The American journal of managed care
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The burden of visiting pharmacies to fill medications is a central contributor to nonadherence to maintenance medications. Recently, pharmacies have begun offering services that align prescription fill dates to allow patients to pick up all medications on a single visit. We evaluated the prevalence and structure of synchronization programs and evidence of their impact on adherence and clinical outcomes. ⋯ As medication synchronization programs shift directions and compete for patients and payer resources, it will be more important than ever to rigorously evaluate their ability to improve clinical outcomes while also providing the growing number of patients managing multiple chronic conditions with the highest level of patient engagement and consumer choice.
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Comparative Study
LDL cholesterol response and statin adherence among high-risk patients initiating treatment.
The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol treatment guideline recommends monitoring percent reduction in low-density lipoprotein cholesterol (LDL-C) among patients initiating statins as an indication of response and adherence. We examined LDL-C reduction and statin adherence among high-risk patients initiating statins in a real-world setting. ⋯ In a real-world setting, many patients did not achieve a 30% or larger LDL-C reduction. These data support the ACC/AHA recommendation to monitor LDL-C response among patients initiating statins.
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Crohn's disease and ulcerative colitis, the 2 most common inflammatory bowel diseases (IBDs), are chronic conditions with periods of exacerbation and remission. Patients with IBD experience clinical gastrointestinal (GI) symptoms, as well as the emotional burden that accompanies chronic conditions characterized by reduced quality of life and ability to work. With estimates of direct and indirect costs ranging between $14.6 and $31.6 billion in 2014, there is a significant healthcare burden associated with IBD. ⋯ Treatment advances have made deep remission a realistic target for some people with IBD. However, achieving deep remission requires a shift in the management paradigm of IBD, encouraging individualized treatment with biologics that focuses less on treating symptoms and more on preventing potential disease progression. Although expensive at onset, this management strategy may ultimately lead to decreased rates of surgeries and hospitalizations, potentially yielding lower long-term costs for treatment.
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The US Preventive Services Task Force (USPSTF) released draft recommendations regarding colorectal cancer (CRC) screening in October 2015. Despite evidence that annual fecal blood testing test use is uncommon in screen eligible adults, with only 10.4% reporting the use of such a test in 2012, and features poor adherence over time, the USPSTF recommended only 3 noninvasive screening strategy options, all including annual fecal occult blood testing: 1) annual fecal immunochemical test (FIT) alone; 2) annual FIT in combination with flexible sigmoidoscopy every 10 years; and 3) annual high-sensitivity fecal occult blood test (hsFOBT). Mt-sDNA is the only FDA-approved CRC screening test, is covered by Medicare every 3 years, and is included as an every-3-year (3y) option in the American Cancer Society guidelines. We demonstrate that USPSTF modeling includes an embedded sensitivity analysis of less frequent than annual test adherence, which provides support for the inclusion of mt-sDNA 3y as a recommended test. ⋯ Given poor adherence to annual testing, any screening opportunity with a test, such as mt-sDNA, that has high sensitivity for CRC and for the most significant precancerous lesions would be an important screening option for patients for maximizing screening effectiveness in reducing CRC incidence and mortality.
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Big data analyses are observational, raising threats to causal inference. Validity checks help, but we must not let enthusiasm about big data obscure the science.