-five percent of companies reported doing eight or more. The most common VFAs were providing access to flu shots, centers of excellence, and wellness programs. Greater access to detailed outcome data was associated with doing more VFAs, as was greater accountability for absence, disability, and productivity outcomes. CONCLUSIONS Employers vary widely in the number of VFAs in which they participate. Decision-makers with more information about, and accountability for, value outcomes reported doing more VFAs.
Collapse
|