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Journal of Managed Care & Specialty... Oct 2017Optimized medication use involves the effective use of medications for better outcomes, improved patient experience, and lower costs. Few studies systematically gather...
BACKGROUND
Optimized medication use involves the effective use of medications for better outcomes, improved patient experience, and lower costs. Few studies systematically gather data on the actions accountable care organizations (ACOs) have taken to optimize medication use.
OBJECTIVES
To (a) assess how ACOs optimize medication use; (b) establish an association between efforts to optimize medication use and achievement on financial and quality metrics; (c) identify organizational factors that correlate with optimized medication use; and (d) identify barriers to optimized medication use.
METHODS
This cross-sectional study consisted of a survey and interviews that gathered information on the perceptions of ACO leadership. The survey contained a medication practices inventory (MPI) composed of 38 capabilities across 6 functional domains related to optimizing medication use. ACOs completed self-assessments that included rating each component of the MPI on a scale of 1 to 10. Fisher's exact tests, 2-proportions tests, t-tests, and logistic regression were used to test for associations between ACO scores on the MPI and performance on financial and quality metrics, and on ACO descriptive characteristics.
RESULTS
Of the 847 ACOs that were contacted, 49 provided usable survey data. These ACOs rated their own system's ability to manage the quality and costs of optimizing medication use, providing a 64% and 31% affirmative response, respectively. Three ACOs achieved an overall MPI score of 8 or higher, 45 scored between 4 and 7.9, and 1 scored between 0 and 3.9. Using the 3 score groups, the study did not identify a relationship between MPI scores and achievement on financial or quality benchmarks, ACO provider type, member volume, date of ACO creation, or the presence of a pharmacist in a leadership position. Barriers to optimizing medication use relate to reimbursement for pharmacist integration, lack of health information technology interoperability, lack of data, feasibility issues, and physician buy-in.
CONCLUSIONS
Compared with 2012 data, data on ACOs that participated in this study show that they continue to build effective strategies to optimize medication use. These ACOs struggle with both notification related to prescription use and measurement of the influence optimized medication use has on costs and quality outcomes. Compared with the earlier study, these data find that more ACOs are involving pharmacists directly in care, expanding the use of generics, electronically transmitting prescriptions, identifying gaps in care and potential adverse events, and educating patients on therapeutic alternatives. ACO-level policies that facilitate practices to optimize medication use are needed. Integrating pharmacists into care, giving both pharmacists and physicians access to clinical data, obtaining physician buy-in, and measuring the impact of practices to optimize medication use may improve these practices.
DISCLOSURES
This research was sponsored and funded by the National Pharmaceutical Council (NPC), an industry funded health policy research group that is not involved in lobbying or advocacy. Employees of the sponsor contributed to the research questions, determination of the relevance of the research questions, and the research design. Specifically, there was involvement in the survey and interview instruments. They also contributed to some data interpretation and revision of the manuscript. Leavitt Partners was hired by NPC to conduct research for this study and also serves a number of health care clients, including life sciences companies, provider organizations, accountable care organizations, and payers. Westrich and Dubois are employed by the NPC. Wilks, Krisle, Lunner, and Muhlestein are employed by Leavitt Partners and did not receive separate compensation. Study concept and design were contributed by Krisle, Dubois, and Muhlestein, along with Lunner and Westrich. Krisle and Muhlestein collected the data, and data interpretation was performed by Wilks, Krisle, and Muhlestein, along with Dubois and Westrich. The manuscript was written primarily by Wilks, along with Krisle and Muhlestein, and revised by Wilks, Westrich, Lunner, and Krisle. Preliminary versions of this work were presented at the following: National Council for Prescription Drug Programs Educational Summit, November 1, 2016; Academy Health 2016 Annual Research Meeting, June 27, 2016; Accountable Care Learning Collaborative Webinar, June 16, 2016; the 21st Annual PBMI Drug Benefit Conference, February 29, 2016; National Value-Based Payment and Pay for Performance Summit, February 17, 2016; National Accountable Care Congress, November 17, 2015; and American Journal of Managed Care's ACO Emerging Healthcare Delivery Coalition, Fall 2015 Live Meeting, October 15, 2015.
