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Biomedical subjects

Chien-Wen Tseng

Publications and source records attributed to Chien-Wen Tseng.

10 recordsLinked to original sources
PubMed2006

Who is tested for diabetic kidney disease and who initiates treatment? The Translating Research Into Action For Diabetes (TRIAD) Study.

OBJECTIVE: We examined factors associated with screening for albuminuria and initiation of ACE inhibitor or angiotensin receptor blocker (ARB) treatment in diabetic patients. RESEARCH DESIGN AND METHODS: We conducted surveys and medical record reviews for 5,378 patients participating in a study of diabetes care in managed care at baseline (2000-2001) and follow-up (2002-2003). Factors associated with testing for albuminuria were examined in cross-sectional analysis at baseline. Factors associated with initiating ACE inhibitor/ARB therapy were determined prospectively. RESULTS: At baseline, 52% of patients not receiving ACE inhibitor/ARB therapy and without known diabetic kidney disease (DKD) were screened for albuminuria. Patients > or =65 years of age, those with higher HbA(1c), those with cardiovascular disease (CVD), and those without hyperlipidemia were less likely to be screened. Of the patients with positive screening tests, 47% began ACE inhibitor/ARB therapy. Initiation of therapy was associated with positive screening test results, BMI > or =25 kg/m(2), treatment with insulin or oral antidiabetic agents, peripheral neuropathy, systolic blood pressure > or =140 mmHg, and CVD. Of the patients receiving ACE inhibitor/ARB therapy or with known DKD, 63% were tested for albuminuria. CONCLUSIONS: Screening for albuminuria was inadequate, especially in older patients or those with competing medical concerns. The value of screening could be increased if more patients with positive screening tests initiated ACE inhibitor/ARB therapy. The efficiency of screening could be improved by limiting screening to diabetic patients not receiving ACE inhibitor/ARB therapy and without known DKD.

Albuminuria↗
PubMed2006

Effect of generic-only drug benefits on seniors' medication use and financial burden.

BACKGROUND: Generic-only drug benefits are a way to provide some coverage, as opposed to no coverage. OBJECTIVE: To examine how switching from brand name to generic-only drug coverage affected seniors' medication use and financial burden. STUDY DESIGN: Data are from a 2002 cross-sectional survey conducted for a separate study on benefit caps. Participants belonged to a Medicare managed care plan in one state and had $2000 capped brand name benefits in 2001 but generic-only benefits in 2002. METHODS: Participants reported their cost-cutting strategies before and after the change to generic-only coverage, the medications affected, and their financial burden. We conducted bivariate and multivariate analyses of cost-cutting strategies and financial burden before and after implementation of generic-only benefits. RESULTS: Among 611 participants (63% response), rates of switching medications increased after discontinuation of brand name coverage (27% vs 8%, P < .001). Switches were from brand name drugs to generic equivalents (14%) (eg, Prozac to fluoxetine hydrochloride), to nonequivalent generics (26%) (eg, Paxil to fluoxetine), and to different brand name drugs (45%) (eg, Paxil to Zoloft). Ninety percent of brand name switches remained in the same therapeutic class (eg, selective serotonin reuptake inhibitors). After discontinuation of brand name coverage, participants reported higher rates of decreased medication use (28% vs 17%) and greater difficulty paying for prescriptions (65% vs 37%) (P < .001 for both). CONCLUSIONS: Changing from brand name benefits to generic-only drug coverage led many participants to switch to less expensive medications but also decreased medication use and increased financial burden. Insurers need to actively help patients adjust to a discontinuation of brand name coverage.

Aged↗
PubMed2004

Cost-lowering strategies used by medicare beneficiaries who exceed drug benefit caps and have a gap in drug coverage.

CONTEXT: The majority of Medicare drug benefits in managed care (Medicare + Choice) have annual dollar limits or caps and many beneficiaries face temporary but potentially significant gaps in coverage after exceeding caps before the end of the year. In the new national Medicare drug benefit, beneficiaries with high medication expenditures will also face a period without drug coverage when their total drug costs exceed annual caps but are not high enough to qualify for catastrophic coverage. OBJECTIVE: To describe strategies adopted by beneficiaries exceeding annual drug benefit caps to lower prescription costs, the type of medications involved, and their financial burden. DESIGN, SETTING, AND PARTICIPANTS: A survey (completed in 2002) of Medicare + Choice beneficiaries aged 65 years and older with high medication costs and benefits capped on the plan's share of drug costs (65% response rate). The different caps offered in different counties were used as a natural experiment. Study participants (n = 665) exceeded a 750 dollars or 1200 dollars yearly cap in 2001 and had coverage gaps of 75 to 180 days. Control participants (n = 643) had 2000 dollars caps, which they did not exceed. Study and control participants were matched by average total drug expenditures per month. MAIN OUTCOME MEASURES: Proportion of beneficiaries reporting specific strategies to decrease medication costs, medications affected, and difficulty paying for prescriptions. RESULTS: In multivariate analyses adjusting for demographic and health characteristics, a higher proportion of patients exceeding caps reported using less prescribed medication than controls (18% vs 10%, respectively; P<.001), but similar proportions reported stopping medications completely (8% for both, P =.86) and of not starting prescribed medications (6% vs 5%, P =.39). Patients exceeding caps more often called pharmacies to find the best price (46% vs 29%, P<.001), switched medications (15% vs 9%, P =.002), used samples (34% vs 27%, P =.006), and had difficulty paying for prescriptions (62% vs 37%, P<.001). Twelve of the 20 therapeutic classes most often affected by decreases in use of medication were for chronic health problems such as hypertension, hyperlipidemia, and emphysema or asthma. CONCLUSIONS: Medicare beneficiaries often decreased use of essential medications and experienced difficulty paying for prescriptions during gaps in coverage. Health professionals need to explore how they can lessen the impact of caps on patients' health and financial burden.

