The American journal of managed care
-
Patient assistance programs (eg, co-pay assistance) may reduce patients' out-of-pocket costs for prescription medicines, providing financial assistance to access medicines for reduced or no cost. A literature review to identify peer-reviewed articles on studies evaluating the impact of co-pay assistance on clinical, patient, and economic outcomes was conducted. ⋯ Limited evidence suggests a potential link between co-pay assistance and clinical outcomes; future research addressing study design challenges in measuring the effects of co-pay assistance is needed.
-
Observational Study
Patients' needs following emergency care for ambulatory care-sensitive conditions.
Poor coordination across care transitions for patients with chronic ambulatory care-sensitive conditions (ACSCs) leads to adverse clinical outcomes. Veterans are at high risk for post-emergency department (ED) adverse outcomes, but the care needs of patients leaving the ED after "treat-and-release" visits are poorly characterized. To inform intervention development and implementation, we assessed for medication changes and follow-up care needs among patients with treat-and-release Veterans Affairs (VA) ED visits for chronic ACSCs. ⋯ More than half of patients with treat-and-release ED visits for chronic ACSCs have recommended medication changes, and two-thirds have at least 1 follow-up care need. This information offers potential foci for testing interventions to improve care coordination for patients with ACSCs who are released from the ED.
-
To quantify temporal changes in colonoscopy indication and assess appropriateness of surveillance use in older adults. ⋯ Guidelines should make clear recommendations about when and how to discontinue postpolypectomy surveillance colonoscopy. Doing so would potentially reduce harms due to complications from low-value procedures and in turn moderate demand and thereby enhance overall procedural access for patients more likely to benefit.
-
Real-world patterns of surveillance testing in colorectal cancer (CRC) and the effects on health and cost outcomes are largely unknown. Our objectives were to (1) assess trends in carcinoembryonic antigen (CEA) testing, CT scans, and colonoscopy utilization and (2) examine the value of CEA testing intensity by characterizing receipt of curative treatment for recurrence and measuring direct medical costs. ⋯ Higher intensity of surveillance, beyond what is recommended by guidelines, may lead to earlier recurrence detection and subsequent treatment, but this is associated with significantly higher direct medical costs.
-
To evaluate structural capabilities in primary care practices employing nurse practitioners (NPs) and test whether they differ across health professional shortage areas (HPSAs) and non-HPSAs. ⋯ Expanding care coordination may be beneficial for HPSA populations with high rates of morbidity and socioeconomic needs. Future research is needed to understand how the NP workforce may be optimized to meet the growing primary care demands in underserved areas.