While diabetes is a common medical condition, the initial presentation of patients with diabetes may vary. In some cases, different types of infections or inflammatory conditions may prompt a patient to seek medical attention. Males may present to their primary care provider with a bothersome inflammation of the penis that may be the first recognition of previously undiagnosed diabetes. Balanitis is an inflammation of the glans of the penis that may prompt a patient to seek medical care. While there are several different causes of balanitis, underlying medical conditions such as uncontrolled diabetes have been associated with balanitis. The genital irritation prompts patients to seek medical evaluation, and at that point diabetes is diagnosed. It is important for pharmacists to recognize that balanitis is a potential though uncommon type of diabetes presentation. It is also important for pharmacists to review other aspects of diabetes care once a patient is diagnosed with diabetes.
In patients with Afib treated with direct oral anticoagulants who will have dermatologic surgery, the bleeding risk is usually low, whereas risk of a possible thromboembolic event is high, and antibiotic prophylaxis should be done to prevent infection.
e19235 Background: New developments in oncology therapy continue to grow in complexity, fueling a dramatically rising cost of care. Traditional care models present opportunities to streamline plan sponsor management efforts, expedite therapy, and improve health outcomes. Studies suggest adherence to evidence-based standards results in higher quality care. Current plan sponsor management platforms match medical policy to individual drugs, not to combination therapy regimens and lack real-time access to standard treatment guidelines. 70% of precertification requests are submitted via antiquated, cumbersome methods such as paper and fax. Methods: CVS Health/Aetna developed a comprehensive oncology solution featuring an enterprise web-based clinical decision support prior authorization tool (Novologix) at the regimen level to reduce administrative burden and support quality care. Novologix regimens were updated via collaboration with the National Comprehensive Cancer Network (NCCN) evidence-based guidelines. Groups also entered a value-based payment (VBP) model to help support quality of care by promoting adherence to NCCN guidelines when clinically appropriate and tool utilization. Eligible members were Commercial, fully-insured members newly diagnosed with breast, colorectal, or lung cancer. Providers were offered dedicated, individual training sessions to provide education on the Novologix tool. NCCN-aligned regimens requested through the platform were automatically certified. Any non-NCCN aligned regimens received accelerated medical review by a board-certified medical oncologist with the option for an external peer-to-peer review upon denial. Providers received ongoing quality and cost of care reporting. Results: Primary in progress. N of precertification requests submitted via Novologix ( 28 requests as of 1/23/2020) - (will include graph displaying N of requests by month). N of regimens submitted via Novologix that were automatically certified (46% as of 1/23). Avg turnaround times for modified regimen requests requiring clinical review (TBD). Avg % adherence to NCCN guidelines (100% as of 1/23/20) Secondary: Total cost of care (preliminary/other leading indicator). Conclusions: By engaging oncology practices through an enhanced payer-provider collaboration and implementing an automated regimen-level precertification process we can facilitate higher-quality oncology care. Future studies will be needed to measure the impact of this program on total cost of care.
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