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Biomedical subjects

David B Nash

Publications and source records attributed to David B Nash.

At least 19 recordsLinked to original sources
PubMed2006

Use of antibiotics for adult upper respiratory infections in outpatient settings: a national ambulatory network study.

BACKGROUND AND OBJECTIVES: Studies have suggested that antibiotics are often inappropriately used in the treatment of acute upper respiratory tract infections (URIs). This study examined antibiotic use for adult URIs in a large national network of offices that use electronic health records (EHRs). METHODS: Using the Medical Quality Improvement Consortium (MQIC) database, URI episodes were identified for patients ages 18 to 65 years from January 1, 1998, to March 31, 2003. The percentage of episodes for which antibiotics were prescribed and the proportion of antibiotics that were broad spectrum were calculated. RESULTS: Of the 52,135 URI episodes identified, 65% received antibiotics. Antibiotics were prescribed for 78% of acute bronchitis episodes, 65% of acute pharyngitis episodes, 81% of acute sinusitis episodes, and 33% of nonspecific URI episodes. The proportion of antibiotics that were broad spectrum was 56% for all URI episodes, 68% for acute bronchitis, 55% for acute sinusitis and nonspecific URI, and 40% for pharyngitis. CONCLUSIONS: This study demonstrates overuse of antibiotics for adult URIs in a large national ambulatory care network, with particular overuse of broad-spectrum antibiotics. The study also illustrates the enormous potential of EHR data for conducting practice-based research across large national office networks.

Adolescent↗
PubMed2005

A systems approach to identifying inappropriate use of controlled substances: the need for balance.

BACKGROUND: The diversion, abuse, and inappropriate use of controlled substances remain of concern among health care practitioners, insurers, and policy makers in the United States. The principle of "balance" represents a need to establish a system of control to prevent abuse, trafficking, and diversion of controlled substances, while ensuring their medical availability for legitimate patients. ADMINISTRATIVE DATABASES TO STUDY OUTCOMES AND QUALITY OF CARE: Some models employ pattern recognition within administrative health databases, for example, to examine outcomes and quality of medical care and monitor fraudulent behaviors and inappropriate medical care. Patients' use of resources or variations in practitioners' practice patterns can be examined. A SYSTEMS APPROACH TO ADDRESS INAPPROPRIATE USE OF CONTROLLED SUBSTANCES: A systems approach would require collaboration with medical and pharmacy directors, systems analysts, coding experts, legal experts, and clinicians to develop the claims-based model. Once a patient and/or practitioner with possible diversion or abuse are identified, a second step is required to distinguish inappropriate and appropriate behaviors and medical care. CONCLUSION: Programs to detect misuse of controlled substances must be validated through clinical research, and a consensus should be reached as to what constitutes a breach of accepted medical practice.

Databases as Topic↗
PubMed2005

Use of chromium picolinate and biotin in the management of type 2 diabetes: an economic analysis.

This paper addresses the potential economic benefits of chromium picolinate plus biotin (Diachrome) use in people with Type 2 diabetes (T2DM). The economic model was developed to estimate the impact on health care systems' costs by improved HbA1C levels with chromium picolinate plus biotin (Diachrome). Lifetimes cost savings were estimated by adjusting a benchmark from the literature, using a price index to adjust for inflation. The cost of diabetes is highly dependent on the HbA1C level with higher initial levels and higher annual increments increasing the cost. Improvement in glycemic control has proven to be cost-effective in delaying the onset and progression of T2DM, reducing the risk for diabetes-associated complications and lowering utilization and cost of care. Chromium picolinate plus biotin (Diachrome) showed greater improvement of glycemic control in poorly controlled T2DM patients (HbA(1C) > or = 10%) compared to their better controlled counterparts (HbA(1C) < 10%). This improvement was additive to that achieved by oral hypoglycemic medications and correlates to calculated levels of cost savings. Average 3-year cost savings for chromium picolinate plus biotin (Diachrome) use could range from 1,636 dollars for a poorly controlled patient with diabetes without heart diseases or hypertension, to 5,435 dollars for a poorly controlled patient with diabetes, heart disease, and hypertension. Average 3-year cost savings was estimated to be between 3.9 billion dollars and 52.9 billion dollars for the 16.3 million existing patients with diabetes. Chromium picolinate plus biotin (Diachrome) use among the 1.17 million newly diagnosed patients with T2DM each year could deliver lifetime cost savings of 42 billion dollars, or 36,000 dollars per T2DM patient. Affordable, safe, and convenient, chromium picolinate plus biotin (Diachrome) could prove to be a cost-effective complement to existing pharmacological therapies for controlling T2DM.

Biotin↗
PubMed2005

Asthma management programs in managed care organizations.

