The American journal of geriatric pharmacotherapy
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Am J Geriatr Pharmacother · Jun 2007
Use of wet nebulized inhaled respiratory medications under criteria-based reimbursement guidelines in a publicly funded Seniors' Pharmacare Program in Nova Scotia, Canada.
During the 1999/2000 fiscal year, approximately 19% of beneficiaries in the Nova Scotia Seniors' Pharmacare Program (NSSPP), a publicly funded drug insurance program in Nova Scotia, Canada, received inhaled respiratory medications by wet nebulization. The cost was estimated at more than Can $2 million annually. On August 1, 2000, the NSSPP initiated new criteria-based reimbursement guidelines for wet nebulized respiratory medications, requiring prior authorization. ⋯ The majority of approved requests for wet nebulization criteria fell within the established reimbursement guidelines. Many approvals outside of guidelines were clinically valid. Approval of requests outside the criteria highlights the need for flexibility in the claims administrative and adjudication system to respond to unique circumstances not covered by established criteria. However, concurrent use of wet nebulization and portable inhalers by some beneficiaries suggests suboptimal use of portable inhalers, the need for portable inhalers for patients using wet nebulization when they leave their residence, and the need for more patient education.
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Am J Geriatr Pharmacother · Jun 2007
Comparative StudyPredictors of long-acting opioid use and oral versus transdermal route among older Medicaid beneficiaries.
The availability of long-acting (LA) opioid medications represents an advance in the treatment of persistent pain, raising the question of what factors predict receipt of this newer treatment approach. ⋯ Demographic and clinical predictors of TDF use differed from predictors of any LA opioid use among these older Medicaid beneficiaries. Qualitative research methods are needed to better understand what factors influence selection of opioid medications for older patients in nursing homes and community settings.
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Am J Geriatr Pharmacother · Jun 2007
Prophylaxis for opioid-induced constipation in elderly long-term care residents: a cross-sectional study of Medicare beneficiaries.
Opioid analgesics are effective therapeutic agents for malignant and nonmalignant pain, but their use is often compromised by unwanted adverse effects on the central nervous system and gastrointestinal (GI) tract. These adverse effects include sedation, respiratory depression, nausea and vomiting, reduction in biliary and pancreatic secretions, decreased GI motility, increased GI transit time, and subsequent constipation. ⋯ Although laxatives are widely recommended in patients taking opioids, only 66% of elderly LTC residents in this study received this standard of care.