BACKGROUND: Several disease-specific information exchanges now exist on Facebook and other online social networking sites. These new sources of knowledge, support, and engagement have become important for patients living with chronic disease, yet the quality and content of the information provided in these digital arenas are poorly understood. OBJECTIVE: To qualitatively evaluate the content of communication in Facebook communities dedicated to diabetes. DESIGN: We identified the 15 largest Facebook groups focused on diabetes management. For each group, we downloaded the 15 most recent "wall posts" and the 15 most recent discussion topics from the 10 largest groups. PATIENTS: Four hundred eighty unique users were identified in a series of 690 comments from wall posts and discussion topics. MAIN MEASURES: Posts were abstracted and aggregated into a database. Two investigators evaluated the posts, developed a thematic coding scheme, and applied codes to the data. KEY RESULTS: Patients with diabetes, family members, and their friends use Facebook to share personal clinical information, to request disease-specific guidance and feedback, and to receive emotional support. Approximately two-thirds of posts included unsolicited sharing of diabetes management strategies, over 13% of posts provided specific feedback to information requested by other users, and almost 29% of posts featured an effort by the poster to provide emotional support to others as members of a community. Approximately 27% of posts featured some type of promotional activity, generally presented as testimonials advertising non-FDA approved, "natural" products. Clinically inaccurate recommendations were infrequent, but were usually associated with promotion of a specific product or service. Thirteen percent of posts contained requests for personal information from Facebook participants. CONCLUSIONS: Facebook provides a forum for reporting personal experiences, asking questions, and receiving direct feedback for people living with diabetes. However, promotional activity and personal data collection are also common, with no accountability or checks for authenticity.KEY WORDS: social networks; online social media; information seeking behavior; Facebook; diabetes; disease management. J Gen Intern Med 26(3):287-92

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Medicare Part D was implemented 4 years ago. Despite the fact that public-use Part D data were unavailable until late 2008, researchers have used alternate data to examine Part D's impact on drug utilization and out-of-pocket costs. In a systematic review of Medline from 2006 – October 2009, we sought to summarize the literature about drug use and costs after implementation and during the transition period and coverage gap. We included studies presenting original results regarding drug utilization and costs following Part D implementation. Case reports and series and simulation studies were excluded. Of 552 originally identified articles, 26 met selection criteria: 13 regarding Part D's overall impact in the year(s) following implementation, 7 describing the Part D transition period, and 6 concerning the coverage gap. Part D implementation was associated with a 6-13% increase in drug utilization and a 13-18% decrease in patients' costs. The transition period was associated with no significant changes in utilization or costs for elderly dual-eligible beneficiaries, but effects in other populations were mixed. Entry into the coverage gap was associated with a 9-16% decrease in drug utilization and increases in costs of up to 89%. In summary, studies examining disparate data associated Part D's implementation found consistent positive effects on drug utilization and costs but revealed unfavorable trends in the coverage gap. The effect of the Part D transition period remains unclear. While public-use data will validate these results, policymakers can use the existing evidence to inform changes and enhancements to Part D immediately.