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Biomedical subjects

D A Sclar

Publications and source records attributed to D A Sclar.

At least 37 records · Page 2Linked to original sources
PubMed1996

Utilization of curanderos among foreign born Mexican-American women attending migrant health clinics.

This study explores the parallel use of "folk healers" and modern medicine among foreign born, Mexican-American women attending migrant health clinics in rural, eastern Washington state. Face-to-face interviews (n = 434) revealed that 21.4% of the women had sought care from curanderos within the past five years. Statistically significant predictors of utilization included Spanish as the language of preference (odds ratio = 2.58), having resided in the U.S. from one to five years (odds ratio = 2.82), and having received medicine or medical care from Mexico within the prior five years (odds ratio = 9.22). Implications for providers working in cross-cultural settings are discussed.

Adult↗
PubMed1994

The costs of interrupting antihypertensive drug therapy in a Medicaid population.

This research explores the association between the interruption or termination of antihypertensive drug therapy and total health care costs among non-institutionalized Medicaid patients older than age 40 who survive the first year after treatment. Multivariate regression analysis was used to estimate the statistical relationship between post-treatment costs and patient demographic characteristics, prior use of services, the type of medication used as initial therapy and whether the patient maintained continuous therapy. Paid claims data from the California Medicaid (Medi-Cal) program were used in the analysis. Total cost of health care in the first year after the initiation of drug therapy was the primary outcome variable. Components of total costs (e.g., hospital, outpatient and physician services, prescription drugs) were also investigated. Nearly 86% of new antihypertensive drug therapy patients interrupted or discontinued purchasing any form of antihypertensive medication during the first year. Patients with interrupted antihypertensive drug therapy consumed an additional $873 per patient (P < .0001) in health care during the first year, not counting a reduction in prescription drug cost of $281 (P < .0001). Increased costs were primarily due to increased hospital expenditures of $637 (P < .0002).

Adult↗
PubMed1994

Overview of issues related to medical compliance with implications for the outpatient management of infectious diseases.

Noncompliance with therapeutic drug regimens is a public health problem with major health and economic implications. Reported rates of noncompliance for all types of drugs range from 13% to 93% among adults and from 25% to 82% among children. In recent years, sophisticated techniques for evaluating noncompliance have evolved, as has our understanding of factors associated with noncompliance. A key factor is the prescribed dosing schedule for a drug. Studies indicate that there is a direct relationship between frequency of dose and compliance. A study of compliance with short-term regimens of oral antibiotic therapy found mean compliance rates of 80%, 69%, and 38% for administration once a day (QD), twice a day (BID), and three times a day (TID), respectively. Pharmacoeconomic analyses of dose-related compliance have demonstrated that significant savings can be achieved with QD dosing of antihypertensive medication. Although similar analyses have not been performed for drug regimens used in the treatment of infectious diseases that are usually treated on an outpatient basis, it is probable that comparable savings will be attained when economic analyses of dose/compliance relationships in short-term antibiotic therapy for such common disorders as sinusitis, pharyngitis, otitis media, urinary tract infections, and community-acquired pneumonia are undertaken.

Adult↗
PubMed1993

Effect of antihypertensive formulation on health service expenditures.

A major barrier to the management of hypertension is the extent to which patients comply with the treatment regimen. Herein we report the findings of a retrospective analysis designed to discern the relationship between antihypertensive formulation, regimen compliance and the utilization of health care services. Data for this analysis were derived from the state of South Carolina's Medicaid computer archive. The study population consisted of 1,000 randomly selected beneficiaries initially prescribed one of the following antihypertensive regimens as monotherapy: atenolol (daily); captopril (twice daily); oral clonidine (twice daily); transdermal clonidine (once a week); diltiazem (twice daily); enalapril (twice daily); metoprolol (twice daily); prazosin (twice daily); terazosin (daily); and verapamil-SR (daily). Multivariate regression analysis was used to determine the incremental influence of selected demographic characteristics, utilization of medical services prior to diagnosis for hypertension, initial antihypertensive medication, medication possession ratio for antihypertensive therapy, and the number of maintenance medications for disease state processes other than hypertension on post-period health care expenditure. Results indicate that patients initially prescribed antihypertensive medication requiring daily or weekly administration experience infrequent changes in their therapeutic regimen, far less use of concomitant therapy for blood pressure control, an increased utilization of antihypertensive medication, and a decrease in the use and cost of physician, hospital and laboratory services.

