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Risk factors for mortality in emphysematous pancreatitis. 肺气肿性胰腺炎死亡的危险因素。
IF 2.4 Pub Date : 2019-10-23 eCollection Date: 2020-01-01 DOI: 10.1080/21556660.2019.1684927
Chin-Yao Chou, Yu-Jang Su, Hsiu-Wu Yang, Chen-Wang Chang

Objective: To investigate the difference in the characteristics between patients with emphysematous pancreatitis (EP) who survived and those who died. Methods: PubMed search was performed to gather EP cases from March 1959 to February 2019. Forty-two articles with 58 EP cases were identified and met the study's inclusion criteria. The elderly were defined as individuals aged >65 years. Data on patients' demographics, clinical symptoms, laboratory results, treatments, outcomes, and mortality were collected and analyzed by chi-square test and Student's t-test. p-Value <.05 (2-tailed) was set as the significance level. Results: Forty-seven men and eleven women aged 61.3 ± 15.9 (mean ± standard deviation) years were included. The elderly accounted for 43.1% (n = 25) of cases. There were 20 mortality cases, and 38 cases survived, with an overall mortality rate of 34.5%. Sex, underlying diseases, etiologies, and laboratory results were not significantly related to mortality. Older age was significantly related to mortality (p = .001). The shock was more commonly seen in the mortality group (100%) than in the survival group (21%) (p < .001). In contrast, fever was less frequent in the mortality group than in the survival group (25 vs. 71%, p = .002). Conclusions: EP patients have a high mortality rate (34.5%). Older age, afebrile status, and presence of shock are associated with high mortality. To improve the survival of this aggressive group, a further prospective investigation involving a larger sample size is necessary.

目的:探讨肺气肿性胰腺炎(EP)患者生存与死亡特征的差异。方法:通过PubMed检索收集1959年3月至2019年2月的EP病例。42篇文章58例EP符合纳入标准。老年人被定义为年龄大于65岁的个体。收集患者的人口统计学、临床症状、实验室结果、治疗、结局和死亡率数据,并通过卡方检验和学生t检验进行分析。p值结果:纳入男性47人,女性11人,年龄61.3±15.9(平均±标准差)岁。老年人占43.1% (n = 25)。死亡20例,存活38例,总死亡率34.5%。性别、潜在疾病、病因和实验室结果与死亡率无显著相关性。年龄与死亡率显著相关(p = 0.001)。休克在死亡组(100%)比存活组(21%)更常见(p p = 0.002)。结论:EP患者死亡率高(34.5%)。老年、不发热状态和休克的存在与高死亡率有关。为了提高这一具有侵略性的群体的生存率,进一步的前瞻性调查涉及更大的样本量是必要的。
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引用次数: 5
The effectiveness and safety of pharmaceuticals to manage excess weight post-bariatric surgery: a systematic literature review. 控制减肥手术后超重的药物的有效性和安全性:系统的文献综述。
IF 2.4 Pub Date : 2019-10-17 eCollection Date: 2019-01-01 DOI: 10.1080/21556660.2019.1678478
Sean Wharton, Elham Kamran, Mahnoor Muqeem, Amina Khan, Rebecca A G Christensen

Objective: To systematically review the literature on weight management pharmaceutical use in patients who have had bariatric surgery. Methods: Google Scholar, Pubmed, Cochrane, Embase, Web of Science, and Clinical Trials were searched from inception to December 31st, 2018 inclusive. Results: Thirteen studies met inclusion and reported decreases in weight with the use of weight management medications in post-bariatric surgical patients. Five studies examined weight loss outcomes by the type of bariatric surgery procedure, and four of these studies observed less weight loss in patients who had undergone gastric sleeve compared to those who had roux-en-y bypass (n = 3 papers) and adjustable gastric banding (n = 1 paper) with medication use. Four studies compared the effectiveness of medications for weight management and observed slightly greater weight loss with the use of topiramate and phentermine as a monotherapy compared to other weight loss medications. Using a sub-sample of participants, authors observed less weight loss on metformin but not phentermine or topiramate for younger adults. Another post-hoc analysis in the same sample observed greater weight loss for older adults with liraglutide 1.8 mg. Side effects were reported in seven studies and were overall consistent with those previously reported in non-surgical populations. Conclusion: Results of this systematic review suggest pharmacotherapy may be an effective tool as an adjunct to diet and physical activity to support weight loss in post-bariatric surgery patients. However, due to most studies lacking a control or placebo group, more rigorous research is required to determine the efficacy of this intervention.

