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Publications (7)15.67 Total impact

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    ABSTRACT: Objective: To investigate adherence, persistence, and switching in patients initiating dabigatran. Study Design: Descriptive analysis using pharmacy claims databases. Methods: Patients with a claim for dabigatran and who were continuously enrolled in pharmacy benefits for 180 days prior to and 180 days following the initiation of dabigatran were identified and stratified by whether there was a history of warfarin treatment prior to dabigatran initiation. Medication adherence was calculated as the proportion of days covered (PDC). Persistence to treatment at 180 days was measured. Among patients who discontinued dabigatran, time to initiating warfarin was determined. Results: In the overall population, 39.9% of 17,691 patients were nonpersistent to dabigatran. The PDC for the warfarin-naïve cohort was 0.674 (standard deviation [SD] 0.364), and 0.712 (SD 0.354) for the warfarin-experienced cohort. For patients persistent to dabigatran, the PDCs for warfarin-naïve and warfarin-experienced cohorts were 0.935 (SD 0.075) and 0.937 (SD 0.074), respectively. In patients discontinuing dabigatran, 16.1% of warfarin-naïve and 41.1% of warfarinexperienced patients initiated warfarin. Among patients discontinuing dabigatran, the mean time to discontinuation in warfarin-naïve and warfarinexperienced cohorts, respectively, was 59.8 (SD 36.2) and 59.6 (SD 36.2) days. The mean time to initiating warfarin in warfarin-naïve and warfarin experienced cohorts, respectively, was 62.5 (SD 47.2) and 60.5 (SD 43.0) days. Conclusions: Two in 5 patients discontinued dabigatran therapy within 6 months, and the majority of these patients were not anticoagulated with warfarin upon discontinuation. These findings highlight potential gaps in the care of patients treated with dabigatran in routine practice.
    The American journal of managed care 01/2013; 19(9):e3251-e332. · 2.12 Impact Factor
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    ABSTRACT: Medication nonadherence is a well-recognized challenge associated with poor health outcomes and increased utilization of health care resources. Although many different behavioral and educational strategies are available to improve patient medication adherence, technological advances, including cell phone text messaging, represent new and innovative modalities to improve adherence and overall health outcomes. To evaluate medication adherence among patients opting to receive text message medication reminders and a well-matched control cohort. This retrospective, observational cohort analysis compared medication adherence of members who opted-in to the text message medication reminder program and a matched control cohort using data from a member portal database and electronic pharmacy claims of a national pharmacy benefit manager with commercial and Medicare membership. Continuously enrolled members who opted to receive at least 1 medication-specific dosage reminder for a chronic oral medication of interest and had at least 1 pharmacy claim for the same chronic oral medication of interest were included. Matching was based on medication therapeutic class, then on propensity score (including variables of age, sex, health plan, Chronic Disease Score, distinct medication count, average baseline medication adherence, and duration of therapy). The primary outcome was chronic oral medication adherence, measured as the proportion of days covered (PDC), between January 1, 2011, and August 31, 2011. Analyses comparing cohorts were conducted using paired t tests and the McNemar test. After implementation of the text messaging program, the mean (SD) PDC was significantly higher for the text message cohort (n = 290) than for the control cohort (n = 290) (0.85 [0.20] vs 0.77 [0.28], respectively; P < 0.001). Of those members identified with a chronic oral antidiabetes medication, the mean PDC was significantly higher in the text message cohort than in the control cohort (0.91 [0.14] vs 0.82 [0.21]; P = 0.029). Significant differences in mean PDC were also seen in members who opted to receive text message reminders for β-blocker therapy over members in the control cohort (0.88 [0.18] vs 0.71 [0.29]; P = 0.006). Findings suggest that members opting into a text message reminder program have significantly higher chronic oral medication adherence compared with members not opting to receive medication-specific text message reminders, and that the use of a text message reminder program assists in preserving higher rates of adherence over time.
