BackgroundChronic obstructive pulmonary disease (COPD) is the fourth leading cause of death among US adults and is projected to be the third by 2020. In anticipation of the increasing burden imposed on healthcare systems and payers by patients with COPD, a means of identifying COPD patients who incur higher healthcare utilization and costs is needed.MethodsThis retrospective, cross-sectional analysis of US managed care administrative claims data describes a practical way to identify COPD patients. We analyze 7.79 million members for potential inclusion in the COPD cohort, who were continuously eligible during a 1-year study period. A younger commercial population (7.7 million) is compared with an older Medicare population (0.115 million). We outline a novel approach to stratifying COPD patients using "complexity" of illness, based on occurrence of claims for given comorbid conditions. Additionally, a unique algorithm was developed to identify and stratify COPD exacerbations using claims data.ResultsA total of 42,565 commercial (median age 56 years; 51.4% female) and 8507 Medicare patients (median 75 years; 53.1% female) were identified as having COPD. Important differences were observed in comorbidities between the younger commercial versus the older Medicare population. Stratifying by complexity, 45.0%, 33.6%, and 21.4% of commercial patients and 36.6%, 35.8%, and 27.6% of older patients were low, moderate, and high, respectively. A higher proportion of patients with high complexity disease experienced multiple (≥2) exacerbations (61.7% commercial; 49.0% Medicare) than patients with moderate- (56.9%; 41.6%), or low-complexity disease (33.4%; 20.5%). Utilization of healthcare services also increased with an increase in complexity.ConclusionIn patients with COPD identified from Medicare or commercial claims data, there is a relationship between complexity as determined by pulmonary and non-pulmonary comorbid conditions and the prevalence of exacerbations and utilization of healthcare services. Identification of COPD patients at highest risk of exacerbations using complexity stratification may facilitate improved disease management by targeting those most in need of treatment.

The pooled analysis of two double-blind, randomized, multicenter, phase-3 studies evaluated predictors of improvement or worsening of schizophrenia-related caregiver burden following paliperidone palmitate long-acting injectables (1-monthly [PP1M] and 3-monthly [PP3M]) treatment. Caregivers were offered to complete the involvement evaluation questionnaire (involvement evaluation questionnaire; 31-item scale). Total, 1498 caregivers (intent-to-treat open-label analysis set, n = 1497; mean [SD] age: 51.5 [13.02] years, 27 countries) were included: 49% were parents and >50% caregivers spent >32 hours/week in caregiving. Majority of caregivers with considerable burden (n = 1405; mean [SD] baseline involvement evaluation questionnaire scores: 28.4 [15.07]) improved significantly from baseline to end-of-study (n = 756; mean [SD] change from open-label baseline to double-blind endpoint in long-acting injectable scores:−8.9 [14.73]); most improvements were seen in urging followed by worrying, tension, and supervision domains (mean [SD] change from open-label baseline to double-blind endpoint in involvement evaluation questionnaire scores, urging: −3.7 [6.45]; worrying:−2.6 [5.11]; tension:−2.3 [4.84]; supervision: −1.3 [3.69]). Improvements significantly correlated with relapse status, patient age, and age of diagnosis (p < 0.001) while long-acting injectable use at baseline, number, and duration of prior psychiatric hospitalizations (<24 months) had no significant correlation. Caregiver burden was significantly improved for patients on prior oral antipsychotics post-switching to long-acting injectable, with less impact on leisure days and hours spent in caregiving (p < 0.001). Family members of patients with schizophrenia experience considerable caregiver burden. Switching from oral antipsychotic to long-acting injectable can provide meaningful and significant improvement in caregiver burden.

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In both trials, most patients were unemployed and not seeking work or were retired at open-label baseline, and only a small number of patients changed their occupational status during the trials. In trial 3012, subjects who received placebo had significantly higher odds of hospitalization for either psychiatric and social reasons or for psychiatric reasons alone compared with subjects who received PP3M. In contrast, in trial 3011, the odds of hospitalizations were not significantly different between PP3M and PP1M.

Referral-level medicine is important in the veterinary curriculum, however veterinary students also need a solid base knowledge of clinically relevant, routine surgical and diagnostic skills to be clinically prepared after graduation. Exposure to a referral-only, or primarily referral caseload, does not always provide veterinary students with the routine hands-on experiences and competencies expected by the American Veterinary Medical Association Council on Education, the Royal College of Veterinary Surgeons, the Australian Veterinary Boards Council, or prospective employers. The aim of this descriptive study was to assess how a shelter medicine program can fill the companion animal caseload gap and create the necessary hands-on experiences considered essential in the veterinary curriculum. Pedagogical frameworks, course curriculum and design, student experiences, and student assessments were described for three core curricular areas (surgery, medical days, population medicine) of the Shelter Medicine Program at Mississippi State University. The shelter surgery experience provided a high-quality, high-volume spay/neuter environment where fourth-year students averaged 65 sterilization surgeries in two weeks and demonstrated a quantifiable decrease in surgical time. The shelter surgery experience added on average 9,000 small animal cases per year to the overall hospital caseload. Shelter medical days, where students provide veterinary care during on-site shelter visits, created opportunities for third-year students to directly interact with shelter animals by performing physical examinations and diagnostic testing, and to gain experience in developing treatment protocols and recommendations for commonly encountered problems. The shelter medical days experience averaged over 700 small animal cases per year and over 1,500 diagnostic procedures. Finally, students participated in 15 onsite shelter consultations where they obtained a working knowledge of biosecurity at a population level, including how to minimize the risk of infectious diseases spreading to healthy populations. Despite several challenges, results from this curricular program assessment support the aim that animal shelters and humane organizations offer opportunities that can be mutually beneficial for both animal organizations and veterinary students. The primary care caseload for the teaching institution was positively impacted, and students were better prepared to meet potential employers’ expectations and fulfill required core competencies in veterinary medical education.