The American journal of managed care
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Despite its unsurpassed efficacy in the management of diabetes, insulin has been resisted and feared for its risk of side effects (ie, weight gain, hypoglycemia). Many patients and providers have perceived insulin as a last resort therapy given to patients with a poor prognosis, and some patients even as a form of punishment for poor self-management. Also, fear of needles is a constant concern. ⋯ Patients generally prefer pen delivery systems, and they are associated with greater adherence and better glycemic control as compared with vial and syringe use. In addition to the ever-increasing variety of insulin formulations and delivery systems, educational initiatives are absolutely vital in order to overcome the limited knowledge about diabetes, self-management, and coping skills that can be seen in a large proportion of people with T2DM. Improved adherence to treatment, better outcomes, and reduced costs are contingent upon the appropriate use of, and full access to, appropriate treatment and patient education.
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To test the usefulness of the Diabetes Complications Severity Index (DCSI) without laboratory test results in predicting healthcare costs, for potential use in disease management programs. ⋯ The DCSI without laboratory data may be useful for stratifying individuals with diabetes into morbidity groups, which can be used for selection into disease management programs or for matching in observational research.
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To evaluate the factors associated with nonadherence in a nationally representative sample of patients receiving lipid-lowering therapy (LLT). ⋯ Medication adherence remains poor in patients receiving LLT. Treatment outcomes and healthcare resource use may be improved by prioritizing adherence programs in at-risk patient populations.
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To identify the factors and strategies that were associated with successful implementation of hospital-based information technology (IT) systems in US Department of Veterans Affairs (VA) hospitals, and how these might apply to other hospitals. ⋯ Overall IT implementation success in the VA depended on: (1) whether there was support for change from both leaders and staff, (2) development of a gradual and flexible implementation approach, (3) allocation of adequate resources for equipment and infrastructure, hands-on support, and deployment of additional staff, and (4) how the implementation team planned for setbacks, and continued the process to achieve success. Problems that developed in the early stages of implementation tended to become persistent, and poor implementation can lead to patient harm.
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To estimate cost savings associated with ProvenHealth Navigator (PHN), which is an advanced model of patient-centered medical homes (PCMHs) developed by Geisinger Health System, and determine whether those savings increase over time. ⋯ Our finding suggests that PCMHs can lead to significant and sustainable cost savings over time.