surement with more than one endpoint is the generation of a cardinal index/score. Without the prioritization and weighting of multiple endpoints a deduction of recommendations might be questionable. METHODS: A pilot study was conducted to elicit patients' preferences about antiviral therapy of chronic hepatitis C. For the Discrete-Choice-Experiment (DCE), 7 attributes were selected with 3 Levels each. Therefore an orthogonal, balanced and efficient design was used and results were analysed with random effects logit models. RESULTS: Patients and experts prioritized the respective endpoints in almost the same order, but weighted them differently. Sustained-Virological-Response received the highest weight followed by frequency of application (patients) or duration of therapy (experts). CONCLUSIONS: Aim was to demonstrate how DCEs can be used to empirically determine which PREs should be included in the efficiency frontier analysis. Further it is demonstrated how such methods can be used to prioritize across such multiple efficiency frontiers. The survey demonstrated how DCEs could be used to empirically determine which PREs are important in antiviral treatment of chronic hepatitis C. The results could be used for the development of innovative therapeutic schemes and new drugs which could meet patients' needs. For IQWiG purposes the weights of PREs are included in the health economic evaluation. OBJECTIVES:To determine health care provider perceptions about timing of 'rapid' warfarin reversal-related patient care events using novel survey methodology. METHODS: Forty-eight adult and pediatric trauma centers were contacted to participate in a direct-to-provider (DTP) survey. Participants were asked to provide aggregate information about patients receiving fresh-frozen plasma (FFP) for acute warfarin reversal. RESULTS: Nineteen to 25 health care professionals from 18 centers provided information by survey. Average perceptions of time needed to infuse FFP under this setting (mean 4.6 hrs from time of triage; 95% CI 1.0 -8.2 hrs) are consistent with actual, published values. In contrast, average perceptions of time needed for initial International Normalized Ratio (INR) normalization using FFP (mean 5.8 hrs; 95% CI 2.8 -8.8 hrs) underestimate actual, published values by 6 -26 hrs. Health care providers perceived that relatively little cumulative time lapses (1.6 hrs, on the average) for completing the first FFP infusion. There is little perceived time lag between ordering and beginning the first FFP infusion (0.3 hrs, on the average), consistent with actual, published values. There is substantial reported time (an additional 3.0 hrs, on the average) needed to complete subsequent FFP infusions, amounting to 52% of all perceived time lapsing for initial INR normalization in this setting. CONCLUSIONS: DTP survey methodology appears to be an efficient method for gathering clinical information for research purposes. Healthcare providers may have perceptions that are different from published studies, including inaccurate percep...
Patients receiving oral bisphosphonates on a monthly basis showed higher rates of medication compliance compared to weekly dosing in our study. However, compliance with bisphosphonates among all new users was suboptimal, suggesting the need for improved strategies to enhance compliance with oral bisphosphonates in the US Military Health System.
A patient safety program with targeted pharmacy messaging reduced TF use among seemingly opioid-naïve patients in the MHS without disrupting treatment for patients whose rejections were overridden.
PDC). The outcome was adherence to AH drugs in the 6-month post-index period. Logistic regression analysis was conducted to explore the impact of CVD hospitalizations on changes in adherence to AH drugs. RESULTS: There were 1332 patients with AH drugs. Patients with a CVD hospitalization were 2.9 times (95% Confidence Interval: 2.1-3.9) more likely to be adherent in the 6-month post-index period compared to control patients. Among patients with a CVD hospitalization, the proportion of patients who were non-adherent to AH drugs in the 6-month post-index period was 30.6%. CONCLUSIONS: Patient adherence to AH drugs improved after a CVD hospitalization, but there was still a substantial proportion of patients who were non-adherent after that hospitalization. Counseling patients on medication adherence during their hospitalization may be an effective way for improving their adherence following discharge. OBJECTIVES:To estimate patient adherence with once-a-day (QD) vs. twice-a-day (BID) chronic medications following hospital discharge for ACS. METHODS: A retrospective cohort study of patients discharged between 1/1/2007 and 4/30/2009 with an ACS diagnosis was performed using a large hospital and pharmacy claims dataset. Two chronic medications dispensed for QD and BID utilization, carvedilol and metformin, were analyzed for adherence measures [persistency, days on therapy, compliance (medication possession ratio, MPR), total # of dispensed prescriptions, gap (days) between refills] over a 12 month post-index period. Included patients had first dispensed prescription of carvedilol or metformin within 60 days of discharge (index prescription) and had Rx activity for any drug Ն 12 months postindex. Persistence was defined as percentage of patients without a therapy lapse of Ͼ 30 days from last dispensed day's supply. RESULTS: Persistency with carvedilol QD vs. BID (Nϭ168 vs. 2086) at 6 months was 44.0% vs 43.7% and at 12 months was 24.4% vs. 25.5%. Persistency with metformin QD vs. BID (Nϭ136 vs. 614) at 6 months was 50.7% vs 53.7% and at 12 months was 28.7 vs. 35.0%. The average days on therapy for carvedilol QD vs. BID at 6 months was 120.5 vs. 121.9 and at 12 months was 196.7 vs. 203.0. Average days on therapy for metformin QD vs. BID at 6 months was 123.6 vs. 136.2 and at 12 months was 206.1 vs. 237.7. Compliance (MPR) with QD vs. BID carvedilol at 12 months was 84.2% vs 80.7% and for metformin was 77.6% vs 81.6%. Additional adherence metrics were consistent for QD vs. BID dosing. CONCLUSIONS: In ACS patients, no clinically meaningful differences on adherence measures were observed between QD versus BID dosing formulations over a 12 month follow-up period. Results indicate potential opportunities to improve persistency with chronic therapies in ACS patients.
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