Abstract:
BACKGROUND:Despite evidence showing the benefits of treatment intensification following an elevated hemoglobin A1c (A1c), clinical inertia, or failure to establish and/or escalate treatment to achieve treatment goals, is a concern among patients diagnosed with type 2 diabetes (T2DM). Clinical inertia may contribute to increased health care utilization and costs due to poor clinical outcomes in MCOs. OBJECTIVES:To (a) identify factors associated with clinical inertia in T2DM and (b) determine differences in A1c goal attainment between patients who experience clinical inertia versus treatment intensification in a commercially insured population. METHODS:Medical and pharmacy claims data were used to identify commercially insured patients in a regional MCO with a recorded A1c ≥ 8.0% between January 1, 2013, and December 31, 2015. In the 4 months following the first elevated A1c value (index date), patients were classified into 2 groups: treatment intensification or clinical inertia. Treatment intensification was defined as the addition of ≥ 1 new noninsulin antihyperglycemic medication, the addition of insulin, or a dose increase of any current noninsulin antihyperglycemic medication. Patients were required to have ≥ 1 follow-up A1c value 6-12 months after the index date and continuous enrollment in the health plan for 12 months before and after the index date. Patients were excluded if they had a diagnosis for gestational diabetes or type 1 diabetes or if they were on insulin in the pre-index period. The primary outcome of attaining A1c < 7.0% was compared between groups after propensity score matching (PSM). Factors associated with clinical inertia were identified using logistic regression. RESULTS:3,078 patients, with a mean (SD) age of 54.4 (10.6) years and a mean (SD) baseline A1c of 9.6% (1.7), were included in the study. Of these, 1,093 patients (36%) experienced clinical inertia. After PSM, 1,760 patients remained; 880 in each group. In the clinical inertia group, 23% of patients achieved an A1c < 7.0% in the post-index period, compared with 35% in the treatment intensification group (P < 0.001). A greater likelihood of experiencing clinical inertia was associated with baseline treatment with 2 (OR = 1.51, 95% CI = 1.22-2.86; P < 0.001) or ≥ 3 (OR = 1.78, 95% CI = 1.30-2.42; P < 0.001) antihyperglycemic medications (vs. none), baseline age ≥ 65 years (OR = 2.11, 95% CI = 1.63-2.74; P < 0.001), and diagnosis of coronary heart disease (OR = 1.44, 95% CI = 1.10-1.88; P = 0.007). A baseline A1c ≥ 9.0% (vs. 8.0%-8.9%) was associated with a lower likelihood of experiencing clinical inertia (OR = 0.56, 95% CI = 0.48-0.66; P < 0.001). CONCLUSIONS:More than a third of patients in a commercially insured population with T2DM and a baseline A1c ≥ 8% experienced clinical inertia. Clinical inertia resulted in worse A1c outcomes over the 12-month follow-up period. Results of this study suggest that treatment intensification should be monitored, with efforts made to educate health care providers on strategies aimed at improving glycemic control for high-risk patients. DISCLOSURES:This study was funded by a grant from Janssen Scientific Affairs, which was involved in study design, interpretation of results, and manuscript review. Wander reports consulting fees from Sanofi Aventis outside the submitted work. McAdam-Marx reports grants from Sanofi Aventis and AstraZeneca outside the submitted work. Pesa and Bailey were employees of Janssen Scientific Affairs during the conduct of the study. Bailey also reports stock ownership in Johnson and Johnson. This study was presented as a poster at the Academy of Managed Care Pharmacy Nexus 2017; October 16-19, 2017; Grapevine, TX.
journal_name
J Manag Care Spec Pharmjournal_title
Journal of managed care & specialty pharmacyauthors
Ruiz-Negrón N,Wander C,McAdam-Marx C,Pesa J,Bailey RA,Bellows BKdoi
10.18553/jmcp.2019.25.3.304subject
Has Abstractpub_date
2019-03-01 00:00:00pages
304-313issue
3eissn
2376-0540issn
2376-1032journal_volume
25pub_type
杂志文章abstract:BACKGROUND:Nearly half of statin users discontinue therapy within the first year of treatment. Nonadherence to statin therapy may lead to an increased risk of atherosclerotic cardiovascular disease and, thus, higher costs due to hospitalizations. Value-based care models, such as accountable care organizations (ACO), ar...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.25.5.588
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:Immunoglobulin (Ig) is a costly blood product prescribed as immune replacement or modulation therapy to treat a wide spectrum of medical conditions. While the FDA has approved Ig for a limited number of indications, there are multiple off-label uses that have demonstrated proven clinical benefit or are curre...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2014.20.4.357
更新日期:2014-04-01 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:Adherence to adjuvant endocrine therapy (AET) for estrogen receptor-positive breast cancer remains suboptimal, which suggests that women are not getting the full benefit of the treatment to reduce breast cancer recurrence and mortality. The majority of studies on adherence to AET focus on identifying factors...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.8.969
更新日期:2016-08-01 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:DISCLOSURES:No funding was involved in the writing of this letter. Outside of the submitted work, Hiligsmann has received research grants through institution from Amgen, Radius Health, UCB, and Teva/Theramex. Reginster has received research grants and/or consulting fees from Servier, Novartis, Negma, Lilly, Wyeth, Amge...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 评论,信件
doi:10.18553/jmcp.2020.26.3.334
更新日期:2020-03-01 00:00:00
abstract:BACKGROUND:Value-based insurance design (VBID) waives or reduces prescription copayments in order to decrease member cost barriers to refilling medications. Medication therapy management (MTM) is a member clinical intervention designed to reinforce members' knowledge of their medications, which addresses barriers to me...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.11.1303
更新日期:2016-11-01 00:00:00
abstract:DISCLOSURES:No funding was received for the writing of this commentary. The author has nothing to disclose. ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2020.26.6.705
更新日期:2020-06-01 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:The introduction of anti-vascular endothelial growth factor (anti-VEGF) drugs to ophthalmology has revolutionized the treatment of neovascular age-related macular degeneration (nAMD). Despite this significant progress, gaps and challenges persist in the diagnosis of nAMD, initiation of treatment, and managem...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章,评审
doi:10.18553/jmcp.2018.24.2-a.s3
更新日期:2018-02-01 00:00:00
