Predictors of Early Discontinuation of Pegylated Interferon for Reasons Other Than Lack of Efficacy in United States Veterans With Chronic Hepatitis C.

During the dual-therapy era, many patients with chronic hepatitis C discontinued therapy for reasons other than lack of efficacy (non-LOE). We determined whether selected patient characteristics predicted non-LOE discontinuation using national databases of U.S.

NatHER: protocol for systematic evaluation of trends in survival among patients with HER2-positive advanced breast cancer.

Background: Human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) is an aggressive form of breast cancer and is historically associated with poor outcomes compared with HER2-negative MBC. Since 1998, four drugs have been globally approved for the targeted treatment of HER2-positive MBC. Additional advances in patient care-such as improved breast cancer screening, HER2 testing, and supportive care-have also occurred.

Predicting Discontinuation of Pegylated Interferon as a Result of Lack of Efficacy in United States Veterans With Chronic Hepatitis C on Dual Therapy.

Background: Many patients with chronic hepatitis C virus (HCV) being treated with pegylated interferon (peg-IFN) plus ribavirin (RBV) do not respond to therapy and do not clear the virus. Standard of care during the era of dual therapy was to discontinue the patient's therapy based on insufficient decreases in viral load after 12 and/or 24 weeks on therapy.

Objectives: We identified patient characteristics that were significant predictors of discontinuation as a result of lack of efficacy (LOE) in a national database of US veterans with genotypes 1 and 4.

High rates of early treatment discontinuation in hepatitis C-infected US veterans.

Background: Patients with chronic hepatitis C (HCV) frequently discontinued dual therapy with pegylated interferon alfa (Peg-IFN) plus ribavirin (RBV) before reaching the recommended duration of 48 or 24 weeks for genotypes (G) 1/4 or 2/3, respectively. We quantified rates of discontinuation despite efficacy (non-LOE) versus lack of efficacy (LOE) versus discontinuation for unknown reasons in a national database of United States veterans.

Methods: We identified a population-based cohort of U.

The association of cytopenias and weight loss with hepatitis C virus virologic response in HIV/HCV-coinfected patients treated with PEG-IFN and RBV.

Background: Pegylated interferon (PEG-IFN)/ribavirin (RBV)-related cytopenias have been associated with improved virological outcomes among hepatitis C virus (HCV)-monoinfected patients. This analysis evaluated PEG-IFN/RBV-related cytopenias with virological responses among HIV/HCV-coinfected patients.

Methods: Pooled data from PARADIGM and AIDS Pegasys Ribavirin International CO-infection Trial (APRICOT) trials of HIV/HCV-infected patients treated with PEG-IFN/RBV.

Improving prescribing safety in patients with renal insufficiency in the ambulatory setting: the Drug Renal Alert Pharmacy (DRAP) program.

Study Objective: To determine whether a computerized Drug Renal Alert Pharmacy (DRAP) program could decrease the rate of medication errors in drug selection or dosing for 15 target drugs in patients with renal insufficiency.

Design: Randomized, controlled, population-based effectiveness trial.

Setting: A large integrated health care delivery system.

Impact of prescription benefit coverage limits on sevelamer hydrochloride adherence for patients with ESRD.

Objective: To assess the impact of prescription benefit coverage on medication adherence in Medicare-eligible members diagnosed with end-stage renal disease taking sevelamer hydrochloride.

Methods: This pilot study involved a retrospective analysis of patients with end-stage renal disease taking sevelamer, with an annual cap on brand prescription drug spending compared with those without a cap. We compared sevelamer adherence and discontinuation proportions between the 2 groups of Medicare patients in 2003 and 2004.

Comorbidities, healthcare service utilization and costs for patients identified with painful DPN in a managed-care setting.

Objective: This study examined the association of comorbidities, healthcare service use, and costs for diabetes patients with and without painful diabetic peripheral neuropathy (pDPN).