目的:系统回顾有关减肥手术患者体重管理用药的文献。方法:检索自成立至2018年12月31日(含12月31日)的Google Scholar、Pubmed、Cochrane、Embase、Web of Science和Clinical Trials。结果:13项研究符合纳入标准,并报道在减肥手术后患者使用体重管理药物后体重下降。五项研究通过减肥手术类型检查了减肥结果,其中四项研究发现,与使用roux-en-y旁路手术(n = 3篇论文)和可调节胃束带(n = 1篇论文)的患者相比,接受胃套管手术的患者体重减轻较少。四项研究比较了体重管理药物的有效性,并观察到与其他减肥药相比,托吡酯和芬特明作为单一疗法的减重效果略好。使用参与者的子样本,作者观察到二甲双胍的体重减轻较少,而非芬特明或托吡酯对年轻人没有效果。另一项针对同一样本的事后分析发现,服用1.8毫克利拉鲁肽的老年人体重减轻更大。七项研究报告了副作用,总体上与之前在非手术人群中报道的副作用一致。结论:本系统综述的结果表明,药物治疗可能是一种有效的工具,作为饮食和体育活动的辅助,以支持减肥手术后患者的体重减轻。然而,由于大多数研究缺乏对照或安慰剂组,需要更严格的研究来确定这种干预的有效性。
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引用次数: 3
Assessment of integrated specialty pharmacy services as a medication optimization strategy for rifaximin in hepatic encephalopathy patients 综合专科药房服务作为利福昔明治疗肝性脑病患者药物优化策略的评估
IF 2.4 Pub Date : 2019-09-03 DOI: 10.1080/21556660.2019.1658320
Elezabeth Mac, A. Battershell, Haitam Buaisha, K. Nolan
Abstract Background: Lactulose non-adherence has been identified as a factor for recurrent episodes of hepatic encephalopathy (HE). Treatment guidelines recommend adding rifaximin (Xifaxan1) to lactulose for ongoing management after an overt HE recurrence on lactulose alone to reduce the risk of further episodes and HE-related hospitalizations. Clinical observations suggested that rifaximin therapy is not initiated in patients upon HE-related hospital discharge where indicated. Aims: Integrate the CHI Health Specialty Pharmacy medication access coordinator (MAC) into the cascade of care of patients during an HE-related hospitalization to optimize access to and initiation of rifaximin upon discharge. Methods: Retrospective assessment of integrated MAC assistance in the CHI Health gastroenterology clinic from 26 September 2018 to 31 March 2019. Hospitalized patients were identified using TheraDoc2 reporting. Inclusion criteria: rifaximin ordered during an HE-related hospital admission at CHI Health. Exclusion criteria: discharge care assignment to an alternative physician group or facility. Primary outcome: the percentage of patients initiated on rifaximin upon hospital discharge via the integrated MAC. Secondary outcomes: cases requiring benefits verification and financial assistance, and number of rifaximin prescriptions acquired by the CHI Health Specialty Pharmacy. Results: A total of 40 patients met the inclusion criteria during the assessed timeframe. Thirty-one patients were excluded, 27 to other groups and 4 to facilities. Integrated MAC assistance was utilized for the remaining 9 patients and 100% were initiated on rifaximin upon discharge. Of those, 4 required benefits prior authorizations, 2 qualified for manufacturer patient assistance and 3 received sample medication. CHI Health Specialty Pharmacy acquired 2 rifaximin prescriptions. Conclusions: Integrated MAC assistance in a health-system gastroenterology clinic optimizes rifaximin access and initiation in patients following an HE-related hospitalization. It is anticipated that more patients going forward will qualify for MAC assistance due to a reduction in the community physician groups providing care at CHI Health. Further evaluation is warranted to determine whether medication optimization results in improved adherence and reduced readmissions in this population.
摘要背景:乳果糖不依从性已被确定为肝性脑病(HE)复发的一个因素。治疗指南建议在单独使用乳果糖后出现明显的HE复发后,在乳果糖中加入利福昔明(西法仙1)进行持续治疗,以降低进一步发作和HE相关住院的风险。临床观察表明,利福昔明治疗不适用于HE相关出院的患者。目的:将CHI Health Specialty Pharmacy药物获取协调员(MAC)整合到HE相关住院期间的患者级联护理中,以优化出院时利福昔明的获取和启动。方法:回顾性评估2018年9月26日至2019年3月31日CHI Health胃肠病诊所的综合MAC援助。使用TheraDoc2报告确定住院患者。纳入标准:在CHI Health的HE相关住院期间订购利福昔明。排除标准:将出院护理分配给替代医师组或机构。主要结果:通过综合MAC在出院时开始服用利福昔明的患者百分比。次要结果:需要福利验证和经济援助的病例,以及CHI健康专业药房获得的利福昔明处方数量。结果:在评估时间段内,共有40名患者符合纳入标准。31名患者被排除在外,27名患者进入其他组,4名患者进入设施。其余9名患者采用综合MAC辅助治疗,出院后100%开始服用利福昔明。其中,4人需要福利事先授权,2人有资格获得制造商的患者援助,3人接受了样本药物。CHI Health Specialty Pharmacy获得了2张利福昔明处方。结论:卫生系统胃肠病诊所的综合MAC辅助优化了HE相关住院患者利福昔明的获取和启动。由于在CHI Health提供护理的社区医生团体减少,预计未来将有更多的患者有资格获得MAC援助。需要进一步评估,以确定药物优化是否能改善该人群的依从性和减少再次入院。
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引用次数: 0
The impact of an integrated health-system specialty pharmacy on HIV antiretroviral therapy adherence, viral suppression and CD4 count in an outpatient ID clinic 综合卫生系统专科药房对门诊ID诊所HIV抗逆转录病毒治疗依从性、病毒抑制和CD4计数的影响
IF 2.4 Pub Date : 2019-09-03 DOI: 10.1080/21556660.2019.1658309
Elizabeth Barnes, Adam Giumenta, Marc Johnson, J. Zhao
