The American journal of managed care
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Pharmacologic treatment options for osteoarthritis (OA) are diverse both in terms of mechanisms of action and delivery formulations; however, no single agent has been demonstrated to consistently offer both a high level of tolerability and a sustained degree of efficacy across a broad OA patient population. Ultimately, a multimodal approach to OA treatment is the best option, offering a greater likelihood of tolerability by avoiding sustained exposure to higher risk agents while improving efficacy by combining agents with more than one mechanism of action. ⋯ Combining these agents with other treatments possessing differing side-effect profiles and mechanisms of action will likely reduce the safety and tolerability risk. The recent availability in the United States of a topical NSAID gel with less systemic exposure than oral NSAIDs may offer clinicians an additional means of achieving effective analgesia in OA of superficial joints while minimizing the risk of adverse events.
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To assess the broad impacts of Medicare Part D and the extent to which prior concerns have been realized. ⋯ Coverage under Part D is comparable to that under non-Part D plans with respect to key features that are likely to be important to Medicare beneficiaries--access to medications and out-of-pocket costs. Nonetheless, concerns remain over drug pricing and gaps in coverage. The government should continue to monitor the competitiveness of the Part D market to ensure it meets the diverse needs of Medicare beneficiaries.
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To minimize out-of-pocket prescription drug plan (PDP) expenditures by Medicare beneficiaries. ⋯ Targeted community outreach services to Medicare Part D beneficiaries can help optimize patient selection of a PDP, thereby resulting in lower out-of-pocket expenditures.
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To examine the association of medication adherence with healthcare use and costs among Medicaid beneficiaries with congestive heart failure (CHF), to investigate whether the association was a graded one, and to estimate the potential savings due to improved adherence. ⋯ Healthcare costs among Medicaid beneficiaries with CHF would be lower if more patients were adherent to prescribed medication regimens. Researchers should reconsider whether a binary threshold for adherence is sufficient to examine the association of adherence with outcomes and healthcare costs.
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To examine whether treatment change for diabetic patients presenting with elevated blood pressure (BP) differed between physicians and midlevel providers (nurse practitioners [NPs] and physician assistants [PAs]) and to determine reasons for any observed differences. ⋯ Midlevel providers were significantly less likely than physicians to change BP treatment for diabetic patients with multiple chronic conditions presenting with elevated BP at a single visit. We could not find good explanations for this difference. Given the expanding role of midlevel providers in delivering primary care to complex patients, we need to understand whether these treatment change differences lead to long-term differences in BP control.