Aged↗
PubMed1993

Effect of value-added utilities on prescription refill compliance and Medicaid health care expenditures--a study of patients with non-insulin-dependent diabetes mellitus.

An estimated 20 million Americans suffer from diabetes. Patients with non-insulin-dependent diabetes mellitus (NIDDM) comprise approximately 90% of the diabetic population. An estimated 10-30% of patients with NIDDM withdraw from their prescribed regimen within 1 year of diagnosis, and of the remainder, nearly 20% administer insufficient medication to facilitate an adequate reduction in blood glucose. A randomized trial was undertaken to discern the effect of pharmacy-based value-added utilities on prescription-refill compliance with sulfonylurea therapy and health service utilization. The subjects were 258 Medicaid beneficiaries from the state of South Carolina, previously untreated for NIDDM, prescribed 5 mg of the second-generation sulfonylurea glyburide twice daily, and monitored with regard to prescription-refill compliance and health service utilization for 1 year. Subjects provided informed consent and were randomly assigned to one of four experimental groups: (i) the control cohort received standard pharmaceutical care with each dispensing of glyburide; (ii) the second cohort received standard pharmaceutical care and was mailed a medication-refill reminder 10 days prior to each sequential refill date; (iii) the third cohort received standard pharmaceutical care and was provided unit-of-use packaging with each prescription-refill request; (iv) the fourth cohort received standard pharmaceutical care, mailed medication-refill reminders, and unit-of-use packaging. Analysis of variance (ANOVA) procedures revealed that patients receiving mailed prescription-refill reminders, unit-of-use packaging, or a combination of both interventions achieved a significant (P < or = 0.05) increase in the Medication Possession Ratio (MPR) for sulfonylurea therapy relative to controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Mellitus, Type 2↗
PubMed1993

Effect of value-added utilities on prescription refill compliance and health care expenditures for hypertension.

A randomised trial was undertaken to discern the effect of pharmacy-based value-added utilities on prescription refill compliance with antihypertensive therapy and subsequent health care expenditures. The subjects were 304 Medicaid beneficiaries from the state of Florida, previously untreated for mild to moderate hypertension, prescribed 240 mg of calcium channel antagonist verapamil once daily and monitored regarding prescription refill compliance and health service utilisation for one year. Subjects provided informed consent and were randomly assigned to one of four experimental groups: (1) the control cohort received standard pharmaceutical care with each dispensing of antihypertensive therapy, (2) the second cohort received standard pharmaceutical care and was mailed a medication-refill reminder ten days prior to each sequential refill date, (3) the third cohort received standard pharmaceutical care and was provided unit-of-use packaging with each prescription-refill request and (4) the fourth cohort received standard pharmaceutical care, mailed medication-refill reminders and unit-of-use packaging. Analysis of variance (ANOVA) procedures revealed that patients receiving mailed prescription-refill reminders, unit-of-use packaging or a combination of both interventions achieved a significant (P < or = 0.05) increase in the Medication Possession Ratio (MPR) for antihypertensive therapy relative to controls. Receipt of both interventions resulted in a significant (P < or = 0.05) improvement in the MPR for antihypertensive therapy relative to all other groups no significant difference was discerned between groups receiving either mailed prescription-refill reminders or unit-of-use packaging.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1993

Utility of a sustained-release formulation for antihypertensive therapy.