abstract::The ever-vulnerable medication supply chain is being further strained by the COVID-19 pandemic. Pharmacists in all settings, including managed care, will need to prepare for a potential exacerbation of existing and new drug shortages in the midst of unprecedented crisis. We summarize the major issues, discuss potentia...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2020.26.8.945
更新日期:2020-08-01 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: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:DISCLOSURES:No funding contributed to the writing of this commentary. Brandsema reports consulting for Alexion, Audentes, AveXis, Biogen, Cytokinetics, PTC Therapeutics, Sarepta, and WaVe and has received research funding as a site investigator from Alexion, AveXis, Biogen, CSL Behring, Cytokinetics, Fibrogen, Pfizer, ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章,评审
doi:10.18553/jmcp.2020.26.4.366
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:The impact of formulary management strategies on utilization and expenditures in overactive bladder (OAB) treatment has not been extensively investigated. In 2013, step therapy (ST) policies for 2 branded OAB treatments, mirabegron and fesoterodine, were removed from Humana Medicare Advantage Prescription Dr...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2017.23.1.27
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Adjuvant trastuzumab treatment is administered to early stage breast cancer patients in physician office (POV) or hospital outpatient (HOP) settings. OBJECTIVE:To identify treatment patterns, utilization, and costs by site of care (POV vs. HOP) of patients with adjuvant treatment of breast cancer with trast...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2014.20.5.485
更新日期:2014-05-01 00:00:00
abstract:BACKGROUND:Opioid pain relievers can be highly effective in providing relief for patients suffering from pain. At the same time, prescription opioid abuse, dependence, overdose, and poisoning (hereinafter "abuse") have become a national public health concern. Opioid abuse is also costly: previous estimates of the annua...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2017.16265
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:The implementation of Medicare Part D provided insurance coverage for outpatient medications, but when persons reach the "gap," they have very limited or no medication insurance coverage until they reach a second threshold for catastrophic coverage. In addition, some patients have a low-income subsidy (LIS),...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2014.20.8.862
更新日期:2014-08-01 00:00:00
abstract:DISCLOSURES:No outside funding supported the writing of this letter. Farley has received funding from the National Community Pharmacy Association for previous research. Schondelmeyer advises the University of Minnesota Health Benefit plan on its prescription drug coverage. Urick has received a grant from Cardinal Healt...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 评论,信件
doi:10.18553/jmcp.2019.25.6.724
更新日期:2019-06-01 00:00:00
abstract:BACKGROUND:Individuals with Down syndrome (DS) experience various comorbidities in excess of the prevalence seen among the non-DS population. However, the extent of the excess burden of comorbidities specifically within commercially and publicly insured DS populations aged < 21 years is not currently known. OBJECTIVES...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2017.23.7.761
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Poor medication adherence is a predictor of poor health outcomes, especially in populations with chronic diseases. Although several self-reported measures of medication adherence exist, the scope of each is limited. OBJECTIVE:To identify barriers to medication adherence in order to facilitate effective del...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2015.21.5.391
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:Gout, hyperuricemia, and cardiovascular disease (CVD) are prevalent conditions in the United States, and while they share common risk factors such as obesity, hypertension, hypercholesterolemia, and type 2 diabetes mellitus, relatively little is known about what patient and disease characteristics may link C...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2017.23.6.677
更新日期:2017-06-01 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:BACKGROUND:Diabetes mellitus is associated with substantial morbidity and mortality. With the rise in prevalence of diabetes, there has been an increased need for clinical pharmacy services focused on diabetes management in ambulatory clinics. However, more data IS needed to determine the overall impact that clinical p...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2014.20.9.914
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:National guidelines and initiatives have promoted the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) for patients with diabetes. The University of Arizona Medication Management Center (UA-MMC) is contracted by Medicare health plans, pharmacy benefit managers ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.1.40
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Persistence with multiple daily insulin injections (MDI) may be challenging for patients with type 2 diabetes (T2DM). However, limited information is available regarding the effect of persistence with MDI on outcomes. OBJECTIVE:To evaluate persistence with basal and bolus insulin therapy and assess its rela...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.19097
更新日期:2019-12-01 00:00:00
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:Allergic rhinitis (AR) is a common condition that can be treated with a number of different therapies. Treatments such as intranasal antihistamines (INAs) and intranasal steroids (INSs) are widely used by AR patients. For some allergy sufferers, a combination of therapies, specifically an INA and an INS, is ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.12.1426
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Natalizumab disease-modifying therapy for relapsing-remitting multiple sclerosis (MS) is efficacious in randomized controlled trials. Few studies have estimated the association between real-world natalizumab persistence behavior and relapse-related outcomes. OBJECTIVES:To (a) examine the impact of using nat...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2015.21.3.210
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:This study is an evaluation of a discharge intervention that occurred in multiple hospitals across Maryland. In this program, patients received medications at their bedside before discharge with the goal of reducing the risk of primary nonadherence to prescribed medications. OBJECTIVE:To test if the interve...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章,多中心研究
doi:10.18553/jmcp.2020.26.3.296
更新日期:2020-03-01 00:00:00