How patient cost-sharing trends affect adherence and outcomes: a literature review.

Objective: We sought to assess the relationship between patient cost sharing; medication adherence; and clinical, utilization, and economic outcomes.

Methodology: We conducted a literature review of articles and abstracts published from January 1974 to May 2008. Articles were identified using PubMed, Ovid, medline, Web of Science, and Google Scholar databases.

Quality of care, health care costs, and utilization among Medicare Part D enrollees with and without low-income subsidy.

The objective of this cross-sectional, retrospective, claims-based analysis was to evaluate disease-specific quality measures, use of acceptable therapies, and health care cost and utilization among Medicare Advantage Part D (MAPD) enrollees overall and by income/subsidy eligibility status. Individuals aged ≥65 years with evidence of ≥1 of 8 common conditions and continuously enrolled in a MAPD plan throughout 2007 were assigned to low-income/dually eligible (LI/DE) or non-LI/DE cohorts. Quality of care metrics were calculated for asthma, chronic obstructive pulmonary disease (COPD), diabetes, and new episode depression.

Adherence to treatment guidelines and therapeutic regimens: a US claims-based benchmark of a commercial population.

The objective of this cross-sectional, retrospective study assessing commercially insured patients was to provide a useful benchmark to US health care payers and decision makers to assess quality of care, medication use and adherence, and health care resource utilization/costs associated with common chronic diseases. Measures of quality of care were suboptimal and substantial numbers of patients were not using any pharmacotherapy considered acceptable according to treatment guidelines. The widespread nature of undertreatment, poor medication adherence, and substantial health care costs highlights deficits and points to the need for comprehensive, multifaceted strategies to improve clinical and economic outcomes for chronic diseases.

Quality of care associated with common chronic diseases in a 9-state Medicaid population utilizing claims data: an evaluation of medication and health care use and costs.

The objective of this cross-sectional, retrospective study was to utilize claims data to establish a quality-of-care benchmark in a large multistate Medicaid population overall and by race. Quality of care and medication adherence (persistence and compliance) per national treatment guidelines, and health care costs/utilization were assessed across common chronic conditions in a large, 9-state Medicaid population. Overall, quality of care was suboptimal across conditions.

Consumers responses to coupons in direct-to-consumer advertising of prescription drugs.

A study was conducted to understand the influence of coupons and consumers' level of involvement in direct-to-consumer advertising. Consumers exposed to prescription drug advertising with a coupon had significantly more favorable ad and brand-related attitudes, and intention to inquire about the drug to their doctor. However, there was no significant difference in perceived product risk between consumers exposed to the ad with a coupon and consumers exposed to the ad without a coupon.

Assessment of psychotropic and psychoactive drug loads and falls in nursing facility residents.

Objective: To determine if there were any differences in fall risk and actual falls between those who were prescribed and those who were not prescribed psychotropic and psychoactive medications in a skilled nursing facility.

Design: An observational, retrospective cohort study of prospective patient data in a skilled nursing facility.

Setting: A public skilled nursing facility of more than 100 beds.

Psychotropic and psychoactive drugs and hospitalization rates in nursing facility residents.

Unlabelled: The purpose of this study was to determine if there were any differences in hospitalization rates due to total psychoactive drug "load" between those using and not or formerly using psychotropic and psychoactive medications in a skilled nursing facility; to determine if the diagnosis of dementia and the change in use and load of psychotropic and psychoactive drugs influenced hospitalization rates.

Methods: An observational retrospective cohort study was conducted of patient chart, facility disposition changes and consultant pharmacist reports data from a skilled nursing facility of more than 100 beds. Some177 patients resident for 30 or more days over a 19 month period of 2978 patient- months data were tabulated.

Concordance among three self-reported measures of medication adherence and pharmacy refill records.

Objective: To evaluate the level of agreement among three previously validated self-reported medication adherence measures and pharmacy refill records (RRs).

Design: Cross-sectional study.

Setting: Five primary care physician office sites in rural northeast Georgia.

Adverse outcomes associated with inappropriate drug use in nursing homes.

Background: Little empirical evidence exists regarding the influence and outcomes of inappropriate medication use among elderly nursing home residents.

Objective: To identify the prevalence of inappropriate medication use among elderly patients in Georgia nursing homes using the Beers criteria and identify the relationship between inappropriate drug use and the likelihood of an adverse health outcome.

Methods: A cohort design was used to review 1117 patient medical records in 15 Georgia nursing homes with a high risk of polypharmacy.

Single-item vs multiple-item measures of stage of change in compliance with prescribed medications.

The Stage of Change construct from the Transtheoretical Model of behavioral change has been widely utilized in the assessment of various health behaviors. The majority of these tests measure the Stage of Change construct using the single-item. multiple-choice format.