Ticagrelor versus clopidogrel for recurrent myocardial infarction: An outcomes-based agreement.

Background: Outcomes-based agreements (OBA) are performance-based risk-sharing agreements between manufacturers and payers which provide the opportunity for collection and evaluation of real-world outcomes to supplement clinical trials.

Objectives: To describe an OBA comparing ticagrelor to clopidogrel in patients admitted with acute coronary syndrome (ACS) and proportion of recurrent myocardial infarction (MI) in a real-world setting.

Methods: Commercial (CM) and Medicare (MC) insurance patients of a large regional health plan, who presented with ACS and were prescribed either ticagrelor or clopidogrel were prospectively analyzed.

Elaborate biologic approval process delays care of patients with moderate-to-severe asthma.

Background: mAbs (biologics) are indicated in patients with poorly controlled moderate-to-severe asthma. The process of prior authorization and administration of a biologic requires exceptional commitment from clinical teams.

Objective: Our aim was to evaluate the process of approval and administration of biologics for asthma and determine the most common reasons associated with denials of biologics and delays in administration.

Translating clinical evidence into value-based payment models: pooled analyses of innovative real-world outcomes agreements for ticagrelor in the United States.

Innovative value strategies for reimbursement of medications include value-based agreements (VBAs) between payers and pharmaceutical manufacturers, which have the potential to improve affordability and patient access to therapy, as well as lead to a reduction in downstream health events and associated medical costs. VBAs link payment for a medication to its performance in real-world clinical practice measured against prespecified outcomes that are aligned to existing evidence. Given its high prevalence, economic burden, and impact on mortality, cardiovascular disease (namely, coronary heart disease) represents an opportunity for VBAs to contribute to improved health outcomes and patient experiences while reducing or containing total medical costs.

Relationship between symptom change, relapse activity and disability progression in multiple sclerosis.

Background: Symptom changes may serve as a risk factor for relapse activity (RA) and disability progression (DP), which could facilitate multiple sclerosis (MS) treatment decisions.

Objective: To assess the relationship of symptom change with RA and DP.

Methods: We evaluated the relationship of symptom change with subsequent RA and DP using NARCOMS registry data reported over a five-year period.

Patient perspectives on switching disease-modifying therapies in the NARCOMS registry.

Introduction: The evolving landscape of disease-modifying therapies (DMTs) for multiple sclerosis raises important questions about why patients change DMTs. Physicians and patients could benefit from a better understanding of the reasons for switching therapy.

Purpose: To investigate the reasons patients switch DMTs and identify characteristics associated with the decision to switch.

Results of the CAPPS: COPD--assessment of practice in primary care study.

Objective: Since many patients with COPD in the US are managed by primary care physicians, we evaluated adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in a primary care setting.

Methods: A cross-sectional study was conducted using a random sample of patients (n=50-150 per site) aged 40-89 years with diagnosed COPD. Patients were identified for study inclusion (N=1517) from 11 US primary care sites.

Review: clinical inertia in the management of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death in the United States. Despite clinical practice guidelines endorsed by national organizations, the management of COPD deviates from guideline recommendations. Patients with COPD are frequently underdiagnosed and misdiagnosed, due in large part to the lack of spirometry testing.

You wrote the prescription, but will it get filled?

Purpose: Despite numerous studies on adherence, there is little research on the first-fill rate of antihypertensive prescriptions. Our study took advantage of the recent increase in electronic prescribing (e-prescribing) and used data from e-prescribing physicians to determine the first-fill failure rate of antihypertensive prescriptions and to assess which factors predict first-fill failure.

Methods: This retrospective study reviewed claims from a Mid-Atlantic managed care organization (MCO).

Understanding barriers to medication adherence in the hypertensive population by evaluating responses to a telephone survey.

Background: Although hypertension is a major risk factor for cardiovascular disease, adherence to hypertensive medications is low. Previous research identifying factors influencing adherence has focused primarily on broad, population-based approaches. Identifying specific barriers for an individual is more useful in designing meaningful targeted interventions.

Hypertension treatment and control within an independent nurse practitioner setting.

Objective: To assess blood pressure (BP) control among patients with hypertension managed by nurse practitioners (NPs) vs physicians.

