A comparative study of chronic spontaneous urticaria and chronic mast cell mediated angioedema.

Mast cell-mediated angioedema (MC-AE) is considered a form of chronic spontaneous urticaria (CSU). To investigate the clinical and laboratory features that distinguish MC-AE from antihistamine-responsive CSU (CSU), and antihistamine-resistant CSU (R-CSU) with and without concomitant AE. A retrospective observational study using the electronic patient record data base of patients with MC-AE, CSU, R-CSU, and sex- and age-matched control group (control), with a case-control ratio of 1:2.

[CHEMOTHERAPY FOR CANCER PATIENTS - ARE WE CHOOSING WISELY?].

Introduction: The American Society of Clinical Oncology has identified non-evidence-based chemotherapy as one of the 10 most prevalent examples of futile care and has identified chemotherapy at the last month of life as a quality indicator of oncology practice.

Objectives: To characterize chemotherapy treatment and the use of palliative and other healthcare services during the last year of life among cancer patients in an Israeli Health Maintenance Organization (HMO).

Methods: A cross-sectional study was conducted of members of Leumit Health Services (LHS) who died of cancer between 2009 and 2013.

Hematologic parameters as biomarkers for antihistamine and omalizumab resistance in chronic spontaneous urticaria.

Biomarkers of resistance to H-antihistamines (AH) and omalizumab in chronic spontaneous urticaria (CSU) are still a matter of debate. To identify clinical and laboratory attributes of the patient that may be predictive of AH and omalizumab resistance in CSU. We conducted a retrospective observational study by using the electronic patient record data base of patients with CSU and of sex- and age-matched controls.

Factors related to omalizumab resistance in chronic spontaneous urticaria.

Omalizumab resistance (OmR) in chronic spontaneous urticaria (CSU) remains poorly understood. To identify clinical and laboratory attributes of patients that may be predictive of OmR in CSU. We conducted a retrospective observational study by using an electronic patient record data base of patients with severe CSU refractory to a fourfold H-antihistamine dose, treated with omalizumab 300 mg every 4 weeks for at least 24 weeks.

Patient and physician characteristics affect adherence to screening mammography: A population-based cohort study.

Background: Screening mammograms are widely recommended biennially for women between the ages of 50 and 74. Despite the benefits of screening mammograms, full adherence to recommendations falls below 75% in most developed countries. Many studies have identified individual (obesity, smoking, socio-economic status, and co-morbid conditions) and primary-care physician parameters (physician age, gender, clinic size and cost) that influence adherence, but little data exists from large population studies regarding the interaction of these individual factors.

Association of alopecia areata with atopic dermatitis and chronic spontaneous urticaria.

Background: Epidemiologic studies report that alopecia areata (AA) is related to various atopic and autoimmune diseases. The purpose of this study was to identify clinical characteristics and the prevalence of comorbid conditions in Israeli patients with AA.

Methods: This retrospective, matched, case-control study was based on data from an electronic patient record data base.

No apparent association between bipolar disorder and cancer in a large epidemiological study of outpatients in a managed care population.

An association between bipolar disorder (BD) and cancer risk has been reported. The purpose of this study was to investigate this association through linkage analysis of a national HMO database and a national cancer registry. All members of the Leumit Health Services (LHS) HMO of Israel from 2000 to 2012 were included.

Revealed Opportunism: How Physicians "Game" Prior Authorization Protocols Until They Are Rescinded.

Background: Prior authorization (PA) is a management technique that has been implemented to manage the utilization of expensive drugs and to improve the precision of drug prescribing. PA requirements may incentivize physicians to document adverse effects, sometimes falsely, to meet the eligibility requirements.

Objectives: To identify documentation patterns that may facilitate the quantitative analysis of physician gaming and underreporting behaviors associated with the prescribing of angiotensin-converting enzyme (ACE) inhibitors in a primary care setting, and to evaluate the effect of a PA requirement on the documentation of adverse events as a way to receive approval for more expensive drugs.

Clinical-laboratory characteristics of ANA-positive chronic idiopathic urticaria.

