Introduction: This study evaluated pharmacoeconomic considerations, specifically drug cost and patient readmission rates, of the non-formulary agent paliperidone palmitate, within the Alegent Creighton Health system. Pharmacy reimbursement rates for paliperidone palmitate are better on an outpatient versus inpatient basis. Given the low reimbursement rates for inpatient psychiatric care and the high cost of paliperidone palmitate, the drug cost could be justified if patients who received the injection demonstrated a subsequent reduction in readmission. Methods: The electronic medical record was used to identify patients who received at least one inpatient injection of paliperidone palmitate within the Alegent Creighton Health system from January 2010 – April 2012. Indication, dose, administration date, concurrent antipsychotics, length of stay (LOS), discharge date, and time to readmission were also recorded. Finance reports determined hospital cost and reimbursement for each inpatient stay and pharmacy c...
{"title":"A retrospective analysis of inpatient utilization of paliperidone palmitate and readmission rates","authors":"M. Klug, April N. Smith, P. Price","doi":"10.9740/MHC.N222763","DOIUrl":"https://doi.org/10.9740/MHC.N222763","url":null,"abstract":"Introduction: This study evaluated pharmacoeconomic considerations, specifically drug cost and patient readmission rates, of the non-formulary agent paliperidone palmitate, within the Alegent Creighton Health system. Pharmacy reimbursement rates for paliperidone palmitate are better on an outpatient versus inpatient basis. Given the low reimbursement rates for inpatient psychiatric care and the high cost of paliperidone palmitate, the drug cost could be justified if patients who received the injection demonstrated a subsequent reduction in readmission. Methods: The electronic medical record was used to identify patients who received at least one inpatient injection of paliperidone palmitate within the Alegent Creighton Health system from January 2010 – April 2012. Indication, dose, administration date, concurrent antipsychotics, length of stay (LOS), discharge date, and time to readmission were also recorded. Finance reports determined hospital cost and reimbursement for each inpatient stay and pharmacy c...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"2022 1","pages":"260-263"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73768106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The terms racemic mixtures, single isomers, prodrugs, active metabolites, extended-release mechanisms were once remembered as the topics of early pharmacy school curriculum. Now they are often the source of confusion for practitioners and, sometimes, big money for manufacturers. Since 2011, nearly ten percent of the top 100 medications by sales were “new and improved” versions of previously released products with 4-5% being revised psychotropics. Since these “new” products are released as brand name agents under patent protection, they are often priced much higher than their predecessors. Clinical evidence is limited to approval trials – a handful of placebo-controlled and/or active-controlled efficacy studies. Rarely, if ever, are the new agents compared head-to-head with predecessor products. Clinicians are faced with marketing claims that, while true statements (e.g., “The starting dose is the proven effective dose”), may not have data to support clinical impact (i.e., differences in response or remission rates). In a time of financial strain for the healthcare system as a whole, the high cost of these new agents can be a hard pill to swallow. Evaluation of clinical utility must include efficacy, safety and cost as with any new medication. As head-to-head trials are extremely rare with these “new” medications, evidence-based comparisons may be limited to pharmacokinetic and pharmacodynamic properties of products. It is also important to use clinical common sense to compare new agents to their predecessors.
{"title":"What's new? Isomers, metabolites and prodrugs, oh my!","authors":"A. Vandenberg","doi":"10.9740/MHC.N186960","DOIUrl":"https://doi.org/10.9740/MHC.N186960","url":null,"abstract":"The terms racemic mixtures, single isomers, prodrugs, active metabolites, extended-release mechanisms were once remembered as the topics of early pharmacy school curriculum. Now they are often the source of confusion for practitioners and, sometimes, big money for manufacturers. Since 2011, nearly ten percent of the top 100 medications by sales were “new and improved” versions of previously released products with 4-5% being revised psychotropics. Since these “new” products are released as brand name agents under patent protection, they are often priced much higher than their predecessors. Clinical evidence is limited to approval trials – a handful of placebo-controlled and/or active-controlled efficacy studies. Rarely, if ever, are the new agents compared head-to-head with predecessor products. Clinicians are faced with marketing claims that, while true statements (e.g., “The starting dose is the proven effective dose”), may not have data to support clinical impact (i.e., differences in response or remission rates). In a time of financial strain for the healthcare system as a whole, the high cost of these new agents can be a hard pill to swallow. Evaluation of clinical utility must include efficacy, safety and cost as with any new medication. As head-to-head trials are extremely rare with these “new” medications, evidence-based comparisons may be limited to pharmacokinetic and pharmacodynamic properties of products. It is also important to use clinical common sense to compare new agents to their predecessors.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"23 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87618651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Treatment-resistant depression is no different. It is a diagnosis that is often dreaded by patients, caregivers, and providers alike. It is responsible for increased hospitalizations, increased outpatient provider visits, greater use of psychotropic medications, and an average six times greater total healthcare cost incurrence compared to non-treatment-resistant depressed patients. Yet, the definition of treatment-resistant depression (TRD) remains somewhat controversial. In its simplest form, TRD can be defined as lack of significant improvement after two adequate trials of two different antidepressants from two different pharmacologic classes. However, the definition can quickly become quite complicated. According to Berlim, one can find more than 10 different definitions of TRD throughout the published literature. In addition, various authors have proposed staging systems for further description and characterization of TRD. Still others have argued that perhaps many instances of TRD actually represent undiagnosed bipolar disorder, nonadherence with therapy, and/or inadequate dose or duration of antidepressant therapy.