Recent pharmacotherapeutic advances in the treatment of hypertension have included the development of sustained-release (SR) dosage formulations, providing patients with the convenience of once daily administration. A one year retrospective analysis was undertaken to determine the economic utility of providing prescription coverage for the SR formulation of verapamil, a calcium channel antagonist, under the state of Florida's Medicaid programme. Data for this analysis were derived from the state of Florida's Medicaid computer archive. The study population consisted of 274 ambulatory beneficiaries diagnosed with hypertension and prescribed either the SR or immediate-release (IR) formulation of verapamil. Multivariate regression analysis was used to discern the incremental influence of selected demographic characteristics, utilisation of medical services prior to diagnosis for hypertension and prescribed formulation of verapamil on health care expenditures one year post-diagnosis. Patients prescribed the SR formulation of verapamil achieved a significant (P < or = 0.05) increase in the Medication Possession Ratio (MPR), an index of compliance, (0.87 +/- 0.13) relative to patients prescribed the IR formulation (0.56 +/- 0.10). Results indicate that receipt of verapamil in an SR formulation was associated with a significant (P < or = 0.05) decrease in aggregate health care expenditures of $110.14 over the one year study period. Receipt of the SR formulation was associated with an increase in expenditures for antihypertensive therapy ($117.83, p < or = 0.05) and a decrease in financial commitments for physician ($50.42, p < or = 0.05), hospital ($153.61, p < or = 0.05) and laboratory ($23.94, p < or = 0.05) services.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

The effects of consultation on over-the-counter medication purchasing decisions.

This article examines factors that predict changes in consumer purchasing decisions of nonprescription medications. Variables corresponding to factors in Andersen's behavioral model are measured, in addition to data regarding characteristics of the 17 pharmacy consultants who provided counseling services. One thousand seven hundred and thirteen consumers in five stores in southern California were provided consultation during a 6-month period, resulting in 25.4% of the patients purchasing a different drug than intended when entering the pharmacy, 1.3% being referred to a physician, and 13.4% not purchasing any over-the-counter medication at all. Logistic regression techniques demonstrated that one enabling variable (availability of generic medications), and four need factors (the discussion of clinical issues, short encounters, cough and cold products, and vitamin products) were significant predictors of the consumer's decision to purchase a different product than intended. Consultant characteristics (introversion, external locus of control) were also important predictors, but opposite the expected direction. Consumers who received information from female consultants were more likely to change their purchasing decisions.

Adult↗
PubMed1992

Pharmacokinetic population parameters for aminoglycosides in cholecystitis patients.

We report the use of a new method to determine patient population pharmacokinetic parameters (nonparametric expected maximum or NPEM). Our purpose was to develop and then analyze the utility of these parameters, compared to a more traditional approach. Nineteen patients with acute cholecystitis made up the control group for defining the parameters via NPEM. The standard of practice was to use a model created from a different intraabdominal infection group (appendicitis), referred to as "surgical patient model." These two models were compared with a group of 23 patients receiving gentamicin for acute cholecystitis. We concluded that the NPEM model was superior to the surgical patient model in predicting gentamicin trough and peak levels with less bias and better precision.

Adult↗
PubMed1992

Tissue concentrations of cefepime in acute cholecystitis patients.

