The American journal of managed care
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To estimate neighborhood income differences between the locations of 340B-covered entities and their contract pharmacies (CPs) and examine whether these differences vary between hospitals and grantees. ⋯ CPs serve at least 2 purposes: They can increase low-income patients' access to medicines directly when a CP is closer to where a covered entity's patients live, and they can increase profits for covered entities (some of which are potentially passed on to patients) and CPs. We find that in 2019, both hospitals and grantees used CPs to generate income but generally they do not appear to contract with pharmacies located in neighborhoods where low-income patients are likeliest to live. Prior research findings have suggested that hospitals and grantees behave differently from each other with respect to CP use, but results of our analysis suggest the opposite.
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COVID-19 vaccination in the United States has stalled, with some of the lowest rates in the South. Vaccine hesitancy is a primary contributor and may be influenced by health literacy (HL). This study assessed the association between HL and COVID-19 vaccine hesitancy in a population residing in 14 Southern states. ⋯ HL was not a significant indicator of vaccine hesitancy in the study population, suggesting that general low rates of vaccination in the Southern region may not be due to knowledge about COVID-19. This indicates a critical need for place-based or contextual research on why vaccine hesitancy in the region transcends most sociodemographic differences.
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To compare the mean per-episode unit cost for a direct-to-consumer (DTC) telemedicine service for medical center employees (OnDemand) with that of in-person care and to estimate whether the offered service increased the use of care. ⋯ These results suggest that DTC telemedicine staffed by an academic health system and offered directly to employees reduced the per-episode unit costs and only marginally increased utilization, suggesting lower cost overall.
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The purpose of our study was to assess the relationship between intervention dosage and hospital utilization outcomes among patients with complex health and social needs enrolled in a care management program. We highlight the importance of measuring patient engagement and intervention dosage in program evaluation. ⋯ Our study elucidates a gap in how care management programs for patients with complex health and social needs are evaluated. Although the study shows an association between intervention dosage and care management outcomes, patients' medical complexity and social circumstances are among the factors that can attenuate the dose-response relationship over time.
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Neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) are the leading causes of vision impairment in elderly patients and people living with diabetes, respectively. Common features of nAMD and DME include increased vascular permeability, inflammation, and neovascularization. ⋯ However, many patients struggle with the burden of frequent injections, experience a suboptimal treatment response, or lose vision over time. For these reasons, the outcomes of anti-VEGF treatment are often worse in the real-world compared with clinical trials.