Abstract:
BACKGROUND:Nonadherence to medication regimens can lead to adverse health care outcomes and increasing costs. OBJECTIVES:To (a) assess the level of medication complexity at an outpatient setting using population-level electronic health record (EHR) data and (b) evaluate its association with medication adherence measures derived from medication-dispensing claims. METHODS:We linked EHR data with insurance claims of 70,054 patients who had an encounter with a U.S. midwestern health system between 2012 and 2013. We constructed 3 medication-derived indices: medication regimen complexity index (MRCI) using EHR data; medication possession ratio (MPR) using insurance pharmacy claims; and prescription fill rates (PFR; 7 and 30 days) using both data sources. We estimated the partial correlation between indices using Spearman's coefficient (SC) after adjusting for age and sex. RESULTS:The mean age (SD) of 70,054 patients was 37.9 (18.0) years, with an average Charlson Comorbidity Index of 0.308 (0.778). The 2012 data showed mean (SD) MRCI, MPR, and 30-day PFR of 14.6 (17.8), 0.624 (0.310), and 81.0 (27.0), respectively. Patients with previous inpatient stays were likely to have high MRCI scores (36.3 [37.9], P < 0.001) and were less adherent to outpatient prescriptions (MPR = 50.3 [27.6%], P < 0.001; 30-day PFR = 75.7 [23.6%], P < 0.001). However, MRCI did not show a negative correlation with MPR (SC = -0.31, P < 0.001) or with 30-day PFR (SC = -0.17, P < 0.001) at significant levels. CONCLUSIONS:Medication complexity and adherence indices can be calculated on a population level using linked EHR and claims data. Regimen complexity affects patient adherence to outpatient medication, and strength of correlations vary modestly across populations. Future studies should assess the added values of MRCI, MPR, and PFR to population health management efforts. DISCLOSURES:No outside funding supported this study. The authors have nothing to disclose. The abstract of this work was presented at INFORMS Healthcare Conference, held on July 27-29, 2019, in Cambridge, MA.
journal_name
J Manag Care Spec Pharmjournal_title
Journal of managed care & specialty pharmacyauthors
Ma X,Jung C,Chang HY,Richards TM,Kharrazi Hdoi
10.18553/jmcp.2020.26.7.860subject
Has Abstractpub_date
2020-07-01 00:00:00pages
860-871issue
7eissn
2376-0540issn
2376-1032journal_volume
26pub_type
杂志文章abstract:BACKGROUND:Acromegaly is a chronic disorder characterized by excess growth hormone secretion and elevated insulin-like growth factor-1 levels most often caused by a pituitary adenoma. Clinical presentation of the disease includes coarsening of the facial features, soft-tissue swelling of the hands and feet, and overgro...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2015.21.12.1106
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Encouraging generic drug use has reduced health care costs for payers and consumers, but the availability of therapeutically interchangeable medications or generic medications of choice is not equal across disease states. The extent to which systems of care are able to substitute with generics is not well un...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2014.20.11.1093
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:Employers have increased efforts to engage employees in health and wellness programs. Providing employees with incentives to participate in these programs has been shown to improve overall enrollment and engagement. One program that has had challenges with enrollment and engagement is medication therapy mana...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2017.23.11.1140
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:Value-based insurance design attempts to align drug copayment tier with value rather than cost. Previous implementations of value-based insurance design have lowered copayments for drugs indicated for select "high value" conditions and have found modest improvements in medication adherence. However, these im...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2015.21.4.269
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Multiple sclerosis (MS) is a neurological degenerative chronic condition without cure. However, long-term disease-modifying therapies (DMTs) help reduce the severity of MS symptoms. Adherence to DMTs is key to their success. Several studies have analyzed what makes patients adherent to their DMTs. As new DMT...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.12.1394
更新日期:2016-12-01 00:00:00
abstract:DISCLOSURES:No additional funding was received for the writing of this letter. The published study referred to in this letter was funded by Janssen Scientific Affairs, which employs Maiese and funded Cornerstone Research Group, a health economic consulting group, to conduct the study. Grima is a founding partner of Cor...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.25.9.1028
