Contribution of Food Groups to Energy and Nutrient Intakes in Five Developed Countries.

Economic growth in developing countries and globalization of the food sector is leading to increasingly similar food consumption patterns worldwide. The aim of this study was to describe similarities and differences in the contributions of main food groups to energy and nutrient intakes in five developed countries across three continents. We obtained summary reports of national food consumption survey data from Australia, France, Denmark, the Netherlands, and the United States.

Can outpatient pharmacy data identify persons with undiagnosed COPD?

Objective: To develop and validate a method for identifying persons with undiagnosed chronic obstructive pulmonary disease (COPD) using outpatient pharmacy data.

Study Design: Case-control analysis of managed care administrative data with clinical validation by spirometry and standardized questionnaires.

Methods: Patients with a new diagnosis of COPD were matched to 3 control subjects by age and sex.

The role of fluticasone propionate/salmeterol combination therapy in preventing exacerbations of COPD.

Exacerbations contribute significantly to the morbidity of COPD, leading to an accelerated decline in lung function, reduced functional status, reduced health status and quality of life, poorer prognosis and increased mortality. Prevention of exacerbations is thus an important goal of COPD management. In patients with COPD, treatment with a combination of the inhaled corticosteroid fluticasone propionate (250 microg) and the long-acting beta(2)-agonist salmeterol (50 microg) in a single inhaler (250/50 microg) is an effective therapy option that has been shown to reduce the frequency of exacerbations, to improve lung function, dyspnea and health status, and to be relatively cost-effective as a COPD maintenance therapy.

The role of combination inhaled corticosteroid/long-acting beta-agonist therapy in COPD management.

Chronic obstructive pulmonary disease (COPD) is now the fourth leading cause of death, affects an estimated 24 million Americans, and accounts for over ten million physician and emergency department (ED) visits and hospitalisations each year. The diagnosis and management of COPD falls largely to primary care practitioners. Previously, COPD management options were limited, but newer treatments have been shown to slow lung deterioration, reduce symptoms and preserve quality of life.

An algorithm for the identification of undiagnosed COPD cases using administrative claims data.

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of death in the United States, but most persons who have airflow obstruction have never been diagnosed with lung disease. This undiagnosed COPD negatively affects health status, and COPD patients may have increased health care utilization several years before the initial diagnosis of COPD is made.

Objective: To investigate whether utilization patterns derived from analysis of administrative claims data using a discriminant function algorithm could be used to identify undiagnosed COPD patients.

Economic evaluation of treating chronic obstructive pulmonary disease with inhaled corticosteroids and long-acting beta2-agonists in a health maintenance organization.

Objectives: In light of recent results from observational studies showing prolonged survival in subjects taking long-acting beta2-agonists (LABA) and/or inhaled corticosteroids (ICS) for chronic obstructive pulmonary disease (COPD), we investigated their cost-effectiveness (CE).

Methods: Costs and survival data were collected for a sample of members enrolled in a large Health Maintenance Organization in the United States. An observational study design was used to evaluate cumulative costs and health benefits of LABA, ICS, ICS+LABA, or comparison drugs.

Survival of COPD patients using inhaled corticosteroids and long-acting beta agonists.

We conducted a historical cohort study to examine the relationship between survival and use of inhaled corticosteroids (ICS) and/or long-acting beta agonists (LABA) in patients with chronic obstructive pulmonary disease (COPD). All COPD patients aged 40 years who were enrolled in one of two regional managed care organizations during 1995-2000, and who had 90 days use of an ICS and/or LABA (N=1288) or of a short-acting bronchodilator (N=397), were identified. Of patients treated with ICS and/or LABA, 14.

Predicting the costs of managing patients with chronic obstructive pulmonary disease.

The economic consequences of chronic obstructive pulmonary disease (COPD) are considerable, although the factors that best predict costs are largely unknown. This study used a population-based cohort to identify the clinical factors during an index year that were most predictive of increased direct medical costs in the subsequent year, and to develop a predictive model that described the cost variations in COPD. The medical records of 2116 patients enrolled in one regional health system who had COPD and health-care resource utilisation data for 1998 and 1999, were abstracted for information about symptoms, smoking history, chronic illnesses, and pulmonary function data.

Laboratory safety monitoring of chronic medications in ambulatory care settings.

Objective: To evaluate laboratory safety monitoring in patients taking selected chronic prescription drugs.

Design: Retrospective study using 1999-2001 claims data to calculate rates of missed laboratory tests (potential laboratory monitoring errors). Eleven drugs/drug groups and 64 laboratory tests were evaluated.

Quality of anticoagulation control and costs of monitoring warfarin therapy among patients with atrial fibrillation in clinic settings: a multi-site managed-care study.

Background: Warfarin is recommended for prevention of stroke in patients with atrial fibrillation who are at moderate or high risk, but requires intensive management to achieve safe and optimal anticoagulation control. Anticoagulation clinics are often used to administer warfarin therapy more effectively.

Objective: To collect data from multiple sites and assess the quality and costs associated with anticoagulation clinic services.

Measuring patient safety in ambulatory care: potential for identifying medical group drug-drug interaction rates using claims data.

Objective: To evaluate the feasibility of using health-plan administrative data to measure potential drug-drug interaction (DDI) rates in the ambulatory setting at the medical-group level and to assess the potential use of DDI rates in performance measurement, quality improvement, and research in patient safety.

Study Design: We combined administrative and pharmacy claims data from 2 large health plans to calculate the rates at which member users of selected chronic medications were potentially exposed to a second drug known to pose a risk of harmful interactions.

Methods: We divided 44 medication combinations with risk of adverse interactions into those with DDIs of moderate/severe clinical significance and those with DDIs of mild significance.

Costs and clinical outcomes associated with low-molecular-weight heparin vs unfractionated heparin for perioperative bridging in patients receiving long-term oral anticoagulant therapy.

Study Objectives: There have been no health-care cost evaluations comparing the use of low-molecular-weight heparin (LMWH) to unfractionated heparin (UH) as "bridge therapy" in the perioperative period in patients receiving long-term oral anticoagulant (OAC) therapy who need interruption of therapy to undergo an elective surgical procedure. We performed a retrospective analysis of the medical and administrative records of health plan members in a managed care organization who underwent bridge therapy perioperatively with either i.v.

A cohort study of the incidence of serious acute liver injury in diabetic patients treated with hypoglycemic agents.

Background: The incidence of acute liver failure or serious liver injury in diabetic patients is needed to evaluate the safety of hypoglycemic drug therapy.

Methods: We conducted a retrospective cohort study of 5 health maintenance organizations. Study patients were 171,264 health plan members 19 years or older when they received oral hypoglycemic drugs or insulin between April 1, 1997, and June 30, 1999.

Management of acute proximal deep vein thrombosis: pharmacoeconomic evaluation of outpatient treatment with enoxaparin vs inpatient treatment with unfractionated heparin.

Objectives: A landmark Canadian randomized controlled clinical trial compared treatment of acute proximal vein thrombosis via low-molecular-weight heparin (LMWH) [enoxaparin] administered primarily at home with IV unfractionated heparin (UH) in the hospital. Results demonstrated equivalent safety and efficacy for home care with enoxaparin with a reduction in cost. Our objective was to validate these findings in the routine practice setting of a US health maintenance organization.