The American journal of managed care
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To evaluate the effects of switching from multiple daily injection (MDI) therapy to insulin pump therapy, also called continuous subcutaneous insulin infusion (CSII), on antidiabetic drug and healthcare resource utilization. ⋯ CSII was associated with significant decreases in antidiabetic drug and healthcare resource utilization, contributing to stability of care. The evidence from this study indicates that CSII should be considered as an option for patients with type 2 diabetes mellitus who are using MDI and are experiencing a high degree of antidiabetic drug and healthcare resource utilization.
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To assess the feasibility of using medical and prescription drug claims data to develop models that identify patients at risk for prescription opioid abuse or misuse. ⋯ Using drug and medical claims data, it is feasible to develop models that could assist prescription-monitoring programs, payers, and healthcare providers in evaluating patient characteristics associated with elevated risk for prescription opioid abuse.
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Depression is one of the most common chronic health problems in the United States, and primary care providers manage a substantial proportion of these patients. Unfortunately, most current knowledge about treatment effectiveness is limited to the acute phase of treatment for new depressive episodes, although most patients seen in the primary care setting have chronic depressive symptoms, meet criteria for more than one mental health disorder, and have one or more chronic medical conditions. This article examines the shortcomings of our current approach to assessing treatment effectiveness in primary care, despite the availability of good measures of symptom-based recovery, such as the 9-item Patient Health Questionnaire (PHQ-9). ⋯ Although there is not yet a standard measure to assess emotional recovery, well-being, or functional recovery, brief measures such as the Sheehan Disability Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, World Health Organization 5-Item Well-Being Index, and new Remission Evaluation and Mood Inventory Tool are available. The opportunity now exists to use these simple tools to integrate outcome monitoring into routine care in the same way other chronic health problems, such as asthma or diabetes, are monitored. Options such as point-of-care outcome assessment with PHQ-9, plus a functional recovery tool; clinician extender ("care manager") monitoring of depressed patients; or a hybrid approach combining both approaches can be practical and effective.
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To help health professionals understand and evaluate the concept of efficiency and its measurement in practice. ⋯ The broad meaning and the value of healthcare efficiency seem uncontroversial, yet any particular application may be confronted with conflicting perspectives and with practical challenges.
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To examine factors associated with prostate-specific antigen (PSA) testing in the multiethnic California Men's Health Study. ⋯ In this insured population for whom financial barriers are minimized, PSA screening varied by race/ethnicity and by other patient and clinical factors, possibly reflecting inconsistencies in prostate cancer screening guidelines. Despite these differences, healthcare providers have a key role in patients' likelihood of undergoing PSA screening.