The aim of this work was to investigate how managed care organizations (MCOs) currently approach asthma treatment and management and to determine factors affecting asthma outcomes. A Web-based survey was administered to a national sample of 351 medical directors of MCOs to investigate the asthma management program components in their organizations as well as gaps and barriers in the management of patients with asthma. All 134 (38.2%) responding medical directors reported that their organizations monitor asthma patients. Plans use a variety of asthma management activities, including general member education (90%), member education by mail (87%), self-management education (85%), and provider education (82%). Educational resources (89%) and telephone advice nurse (77%) were the most common self-management strategies offered. Among factors impeding the provision of effective asthma care, noncompliance with asthma treatment, the inappropriate use of medications, and the need for multiple medications were cited by virtually all respondents. Health plans rely on an array of strategies to manage asthma patients. Education encouraging patient self-management is a key component of asthma management programs. However, a considerable number of treatment approach barriers are impeding the achievement of proper asthma care. Without innovative approaches to care, it appears that current MCOs' asthma management efforts may not result in substantial improvements in asthma outcomes.

Asthma↗
PubMed2005

Pharmacy utilization and the Medicare Modernization Act.

To control expenditures and use medications appropriately, the Medicare drug coverage program has established pharmacy utilization management (PUM) measures. This article assesses the effects of these strategies on the care of seniors. The literature suggests that although caps on drug benefits lower pharmaceutical costs, they may also increase the use of other health care services and hurt health outcomes. Our review raises concerns regarding the potential unintended effects of the Medicare drug program's PUM policies for beneficiaries. Therefore, the economic and clinical impact of PUM measures on seniors should be studied further to help policymakers design better drug benefit plans.

Aged↗
PubMed2005

Oral serotonin receptor agonists: a review of their cost effectiveness in migraine.

Migraine headache is a highly prevalent chronic, episodic condition. The direct and indirect costs of migraine headache have a tremendous economic impact in the US. Research has shown that serotonin (5HT(1B/D)) receptor agonists reduce healthcare costs, improve health-related QOL (HR-QOL), decrease migraine disability and keep patients effective in the workplace. The purpose of this manuscript is to examine the cost effectiveness of oral 5HT(1B/D) receptor agonists for the treatment of migraine headache. In general, 5HT(1B/D) receptor agonists are associated with increases in direct healthcare costs; however, they are also associated with reductions in the indirect costs associated with migraine headache. Therefore, it appears that the relatively high acquisition cost of these medications is offset and, as a class, these medications appear to be cost effective and demonstrate net benefits from the societal perspective. Based on meta-analyses in which data on eletriptan were not available, it appears that within the class, almotriptan and rizatriptan are the most cost effective. In a prospective study comparing eletriptan with sumatriptan, it appears that the former may be more cost effective than the latter. Additional investigations are needed to further explore the application of the friction-cost approach and QALYs to cost-effectiveness analyses of this class of medication.

Cost-Benefit Analysis↗
PubMed2005

Are employers pursuing value-based purchasing?

Some employers have begun to undertake a variety of initiatives, collectively termed value-based purchasing (VBP), which aim at factoring quality into the purchasing decision-making process when negotiating costs with providers and insurers. There is evidence that the VBP movement has begun gaining momentum; yet it is unclear whether employers are firmly committed to VBP principles. By surveying a national sample of employers, this study investigates the extent to which employers are currently engaged in VBP activities and also increases our understanding of barriers hampering the broader implementation of these activities.

Commerce↗
PubMed2004

Reclassification of simvastatin to over-the-counter status in the United Kingdom: a primary prevention strategy.

Simvastatin (10-mg tablet) has been reclassified for sale as a pharmacy-only over-the-counter medicine in the United Kingdom. It is designed to be a primary prevention agent targeting that segment of the population having a moderate risk of coronary artery disease (CAD). The anticipated effect is a reduction of risk of a first major coronary event (nonfatal myocardial infarction or CAD death). Simvastatin is a component of the Heart Health Programme, which also addresses other modifiable risk factors such as diet, exercise, and smoking. Men >/=55 years of age, men aged 45 to 54 years with >/=1 risk factor, and women aged >/=55 years with >/=1 risk factor have a moderate (10% to 15%) 10-year risk of developing CAD. Risk factors include having a first-degree relative with a history of early family CAD, smoking, being overweight, and South Asian ethnicity. Simvastatin 10 mg lowers low-density lipoprotein cholesterol levels by approximately 30%, with a resultant 33% reduction in risk of a major CAD event after 3 years. After the patient completes a check-box questionnaire regarding his or her medical history and other specific risk factors, the pharmacist performs a few simple physical measurements and makes a decision as to CAD risk and simvastatin eligibility. After 1 month of simvastatin therapy, cholesterol testing is highly recommended to patients, and a kit is made available that permits home blood collection and analysis at a central laboratory.

