The American journal of managed care
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Chronic cough is a severely debilitating condition that results in individuals coughing hundreds to thousands of times per day. Unfortunately, at the time of this writing, the majority of treatments currently available address acute cough and have minimal efficacy for chronic cough. There are no current FDA-approved pharmacologic treatments for chronic cough, resulting in a large, unmet need for patients. ⋯ All patients should be evaluated for red-flag symptoms and any underlying conditions that may explain the patient's chronic cough. Historical treatments, such as opiates and neuromodulators, have been used with limited success. Emerging agents that target specific channel receptors have shown initial positive benefits concerning cough frequency, severity, and quality of life and may become available on the market as they have shown to be generally well tolerated without any safety concerns in clinical studies.
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Although the Affordable Care Act has greatly expanded coverage, the physician workforce has not increased commensurately. Data on wait times, especially among dermatologists who accept Medicaid, are lacking. The objective of this study was to evaluate wait times in dermatology clinics by insurance coverage and chief complaint. ⋯ Wait times for clinic appointments were longer for patients with Medicaid, especially when requesting an evaluation for a medical dermatologic issue compared with a cosmetic consultation. Delay in medical dermatologic care, especially among Medicaid patients, must be addressed.
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Parkinson disease, the second-most-common neurodegenerative disorder, affects approximately 1 million individuals in the United States, and this number is projected to increase to 1.2 million by 2030. Characterized pathologically by degeneration of dopaminergic neurons, with widespread pathology in nondopaminergic systems, Parkinson disease leads to an array of motor and nonmotor symptoms that can significantly impact an affected individual's quality of life. ⋯ OFF periods can occur for many individuals with Parkinson disease, especially as the disease progresses, and can pose a substantial burden to those with the disease and their caregivers. Available treatments for OFF periods may help alleviate this burden.
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Liver cancer is the most rapidly increasing cancer in the United States and is associated with a high cancer-related mortality. Seventy-five percent of liver cancers are hepatocellular carcinoma (HCC) resulting from cirrhosis. ⋯ The direct and indirect costs of HCC are substantial, and are expected to increase with the rise in disease incidence as well as a growing number of high-cost therapies entering the market. There are opportunities to improve the quality of care for patients with HCC through implementation of value-based reimbursement principles and pharmacist involvement in care.