Aged↗
PubMed2004

Barriers to patient-physician communication about out-of-pocket costs.

BACKGROUND: Though many patients and physicians believe that they should discuss out-of-pocket costs, research suggests that they infrequently do. OBJECTIVE: To examine barriers preventing patient-physician communication about out-of-pocket costs among study subjects recalling a time when they wanted to discuss these costs but did not do so. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional surveys of 133 general internists and 484 of their patients from 3 academic and 18 community practices in a large midwestern metropolitan region. MEASUREMENTS: Patient- and physician-reported barriers to discussing out-of-pocket costs. MAIN RESULTS: Overall, 54 patients (11%) and 27 physicians (20%) were able to recall a specific time when they wanted to discuss out-of-pocket costs but did not do so. Among patients, a wide variety of barriers were reported including their own discomfort (19%), insufficient time (13%), a belief that their physician did not have a viable solution (11%), and concerns about the impact of discussions on quality of care (9%). Among physicians, the most common barriers reported were insufficient time (67%) and a belief that they did not have a solution to offer (19%). CONCLUSIONS: Efforts to promote discussions of out-of-pocket costs should emphasize the legitimacy of patients' concerns and brief actionable alternatives that physicians can take to address them.

Adolescent↗
PubMed2004

Cancer in the Commonwealth of the Northern Marianas Islands (CNMI).

The purpose of this study, funded by the National Cancer Institute, was to document the state of cancer awareness and services in the Commonwealth of the Northern Mariana Islands (CNMI) and to begin to identify cancer-care needs. Findings suggest that cancer is the second-leading cause of death in the CNMI, and that the most prevalent cancers are those that can be prevented and/or cured with early detection and treatment. Key informants identified a number of cancer-related service needs, and an action plan was developed based on three priority areas: 1) developing a cancer registry; 2) increasing resources dedicated to cancer prevention and control programs, and 3) increasing capacity of health professionals and support staff.

Awareness↗
PubMed2004

Cancer in the Territory of Guam.

The purpose of this study, funded by the National Cancer Institute, was to assess cancer awareness and service needs in Guam. Guam maintains a cancer registry, and data suggest that cancer is the second-leading cause of death in Guam. A chapter of the American Cancer Society has been established on the island. Although basic cancer diagnosis and treatment services can be provided on Guam, many cancer patients must travel to Hawai'i, the U.S. continent, or to Asian countries to seek more advanced medical care. This places a severe strain on the island's limited financial resources that, in turn, affects all aspects of health care for the people of Guam. Key informants identified a number of cancer-related service needs, and an action plan was developed based on five priority areas: 1) increasing the capacity of cancer prevention and control staff; 2) increasing public awareness of cancer risk factors; 3) expanding the capacity of the Guam Cancer Registry; 4) establishing a Cancer Prevention and Control Advisory Board for the Territory; and 5) improving early detection and screening for priority cancers.

Delivery of Health Care↗
PubMed2003

Impact of an annual dollar limit or "cap" on prescription drug benefits for Medicare patients.

CONTEXT: Annual dollar limits, or "caps," on drug benefits are common in Medicare managed care (Medicare + Choice) and have been part of several proposals for a national Medicare drug benefit. OBJECTIVES: To determine how cap levels affect the percentage of patients exceeding the cap and their out-of-pocket drug costs and to identify the medications that contribute most to prescription costs. DESIGN AND SETTING: Cross-sectional analysis of 2001 pharmacy claims data from a large Medicare + Choice plan in a mature market with caps of 750 dollars to 2000 dollars per year applied to the plan's share of prescription costs. PARTICIPANTS: Patients who filled at least 1 prescription in 2001 (n = 438 802). MAIN OUTCOME MEASURES: Percentages of patients exceeding caps, identified from prescription claims; out-of-pocket patient costs before exceeding caps, calculated from patients' co-payments; and out-of-pocket patient costs after exceeding caps, estimated from total prescription costs before exceeding the cap. Each unique drug was ranked by total expenditures, which included spending by patients who exceeded caps and by the plan for that drug. RESULTS: A total of 22%, 14%, and 4% of Medicare patients exceeded caps of 750 dollars, 1000 dollars, and 2000 dollars, respectively. Across caps, patients faced a potential 2- to 3-fold increase in median out-of-pocket costs after exceeding caps (179 dollars-305/mo dollars) to continue the same prescription use as before exceeding caps (79-100/mo dollars). For patients who exceeded a cap of 750 dollars, yearly out-of-pocket drug costs ranged from 564 dollars to 4201 dollars (5th-95th percentiles). Fifteen of the 20 medications with the highest total prescription expenditures for patients who exceeded the cap were for chronic conditions. Seven had lower-cost generic versions or a generic medication available in the same treatment class. CONCLUSIONS: At lower caps, a substantial proportion of Medicare patients exceeded their annual drug benefit. To continue the same medication use as before exceeding caps, these patients faced potentially high increases in out-of-pocket costs for medications used primarily to treat chronic conditions. Generic options were not available for many of these drugs.

Aged↗
PubMed2003

Medicare calibration of the clinically detailed risk information system for cost.

The clinically detailed risk information system for cost (CD-RISC) contains definitions for several hundred severity-adjusted conditions that can be used to predict future health care costs. We develop a prospective Medicare CD-RISC model using a 5-percent sample of Medicare beneficiaries and data that contain 1996 diagnostic information and 1997 annualized costs. The CD-RISC model has a hierarchical structure that implies that only the most expensive condition-severity variable within a body system affects payments. This minimizes incentives to game the system by entering multiple related codes for the same condition. The R2 for the CD-RISC model is 11 percent.

Adolescent↗