No abstract

OBJECTIVE: Successful colorectal cancer screening relies in part on physicians ordering a complete diagnostic evaluation of the colon (CDE) with colonoscopy or barium enema plus sigmoidoscopy after a positive screening fecal occult blood test (FOBT). DESIGN:We surveyed primary care physicians about colorectal cancer screening practices, beliefs, and intentions. At least 1 physician responded in 318 of 413 (77%) primary care practices that were affiliated with a managed care organization offering a mailed FOBT program for patients aged 50 years. Of these 318 practices, 212 (67%) had 602 FOBT+ patients from August through November 1998. We studied 184 (87%) of these 212 practices with 490 FOBT+ patients after excluding those judged ineligible for a CDE or without demographic data. Three months after notification of the FOBT+ result, physicians were asked on audit forms if they had ordered CDEs for study patients. Patient-and physicianpredictors of ordering CDEs were identified using logistic regression. MEASUREMENTS AND MAIN RESULTS:A CDE was ordered for only 69.5% of 490 FOBT+ patients. After adjustment, women were less likely to have had CDE initiated than men (adjusted odds, 0.66; confidence interval, 0.44 to 0.97). Physician survey responses indicating intermediate or high intention to evaluate a FOBT+ patient with a CDE were associated with nearly 2-fold greater adjusted odds of actually initiating a CDE in this circumstance versus physicians with a low intention.CONCLUSIONS: Primary care physicians often fail to order CDE for FOBT+ patients. A CDE was less likely to be ordered for women and was influenced by physician's beliefs about CDEs.KEY WORDS: colorectal neoplasms; primary health care; occult blood; mass screening; attitude of health personnel.

In sum, economic factors appeared to play an important role in medication decisions by the elderly. The magnitude of the impact was sufficiently high that it could have major negative consequences on the health of elderly persons who are poor and lack drug coverage.

The aim was to evaluate the impact of a multifaceted set of medication management interventions offered by a community pharmacy on adherence, health care utilization, and costs within a commercial population. Patients initiating therapy within 16 drug classes from February 7, 2013, to October 6, 2013, were offered various adherence interventions by Walgreens pharmacy. Patients were linked deterministically to IMS medical and prescription databases for 6-month pre- and post-index data analysis. Walgreens patients (intervention) were matched to patients using other pharmacies (control) on drug class, index date, baseline demographics, clinical factors, utilization, and costs. Outcomes were evaluated at the intent-to-treat level using post-index differences and generalized estimating equations (GEE) regression model. Paired t tests (continuous variables) and McNemar's test (dichotomous variables) were used to determine the significance of estimated model coefficients at α = 0.05. The groups (n = 72,410 each) had similar age (47.1 vs. 45.7 years), sex (41.2% vs. 40.2% male), and disease burden (0.52 vs. 0.40 mean Charlson comorbidity index). In the 6-month post-index period, the intervention group had 3.0% greater medication adherence, 1.8% fewer hospital admissions, 2.7% fewer emergency room (ER) visits, and 0.53 fewer mean outpatient visits compared to the control group (all P < 0.0001). The intervention group incurred significantly lower GEE-adjusted pharmacy costs (−$92), outpatient costs (−$120), ER costs (−$38), and total health care costs (−$226.07) (all P < 0.0001), and higher inpatient costs ($86, P < 0.004) per patient. A multifaceted set of medication management interventions offered by a community pharmacy were associated with patients in a commercial population having significantly higher medication adherence and lower health care utilization and costs.