Abstract Background: Atrium Health (AH) is a Charlotte-based not for profit hospital network that currently cares for HIV-infected patients through three outpatient ID clinics. AH recognized that novel approaches to patient care which incorporate clinical pharmacists and health-system specialty pharmacy into the practice model can help improve the HIV continuum. As a result, AH created an HIV specialty pharmacy service line that embedded an HIV-trained clinical pharmacist and pharmacy technician within one of three health-system outpatient ID clinics. Aims: This study aimed to evaluate the antiretroviral medication adherence rate, viral load, and CD4 count among patients utilizing Atrium Health Specialty Pharmacy Service (AH SPS) compared to patients that opted out of the program. Methods: This was a single-center, retrospective cohort study conducted from 7 August 2017 to 30 June 2018. All patients were already on HIV therapy at either entry or declination to the AH SPS program. The intervention group was defined as HIV patient care that incorporated AH SPS into the practice model. The control group was defined as HIV patient care that did not involve our health-system specialty pharmacy. The primary endpoints were medication adherence, viral suppression, and CD4 counts. Adherence was measured using pharmacy claims data and the Medication Possession Ratio (MPR) calculation. Baseline viral load and CD4 count at the time of entry or declination to the program was recorded as well as at the end of the observation period. Comparisons between the opt-in and opt-out groups were made. Results: For those patients using AH SPS, the overall average adherence rate was 100% versus only 89% for those patients that opted out of the service (p < 0.01). Furthermore, all but 3 patients using AH SPS reached viral suppression (p = 0.03) and all but one had improved immunefunction with a CD4 count 200 or greater by the end of the observation period (p = 0.03). The change in viral suppression and CD4 count of 200 or greater was not statistically improved between baseline and follow up in those opting out of using AH SPS. Conclusions: The AH SPS utilized an innovative practice model that fully integrated a specialty pharmacy team within an outpatient ID clinic. This novel approach to patient care significantly improved adherence which in turn lead to improved viral suppression and immune markers in patients enrolled within the program compared to those opting out.
背景:Atrium Health (AH)是一家总部位于夏洛特的非营利性医院网络,目前通过三个门诊ID诊所护理hiv感染患者。AH认识到,将临床药剂师和卫生系统专业药房纳入实践模式的患者护理新方法可以帮助改善艾滋病毒的连续性。因此,卫生部设立了艾滋病毒专科药房服务热线,在三家卫生系统门诊ID诊所之一内安置了一名受过艾滋病毒培训的临床药剂师和药学技术人员。目的:本研究旨在评估使用心房健康专业药房服务(AH SPS)的患者与选择退出该计划的患者的抗逆转录病毒药物依从率、病毒载量和CD4计数。方法:这是一项单中心、回顾性队列研究,于2017年8月7日至2018年6月30日进行。所有患者在进入或拒绝AH SPS计划时已经接受了HIV治疗。干预组被定义为将AH SPS纳入实践模型的HIV患者护理。对照组定义为不涉及我们卫生系统专业药房的HIV患者护理。主要终点是药物依从性、病毒抑制和CD4计数。使用药房索赔数据和药物占有比(MPR)计算来测量依从性。基线病毒载量和CD4计数在进入或退出程序时以及在观察期结束时被记录下来。在选择加入组和选择退出组之间进行比较。结果:对于使用AH SPS的患者,总体平均依从率为100%,而选择退出服务的患者仅为89% (p < 0.01)。此外,除3例患者外,使用AH SPS的所有患者均达到病毒抑制(p = 0.03),并且在观察期结束时,除1例患者外,所有患者的免疫功能均得到改善,CD4计数达到200或更高(p = 0.03)。在选择退出AH SPS的患者中,病毒抑制和CD4计数200或更高的变化在基线和随访期间没有统计学上的改善。结论:AH SPS利用了一种创新的实践模式,充分整合了门诊ID诊所内的专业药房团队。这种新颖的患者护理方法显着提高了依从性,这反过来又导致与选择退出的患者相比,参加该计划的患者的病毒抑制和免疫标记得到改善。
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引用次数: 0
Impact of a specialty pharmacy benefit on rheumatoid arthritis medication adherence and functional status: a continuation study 专业药房福利对类风湿性关节炎药物依从性和功能状态的影响:一项持续研究
IF 2.4 Pub Date : 2019-09-03 DOI: 10.1080/21556660.2019.1658305
Miranda Kozlicki, M. Zande, Marleen Wickizer, R. Topp, Sharon Faust, C. Hustad
Abstract Background: Patients with rheumatoid arthritis (RA) have benefited from the introduction of tumor necrosis factor (TNF) inhibitors; however, multiple studies have reported that rates of medication adherence are sub-optimal. Specialty pharmacies offer various management strategies to improve adherence in patients with RA to help improve disease status. Aims: To expand the initial analysis results by gathering adherence data between 6 and 12 months and HAQ-II scores at 12 months after transitioning members to the specialty pharmacy to determine the impact of a specialty pharmacy benefit on RA medication adherence and functional status. Methods: A retrospective analysis was conducted using an internal pharmacoadherence application. Members with claims for TNF-inhibitors were included, provided they received at least two fills within the study time periods