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:Several authors have hypothesized that adverse drug events (ADEs) upon switching from reference biologics to biosimilar products are related to the nocebo effect. However, a thorough and current review of the existing literature has not been conducted. OBJECTIVE:To evaluate if patient and/or physician knowl...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2018.24.10.952
更新日期:2018-10-01 00:00:00
abstract:UNLABELLED:Medication adherence is a problem that has received widespread attention in the medical literature and health policy circles. With the increased emphasis on recognizing and rewarding quality in the U.S. health care system, medication adherence measures are increasingly being adopted to assess quality of medi...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.5.598
更新日期:2016-05-01 00:00:00
abstract:BACKGROUND:Research describing patient experience and outcomes with extended half-life recombinant factor VIII (EHL rFVIII) outside of clinical trials is limited. Real-world rFVIII consumption studies, when people with hemophilia A (PWHA) switch from standard half-life (SHL) to EHL rFVIII, may help payers and clinician...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2020.26.4.492
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Adherence to treatment is correlated with treatment success in chronic myeloid leukemia (CML). CVS Specialty explored novel methods to improve adherence in this population to ensure optimal adherence and lower the risk of unsuccessful treatment. One novel program explored involved an interactive 2-way clinic...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.25.11.1290
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Diabetes is a leading cause of morbidity, mortality, and medical resource utilization in the United States and worldwide. Treatment is aimed at keeping blood glucose levels close to normal and preventing or delaying medical complications. It has been estimated that only 50% of patients with diabetes in the U...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.5.467
更新日期:2016-05-01 00:00:00
abstract:BACKGROUND:All Department of Veterans Affairs Medical Centers (VAMCs) operate under a single national drug formulary, yet substantial variation in prescribing and spending exists across facilities. Local management of the national formulary may differ across VAMCs and may be one cause of this variation. OBJECTIVE:To c...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.14251
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND:The federal 340B Drug Discount Program provides access to significant drug price discounts for health care organizations in the United States that serve a disproportional share of disadvantaged patients. OBJECTIVE:To analyze trends over a 10-year period (2006~2016) in the price of specialty drugs, contrasti...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.25.2.178
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Prescription opioid abuse is associated with substantial economic burden, with estimates of incremental annual per-patient health care costs of diagnosed opioid abuse exceeding $10,000 in prior literature. A subset of patients diagnosed with opioid abuse has disproportionately high health care costs, but lit...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2015.21.10.902
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Sarcoidosis is a multisystem inflammatory disorder characterized by the presence of noncaseating granulomas in involved organs. Prior research has found that sarcoidosis imposes a significant economic burden to U.S. payers. However, the drivers of high health care costs among sarcoidosis patients are unknown...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2017.17203
更新日期:2017-12-01 00:00:00
abstract::In a study published last year in the October 2014 issue of the Journal of Managed Care Specialty Pharmacy, Trivedi et al. compared treatment patterns of dasatinib and nilotinib as second-line tyrosine kinase inhibitors (TKI) therapy in chronic myeloid leukemia (CML) patients during the first year of treatment.1 Trive...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 评论,信件
doi:10.18553/jmcp.2015.21.11.1088
更新日期:2015-11-01 00:00:00
abstract::Section 3002 of the 21st Century Cures Act, which was signed into law in December 2016, requires the FDA to develop one or more sets of new guidances regarding the collection of patient experience data. To explore how patient-reported outcomes (PROs) can support value-based care and discuss challenges to using PROs mo...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.19034
更新日期:2019-03-21 00:00:00
abstract:BACKGROUND:New 3-drug regimens have been developed and approved to treat multiple myeloma (MM). The absence of direct comparative data and the high cost of treatment support the need to assess the relative clinical and economic outcomes across all approved regimens. OBJECTIVE:To evaluate the cost-effectiveness of trea...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2018.24.1.29
