Patient perspective, complexities, and challenges in managed care.

Background: Lack of coordination of care is one of the largest obstacles involved with treating opioid dependence. Physicians also face the challenges of managing comorbidities and dealing with relapse.

Objective: To examine the clinical, economic, and humanistic factors involved in treating opioid dependence.

Introduction: landscape of opioid dependence.

Background: The use of opioids for chronic noncancer pain increased 222% from 1992 to 2002. Opioid dependence has also increased significantly, leading to a burden on patients, employers, insurers, society, and the entire health care system. It is imperative that opioid dependence is addressed and treated properly, in order to return patients to being productive participants in the workplace and society.

Prescriber compliance with black box warnings in older adult patients.

Background: Patients prescribed medications with US Food and Drug Administration-issued black box warnings (BBWs) warrant additional vigilance by prescribers because these drugs can cause serious adverse drug events. Seniors are at greater risk for adverse drug events due to increased medication burden and greater health vulnerability.

Objective: To improve our understanding of the prescribing and patient-monitoring practices of physicians prescribing medications with a BBW to patients age >or=65 years in an ambulatory care setting.

Measuring concurrent adherence to multiple related medications.

Objectives: To propose standardized methods for measuring concurrent adherence to multiple related medications and to apply these definitions to a cohort of patients with diabetes mellitus.

Study Design: Retrospective cohort study of 7567 subjects with diabetes prescribed 2 or more classes of oral hypoglycemic agents in 2005.

Methods: For each medication class, adherence for each patient was estimated using prescription-based and interval-based measures of proportion of days covered (PDC) from cohort entry until December 31, 2006.

Adherence to osteoporosis medications after patient and physician brief education: post hoc analysis of a randomized controlled trial.

Objective: To examine whether adherence to osteoporosis medications can be improved by educational interventions targeted at primary care physicians (PCPs) and patients.

Study Design: Post hoc analysis of data collected as part of a prospective randomized controlled trial to improve initiation of osteoporosis management such as bone mineral density testing or osteoporosis drug initiation.

Methods: The trial was conducted among patients at risk for osteoporosis enrolled in Horizon Blue Cross Blue Shield of New Jersey.

Utilization patterns of second-line antibiotics in a health plan setting.

Increased utilization of second-line antibiotics where first-line agents are appropriate, and the use of antibiotics for viral infections, are leading to the development of resistance. This retrospective study evaluated antibiotic utilization patterns of cephalosporins, macrolides, and quinolones for community-acquired infections in a health plan's patient population. Patients were identified through the health plan's computerized pharmacy claims database.