Despite the established association between chronic idiopathic/spontaneous urticaria (CIU) and presence of antinuclear antibodies (ANAs), the prevalence of autoimmune comorbidities in this population has not been analyzed. Here, we aim to identify clinical and laboratory manifestations associated with ANA-positive CIU. ANA-positive patients were identified via electronic data capture from the electronic patient record database of Leumit Health care Services (LHS) of Israel.

A natural experiment in mass media modulated pharmacokinetics after a change in tablet formulation.

Background: After a new formulation of levothyroxine was distributed in Israel, side effects were reported to the Ministry of Health generating extensive media coverage. The purpose of this study was to determine whether the new formulation was associated with a change in thyroid-stimulating hormone (TSH) levels of treated patients and to evaluate the effect of the extensive media coverage on the incidence of laboratory test performance.

Study Design: Retrospective-cohort and crosssectional analysis.

Modifying prescribing behaviour of angiotensin receptor blockers by selectively rescinding managerial prior authorization requirements for losartan.

Aims: To evaluate whether rescinding the prior authorization (PA) requirement (managerial pre-approval) for losartan in an health maintenance organization (HMO) could reduce prescribing of the more expensive angiotensin receptor blockers (ARBs).

Methods: HMO physicians were notified that losartan would no longer require PA, and appropriate changes were made to the electronic prescribing computer program. The monthly distribution by drug of the number of prescriptions for ARBs dispensed for new patients was calculated before and after the policy change from data captured from electronic records.

Drug use evaluation of tamoxifen focusing on off-label use in a managed care population in Israel.

Background: Policy development to manage new off-label uses of medications is an issue relevant to health policy stakeholders internationally. Retrospective drug utilization analyses may be useful to identify practice trends in the use of drugs for unapproved (off-label) uses. Since drug use evaluations (DUE) are generally performed for expensive medications or when safety concerns warrant increased scrutiny, patterns of off-label use of inexpensive drugs will probably be undetected.

Prior authorization to improve testing of glycosylated hemoglobin in a managed care setting.

Objective: To ascertain whether revocation of a prior authorization (PA) requirement by the Leumit Health Fund of Israel resulted in inferior rates of glycosylated hemoglobin (A1C) testing among new users of expensive diabetes medications.

Study Design: Electronic patient record (EPR) database study.

Methods: Data on new users of the target drugs and on A1C testing in these patients were extracted from EPR databases for the 6-month period after the revocation.

The tools of an evidence-based culture: implementing clinical-practice guidelines in an Israeli HMO.

Purpose: Although clinical-practice guidelines (CPGs) are implemented on the assumption that they will improve the quality, efficiency, and consistency of health care, they generally have limited effect in changing physicians' behavior. The purpose of this study was to design and implement an effective program for formulating, promulgating, and implementing CPGs to foster the development of an evidence-based culture in an Israeli HMO.

Method: The authors implemented a four-stage program of stepwise collaborative efforts with academic institutions composed of developing quantitative tools to evaluate prescribing patterns, updating CPGs, collecting MDs' input via focus groups and quantitative surveys, and conducting a randomized controlled trial of a two-stage, multipronged intervention.

Curtailing laboratory test ordering in a managed care setting through redesign of a computerized order form.

Objective: To increase appropriate use of blood tests for folic acid and vitamin B12 ordered by primary care physicians in a managed care organization in Israel through redesign of a computerized order form.

Study Design: Pre-post intervention.

Methods: A new version of the computerized order form was launched.

Ethnic variability in warfarin maintenance in the community setting: a population-based study in a managed care environment in Israel.

Background: Ethnicity has been associated with variance in warfarin treatment regimens in various settings.

Objectives: To determine whether ethnicity is associated with variance in patient management in Israel.

Methods: Data were extracted from the electronic patient records of Clalit Health Services clinics in the Sharon Shomron region.

Empiric treatment of uncomplicated urinary tract infection with fluoroquinolones in older women in Israel: another lost treatment option?

