Association of Intensive Lifestyle Intervention for Type 2 Diabetes With Labor Market Outcomes.

Importance: An intensive lifestyle intervention (ILI) has been shown to improve diabetes management and physical function. These benefits could lead to better labor market outcomes, but this has not been previously studied.

Objective: To estimate the association of an ILI for weight loss in type 2 diabetes with employment, earnings, and disability benefit receipt during and after the intervention.

New-onset treatment-dependent diabetes mellitus and hyperlipidemia associated with atypical antipsychotic use in older adults without schizophrenia or bipolar disorder.

Objectives: To examine the association between atypical antipsychotic medications and incident treatment for diabetes mellitus or hyperlipidemia in elderly adults without diagnoses of schizophrenia or bipolar disorder.

Design: Two case-control studies using medical and pharmacy claims data.

Setting: United States managed care population from multiple insurance plans.

Mail-order pharmacy use and medication adherence among Medicare Part D beneficiaries with diabetes.

Objective: To examine medication adherence among Medicare Part D beneficiaries initiating oral anti-diabetic medications and explore whether there is any association of using mail-order pharmacy (vs. retail pharmacy) with better adherence in this patient population.

Research Design And Methods: Using administrative pharmacy claims data, we conducted a retrospective cohort study on Medicare Part D beneficiaries who newly initiated oral anti-diabetic treatment between July 1, 2008 and December 31, 2008.

Clinical and pharmacy utilization outcomes with brand to generic antiepileptic switches in patients with epilepsy.

Purpose: To determine if switching from select branded to generic equivalent antiepileptic drugs (AEDs) in patients with epilepsy is associated with adverse outcomes.

Methods: A retrospective cohort study using a large health insurance plan claims database comparing patients with epilepsy who switched from brand to generic equivalent phenytoin, lamotrigine, or divalproex after 6 months (switch cohorts) to matched patients who remained on the brand (nonswitch cohorts). Primary outcomes measured include the incidence rate ratio (IRR) of discontinuation of the index AED; change in dose of index AED or addition of another AED; and the event rate ratio (ERR) of the composite of all-cause emergency department (ED) visits or hospitalizations.

Outcomes of a rheumatoid arthritis disease therapy management program focusing on medication adherence.

Background: A national pharmacy benefits management company implemented a rheumatoid arthritis (RA) disease therapy management (DTM) program as an enhanced offering to patients receiving specialty pharmacy services. The program was designed to improve medication adherence, maximize therapeutic outcomes, and enhance physical functioning and health-related quality of life (HRQOL) by empowering patients and improving their knowledge of RA.

Objectives: To evaluate (a) adherence to injectable RA medications for patients participating in an RA DTM program compared with nonparticipating patients receiving injectable RA medications at specialty or community pharmacies and (b) HRQOL, work productivity, and physical functioning before versus after completing the RA DTM program.

Risk of rehospitalization for patients using clopidogrel with a proton pump inhibitor.

Background: Recent pharmacodynamic and retrospective clinical analyses have suggested that proton pump inhibitors (PPIs) may modify the antiplatelet effects of clopidogrel bisulfate.

Methods: We conducted a retrospective cohort study of persons enrolled in a multistate health insurance plan with commercial and Medicare clients to evaluate adverse clinical outcomes in patients using clopidogrel plus a PPI compared with clopidogrel alone. Patients who were discharged from the hospital after myocardial infarction (MI) or coronary stent placement and treated with clopidogrel plus a PPI (n = 1033) were matched 1:1 (using propensity scoring) with patients with similar cardiovascular risk factors treated with clopidogrel alone.

Improving patient self-management of multiple sclerosis through a disease therapy management program.

Objective: To examine the effect of a multiple sclerosis (MS) disease therapy management (DTM) program that incorporates a disease self-management component and a medication therapy management component within a structured 7-month program.

Study Design: Observational cohort study.

Methods: Pharmacy claims were evaluated over an 8-month follow-up period to calculate injectable MS medication adherence and persistence among 156 continuously eligible patients who completed the DTM program compared with 156 patients in each of 2 propensity score-matched control groups (retail pharmacy patients and specialty pharmacy patients).

Risk of acute myocardial infarction in patients treated with thiazolidinediones or other antidiabetic medications.

Purpose: Controversy surrounds the question whether thiazolidinediones (TZDs) increase the risk of acute myocardial infarction (AMI). This study examined risk of AMI in patients with type 2 diabetes mellitus (T2DM) who were taking TZDs or other antidiabetic medications.

Methods: Using a nested case-control design, a cohort of patients aged 18-84 years with T2DM and use of an oral antidiabetic medication or exenatide between January 2002 and June 2006 was identified.

Effect of an intervention to increase statin use in medicare members who qualified for a medication therapy management program.

Background: The cardiovascular (CV) benefits of lipid-lowering therapy in older adults with hypercholesterolemia and underlying risk factors for coronary artery disease (CAD) have been well documented. Significant reductions in the risk of myocardial infarction (MI) and coronary death have been demonstrated with statin therapy, benefits that are of particular relevance in patients with diabetes. Managed care interventions with prescribers have increased the use of selected drugs such as statins.

Use of controller medications in patients initiated on a long-acting beta2-adrenergic agonist before and after safety alerts.

Purpose: The utilization of controller medications before initiating a long-acting beta(2)-adrenergic agonist (LABA) before and after the Food and Drug Administration (FDA) alerts is examined.

Methods: Electronic claims from a health insurer in the Western United States were examined during two distinct identification periods: before FDA alerts (October 1, 2003, through September 30, 2005) and after FDA alerts (December 1, 2005, through September 30, 2006). Identified patients were at least 12 years old, newly initiated on an LABA, and continuously enrolled during the preperiod (six months before the identification date).

Acute and continuation treatment adequacy with venlafaxine extended release compared with fluoxetine.

Study Objective: To compare treatment adequacy in the management of depression during the acute and continuation phases between patients newly treated with venlafaxine extended release (XR) and those newly treated with fluoxetine.

Design: Retrospective observational analysis of pharmacy claims data.

Setting: Large California-based managed care organization.