of May 1, 2017–December 31, 2017 (pre-transition), January 1, 2018–August 31, 2018 (post-transition), and September 1, 2018–April 30, 2019 (extension). Pharmacy claims were analyzed to measure adherence by calculating the proportion of days covered (PDC) in each time period. Members with a baseline HAQ-II score after transition were compared to 6-month post-transition and 12-month extension HAQ-II scores for a correlation to adherence. Results: A total of 101 members with RA were included. Prior to transition, 34% of members were filling at non-specialty pharmacies and 66% of members were filling at specialty pharmacies. PDC values for baseline, post-transition, and extension time periods were 0.848, 0.907, and 0.819, respectively, for members filling at non-specialty pharmacies prior to transition and 0.904, 0.889, and 0.818, respectively, for members filling at a specialty pharmacy prior to transition. The percentage of patients achieving a desired adherence level (PDC>0.8) increased post-transition for members previously filling at non-specialty pharmacies (65.2% vs 84.8%). A statistically significant inverse relationship was found between baseline HAQ-II score and pre-transition PDC value (r = –0.200, p = .035) for 112 members with completed functional assessments. Conclusions: PDC is significantly correlated to HAQ-II scores at baseline, and adherence is also shown to increase for members transitioning from a non-specialty to specialty pharmacy. More analysis is needed to determine if the HAQ-II is an appropriate functionality questionnaire to assess RA disease status.
摘要背景:类风湿性关节炎(RA)患者受益于肿瘤坏死因子(TNF)抑制剂的引入;然而,多项研究报告称,药物依从性是次优的。专业药房提供各种管理策略,以提高RA患者的依从性,从而帮助改善疾病状况。目的:通过收集6至12岁的依从性数据来扩大初步分析结果 月和HAQ-II评分为12 将成员转移到专业药房后数月,以确定专业药房福利对RA药物依从性和功能状态的影响。方法:采用内部药物依从性应用程序进行回顾性分析。有TNF抑制剂申请的成员也包括在内,前提是他们在2017年5月1日至2017年12月31日(过渡前)、2018年1月1日-2018年8月31日和2018年9月1日–2019年4月30日(延期)的研究时间段内至少接受了两次填充。分析药房索赔,通过计算每个时间段的覆盖天数比例(PDC)来衡量依从性。将过渡后基线HAQ-II评分的成员与过渡后6个月和延期12个月的HAQ-II分数进行比较,以确定与依从性的相关性。结果:共纳入101名RA患者。在过渡之前,34%的会员在非专科药店配药,66%的会员在专科药店配药。过渡前在非专科药房配药的会员的基线、过渡后和延长时间段的PDC值分别为0.848、0.907和0.819,过渡前在专科药房填表的会员的PDC值则分别为0.904、0.889和0.818。达到所需依从性水平(PDC>0.8)的患者百分比在过渡后比之前在非专科药店配药的成员增加(65.2%比84.8%)。基线HAQ-II评分和过渡前PDC值之间存在统计学显著的负相关(r=–0.200,p = .035),用于完成功能评估的112名成员。结论:PDC与基线时的HAQ-II评分显著相关,从非专业药房过渡到专业药房的成员的依从性也有所增加。需要更多的分析来确定HAQ-II是否是评估RA疾病状态的适当功能问卷。
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引用次数: 0
Medication adherence and graft survival among heart transplant recipients 心脏移植受者的药物依从性和移植物存活率
IF 2.4 Pub Date : 2019-09-03 DOI: 10.1080/21556660.2019.1658329
Safia Boghani, H. Kirkham, E. Witt, N. Hira, W. Cherikh, A. Wilk, J. Maghirang, Glen Pietradoni
Abstract Background: Though medication adherence is essential for graft survival, little is known about the impact of non-adherence on heart transplant survival. Aims: The objective of this study was to examine the association between graft survival and adherence in heart transplant recipients. Methods: This retrospective, observational cohort study used claims data from a single, large national pharmacy chain (claims data from 2013-2016) and post-transplant follow-up data from the OPTN database (data from post-transplant to 2016). The sample included adult, deceased-donor heart transplant recipients (most recent if more than one) who had >2 pharmacy claims for any immunosuppressant >150 days apart in the 12-months after their first fill in the study period (2013–2016). Proportion of days covered (PDC) by any immunosuppressant for 12-months after first fill was calculated as a measure of adherence (defined as PDC >80%). Graft survival was defined as having a surviving graft at the end of the study period. Logistic regression was used to estimate the association between adherence and graft survival controlling for covariates (age at transplant, time since transplant, gender, race/ethnicity, copay, number of prescriptions for chronic conditions, pharmacy insurance plan, brand medication usage, digital fills, filling at a transplant specialized pharmacy, and receiving financial assistance). Results: Of the 3,435 heart transplant recipients who were eligible for the study, 75% were adherent and 81% had a surviving graft (range = 6–10,012 days post-transplant; median = 1,409 days). After adjusting for covariates, the odds of having a surviving graft were almost double for adherent patients than for non-adherent patients (OR = 1.94 [95% CI = 1.58–2.37]; p < 0.001). Other notable factors associated with graft survival included having three or fewer post-index prescriptions for chronic conditions (OR = 4.33 [3.55–5.27]; p < 0.001) and filling immunosuppressants digitally (OR = 2.25 [1.13–4.48]; p < 0.001). A sensitivity analysis using a PDC >90% as the definition for adherence showed that the odds of having a surviving graft were 2.01 (95% CI [1.67–2.43]) times more likely for adherent patients. Conclusions: This analysis suggests adherent patients had greater odds of having a surviving graft than those who were not adherent to immunosuppressants. Future studies should aim to show which patient behaviors contribute to medication adherence and what PDC threshold should be used for transplant research.
背景:虽然药物依从性对于移植心脏的生存至关重要,但对不依从性对心脏移植生存的影响知之甚少。目的:本研究的目的是检查心脏移植受者移植存活与依从性之间的关系。方法:这项回顾性、观察性队列研究使用了来自单一大型国家连锁药店的索赔数据(2013-2016年的索赔数据)和来自OPTN数据库的移植后随访数据(移植后至2016年的数据)。样本包括在研究期间(2013-2016年)第一次填写后的12个月内间隔150天有2次免疫抑制剂>药房索赔的成人,已故供体心脏移植受者(最近一次如果不止一个)。计算首次填充后12个月内任何免疫抑制剂覆盖天数(PDC)的比例,作为依从性的衡量标准(定义为PDC >80%)。移植物存活被定义为在研究期结束时有一个存活的移植物。使用Logistic回归来估计依从性和移植物存活之间的关联,控制协变量(移植时的年龄、移植后的时间、性别、种族/民族、共付额、慢性病处方数量、药房保险计划、品牌药物使用、数字填充、在移植专业药房填充和接受经济援助)。结果:在符合研究条件的3435名心脏移植受者中,75%的人粘附,81%的人移植后存活(范围=移植后6 - 10012天;中位数= 1409天)。在调整协变量后,粘附患者的移植物存活几率几乎是非粘附患者的两倍(OR = 1.94 [95% CI = 1.58-2.37];p < 90%作为依从性的定义,表明移植存活的几率是依从性患者的2.01倍(95% CI[1.67-2.43])。结论:该分析表明,坚持使用免疫抑制剂的患者比不坚持使用免疫抑制剂的患者有更大的移植存活几率。未来的研究应旨在表明哪些患者行为有助于药物依从性,以及移植研究应使用何种PDC阈值。
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引用次数: 0
Psoriasis patients utilizing secukinumab, ixekizumab, or brodalumab – comparisons to prior biologic medication adherence levels, reasons for switching, and reported changes in disease symptoms 使用secukinumab, ixekizumab或brodalumab的银屑病患者-与先前生物药物依从性水平的比较,转换的原因,以及疾病症状的报告变化
IF 2.4 Pub Date : 2019-09-03 DOI: 10.1080/21556660.2019.1658298
R. Baiano, F. Staskon, Richard T. Miller
Abstract Background: Since the approval of interleukin-17 (IL-17) inhibitors to treat psoriasis progression, an increasing number of patients have switched to these third-generation biologics (i.e. secukinumab, ixekizumab, or brodalumab). Little is known about the impact of the new therapy choices upon patient adherence, reasons for switching, or patient reported impacts. Aims: Describe pharmacy utilization for IL-17 inhibitors, and investigate differences from prior biologic treatments (i.e. adalimumab, ustekinumab, or etanercept) on associated medication adherence levels, or patient reported reasons for switching and current disease symptoms after switching. Methods: Pharmacy records from a national specialty pharmacy were examined retrospectively for patients starting an IL-17 inhibitor from January 2016–December 2017, as well as their biologic treatment in the prior 12-months (i.e. adalimumab, ustekinumab, or etanercept). In addition, patient reported information from the clinical management platform was included for those switching from a prior therapy. A 180 day follow-up period was used after starting the IL-17 inhibitor (till May 31, 2018). The medication adherence outcome was the proportion of days covered (PDC) in the observation period (180 days). Excluded patients were under the age of 18 at the start of the new IL-17 inhibitor, or those residing in a US territory. Results: The study sample of 5,215 consisted of 2,218 (42.5%) switching from a prior treatment. The most frequent IL-17 inhibitor dispensed was secukinumab (76.1%), followed by ixekizumab (23.7%), and the more frequent prior treatments were etanercept (37%) and adalimumab (35.8%). Gender and age distributions were similar across the IL-17 inhibitors. Medication adherence significantly increased after switching 6.4% on average PDC, and patients were 1.56-times more likely to be adherent (PDC ≥80%); after adjusting for age, gender, census location, and provider specialty. In these multivariate models, the only covariate significantly associated to higher adherence was if the provider specialty was in rheumatology. The most common reason reported for switching was “ineffective treatment” (64.7%). After switching to an IL-17 inhibitor, 45.7% of patients report symptoms as “better”, 26.5% the “same”, and only 5.3% state “worse” symptoms. Conclusions: Specialty pharmacies offering the recent IL-17 inhibitors allow for additional treatment options for patients needing alternative therapies.