Background: Current guidelines for the treatment of uncomplicated urinary tract infection (UTI) in women recommend empiric therapy with antibiotics for which local resistance rates do not exceed 10-20%. We hypothesized that resistance rates of Escherichia coli to fluoroquinolones may have surpassed this level in older women in the Israeli community setting.

Objectives: To identify age groups of women in which fluoroquinolones may no longer be appropriate for empiric treatment of UTI.

Suboptimal pneumococcal pneumonia vaccination rates among patients at risk in a managed care organization in Israel.

Objective: Pneumococcal pneumonia is a vaccine-preventable disease that poses a significant threat to immunocompromised patients. Vaccination rates tend to be low despite recommendations for vaccination in several groups of high-risk patients including any person aged 65 years or older. The purpose of this study was to (a) evaluate the vaccination rates among high-risk patients in a managed care setting in Israel and (b) gain a better understanding of the factors associated with suboptimal use of this vaccine.

When gatekeepers meet the sentinel: the impact of a prior authorization requirement for cefuroxime on the prescribing behaviour of community-based physicians.

Aims: Prior authorization (PA), the requirement of physicians to obtain pre-approval as a prerequisite for coverage, may decrease drug utilization via a 'sentinel effect', a decrease in utilization caused by external review of prescribing. The purpose of this study was to assess the affect a PA restriction had on the utilization patterns of cefuroxime tablets in a managed care organization (MCO) in Israel.

Methods: Physician prescribing patterns were evaluated by conducting a retrospective drug utilization analysis.

Teaching evidence-based medicine in a managed care setting: from didactic exercise to pharmacopolicy development tool.

Objectives: To implement a residency-based program for the teaching of evidence-based medicine in an Israeli HMO and to incorporate this effort into the HMO's routine drug policy formulation process.

Methods: Residents and preceptors participating in the family practice residency program in The Leumit Health Fund, 1 of the 4 HMOs operating in Israel, were invited to participate in a workshop for the formulation of guidelines for antibiotic treatment of the common infectious diseases encountered in primary care. The participants were allocated to teams consisting of a preceptor (an attending physician) and a resident physician, with each team choosing a different disease to analyze.

A pharmacoepidemiological approach to investigating inappropriate physician prescribing in a managed care setting in Israel.

Objective: To identify cases of inappropriate physician prescribing in a managed care setting in Israel that may have resulted from misuse of magnetic-stripe membership cards.

Study Design: Retrospective drug utilization analysis of electronic patient prescription data.

Methods: In a managed care setting involving approximately 1000 physicians who issue approximately 1.

Physician speciality and adherence to guidelines for the treatment of unsubstantiated uncomplicated urinary tract infection among women.

Purpose: To evaluate the variance in rates of physician adherence to guidelines for the empiric treatment of uncomplicated urinary tract infection (UTI) in women recommending either trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin, in all relevant physician subspecialities practising in a managed care community setting in Israel.

Methods: Data were derived from the computerised medical records of Maccabi Healthcare Services, a health maintenance organisation (HMO) in Israel providing care to more than 1.6 million members nation-wide.

Economic evaluation of an updated guideline for the empiric treatment of uncomplicated urinary tract infection in women.

Background: Until recently trimethoprim-sulfamethoxazole was the drug recommended in the Leumit Health Fund for the empiric treatment of uncomplicated urinary tract infection in women. However, due to increased uropathogen resistance to this drug, the fund has designated nitrofurantoin as its new drug of choice.

Objectives: To evaluate the potential economic impact of implementing this new pharmaco-policy.

Physician adherence to recommendations for duration of empiric antibiotic treatment for uncomplicated urinary tract infection in women: a national drug utilization analysis.

Background: Current guidelines for the empiric treatment of uncomplicated urinary tract infection in women recommend that first-line trimethoprim-sulfamethoxazole (TMP-SMX) or ofloxacin be given for 3 days and nitrofurantoin for 5 days. Increasing the duration of treatment raises costs, and perhaps, the incidence of adverse effects, without contributing to effectiveness. The aim of this study was to investigate physician adherence to these recommendations.