Topics: Accountable Care Organizations; Costs and Cost Analysis; Cross-Sectional Studies; Disease Management; Health Expenditures; Humans; Leadership; Medicare; Pharmaceutical Preparations; Pharmacists; Physicians; Reimbursement, Incentive; United States
PubMed: 28944730
DOI: 10.18553/jmcp.2017.23.10.1054 -
Current Opinion in Pulmonary Medicine Jul 2020The current review aims to seek attention for the interaction between drugs and nutrition. Traditionally, drugs and nutrition are regarded as separate categories.... (Review)
Review
PURPOSE OF REVIEW
The current review aims to seek attention for the interaction between drugs and nutrition. Traditionally, drugs and nutrition are regarded as separate categories. Nutrition is to maintain health and drugs are for curing disease. Dieticians deal with food and the medical doctor prescribes drugs. During the last decade, both categories are getting closer.
RECENT FINDINGS
Some drugs used in pulmonology lead to decrease in nutrients. Other drugs negatively affect taste. This is remarkable because the diseases for which these drugs are intended, benefit from nutrition. Gradually examples emerge that suggest that the action of drugs profit from certain dietary components.
SUMMARY
A closer look into the interaction between diet and drugs will eventually benefit the patient.
Topics: Diet; Disease Management; Humans; Lung Diseases; Nutritional Status; Pharmaceutical Preparations
PubMed: 32452899
DOI: 10.1097/MCP.0000000000000688 -
Health Data Management Jun 1997Disease management efforts are becoming an important competitive strategy for providers and managed care plans alike. More than ever, purchasers of care want value from...
Disease management efforts are becoming an important competitive strategy for providers and managed care plans alike. More than ever, purchasers of care want value from their health care dollars, and integrated delivery systems want to better coordinate care. Information technology will be crucial in implementing disease management programs.
Topics: Capitation Fee; Chronic Disease; Delivery of Health Care, Integrated; Disease Management; Health Maintenance Organizations; Humans; Medical Records Systems, Computerized; Patient Compliance; Point-of-Care Systems; Practice Guidelines as Topic; United States
PubMed: 10167737
DOI: No ID Found -
The Journal of Supportive Oncology 2012Patients with a life-limiting illness frequently experience pain and other symptoms. It is important to pay close attention when medication therapy is used to manage...
Patients with a life-limiting illness frequently experience pain and other symptoms. It is important to pay close attention when medication therapy is used to manage these symptoms. Occasionally, practitioners need to be creative in selecting, dosing, administering, and discontinuing medications at the end of life because of the patient's changing health care needs. This article offers practical end-of-life medication tips including, but not limited to, medication administration; guidance on how to increase and decrease doses; medication selection for difficult-to-treat patients; alternative dosage formulations; routes of medication administration; debridement medication regimens; and appropriate drug therapy selection.
Topics: Analgesics, Opioid; Continuity of Patient Care; Dosage Forms; Drug Administration Routes; Drug Administration Schedule; Drug Storage; Humans; Neoplasms; Pain Management; Prescription Drugs; Respiration, Artificial; Terminal Care
PubMed: 23158954
DOI: 10.1016/j.suponc.2012.08.002 -
The Journal of Hospital Infection Jun 2003In nature, apparently complex behavioural patterns are the result of repetitive simple rules. Complexity science studies the application of these rules and looks for... (Review)
Review
In nature, apparently complex behavioural patterns are the result of repetitive simple rules. Complexity science studies the application of these rules and looks for applications in society. Complexity management opportunities have developed from this science and are providing a revolutionary approach in the constantly changing workplace. This article discusses how complexity management techniques have already been applied to communicable disease management in Wales and suggests further developments. A similar approach is recommended to others in the field, while complexity management probably has wider applications in the NHS, not least in relation to the developing managed clinical networks.