背景:自从白介素-17 (IL-17)抑制剂被批准用于治疗银屑病进展以来,越来越多的患者转而使用这些第三代生物制剂(即secukinumab, ixekizumab或brodalumab)。对于新疗法选择对患者依从性的影响、转换的原因或患者报告的影响知之甚少。目的:描述IL-17抑制剂的药物使用情况,并调查与先前的生物治疗(如阿达木单抗、乌斯特金单抗或依那西普)在相关药物依从水平上的差异,或患者报告的转换原因和转换后的当前疾病症状。方法:回顾性检查2016年1月至2017年12月开始使用IL-17抑制剂的患者的国家专业药房的药房记录,以及他们在过去12个月内的生物治疗(即阿达木单抗、乌斯特金单抗或依那西普)。此外,来自临床管理平台的患者报告信息包括那些从先前治疗转换的患者。在开始使用IL-17抑制剂后的180天随访期(至2018年5月31日)。用药依从性指标为观察期内(180天)覆盖天数的比例(PDC)。排除的患者在新的IL-17抑制剂开始时未满18岁,或居住在美国领土。结果:5215例研究样本包括2218例(42.5%)从先前的治疗中切换。最常见的IL-17抑制剂是secukinumab(76.1%),其次是ixekizumab(23.7%),之前更常见的治疗是依那西普(37%)和阿达木单抗(35.8%)。IL-17抑制剂的性别和年龄分布相似。转换平均PDC后,药物依从性显著增加6.4%,患者的依从性增加1.56倍(PDC≥80%);在调整了年龄、性别、普查地点和提供者专业后。在这些多变量模型中,唯一与高依从性显著相关的协变量是提供者专业是否为风湿病学。最常见的原因是“治疗无效”(64.7%)。改用IL-17抑制剂后,45.7%的患者报告症状“好转”,26.5%的患者报告症状“相同”,只有5.3%的患者报告症状“恶化”。结论:专业药房提供最近的IL-17抑制剂为需要替代疗法的患者提供了额外的治疗选择。
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引用次数: 2
Coupling patient care management operations with technology and data platform to optimize hepatitis C therapy outcomes 将患者护理管理操作与技术和数据平台相结合,优化丙型肝炎治疗结果
IF 2.4 Pub Date : 2019-09-03 DOI: 10.1080/21556660.2019.1658293
Lily Duong, M. Malachowski, K. Tran
Abstract Background: Over the past 20 years there have been major improvements in the treatment and outcomes of hepatitis C pharmacotherapy. While the HCV treatment regimen is much simpler, safer, and more effective, there is an opportunity to improve the overall patient journey. Aims: The objective of this observational study is to demonstrate the cure rate measurement possible with standardized pharmacy clinical operations supported by a technology platform. Methods: The study period covered January 1 to September 30, 2018. In the patient care process, the pharmacist collaborates with the clinic staff to select the best treatment regimen based on clinical guidelines. The pharmacist also selects the treatment regimen to satisfy coverage policy. In this way, patient onboarding is streamlined and therapy initiation is expedited. Patient evaluation is performed in the clinic, and initial patient education is provided and documented. The data necessary for outcomes measures such as genotype, viral load, and past medical history is documented during the care process. The monthly monitoring plan is established for adherence and side-effect management. The entire care process is facilitated by a technology platform where documentation is completed. Results: In the study cohort, 209 patients were onboarded to the technology platform through the clinic process. Of the 209 patients, 183 were provided an initial clinical assessment. The appropriate end points for this study were: documentation of therapy completion using dispensing and adherence data, lab data at the end of treatment, and SVR12 value. A total of 150 patients had all three of the end point measures documented. Of the 28 patients who did not have the end points documented, seven had a discontinuation survey completed and 21 were lost to follow-up for unknown reasons. In this study cohort, 99% of patients completed therapy and had SVR12 confirmed by lab data, yielding a cure rate of 98%. Conclusions: In this observational study of standardized clinical pharmacy operations provided in a medical clinic supported by a pharmacy technology platform it was demonstrated that the pharmacy care process can be streamlined between the numerous steps and become a dynamic patient management operation. In addition, the study demonstrated that an intuitive and robust data platform can greatly improve longitudinal follow-up and HCV cure rate measurement.