Cefepime is a new broad-spectrum cephalosporin with activity against Staphylococcus, Streptococcus, Pseudomonas, and the Enterobacteriaceae. The purpose of this study was to measure cefepime concentrations in plasma, peritoneal fluid, bile fluid and appendix tissue in patients undergoing elective cholecystectomy. Patients were randomly assigned to receive either cefepime, 2 g intravenously in phosphate buffer (IVPB) q 12 h or gentamicin 1.5 mg/kg IVPB q 8 h plus mezlocillin 4 g IVPB q 6 h. During surgery, gall bladder tissue, plasma, peritoneal fluid, and bile fluid samples were obtained at approximately the same time. Thirty-three patients had data acceptable for analysis. Values are given as mean +/- standard deviation. The mean delta time (defined as the time between the administration of cefepime and the time the samples were obtained) was 8.58 +/- 3.53 h. The values for plasma, peritoneal fluid, bile fluid, and gall bladder tissue concentrations were 7.63 +/- 14.17 micrograms/ml, 5.66 +/- 6.80 micrograms/ml, 15.51 +/- 16.94 micrograms/ml, and 5.36 +/- 6.57 micrograms/gm, respectively. The peritoneal fluid/plasma ratio was 2.10 +/- 2.33, the bile fluid/plasma ratio was 14.44 +/- 31.99, and the gall bladder tissue/plasma ratio was 1.44 +/- 1.82. There was a significant correlation between peritoneal fluid and plasma concentration (r = 0.91, p less than 0.0005), and gall bladder tissue and plasma concentration (r = 0.90, p less than 0.0005). There was no correlation between bile fluid and plasma cefepime concentrations. The minimum inhibitory concentration (MIC) data from previous in vitro studies indicate that cefepime concentrations achieved in this patient population would be adequate against typical biliary tract pathogens.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1991

Utility of a transdermal delivery system for antihypertensive therapy. Part 1.

A retrospective evaluation of patient-level Medicaid claims data from two states was undertaken to discern the fiscal utility of transdermally delivered clonidine versus both the oral formulation of clonidine and oral formulations of eight other antihypertensive agents. In the first phase of our two-part study, we compared paid claims data (n = 1,135) from Florida for transdermal and oral clonidine. Multivariate regression analysis was used to evaluate the incremental impact of six variables on health-care expenditures in the first year after patients were given a diagnosis of hypertension. These variables were: age, gender, prior utilization of medical services, regimen complexity, and dosage formulation. Patients prescribed transdermal clonidine experienced a significant (p less than or equal to 0.001) increase in prescription expenditures and significant reductions in the use of physician (p less than or equal to 0.05), laboratory (p less than or equal to 0.10), and hospital (p less than or equal to 0.05) services. Moreover, savings were maximized (p less than or equal to 0.001) where multi-drug regimens incorporated the transdermal delivery system. In the second phase of our study we compared paid claims data (n = 8,894) from South Carolina for transdermal clonidine and for nine oral antihypertensive agents: atenolol, captopril, clonidine, diltiazem, enalapril, metoprolol, prazosin, terazosin, and verapamil-SR. Once again, regression analysis was used, this time to evaluate the incremental impact of five variables on health-care expenditures in the first year post diagnosis: age, gender, prior utilization of medical services, regimen complexity, and Medication Possession Ratio (MPR), an index of compliance. The data from part 2 of our study revealed that patients assigned a b.i.d. oral antihypertensive agent experienced a significant reduction (p less than or equal to 0.05) in MPR and a significant (p less than 0.05) increase in health-care expenditures when compared to patients prescribed the transdermal delivery system and to patients prescribed once-daily oral medications. These data confirm previous findings concerning the impact of complicated dosing regimens on compliance in hypertensive patients. In this two-part paper we report the data from both phases of our study.

Administration, Cutaneous↗
PubMed1991

Analysis of cefepime tissue penetration into human appendix.