{"title":"Treatment-resistant depression","authors":"Amy Werremeyer","doi":"10.9740/MHC.N207177","DOIUrl":"https://doi.org/10.9740/MHC.N207177","url":null,"abstract":"Treatment-resistant depression is no different. It is a diagnosis that is often dreaded by patients, caregivers, and providers alike. It is responsible for increased hospitalizations, increased outpatient provider visits, greater use of psychotropic medications, and an average six times greater total healthcare cost incurrence compared to non-treatment-resistant depressed patients. Yet, the definition of treatment-resistant depression (TRD) remains somewhat controversial. In its simplest form, TRD can be defined as lack of significant improvement after two adequate trials of two different antidepressants from two different pharmacologic classes. However, the definition can quickly become quite complicated. According to Berlim, one can find more than 10 different definitions of TRD throughout the published literature. In addition, various authors have proposed staging systems for further description and characterization of TRD. Still others have argued that perhaps many instances of TRD actually represent undiagnosed bipolar disorder, nonadherence with therapy, and/or inadequate dose or duration of antidepressant therapy.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"7 1","pages":"211-211"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89962995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Agboton, Soheyla Mahdavian, Angela Singh, P. Ghazvini, Angela M. Hill, R. Sweet
Introduction. Although not definite, studies are finding Alzheimer's disease may be related to loss of cholinergic innervation. In order to impact this loss of function, therapeutic agents have been developed to reduce the breakdown of acetylcholine, a neurotransmitter vital in cognitive processes. Donepezil has been used in Alzheimer's disease for improving cognition. Although the package insert suggests nighttime administration to reduce the instance of daytime side effects, some patients report sleep disturbances. Methods. Patient charts at the Tallahassee Memorial Healthcare Neuroscience Center (TMH-NSC) were reviewed. Charts of those patients who met the inclusion criteria were used to determine the correlation between night time administration of donepezil and sleep disturbances. Results. A total of 186 patient charts were analyzed. Of those 186, 103 of the patients were taking donepezil as directed in the package labeling, at night time. Nearly half (47.6%) of the patients taking donepezil at night...
{"title":"Impact of nighttime donepezil administration on sleep in the older adult population: A retrospective study","authors":"C. Agboton, Soheyla Mahdavian, Angela Singh, P. Ghazvini, Angela M. Hill, R. Sweet","doi":"10.9740/MHC.N222761","DOIUrl":"https://doi.org/10.9740/MHC.N222761","url":null,"abstract":"Introduction. Although not definite, studies are finding Alzheimer's disease may be related to loss of cholinergic innervation. In order to impact this loss of function, therapeutic agents have been developed to reduce the breakdown of acetylcholine, a neurotransmitter vital in cognitive processes. Donepezil has been used in Alzheimer's disease for improving cognition. Although the package insert suggests nighttime administration to reduce the instance of daytime side effects, some patients report sleep disturbances. Methods. Patient charts at the Tallahassee Memorial Healthcare Neuroscience Center (TMH-NSC) were reviewed. Charts of those patients who met the inclusion criteria were used to determine the correlation between night time administration of donepezil and sleep disturbances. Results. A total of 186 patient charts were analyzed. Of those 186, 103 of the patients were taking donepezil as directed in the package labeling, at night time. Nearly half (47.6%) of the patients taking donepezil at night...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"134 2 1","pages":"257-259"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79624555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite new insights and evidence-based treatment options for clinical depression in the recent years, the current choices of safe and effective therapies are still inadequate to sustain a long-term response in the depressed patient. Many do not improve, improve partially or are classified as ‘treatment resistant’ with poor compliance and marked functional impairment. The aim of this article is to review future therapeutic options and advances in treatments available for this cohort of patients. Several innovative and promising studies are underway to explore the role of ketamine, a glutamate N-methyl-d-aspartate (NMDA) antagonist in treating treatment-resistant depression and acute suicidal ideation. Furthermore, new research reveals that depression is associated with a significant drop in neurotrophic factors such as brain derived neurotrophic factor (BDNF) and increasing BDNF may be a new strategy for developing new antidepressants. Neuromodulation interventions by stimulating specific brain regions in...