背景:在过去的20年里,丙型肝炎药物治疗的治疗和结果有了重大的改善。虽然HCV治疗方案更简单、更安全、更有效,但仍有机会改善患者的整体治疗过程。目的:本观察性研究的目的是证明在技术平台支持下标准化药学临床操作的治愈率测量的可能性。方法:研究时间为2018年1月1日至9月30日。在病人的护理过程中,药剂师与临床工作人员合作,根据临床指南选择最佳的治疗方案。药剂师也选择治疗方案,以满足保险政策。通过这种方式,简化了患者入职流程,加快了治疗启动速度。患者评估在诊所进行,并提供初步的患者教育和记录。结果测量所需的数据,如基因型、病毒载量和过去的病史记录在护理过程中。制定每月监测计划,以确保依从性和副作用管理。整个护理过程由一个完成文档的技术平台促进。结果:在研究队列中,209例患者通过临床流程登录到技术平台。在209例患者中,183例进行了初步临床评估。本研究的适当终点是:使用配药和依从性数据完成治疗的记录,治疗结束时的实验室数据和SVR12值。共有150名患者记录了所有三个终点测量值。在没有记录终点的28例患者中,7例完成了停药调查,21例因不明原因失去了随访。在该研究队列中,99%的患者完成了治疗,实验室数据证实SVR12,治愈率为98%。结论:在药学技术平台支持下的临床药学规范化操作的观察性研究中,药学护理流程可以在众多步骤之间简化,成为一种动态的患者管理操作。此外,该研究表明,一个直观、稳健的数据平台可以大大提高纵向随访和HCV治愈率的测量。
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引用次数: 0
Impact of using real-world outcomes versus clinical evidence and list prices on value assessments 使用真实世界的结果与临床证据和标价对价值评估的影响
IF 2.4 Pub Date : 2019-09-03 DOI: 10.1080/21556660.2019.1658312
D. Meade, M. Ng, S. Hensley Alford
Abstract Background: To assess value, industry organizations often use list or net prices to calculate average prices per patient or price per QALY. However, this methodology requires numerous assumptions which need to be validated and can be challenging to ascertain. A better approach is to use fully adjudicated net prices and real-world clinical outcomes data for value assessments. Aims: We sought to demonstrate the impact on value analyses of using list vs. net prices. Methods: Using the IBM Access and Value Connect solution, patients in the IBM MarketScan Commercial Database between 1 October 2016 and 30 September 2017 with a psoriasis diagnosis were identified. To demonstrate an example of impact on value assessments, we calculated the mean per-patient-per-month (PPPM) cost associated with apremilast and compared that to the net price calculation reported in the 2018 Plaque Psoriasis Condition Update by the Institute for Clinical and Economic Review (ICER), based on per-unit dosing and discount assumptions. Results: We identified 4169 patients with a psoriasis diagnosis during the study period. The adjudicated claims PPPM cost for US health plans was $20,821 with a mean duration of exposure to apremilast of 243 days and including concomitant psoriasis medications. This is approximately $10,000 less than the net price presented in the 2018 ICER report ($30,807 Year 1, $31,018 Year 2) . Numerous additional differences between the real-world performance data and ICER evidence report were identified. Conclusions: Our analysis found that using a fully adjudicated net price: (1) allowed direct comparison of prices amongst therapies quickly and easily; and (2) facilitated a more accurate reflection of price versus value when used alongside analysis of the real-world clinical outcomes data. We recommend that net prices and real-world data be used for value assessments whenever possible. Value assessment organizations should incorporate the numerous data sets and tools available to improve transparency, accuracy and ease of analysis.