Topics: Communicable Disease Control; Communicable Diseases; Disease Management; Disease Outbreaks; Drug Resistance; Humans; Information Systems; Models, Organizational; National Health Programs; Nonlinear Dynamics; Operations Research; Organizational Innovation; Philosophy, Medical; Population Surveillance; Public Health Practice; Systems Theory; Wales
PubMed: 12818579
DOI: 10.1016/s0195-6701(03)00081-1 -
The American Journal of Nursing Nov 1980
Topics: California; Drug Packaging; Medication Errors; Medication Systems, Hospital; Pharmaceutical Preparations
PubMed: 6903425
DOI: No ID Found -
Salud Colectiva Dec 2013The aim of this study was to describe and analyze changes in the definition of diabetes as a disease and the relationship between these changes and subsequent... (Review)
Review
The aim of this study was to describe and analyze changes in the definition of diabetes as a disease and the relationship between these changes and subsequent modifications in the therapeutic management of the disease. A content analysis was performed using articles, guidelines, and consensuses published by the Argentina Diabetes Society and the Latin American Diabetes Association between 1980 and 2010. The different classifications, values used to define a person as diabetic, and treatments were assessed and the changes and modifications discovered were critically analyzed using categories such as medicalization, risk and lifestyles. As a result of the analysis we can observe how the growing process of medicalization, the dependence on the scientific knowledge of central countries, the interests of the pharmaceutical industry, and the crucial role played by pharmacological treatments are all inscribed within the management of diabetes, which can be made visible through the changes that have taken place over the last 30 years.
Topics: Consensus; Diabetes Mellitus; Humans; Life Style; Medicalization; Publishing; Societies, Medical
PubMed: 24500550
DOI: 10.1590/S1851-82652013000300008 -
Journal of Clinical Apheresis 2011Therapeutic apheresis procedures are a form of extracorporeal therapy that use different techniques to separate blood into the different components out of which the part... (Review)
Review
Therapeutic apheresis procedures are a form of extracorporeal therapy that use different techniques to separate blood into the different components out of which the part containing the etiological agent in a disease process is discarded and the rest of the components of blood are re-infused into the patient, frequently with the addition of a replacement fluid or volume. These complex procedures have inherent risks of adverse events and factors that may impact on the incidence these events include the underlying disease state, anticoagulation techniques, replacement fluid type including the volume, issues related to the vascular access used, and the therapeutic apheresis procedure type and technique. We present a representative case based review of common complications of therapeutic apheresis and suggestions about how to prevent or manage these as presented at the 2010 Therapeutic Apheresis Academy.
Topics: Adult; Anticoagulants; Blood Component Removal; Disease Management; Female; Humans; Incidence; Pharmaceutical Preparations; Pregnancy; Purpura, Thrombotic Thrombocytopenic; Risk; Therapeutics
PubMed: 21898573
DOI: 10.1002/jca.20303 -
Clinics in Geriatric Medicine May 2017Polypharmacy has come to mean the inappropriate use of multiple medications. Polypharmacy can occur as a result of a range of situations, including the excessive... (Review)
Review
Polypharmacy has come to mean the inappropriate use of multiple medications. Polypharmacy can occur as a result of a range of situations, including the excessive application of clinical guidelines, lack of coordination among multiple prescribers, treating adverse drug events, misaligned medications across transitions of care, patient self-treatment, and inappropriate overtreatment. Polypharmacy is a problem because the benefits of a specific medication at the dose and frequency that an individual patient is taking are often outweighed by the costs. These costs can be financial; however, they may place a greater burden when they lead to unrealized benefits or adverse clinical effects.
Topics: Aged; Disease Management; Drug-Related Side Effects and Adverse Reactions; Humans; Managed Care Programs; Polypharmacy
PubMed: 28364994
DOI: 10.1016/j.cger.2017.01.005 -
Health (London, England : 1997) Nov 2014There is a growing emphasis within the diabetes literature on the importance of empowerment as a way of encouraging people to take control of and responsibility for the... (Review)
Review
There is a growing emphasis within the diabetes literature on the importance of empowerment as a way of encouraging people to take control of and responsibility for the successful management of their disease. Patients are actively encouraged to become active participants in their care, and there is an expectation that health-care professionals will facilitate this process. This article uses Bourdieu's concept of field, as a bounded social space in which actors conduct their lives day-to-day, to explore the context within which issues of empowerment are addressed and negotiated. The practice of empowerment within the biologically defined and biomedically 'policed' field of diabetes is explored using empirical data from a study of diabetes health-care professionals' understanding and practices around empowerment. It is concluded that rather than promoting active self-management and empowerment, the nature of the field of diabetes, and in particular its privileging of the biomedical, can mitigate against people with diabetes negotiating the field effectively and taking control of the disease and its management.
Topics: Adaptation, Psychological; Adult; Aged; Chronic Disease; Diabetes Mellitus, Type 2; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Male; Medicalization; Middle Aged; Power, Psychological; Quality of Life; Risk Assessment; Self Care; Treatment Outcome; United Kingdom
PubMed: 24695383
DOI: 10.1177/1363459314524801