ObjectiveNon-personal promotion (NPP) such as digital, print-based marketing, direct promotional visits and free drug samples are means of pharmaceutical marketing. This study described practices of drug information, pharmaceutical detailing and engagement with NPP at an integrated network of providers.DesignThis was a sequential explanatory mixed-methods study. A survey was followed by semistructured interviews. The questionnaire elicited preferred sources of drug information, management of drug information and perceptions on drug samples, coupons and pharmaceutical representative visits. Interviews were audio-recorded and transcribed. Data were analysed using descriptive statistics (quantitative) and content analysis (qualitative).SettingFace-to-face or telephonic interviews were conducted at a large physicians network in Northern Kentucky.ParticipantsEighty-two medical assistants, primary care, specialty providers and other office staff who completed the survey and 16 interviewees.ResultsMost respondents were women (79.3%), office managers (26.8%) and individuals employed for 15 years or longer within the organisation (30.5%). Most participants (85.3%) indicated that pharmaceutical representative visits are the most common source of drug information. Paper-based material was the most frequent form in which information was received in physician offices (62.2%). Medical assistants were usually responsible for handling drug information (46.3%) on arrival in the office, compared with 15.3% of physicians. Drug representative detailing and lunches (62.2%) were the desired method of drug information communication followed by electronic mail or e-journals (11%). Interviewees generated three themes that described pharmaceutical representative visits and interactions with prescriber and non-prescriber personnel in the offices.ConclusionsWe found significant involvement of non-prescriber personnel in drug information management at primary and specialty care offices. Participants perceived that pharmaceutical representatives have an important role in keeping the offices informed and supplied with relevant drug information, coupons and samples. Findings highlight the importance of engaging prescriber and non-prescriber personnel to guarantee relevant information reaches providers.
Background: Health-Related Social Needs (HRSN) are unmet person-level social and economic challenges, such as food and housing insecurity, that potentially impact health outcomes. Evidence of HRSN burden in cancer survivors is limited and differences across age groups largely unexplored. Our goal is to estimate the prevalence of HRSN among cancer survivors across age groups and explore associated factors in a nationally representative sample. Methods: A cross-sectional cohort of cancer survivors, 18 years and older, was identified from the National Health Interview Survey (NHIS), 2016-2018. Survivorship (i.e., time since cancer diagnosis) was assessed at the time of the survey. Key needs for cancer survivors (food insecurity, transportation needs, inability to pay for utilities, inability to pay for housing, and inability to pay for healthcare needs) were used in this analysis. Individuals report their current experience with needs at the time of the survey. Prevalence rates were estimated as the proportion of cancer survivors with a given need within each of the five key needs. A measure of HRSN was developed to indicate whether an individual experienced at least one or more HRSN (any HRSN). Multivariable logistic regression was used to explore the association between having any HRSN and current age (young [YA], 18-39y; middle age [MA], 40-64y; older adult [OA], >=65 y), key sociodemographic characteristics, age at cancer diagnosis, and survivorship. All estimates, including Odds Ratios (OR) and 95% confidence intervals (CI), were weighted to represent the US census-based population. Results: We identified 7,179 cancer survivors, 44.9% under 65 years old, 59.1% female, 85.9% White. Overall, 44.8% reported experiencing any HRSN at any time during survivorship, with 21.4% experiencing any HRSN in their first two years after cancer diagnosis. Inability to pay for utilities was the most prevalent need, with differences across age groups (40.7% YA, 33.4% MA, 17.2% OA). Higher inability to pay for housing was reported among YA (28.64%) than MA (25.9%) or OA (11.9%). There were no differences in reported food insecurity across age groups (YA 16.2%, MA 16.5%, OA 16.5%). When compared to OA, YA (OR 1.77, CI 1.24-2.60) and MA (OR 1.74, CI 1.49-2.01) had higher odds of having any HRSN. Key factors associated with higher odds of any HRSN include being non-White (OR 1.42, CI 1.16-1.74), Hispanic (OR 1.46, CI 1.08-1.98), female (OR 1.31, CI 1.14-1.51), or being diagnosed with cancer during childhood (OR 1.62, CI 1.04-2.52) or young adulthood (OR 1.65, CI 1.29-2.23). Conclusion: HRSN are prevalent throughout cancer survivorship. Our findings show that young and middle age are more likely than older adults to experience HRSN at any point during survivorship. Further exploration of pathways leading to unmet needs is needed to address inequalities and improve survivorship care across age groups. Citation Format: Wendy Camelo Castillo, Udim Damachi, Phuong Tran, Christabel K. Cheung, Ester Villalonga-Olives, Eberechukwu Onukwugha. Differences in health-related social needs between younger and older cancer survivors in a United States representative sample, 2016-2018 [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B097.