Study Design: Cross-sectional study.

Methods: Retrospective medical record reviews were conducted at 3 independent NP-based practices and at 21 physician-based practices.

Effect of African American race on hypertension management: a real-world observational study among 28 US physician practices.

Objective: To assess the impact of African American race on hypertension management among a real-world hypertensive population.

Design: Cross-sectional study.

Setting: 28 US physician practices.

Hypertension treatment and control among 28 physician practices across the United States: results of the Hypertension: Assessment of Treatment to Target (HATT) Study.

Chart reviews were conducted at 28 US physician practices to evaluate blood pressure (BP) management. The cross-sectional study included 8250 adult patients diagnosed with hypertension. The primary outcome variable was BP control (BP <140/90 mm Hg for nondiabetic and <130/80 mm Hg for diabetic patients).

Potential value of electronic prescribing in health economic and outcomes research.

Improving access and quality while reducing expenditures in the United States health system is expected to be a priority for many years. The use of health information technology (HIT), including electronic prescribing (eRx), is an important initiative in efforts aimed at improving safety and outcomes, increasing quality, and decreasing costs. Data from eRx has been used in studies that document reductions in medication errors, adverse drug events, and pharmacy order-processing time.

A narrative review of clinical inertia: focus on hypertension.

Clinical practice guidelines report standards of care for the management of medical conditions based on review of evidence-based medicine. The inherent responsibility and challenge for health care providers is devising a patient-specific care plan through adaptations of established treatment recommendations using the latest clinical evidence and clinical decision-making skills. Clinical inertia (CI) is viewed as the failure of health care providers in adherence to or persistence with established treatment recommendations.

Effect of cardiometabolic risk factors on hypertension management: a cross-sectional study among 28 physician practices in the United States.

Objective: This cross-sectional study sought to determine the prevalence of cardiometabolic risk factor clusters (CMRFCs) and their effect on BP control among hypertensive patients from 28 US physician practices.

Methods: Each participating practice identified a random sample of 150-300 adults aged >or= 18 years diagnosed with hypertension. The primary outcome variable was BP control (BP < 140/90 mmHg for non-diabetic and <130/80 mmHg for diabetic patients).

Identifying barriers to hypertension care: implications for quality improvement initiatives.

The role of clinical inertia in the treatment of patients with hypertension was assessed by evaluating health care providers' knowledge, attitudes, and clinical practices regarding hypertension management. A cross-sectional survey was conducted at the Forsyth Medical Group in North Carolina. Participants were physicians (N = 18, 10 sites) and support staff (N = 20, 12 sites), who were surveyed in 2006.

Cardiac cath lab activation by the emergency physician without prior consultation decreases door-to-balloon time.

Objective: The purpose of this before-and-after study is to determine whether an ED strategy which calls for cardiac catheterization lab (cath lab) activation directly by the emergency physician (EP) is effective in decreasing door-to-balloon time (DTBT).

Methods: In our active community teaching hospital ED, with an annual census of 55,000, the traditional practice for STEMI required cardiology consultation prior to cath lab notification. In November 2003 we instituted an ED protocol which mandated direct cath lab activation by the EP for eligible STEMI patients without prior notification of the cardiologist.

Correlates of hypertension control in a primary care setting.

Background: Numerous clinical trials have demonstrated reduction in cardiovascular events as a result of lowering blood pressure (BP). Despite these findings, BP control rates, especially in primary care settings, remain suboptimal. This study describes hypertension control and its predictors, using data from a sample of 631 adult patients drawn from an established primary care practice.

Improving guideline compliance: assessment of unit-based reminder for monitoring platelet counts post-PCI.

In assessing our institution's vascular access site bleeding complication rate, we found (anecdotally) that for many patients platelet count was not measured according to recommendations of the manufacturer of the predominantly used glycoprotein (GP) IIb/IIIa agents, in either the catheterization recovery unit (CRU) or the coronary care unit (CCU). We hypothesized that a unit-focused effort to remind cardiologists to order platelet counts after percutaneous coronary interventions GP IIb/IIIa would improve compliance. Findings indicated that a greater number of patients had platelet counts drawn after a reminder effort had been implemented.