BACKGROUND: Multi-tier copayment designs in pharmacy benefit plans are intended to steer patients and prescribers to preferred drug therapies that have lower out-of-pocket costs for patients.OBJECTIVE: To describe and assess physicians' prescribing experiences and opinions in a multi-tier, primarily 3-tier formulary environment in 2 Midwestern states.METHODS: This was a cross-sectional survey of physicians practicing in either Minnesota or North Dakota. A packet consisting of a survey instrument, a cover letter, and a postage-paid return envelope was mailed to a random sample of 690 physician members of the Minnesota Medical Assoc iation (n = 460, 5.1% of members) or the North Dakota Medical Association (n = 230, 25.6% of members). Surveys were mailed between March and May 2006. Nonresponders were mailed up to 2 additional surveys. Survey items included practice specialty, sources used to obtain drug information, perceived importance of cost containment actions (e.g., prescribing drug with lowest total cost, prescribing drug that minimizes patient out-of-pocket cost), and how often the physician was personally aware of the following when writing a prescription: identity of the patient's insurer, patient's pharmacy benefit structure, preferred medications on the insurer's formulary, patient's copayment (out-of-pocket cost) responsibility, and list price of the medication.RESULTS: The survey response rate was 49.8% (296 of 594). The results were as follows: 93.5% of respondents agreed that it was important to prescribe the drug that would minimize the patient's out-of-pocket costs, 73.2% agreed that it was important to discuss out-of-pocket medication costs with patients, 81.8% of respondents agreed that it was important to prescribe the drug with the lowest total costs, and 33.3% of respondents believed that it was their responsibility to prescribe a preferred (formulary) medication. According to the survey, 61.6% of respondents were rarely or never aware of their patient's copayment amounts, and 42.4% were rarely or never aware of the list price of the medication. Physician specialty was associated with the awareness of the identity of the patient's insurer (generalists, 41.1% vs. specialists, 19.2%; P = 0.001) and use of personal digital assistant (PDA) when prescribing (generalists, 38.9% vs. specialists, 21.1%; P = 0.005).CONCLUSION: Physicians who responded to this survey believed that it was important to prescribe drugs that would minimize patients' prescription copayments, but they were often unaware of the preferred medications on the formulary, the patients' copayment amounts, or the price of the drugs prescribed.
VR counselors should be aware that although most applicants with psychiatric disabilities place a great deal of importance on being employed, they face additional barriers to employment. (PsycINFO Database Record
Children in food insecure households were less likely to be physically active and to eat breakfast at home. However, the school breakfast program is negating any difference between the 2 groups in terms of eating breakfast at all. We consider this a success given the short- and long-term implications of food insecurity in children. We believe these findings have important implications for schools, policy makers, and programs to reduce food insecurity.
Objective-To describe the effect of the Vermont Diabetes Information System (VDIS) on hospital and emergency room use Data Source-Statewide discharge databaseStudy Design-Randomized controlled trial of a decision support system for 7,412 adults with diabetes and their 64 primary care providers.Data Collection/ Data Extraction-Charges and dates for hospital admissions and emergency room care in Vermont during an average of 32 months of observation. Data from New York hospitals were not available.Principal Findings-Patients randomized to VDIS were admitted to the hospital less often than control subjects (0.17 admissions vs. 0.20; P=0.01) and generated lower hospital charges ($3,113 vs. $3,480; P=0.019). VDIS patients also had lower emergency room utilization (0.27 visits vs. 0.36; P<0.0001) and charges ($304 vs. $414; P<0.0001). The intervention was particularly effective in men and in older subjects.Conclusions-In spite of data limitations that tended to reduce the apparent effect of the system; this randomized, controlled trial showed that VDIS reduces hospitalization and emergency room utilization and expenses. © 2010 Elsevier Inc. All rights reserved.Correspondence to: Shamima Khan. Conflict of interest: Drs. MacLean and Littenberg, along with the University of Vermont, hold equity in Vermedx, Inc. which distributes the Vermedx® Diabetes Information System, which is based on the work described in this manuscript. The authors comply with all conflict of interest policies of the National Institutes of Health and of the University of Vermont.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. VDIS uses the Chronic Care Model as an organizing framework with daily data feeds from otherwise independent laboratories, automatic test interpretation using algorithms based on consensus guidelines, use of fax and mail to report to providers and patients not easily reached by electronic networks, and report formats that are accessible and useful to patients and providers. The primary function of the system is to collect pertinent clinical information (hemoglobin A1C, cholesterol, serum creatinine, and urine protein results) and generate five types of reports: flow sheets to providers with accurate and timely laboratory results, reminders of overdue laboratory tests to providers, overdue reminders to patients, alerts to patients with elevated test results, and summary population reports for providers regarding their diabetes roster.4 -5The intervention has been described in detail elsewhere, along with a prospective, clusterrandomized clinical trial in which 7,412 patients and ...
Objective Assess the effect of a 50% discount on fruits and vegetables (F&V) on the purchase and intake of F&V and on psychosocial determinants of F&V intake: self-efficacy (SE), stages of change (SOC), and perceived barriers (PB). Methods This randomized controlled trial was conducted in local supermarkets over 16-weeks, including a 4-week baseline, 8-week discount intervention, and 4-week follow-up. Shoppers with overweight or obesity (BMI>25) were randomized to receive a discount or no discount via their reward scan card after the baseline. Twenty-four hour recalls and psychosocial measures were obtained for each study period. Results Purchases (p<0.0005) and intakes of F&V (p = 0.019) increased significantly during the intervention, only F&V intake was sustained at follow-up. The discount intervention increased SE (p<0.01) and SOC (p<0.05), and did not decrease PB (p = 0.057), during the intervention. SOC mediated the discount intervention effect on F&V intake (p<0.05) during the intervention, explaining 43% of variance. Conclusion A supermarket discount intervention led to increases in purchases and intakes of F&V, and the psychosocial factors SE and SOC, and did not decrease PB. The discount intervention prompted participants to move from the preparation to action stage of SOC, which acted as a mediator for increased F&V intake.
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