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:Diabetes requires close monitoring to achieve optimal outcomes and avoid adverse effects. Continuous glucose monitoring (CGM) is one approach to measuring glycemia and has become more widespread with recent advances in technology; however, ideal implementation of CGM into clinical practice is unknown. CGM ca...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2020.26.5.600
更新日期:2020-05-01 00:00:00
abstract:BACKGROUND:Concomitant use of stimulants and atypical antipsychotics is common in pediatric attention deficit hyperactivity disorder (ADHD). However, little is known about the determinants of concomitant use and its utility in the management of pediatric ADHD. OBJECTIVES:To (a) examine predictors of concomitant stimul...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2015.21.6.486
更新日期:2015-06-01 00:00:00
abstract::Improving medication adherence has been identified as a crucial step towards improving health outcomes for patients with chronic disease and has provided the motivation for many changes in our health care system. Despite the volume of research done on this topic, however, we still lack important basic information abou...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章,评审
doi:10.18553/jmcp.2014.20.8.775
更新日期:2014-08-01 00:00:00
abstract::While some incremental and fragmented progress has been made in recent years, assessing the quality of care provided by pharmacists and pharmacy organizations remains an elusive goal. Revisiting the simple, elegant model of quality assessment originally proposed by physician and scholar Avedis Donabedian can assist ph...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2018.24.4.354
更新日期:2018-04-01 00:00:00
abstract::DISCLOSURES: Funding for the study referred to in this letter was contributed by Bayer Healthcare. Xia and Williamson are employees of Bayer Healthcare. Roth, Carlson, and Sullivan are consultants to Bayer Healthcare. Carlson also reports fees from Adaptive Biotechnologies, unrelated to the study. Roth reports consult...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 信件
doi:10.18553/jmcp.2020.26.12.1617
更新日期:2020-12-01 00:00:00
abstract::The AMCP Abstracts program provides a forum through which authors can share their insights and outcomes of advanced managed care practice through publication in AMCP's Journal of Managed Care & Specialty Pharmacy (JMCP). Most of the reviewed and unreviewed abstracts are presented as posters so that interested AMCP mee...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.4.S1
更新日期:2016-04-01 00:00:00
abstract:DISCLOSURES:No funding supported the writing of this letter. Preblick, Ali, and DasMahapatra are employees and shareholders of Sanofi Genzyme. Gray is a postdoctoral fellow at Sanofi Genzyme and Rutgers University. ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 信件
doi:10.18553/jmcp.2020.26.9.1177
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:The functional impairment associated with migraine can cause physical, emotional, and economic ramifications that can affect occupational, academic, social, and family life. Understanding the relationship between headache-free days (HFDs) and the disease burden of migraine may help with decisions regarding t...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2020.20103
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND:Oral pharmacological treatment for overactive bladder (OAB) consists of antimuscarinics and the beta-3 adrenergic agonist mirabegron. Antimuscarinic adverse events (AEs) such as dry mouth, constipation, and blurry vision can result in frequent treatment discontinuation rates, leaving part of the OAB populati...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.9.1072
更新日期:2016-09-01 00:00:00
abstract::It has been nearly 20 years since the Academy of Managed Care Pharmacy (AMCP) and other stakeholders adopted the Principles for a Sound Formulary System. Since that time, best practices for pharmacy and therapeutics (P&T) committees have matured throughout the health care system. On March 28, 2019, AMCP convened a gro...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 共识发展会议,杂志文章
doi:10.18553/jmcp.2020.26.1.48
更新日期:2020-01-01 00:00:00
abstract::BACKGROUND: Nonadherence and nonpersistence to antidepressants in major depressive disorder (MDD) are common and associated with poor clinical and functional outcomes and increased health care resource utilization (HCRU) and costs. However, contemporary real-world evidence on the economic effect of antidepressant nona...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2021.27.2.223
更新日期:2021-02-01 00:00:00
abstract:BACKGROUND:Discarding unused drugs after dose changes or discontinuation can significantly affect pharmacy budgets. This is especially concerning for expensive oncology agents. However, few economic studies account for drug wastage, providing an inaccurate estimate of a drug's actual economic cost, cost-effectiveness, ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.25.8.859
更新日期:2019-08-01 00:00:00