Interventions designed to improve the quality and efficiency of medication use in managed care: A critical review of the literature – 2001–2007

Lu, Christine Y.; Ross‐Degnan, Dennis; Soumerai, Stephen B.; Pearson, Sallie‐Anne

doi:10.1186/1472-6963-8-75

Cited by 119 publications

(127 citation statements)

References 70 publications

(105 reference statements)

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“…45,46 There has also been 48 explored the use of financial incentives to increase adherence to warfarin. Although changes in co-payment amounts have been found to affect adherence, these studies 15,49 have been primarily studies of trends over time, not studies of individual patients.…”

Section: Discussionmentioning

confidence: 99%

Association Between Prescription Co-Payment Amount and Compliance With Adjuvant Hormonal Therapy in Women With Early-Stage Breast Cancer

Neugut

Subar

Wilde

et al. 2011

JCO

310

244

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A B S T R A C T PurposeNoncompliance with adjuvant hormonal therapy among women with breast cancer is common. Little is known about the impact of financial factors, such as co-payments, on noncompliance. Patients and MethodsWe conducted a retrospective cohort study by using the pharmacy and medical claims database at Medco Health Solutions. Women older than age 50 years who were taking aromatase inhibitors (AIs) for resected breast cancer with two or more mail-order prescriptions, from January 1, 2007, to December 31, 2008, were identified. Patients who were eligible for Medicare were analyzed separately. Nonpersistence was defined as a prescription supply gap of more than 45 days without subsequent refill. Nonadherence was defined as a medication possession ratio less than 80% of eligible days. ResultsOf 8,110 women younger than age 65 years, 1,721 (21.1%) were nonpersistent and 863 (10.6%) were nonadherent. Among 14,050 women age 65 years or older, 3,476 (24.7%) were nonpersistent and 1,248 (8.9%) were nonadherent. In a multivariate analysis, nonpersistence (ever/never) in both age groups was associated with older age, having a non-oncologist write the prescription, and having a higher number of other prescriptions. Compared with a co-payment of less than $30, a co-payment of $30 to $89.99 for a 90-day prescription was associated with less persistence in women age 65 years or older (odds ratio [OR], 0.69; 95% CI, 0.62 to 0.75) but not among women younger than age 65, although a co-payment of more than $90 was associated with less persistence both in women younger than age 65 (OR, 0.82; 95% CI, 0.72 to 0.94) and those age 65 years or older (OR, 0.72; 95% CI, 0.65 to 0.80). Similar results were seen with nonadherence. ConclusionWe found that higher prescription co-payments were associated with both nonpersistence and nonadherence to AIs. This relationship was stronger in older women. Because noncompliance is associated with worse outcomes, future policy efforts should be directed toward interventions that would help patients with financial difficulties obtain life-saving medications.

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Section: Discussionmentioning

confidence: 99%

Association Between Prescription Co-Payment Amount and Compliance With Adjuvant Hormonal Therapy in Women With Early-Stage Breast Cancer

Neugut

Subar

Wilde

et al. 2011

JCO

310

244

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“…A treatment is considered appropriate when there is clear evidence to support its use for the given indication, it is well tolerated and has a favorable cost-effectiveness profile [13]. Inappropriate prescribing also includes the use of drugs with incorrect duration, drug interactions and duplications [14].…”

Section: Discussionmentioning

confidence: 99%

Cost analysis of inappropriate treatments for suspected dermatomycoses

Fiammenghi¹,

Patalano²,

Conte³

et al. 2015

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Superficial mycoses are estimated to affect more than 20-25% of the world's population with a consistent increase over the years. Most patients referred to our clinic for suspected dermatomycoses have already been treated with pharmacotherapy, without a previous mycological examination and many show changes in the clinical manifestations. Indeed, some medications, such as steroids, antiviral, antibiotics and antihistamines are not able to erase a fungal infection, but also they can cause atypical clinical manifestations. The consequences of inappropriate treatment include delayed diagnosis, prolonged healing time, and additional costs. The aims of this study were (1) to evaluate the incidence of increased costs attributable to inappropriate therapy sustained by the National Health Service and patients and (2) to highlight the importance of mycological evaluation before starting treatment, in order to improve diagnostic accuracy. An observational retrospective and prospective study was performed from September 2013 to February 2014, in 765 patients referred to our center (University Hospital " Federico II") in Naples, Italy, for suspected mycological infection. The following treatments (alone or in combination) were defined as inappropriate: (1) cortisone in a patient with at least one positive site; (2) antifungals in (a) patients with all negative sites or (b) ineffective antifungal treatment (in terms of drug chosen, dose or duration) in those with all positive sites; or (3) antibiotics; (4) antivirals or (5) antihistamines, in patients with ≥ 1 positive site. Five hundred and fifty patients were using medications before the assessment visit. The total amount of avoidable costs related to inappropriate previous treatments was € 121,417, representing 74% of the total treatment costs. 253/550 patients received drugs also after the visit. For these patients, the cost of treatment prescribed after mycological testing was € 42,952, with a decrease with respect to the total consumption of drugs at the time of access to the Mycology Laboratory of € 34,781. Thus, our cost analysis shows that it is important to obtain a reduction of costs for pathologies that need to be confirmed by examinations before starting treatment.

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“…We identified literature from a PubMed search, a targeted scan of managed care journals, and a scan of the bibliographies of 6 review articles on managed care pharmacy interventions. [1][2][3][4][5][6] We reviewed and rated a total of 62 unique articles, representing studies on tiered formularies (n = 27), PA (n = 9), step therapy (n = 7), Several studies found a decrease in the MCO's prescription drug spending for specific drugs in multi-tiered formularies or when switched to multi-tiered formularies or, conversely, an increase in prescription drug spending with a switch from a multi-tiered formulary to a 1-tier formulary. [8][9][10]15,17 Similarly, Joyce et al (2002) found that spending was lower among higher cost-sharing plans compared with lower cost-sharing plans.…”

Section: ■■ Methodsmentioning

confidence: 99%

“…The bibliographies of 6 review articles were scanned for relevant articles on the select interventions and met the selection criteria. [1][2][3][4][5][6] Across the 6 review articles, there were approximately 250 unique articles on various managed care pharmacy interven-S18 Supplement to Journal of Managed Care Pharmacy JMCP July 2010 Vol. 16, No.…”

Section: Targeted Search Of Relevant Journalsmentioning

confidence: 99%

Effect of 6 Managed Care Pharmacy Tools: A Review of the Literature

2010

JMCP

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Interventions designed to improve the quality and efficiency of medication use in managed care: A critical review of the literature – 2001–2007

Cited by 119 publications

References 70 publications

Association Between Prescription Co-Payment Amount and Compliance With Adjuvant Hormonal Therapy in Women With Early-Stage Breast Cancer

Association Between Prescription Co-Payment Amount and Compliance With Adjuvant Hormonal Therapy in Women With Early-Stage Breast Cancer

Cost analysis of inappropriate treatments for suspected dermatomycoses

Effect of 6 Managed Care Pharmacy Tools: A Review of the Literature

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