from the patients' medical records. The data were analyzed using SPSS version 20. A binary logistic regression model was used to check the effect of different factors on the patients' adherence level. Results: Of 310 study participants only 22.3 % (95% CI, 17.4%-26.8%) of heart failure patients reported good adherence to their self-care recommendations. Adherence to self-care recommendation was positively associated with being male in gender (AOR=2.34, 95% CI: 1.18-4.62), good level of heart failure knowledge (AOR =2.49, 95% CI: 1.276-4.856) and absence of chronic comorbid diseases (AOR =2.57, 95% CI: 1.28-5.14). Conclusions: Overall, heart failure patients' adherence to self-care recommendation is poor and selective. Being male in gender, the absence of chronic comorbidity, and a good level of heart failure knowledge were positively associated with adherence to self-care recommendations. It is therefore strategic to plan improving heart failure patients' knowledge about heart failure signs, symptoms and its management, to improve the patients' adherence level.
Objectives: This study evaluates the budgetary impact of adding ibalizumab, a recently approved, long-acting post-attachment HIV-1 inhibitor to a United States (US) Medicare health plan for the treatment of multidrug-resistant (MDR) HIV-1 infection. Methods: A budget-impact model with an underlying Markov structure was developed to estimate the economic impact of including ibalizumab on a hypothetical Medicare plan with 1 million members. The model compares costs over a 3-year period for two scenarios: with and without ibalizumab included on the formulary as an add-on to optimized background therapy. Model inputs were based on ibalizumab clinical trial data, market uptake projections (5%, 10%, 15%), and published literature, with costs in 2019 US dollars. The model estimates the number of treatment-eligible beneficiaries with MDR HIV-1 infection, total annual and per-member per-month (PMPM) costs for each scenario, and the incremental budget impact. Key input parameters were tested in scenario analyses. Results: In year 1, approximately 62.6 Medicare beneficiaries with MDR HIV-1 are expected to be treated with antiretroviral therapy.
e18890 Background: For middle-aged adults taking antidepressants before cancer diagnosis, concerns exist about drug-drug interactions between antidepressants and antineoplastics. Clinical guidelines recommend detailed assessment of the new cancer survivor's past history of antidepressant use before considering antidepressant discontinuation. We aimed to determine whether, in real-world settings, the risk of antidepressant discontinuation after cancer diagnosis is associated with survivors’ past antidepressant adherence trajectories. Methods: A retrospective cohort of 45 to 64-year old individuals with incident cancer diagnosis (index date) and ≥2 antidepressant fills in the 9 months before index date, IQVIA PharMetrics Plus for Academics claims, 2006-2020. Antidepressant adherence in the 9-month baseline was measured as monthly proportion of days covered (PDC) before tamoxifen initiation. Group-based trajectory modeling (GBTM) was used to identify clusters of survivors with distinct antidepressant adherence trajectories pre-index date i.e., we calculated polynomial functions of monthly PDCs and compared 2 to 6-group finite mixture models to determine which model best fit the data, based on the Bayesian Information Criterion, expert-adjudged parsimony and ≥10% of the sample in each trajectory group. Antidepressant discontinuation after cancer diagnosis was defined as a 45-day gap in antidepressant supply. Survivors were censored at first of either antidepressant discontinuation, loss of enrollment or 1 year post-index date. Cox regression compared the hazard of antidepressant discontinuation by trajectory group, adjusted for demographics, mental disorder and cancer type. Results: We identified 7,293 middle-aged cancer survivors with prior antidepressant use; females 72%, mean age (SD) 56 (7) years. GBTM identified 4 adherence trajectory groups (consistently high, steady increase, declining, and recent start); metastatic cancer being characteristic of the latter 3 groups relative to the consistently high group. Antidepressant discontinuation was lowest in the consistently high group (26% [mean months-to-discontinuation: 9]) and highest in the declining (68% [5]) and recent start (51% [6]) groups, p < .01. Hazard ratios [95% CI] of discontinuation were significantly higher in the declining (2.7 [2.3 – 3.2]), recent start (1.9 [1.7 – 2.0]) and steady increase (1.5 [1.4 – 1.6]) groups, relative to the consistently high group. Conclusions: Middle-aged cancer survivors with past trajectories of consistently high adherence to antidepressants experience lower risk of antidepressant discontinuation after cancer diagnosis in real-world practice. However, concern remains about the unintended health outcomes of relatively higher antidepressant discontinuation among survivors diagnosed with metastatic cancer.
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