The American journal of managed care
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Methods for efficient medication reconciliation are increasingly important in primary care. Aggregated pharmacy data within the native electronic health record (EHR) may create a new opportunity for efficient and systematic medication reconciliation in practice. Our objective was to identify the prevalence and predictors of medication discrepancies between pharmacy claims data and the medication list in a primary care EHR. ⋯ Our study revealed a high rate of discrepancies between pharmacy claims data and the provider medication list. Aggregated pharmacy claims data available through the EHR may be an important tool to facilitate medication reconciliation in primary care.
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The purpose of this study was to determine the value of life-years saved due to colorectal cancer (CRC) screening with colonoscopy for the population aged 50 to 64 years. The cost perspective is that of a private (commercial) insurer, while the value perspective includes survival past age 65 years, when most of the US population is insured by Medicare. We focused on colonoscopy because it is not only diagnostic but also therapeutic; because positive results on other screening tests generally are followed up with colonoscopy; and to build on previous study results that colonoscopy is ultimately more cost-effective than other screening, even considering its expense. ⋯ Our results suggest that commercial insurers and employers should promote CRC screening as a high-value service. Promoting such screening through high-quality, low-cost providers would be an exemplar of efficient system innovation.
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Review Meta Analysis
Cost-effectiveness of combinatorial pharmacogenomic testing for treatment-resistant major depressive disorder patients.
To describe the lifetime outcomes and economic implications of combinatorial pharmacogenomic (CPGx) testing versus treatment as usual (TAU) psychopharmacologic medication selection for a representative major depressive disorder patient who has not responded to previous treatment(s). ⋯ CPGx testing has been shown by prospective studies to modify treatment decisions for patients nonresponsive to previous treatment(s), with increased rates of treatment response. These effects are projected to increase quality-adjusted survival, and to save both direct and indirect costs to individual patients and society generally.
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A core tenet of the patient-centered medical home is improving patient experiences of care, but evidence is limited on the impact of medical home adoption on patient experiences of care. ⋯ Despite wide implementation of the medical home, we did not see an improvement in patient experiences of care in the VHA. As we focus on primary care transformation, we need to find ways to incorporate the patient's voice and input into these transitions.
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To compare patients who accepted ("acceptors") post acute care services (PAC) with those who were offered services and refused ("refusers") in terms of their sociodemographic and clinical characteristics, quality of life, health-related problems, and unmet needs; and to examine the association between refusing PAC services and the risk for 30- and 60-day readmission. ⋯ PAC refusers are younger, better educated, and healthier, but they have twice-higher odds of 30- and 60-day readmissions, compared with PAC acceptors. Further investigation into reasons for PAC refusal is critical to foster enhanced patient communication regarding PAC services, improve rates of service acceptance, and ultimately decrease readmissions.