{"title":"Emerging therapies for treatment resistant depression","authors":"R. Wijesinghe","doi":"10.9740/MHC.N207179","DOIUrl":"https://doi.org/10.9740/MHC.N207179","url":null,"abstract":"Despite new insights and evidence-based treatment options for clinical depression in the recent years, the current choices of safe and effective therapies are still inadequate to sustain a long-term response in the depressed patient. Many do not improve, improve partially or are classified as ‘treatment resistant’ with poor compliance and marked functional impairment. The aim of this article is to review future therapeutic options and advances in treatments available for this cohort of patients. Several innovative and promising studies are underway to explore the role of ketamine, a glutamate N-methyl-d-aspartate (NMDA) antagonist in treating treatment-resistant depression and acute suicidal ideation. Furthermore, new research reveals that depression is associated with a significant drop in neurotrophic factors such as brain derived neurotrophic factor (BDNF) and increasing BDNF may be a new strategy for developing new antidepressants. Neuromodulation interventions by stimulating specific brain regions in...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"32 1","pages":"226-230"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88579012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This toolbox compares pharmacologic options for treatment-resistant depression (TRD) that may be considered if the patient fails to experience adequate response or remission despite optimizing antidepressant therapy.
{"title":"Toolbox: Psychotropic medications for augmentation or combination in treatment-resistant depression","authors":"Audrey V. Ng","doi":"10.9740/MHC.N207188","DOIUrl":"https://doi.org/10.9740/MHC.N207188","url":null,"abstract":"This toolbox compares pharmacologic options for treatment-resistant depression (TRD) that may be considered if the patient fails to experience adequate response or remission despite optimizing antidepressant therapy.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"4 1","pages":"212-218"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72942971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Trends in sedative-hypnotic therapy","authors":"G. Levin","doi":"10.9740/MHC.N193671","DOIUrl":"https://doi.org/10.9740/MHC.N193671","url":null,"abstract":"","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"101 1","pages":"40-40"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77416998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dual acting orexin antagonists are a novel class of medications in development for the treatment of insomnia. This article reviews the available data on these agents.
双作用食欲素拮抗剂是一种正在开发的治疗失眠的新型药物。本文回顾了关于这些代理的现有数据。
{"title":"Orexin receptor antagonists: Novel hypnotic agents","authors":"C. Cooper","doi":"10.9740/MHC.N190094","DOIUrl":"https://doi.org/10.9740/MHC.N190094","url":null,"abstract":"Dual acting orexin antagonists are a novel class of medications in development for the treatment of insomnia. This article reviews the available data on these agents.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"18 1","pages":"73-77"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78859476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah J. Steinhardt, Thea R Moore, Sean S. Casella
There has been a recent increase in public awareness of the drug 3,4-methylenedioxymethamphetamine (MDMA), commonly known as Ecstasy. A purified version of this drug, known as “Molly”, is perceived by users to be safer than other illicit drugs, as it is expected to be free of toxic adulterants. This article reviews the clinical effects and toxicity associated with MDMA, as well as data on the purity of Molly and Ecstasy.
{"title":"Have you seen Molly? A review of Molly in primary literature","authors":"Sarah J. Steinhardt, Thea R Moore, Sean S. Casella","doi":"10.9740/MHC.N207181","DOIUrl":"https://doi.org/10.9740/MHC.N207181","url":null,"abstract":"There has been a recent increase in public awareness of the drug 3,4-methylenedioxymethamphetamine (MDMA), commonly known as Ecstasy. A purified version of this drug, known as “Molly”, is perceived by users to be safer than other illicit drugs, as it is expected to be free of toxic adulterants. This article reviews the clinical effects and toxicity associated with MDMA, as well as data on the purity of Molly and Ecstasy.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"220 1","pages":"231-235"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77776148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Behavioral and psychiatric symptoms of dementia (BPSD) refer to a heterogeneous group of symptoms that represent non-cognitive complications of Alzheimer's disease (AD) and other dementias. Current...
{"title":"Antipsychotic use in elderly patients with dementia: Efficacy and safety concerns","authors":"Marketa Marvanova","doi":"10.9740/MHC.N204371","DOIUrl":"https://doi.org/10.9740/MHC.N204371","url":null,"abstract":"Behavioral and psychiatric symptoms of dementia (BPSD) refer to a heterogeneous group of symptoms that represent non-cognitive complications of Alzheimer's disease (AD) and other dementias. Current...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"147 5","pages":"170-176"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91475298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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