Cefepime is a new extended-spectrum cephalosporin with gram-positive and gram-negative coverage including Staphylococcus aureus and Pseudomonas aeruginosa. We evaluated the drug's plasma, peritoneal fluid, and appendix tissue concentrations in patients with a postoperative diagnosis of perforated or gangrenous appendicitis. Patients 18 years of age or older were randomly assigned to receive either cefepime 2 g every 12 hours plus metronidazole 500 mg every 6 hours intravenously, or gentamicin 1.5 mg/kg plus clindamycin 900 mg every 8 hours intravenously. During surgery, appendix tissue, plasma, and peritoneal fluid samples were obtained, and frozen at -70 degrees C for high-pressure liquid chromatographic analysis. Thirty-five patients with perforated (26) or gangrenous (9) appendicitis had concentrations acceptable for analysis. The mean time between the administration of cefepime and the time of sampling (referred to as delta time) was 5.99 +/- 3.75 hours (mean +/- SD). The values for plasma (n = 34), tissue (n = 33), and peritoneal fluid (n = 25) concentrations were 16.27 +/- 21.87 micrograms/ml, 4.84 +/- 6.15 micrograms/g, and 14.4 +/- 22.84 micrograms/ml, respectively. The appendix tissue:plasma ratio was 0.66 +/- 0.52 and the peritoneal fluid:plasma ratio was 0.66 +/- 0.51. Spearman rank correlations indicated statistically significant correlations between plasma concentration (r = -0.889; p less than 0.0001), peritoneal fluid concentration (r = -0.783; p = 0.0002), and appendix tissue concentration (r = -0.704; p = 0.0016) versus delta time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Intraoperative concentrations of ofloxacin in serum, bile fluid, and gallbladder wall tissue.

To evaluate concentrations of ofloxacin in serum, bile fluid, and gallbladder wall tissue after intravenous administration, patients greater than or equal to 16 years old diagnosed with acute cholecystitis were randomly assigned to receive ofloxacin (400 mg) intravenously every 12 h or ceftazidime (2 g) intravenously every 8 h. Doses of each regimen were given preoperatively. Serum, bile fluid, and gallbladder wall tissue samples of consecutive patients in the ofloxacin group were obtained intraoperatively. The samples were frozen at -70 degrees C until analyzed by high-pressure liquid chromatography. Twenty-three patients (6 males and 17 females) were evaluated. The mean (+/- the standard deviation) ofloxacin concentrations in serum, bile fluid, and gallbladder wall tissue were 2.9 +/- 2.4 and 6.0 +/- 7.9 micrograms/ml and 3.1 +/- 2.9 micrograms/g, respectively. The mean number of doses each patient received before surgery was 5.3 +/- 3.0, and the mean delta time (time elapsed between last antibiotic administration and when intraoperative samples were obtained) was 9.6 +/- 7.5 h. The mean tissue-to-serum ratio was 1.2 +/- 0.5, and the mean bile-to-serum ratio was 2.3 +/- 1.4. The mean serum ofloxacin concentrations were not statistically different from the concentrations in bile (P = 0.1) and tissue (P = 0.7) at the mean delta time. The study revealed that concentrations of ofloxacin in serum, bile fluid, and gallbladder tissue after intravenous dosing were adequate against susceptible organisms found in the biliary tract.

Adult↗
PubMed1990

The cost of antidepressant drug therapy failure: a study of antidepressant use patterns in a Medicaid population.

Paid claims data from the California Medicaid (Medi-Cal) program were used to examine the utilization of antidepressants and to estimate the costs of antidepressant treatment failure for patients with major depressive disorders (MDD). Data for 6713 new patient episodes of antidepressant therapy were available for the analysis; over 45% of these patients never achieved a minimum daily dose of antidepressants indicative of treatment for depression and were excluded from further analysis. That left a possible depression patient population of 3664 patients of which 2344 patients had a minimum of 1 full year of post-episode data for analysis. Only 81 patients (3.5%) displayed antidepressant use patterns consistent with the successful treatment of MDD; 296 patients (12.6%) displayed use patterns suggestive of antidepressant treatment failure. The remaining 1967 (84%) patients could not be clearly classified; they were either (1) patients being treated for problems other than MDD, (2) MDD patients who were being prescribed subtherapeutic doses by their physician due to side effects or other reasons, (3) MDD patients who were noncompliant for a variety of reasons, or (4) MDD patients who had prematurely terminated antidepressant therapy. Multivariate regression analysis was used to estimate the costs associated with MDD treatment failure. These analyses indicated that MDD treatment failure resulted in increased costs of approximately $1043 in the first post-episode year (p less than .10). These increased costs were primarily due to higher hospital costs ($921, p less than .05), while drug costs were reduced by $222 (p less than .001).

Antidepressive Agents↗