    Clinical Therapeutics 05/2012; 34(5):1084-91. · 2.23 Impact Factor
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    ABSTRACT: A national pharmacy benefits management company implemented a rheumatoid arthritis (RA) disease therapy management (DTM) program as an enhanced offering to patients receiving specialty pharmacy services. The program was designed to improve medication adherence, maximize therapeutic outcomes, and enhance physical functioning and health-related quality of life (HRQOL) by empowering patients and improving their knowledge of RA. To evaluate (a) adherence to injectable RA medications for patients participating in an RA DTM program compared with nonparticipating patients receiving injectable RA medications at specialty or community pharmacies and (b) HRQOL, work productivity, and physical functioning before versus after completing the RA DTM program. Patients who had an RA diagnosis and a pharmacy claim for an injectable RA medication during the identification period (August 2007 through September 2008) and were continuously enrolled with the plan from 4 months before through 8 months after the identification date were stratified into 3 patient cohorts: DTM, specialty pharmacy, and community pharmacy. DTM patients were further categorized into a DTM intent-to-treat (ITT) cohort (all 340 DTM-enrolled patients) and a DTM completer cohort (subset of 266 ITT patients who completed the month 6 consultation). DTM completer, specialty, and community pharmacy cohorts were matched 1:1:1 (n = 244 in each cohort after matching) using a propensity score that represented the likelihood of completing the DTM program. The primary outcome was adherence to injectable RA medications, measured as the proportion of days covered (PDC) over an 8-month post-identification period. Patient-reported outcomes (short form [SF]-12, Work Productivity Activity Impairment [WPAI], and Health Assessment Questionnaire-Disability Index [HAQ-DI]) were evaluated among all 371 DTM patients who completed the month 0 and month 6 consultations regardless of whether they met continuous enrollment requirements (patient-reported sample). Of specialty pharmacy patients, approximately 14% chose DTM participation. During the post-identification period, mean PDC was 0.83 for DTM ITT, 0.89 for DTM completer, 0.81 for specialty pharmacy, and 0.60 for community pharmacy patients. Differences were statistically significant for both DTM cohorts compared with the community pharmacy cohort (P < 0.001) and for the DTM completer cohort compared with the specialty pharmacy cohort (P < 0.001), but not for the DTM ITT cohort compared with the specialty pharmacy cohort (P = 0.291). In the patient-reported sample, mean SF-12 physical component scores significantly increased by 1.1 points (P = 0.048); mean SF-12 mental component scores were not significantly changed (P = 0.679); mean WPAI work productivity decreased by 10.8 percentage points (P = 0.045); and mean HAQ-DI scores significantly improved by 0.08 points (P < 0.001). Patients participating in the RA DTM program had significantly higher injectable RA medication adherence compared with community pharmacy patients. Adherence to injectable RA medications was significantly higher for patients completing the RA DTM program, but not for the DTM ITT group, compared with patients receiving specialty pharmacy services alone. Patients completing the RA DTM program experienced improvements in SF-12 physical component and HAQ-DI scores but did not demonstrate improvements to SF-12 mental scores or work productivity.
    Journal of managed care pharmacy: JMCP 10/2010; 16(8):593-604. · 2.41 Impact Factor
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    Value in Health 05/2010; 13(3):A6–A7. · 2.19 Impact Factor
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    ABSTRACT: To examine the effect of a multiple sclerosis (MS) disease therapy management (DTM) program that incorporates a disease self-management component and a medication therapy management component within a structured 7-month program. Observational cohort study. Pharmacy claims were evaluated over an 8-month follow-up period to calculate injectable MS medication adherence and persistence among 156 continuously eligible patients who completed the DTM program compared with 156 patients in each of 2 propensity score-matched control groups (retail pharmacy patients and specialty pharmacy patients). For 283 patients completing the DTM program, the Short Form 12, Work Productivity Activity Impairment questionnaire, and MS relapses were assessed at month 0 and at month 6. Injectable MS medication adherence was significantly higher for DTM patients compared with retail pharmacy patients (0.92 vs 0.86, P <.001) and was similar for DTM patients and specialty pharmacy patients (0.92 vs 0.90, P = .23). The DTM patients demonstrated significantly greater persistence on therapy (220 days) compared with the specialty pharmacy patients (188 days) (P = .002) and the retail pharmacy patients (177 days) (P <.01). The Short Form 12 and Work Productivity Activity Impairment results did not significantly change from month 0 to month 6. Multiple sclerosis relapses were reported by 14.0% of patients at month 0 and by 9.3% of patients at month 6 (P = .03). Ninety-seven percent of patients at month 6 reported that the DTM program was very helpful or somewhat helpful in enabling them to better manage their health. An MS DTM program incorporating medication management resulted in increased adherence and persistence to injectable MS medications and decreased MS relapses. Quality of life and work productivity were not significantly changed. Patients reported improved ability to manage their health.