Methods: This was a retrospective, cohort analysis of data from members of a health maintenance organization. Patients with pDPN identified from a previously validated algorithm that was based on inclusion ICD-9 diagnosis codes consistent with signs and symptoms of peripheral neuropathy, as well as ICD-9 diagnosis codes to exclude non-diabetic etiologies.

Painful diabetic peripheral neuropathy in a managed care setting: patient identification, prevalence estimates, and pharmacy utilization patterns.

The objectives of this study were to validate an algorithm for identifying patients with painful diabetic peripheral neuropathy (pDPN) and demonstrate its practical applications. Using the Kaiser Permanente Colorado Diabetes Registry, an algorithm was developed with selected ICD-9 diagnosis codes combined with automated pharmacy data for medications prescribed for pDPN symptoms. Medical records were reviewed to confirm pDPN presence and to inform algorithm refinement.

Factors related to adherence to statin therapy.

Background: Retrospective database analyses have revealed that 50% of patients receiving statins discontinue therapy after one year of treatment. Typically, these data do not focus on patient-specific reasons for discontinuation.

Objective: To examine the reasons that patients discontinue statins and compare the patient and clinical factors of those who do and do not discontinue therapy.

Randomized trial to improve prescribing safety in ambulatory elderly patients.

Objectives: To determine whether a computerized tool that alerted pharmacists when patients aged 65 and older were newly prescribed potentially inappropriate medications was effective in decreasing the proportion of patients dispensed these medications.

Design: Prospective, randomized trial.

Setting: U.

Cultural competence in health care and its implications for pharmacy. Part 1. Overview of key concepts in multicultural health care.

Pharmacists are caring for more individuals of diverse age, gender, race, ethnicity, socioeconomic status, religion, sexual orientation, and health beliefs than in previous decades. Not all residents of the United States equally experience long life spans and good health. Health disparities in various cultures have been documented.

Estimation of the period prevalence of inflammatory bowel disease among nine health plans using computerized diagnoses and outpatient pharmacy dispensings.

Background: There are few contemporary estimates of prevalence rates for inflammatory bowel disease (IBD) in diverse North American communities.

Methods: We estimated the period prevalence of IBD for January 1, 1999, through June 30, 2001, among 1.8 million randomly sampled members of nine integrated healthcare organizations in the US using computerized diagnoses and outpatient pharmaceutical dispensing.

Racial differences in tumor stage and survival for colorectal cancer in an insured population.

Background: Despite declining death rates from colorectal cancer (CRC), racial disparities have continued to increase. In this study, the authors examined disparities in a racially diverse group of insured patients.

Methods: This study was conducted among patients who were diagnosed with CRC from 1993 to 1998, when they were enrolled in integrated healthcare systems.

Assessing the value of hospice care: is documentation of cost savings necessary.

Hospice care is one end-of-life option that since its inception has been the subject of numerous cost comparisons. Early hospice care emerged as a social movement in the United Kingdom. This movement began outside the medical services establishment and sought to improve care for the terminally ill through palliative and supportive services, provided in the patient's own home (1).

Disparities and survival among breast cancer patients.

Background: Although rates of survival for women with breast cancer have improved, the survival disparity between African American and white women in the United States has increased.

Purpose: To determine whether this survival disparity persists in an insured population with access to medical care.

Methods: In this retrospective cohort study, we extracted data from the tumor registries of six nonprofit, integrated health care delivery systems affiliated with the Cancer Research Network and assessed the survival of African American (n = 2276) and white (n = 18 879) female enrollees who were diagnosed with invasive breast cancer from January 1, 1993, through December 31, 1998.

The power of collaboration: using internet-based tools to facilitate networking and benchmarking within a consortium of academic health centers.

The University HealthSystem Consortium (UHC) represents a strategic alliance of 169 academic health centers and associated institutions engaged in knowledge sharing and idea-generation. The use of the Internet as a tool in the delivery of UHC's products and services has increased dramatically over the past year and will continue to increase during the foreseeable future. This paper examines the current state of UHC-member institution driven tools and services that utilize the Web as a fundamental component in their delivery.