Clinical therapeutics
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Clinical therapeutics · Jan 2011
ReviewAnalysis of different recommendations from international guidelines for the management of acute pharyngitis in adults and children.
Streptococcal pharyngitis is a frequently observed condition, but its optimal management continues to be debated. ⋯ The present review found substantial discrepancies in the recommendations for the management of pharyngitis among national guidelines in Europe and North America.
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Clinical therapeutics · Jan 2011
ReviewDoes packaging with a calendar feature improve adherence to self-administered medication for long-term use? A systematic review.
The therapeutic benefit of self-administered medications for long-term use is limited by an average 50% nonadherence rate. Patient forgetfulness is a common factor in unintentional nonadherence. Unit-of-use packaging that incorporates a simple day-and-date feature (calendar packaging) is designed to improve adherence by prompting patients to maintain the prescribed dosing schedule. ⋯ Calendar packaging, especially in combination with education and reminder strategies, may improve medication adherence. Methodological limitations preclude definitive conclusions about the effect size of adherence and clinical benefits or harms associated with CBP and CPO. High-quality trials of adequate size and duration are needed to assess the clinical effectiveness of such interventions.
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Clinical therapeutics · Jan 2011
Impact of prior authorization on the use and costs of lipid-lowering medications among Michigan and Indiana dual enrollees in Medicaid and Medicare: results of a longitudinal, population-based study.
Some Medicaid programs have adopted prior-authorization (PA) policies that require prescribers to request approval from Medicaid before prescribing drugs not included on a preferred drug list. ⋯ The PA policy was associated with substantially lower use of nonpreferred lipid-lowering drugs in Michigan, offset by increases in the use of preferred medications, but there was less change in Indiana. Data limitations did not permit the evaluation of the impact of policy-induced switching on clinical outcomes such as cholesterol levels. The monetary benefit of PA policies for lipid-lowering agents should be weighed against administrative costs and the burden on patients and health care providers.