Anticholesteremic Agents↗
PubMed2004

Assessing return on investment of defined-population disease management interventions.

BACKGROUND: Strategies to reduce health expenditures through the improvement of health and quality of care are in high demand. A group of experts formed a nonpartisan, independent work group, under the sponsorship of the National Managed Health Care Congress. Its goal was to establish a list of easy-to-understand, actionable, and usable recommendations to enable disease management program advocates to conduct basic-level evaluations. RECOMMENDATIONS: The work group made recommendations concerning identification of reference and intervention population, population definitions, quantitative methods and data quality, confounding and bias, and stakeholder agreements/contracting. CASE STUDY: A case study was created to quantitatively illustrate some of the major issues raised by the work group. Five typical errors were simulated by applying different rules to the intervention population than to the reference population: differential inclusion (high versus low risk), differential exclusion (high versus low risk) and differential claims run-out. Compared with the true impact, four of the five errors resulted in a bias toward "intervention effect," while one (differential inclusion of high-risk patients) was biased against the "intervention effect." The direction and magnitude of the bias in natural settings will not necessarily follow this pattern.

Advisory Committees↗
PubMed2003

Prescription drug use in the elderly: a descriptive analysis.

In the current policy debate, pharmaceutical use in the elderly has been characterized largely by its economic impact, with little discussion of what drugs the elderly are taking. Based on data from the Medicare Current Beneficiary Survey (MCBS), this study defines subgroups of the community-dwelling elderly using health and functional status, and provides a comprehensive description of the composition of prescription drug use in this population. Drugs are classified into 16 primary therapeutic classes, with further breakdown into secondary classes and characterization by chronic versus acute use. Utilization is reported by age and health status categories.

Activities of Daily Living↗
PubMed2002

Developing a quality measurement tool and reporting format for long- term care.

BACKGROUND: Quality measurement in long term care (LTC) presents many challenges: the lack of a uniform definition of quality, the existence of multiple domains for measurement, a multitude of potential perspectives, and regulatory influences that emphasize measurement only of poor quality. Research efforts have yet to solve the issues of measurement; however, operators of long term care facilities must use the current state of the art in quality measurement as the basis for their quality improvement efforts. A project was commissioned by management of a large integrated delivery system with a robust network of LTC facilities who wished to implement a continuous quality improvement process on the basis of a measurement tool that provides a comprehensive resident-centered assessment of quality. The objectives of this project, therefore, were to identify domains of quality, to select and adapt validated instruments for measurement within each domain, to pilot test a data collection process, and to develop an operational quality profiling report format for LTC facilities. DESIGN AND METHODS: Using an expert panel and the LTC research literature, an operational measurement tool was developed, consisting of four domains of quality: organizational, clinical, environmental, and social. DISCUSSION: A pilot study conducted in two nursing facilities demonstrated that the data collection process could be operationalized within tight resource and budgetary constraints. The development of an operational quality assessment tool enables management to take a consistent view of diverse institutions, focusing in detail on quality of care as it is perceived by residents. The tool allows evaluation of trends over time and comparison to external norms.

Advisory Committees↗
PubMedDate not supplied

Reliability and validity of the migraine therapy assessment questionnaire.

OBJECTIVE: To determine the reliability and validity of the Migraine Therapy Assessment Questionnaire (MTAQ). DESIGN/METHODS: Eligible patients between ages 18 and 65 with at least one migraine per month, a physician visit in the preceding 6 months, and a migraine diagnosis were recruited from physician offices in the Philadelphia area. Participants completed the MTAQ, Short Form-36 (SF-36), the Migraine Disability Assessment Score (MIDAS), the Beck Depression Inventory, a demographic questionnaire, and a medication use survey. The first 100 participants completed a second MTAQ approximately 2 weeks later. The test-retest reliability, construct, and predictive validity of the MTAQ were assessed. RESULTS: Two hundred fifty-one patients were recruited; 243 patients were assessable. All MTAQ questions had a kappa statistic of.5 or higher and an agreement of at least 76%. There was a significant level of agreement (.71) for the MTAQ summary score. MTAQ items regarding control, frequency, work loss, resource use, and satisfaction were associated with significant differences in SF-36 scores. MTAQ items related to work loss, emergency department use, headache frequency, and control were associated with days missed from work and degree of disability as measured by MIDAS. Suboptimal migraine management was significantly associated with MTAQ items indicating three or more headaches per month, missing time from work or school, taking daily medication for headaches, and having an emergency department visit in the last 6 months. CONCLUSION: MTAQ is a reliable and valid questionnaire to identify migraineurs whose migraine management may be suboptimal in a primary care setting.

Adolescent↗