    The American journal of managed care 02/2010; 16(2):139-44. · 2.12 Impact Factor
  • Value in Health 01/2010; 13(3). · 2.19 Impact Factor
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    ABSTRACT: The cardiovascular (CV) benefits of lipid-lowering therapy in older adults with hypercholesterolemia and underlying risk factors for coronary artery disease (CAD) have been well documented. Significant reductions in the risk of myocardial infarction (MI) and coronary death have been demonstrated with statin therapy, benefits that are of particular relevance in patients with diabetes. Managed care interventions with prescribers have increased the use of selected drugs such as statins. To (1) measure the increase in new users of statins associated with the implementation of a statin initiation intervention aimed at prescribers for Medicare Part D Medication Therapy Management Program (MTMP) members with diabetes or CAD and (2) estimate the potential cost savings associated with the projected reduction in CV events based on published controlled trials. Medicare Advantage Prescription Drug (MA-PD) and prescription drug plan (PDP) members of a pharmacy benefits manager (PBM) were identified for the intervention who (1) met the criteria for MTMP (expected to incur at least dollars 4,000 in annual pharmacy expenditures for Part D-covered medications, filled at least 10 distinct Part D-covered medications, and had at least 3 of 5 chronic diseases of interest); (2) were identified as having diabetes or CAD (patients with a history of MI were considered to have CAD); and (3) had no pharmacy claims for a statin between January and June 2006. In August 2006, the primary prescribers for antidiabetic or CV medications of 1,144 identified members were sent educational materials and a report listing their patients with diabetes or CAD who were not receiving statin therapy. A comparison group of MA-PD members (N = 700) with diabetes or CAD was identified who did not receive the intervention but who met all of the MTMP criteria except the presence of at least 3 of 5 chronic diseases of interest. Logistic regression was conducted to evaluate the intervention effectiveness after adjusting for age, gender, geography, and chronic disease score. To determine the implications of this intervention for routine practice, outcome measures included estimates of (1) the number of patient interventions necessary to prevent 1 major CV event and (2) the coronary event costs avoided by the intervention. The number of interventions necessary to prevent 1 major CV event was estimated by (1) calculating the number of members requiring interventions in order for 1 member to initiate statin therapy, based on the present study's findings, and then (2) calculating the number of statin initiations necessary to avoid a major CV event, based on clinical trial estimates of the effect of statin treatment on CV event rates. During the 4-month period following the intervention, 12.1% (n = 138) of the intervention members started a statin medication compared with 7.3% (n =51) of comparison members (P = 0.001). After covariate adjustment, the odds of initiating a statin medication were 65% higher (adjusted odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.15-2.36; P = 0.006) in the intervention than in the comparison group. The estimated number of members requiring interventions to prevent 1 major CV event was 220. The estimated coronary event cost avoidance is dollars 12,323 per 220 members who received the intervention, after subtraction of program administrative costs and the cost of statin drug therapy. A statin initiation intervention aimed at prescribers for MA-PD and PDP members with diabetes or CAD who qualified for MTMP services was successful in increasing statin use among this group of members at high risk for CV events.
    Journal of managed care pharmacy: JMCP 01/2008; 14(6):532-40. · 2.41 Impact Factor