摘要背景:为了评估价值,行业组织通常使用标价或净价来计算每个患者的平均价格或每个QALY的价格。然而,这种方法需要大量的假设,这些假设需要验证,并且很难确定。更好的方法是使用完全裁定的净价和真实世界的临床结果数据进行价值评估。目的:我们试图证明使用标价与净价对价值分析的影响。方法:使用IBM Access和Value Connect解决方案,确定2016年10月1日至2017年9月30日期间IBM MarketScan商业数据库中诊断为银屑病的患者。为了证明对价值评估的影响,我们计算了与阿培司特相关的每位患者每月平均费用(PPPM),并根据单位剂量和折扣假设,将其与临床与经济审查研究所(ICER)在2018年斑块型银屑病病情更新中报告的净价计算进行了比较。结果:在研究期间,我们确定了4169名被诊断为银屑病的患者。已裁定的美国健康计划PPPM费用为20821美元,平均暴露于阿普司特的时间为243 天,包括伴随的银屑病药物。这比2018年ICER报告中的净价(第一年30807美元,第二年31018美元)低了约10000美元。真实世界的性能数据和ICER证据报告之间存在许多其他差异。结论:我们的分析发现,使用完全裁定的净价:(1)可以快速方便地直接比较不同疗法的价格;以及(2)当与真实世界临床结果数据的分析一起使用时,有助于更准确地反映价格与价值的关系。我们建议尽可能使用净价和真实世界的数据进行价值评估。价值评估组织应纳入大量可用的数据集和工具,以提高分析的透明度、准确性和易用性。
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引用次数: 0
Impact of ambulatory clinical pharmacist interventions on outcomes in the HIV population 门诊临床药师干预对HIV人群预后的影响
IF 2.4 Pub Date : 2019-09-03 DOI: 10.1080/21556660.2019.1658297
Lindsey Foltanski
Abstract Background: Previous studies have demonstrated the benefit of clinical pharmacist intervention in the care of patients with human immunodeficiency virus (HIV) in an ambulatory care setting. Patients who receive interprofessional care that includes a clinical pharmacist are more likely to see clinical benefit including improved adherence and reduced HIV viral load. With recent improvements in virologic testing and HIV medications, it is useful to identify which types of pharmacist interventions are significantly improving clinical outcomes in the most difficult-to-treat patients. Aims: Determine the impact of clinical pharmacy interventions and specialty pharmacy involvement in an uncontrolled HIV population. Methods: HIV patients with a detectable HIV viral load (>20 copies/mL) were retrospectively included in the study if they had at least one visit with a clinical pharmacist and at least one follow-up HIV viral load documented after the visit between January 1, 2017 and March 1, 2019. Patient charts were reviewed to obtain information regarding HIV history, relevant interventions made by the clinical pharmacist, and adherence rates. The primary outcome was the proportion of patients who achieved an undetectable viral load (<20 copies/mL) after seeing a pharmacist in clinic. Secondary outcomes included types of pharmacist interventions, and specialty pharmacy capture rate. Results: Fifty-one patients were included in the primary analysis. The median baseline viral load was 22,900 copies/mL and 68.6% of patients were able to achieve an undetectable HIV viral load after meeting with a pharmacist. The most common pharmacist intervention was compliance counseling, followed by medication change and medication initiation. In this cohort where 30% of patients were uninsured and unable to fill medications at the associated specialty pharmacy, the specialty pharmacy capture rate was 39%. Conclusions: The clinical pharmacists within the Regional Center for Infectious Disease care for a large proportion of the clinic’s difficult-to-treat HIV patients with uncontrolled viral loads. Within this population, patients whose care included clinical pharmacist interventions were able to achieve an undetectable viral load more than two-thirds of the time. Clinical pharmacists are also uniquely positioned to encourage utilization of specialty pharmacies to improve delivery and adherence. Utilization of skilled pharmacists will be vitally important in achieving new viral suppression rate targets, particularly within difficult-to-treat patient populations.
背景:先前的研究已经证明临床药师干预在门诊护理中对人类免疫缺陷病毒(HIV)患者的护理是有益的。接受包括临床药师在内的跨专业护理的患者更有可能看到临床益处,包括改善依从性和降低艾滋病毒载量。随着最近病毒学检测和HIV药物的改进,确定哪些类型的药剂师干预措施显著改善了最难治疗患者的临床结果是有用的。目的:确定临床药学干预和专业药学介入对未控制HIV人群的影响。方法:在2017年1月1日至2019年3月1日期间,如果可检测到HIV病毒载量(bbb20拷贝/mL)的HIV患者至少有一次与临床药剂师就诊并在就诊后至少有一次随访记录HIV病毒载量,则回顾性地将其纳入研究。我们回顾了患者的病历,以获得有关HIV病史、临床药师的相关干预措施和依从率的信息。主要结局是在诊所见过药剂师后达到不可检测病毒载量(<20拷贝/mL)的患者比例。次要结局包括药师干预类型和专科药房捕获率。结果:51例患者纳入初步分析。中位基线病毒载量为22,900拷贝/mL, 68.6%的患者在与药剂师会面后能够达到不可检测的HIV病毒载量。最常见的药剂师干预是依从性咨询,其次是药物改变和药物开始。在这个队列中,30%的患者没有保险,无法在相关的专业药房配药,专业药房的捕获率为39%。结论:区域传染病中心的临床药师护理了很大比例的临床难治性HIV患者,这些患者的病毒载量无法控制。在这一人群中,患者的护理包括临床药师干预能够达到检测不到的病毒载量超过三分之二的时间。临床药师也有独特的定位,鼓励利用专业药房,以提高交付和依从性。利用熟练的药剂师将是至关重要的,在实现新的病毒抑制率目标,特别是在难以治疗的患者群体。
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引用次数: 0
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Journal of Drug Assessment
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