Biomedical subjects

Donald G Klepser

Publications and source records attributed to Donald G Klepser.

6 recordsLinked to original sources

PubMed2005

Effect of clinical characteristics on neutropenia-related inpatient costs among newly diagnosed non-Hodgkin's lymphoma cases during first-course chemotherapy.

STUDY OBJECTIVE: To estimate the costs of hospitalization for neutropenia among chemotherapy-treated patients with newly diagnosed non-Hodgkin's lymphoma and to assess baseline patient factors associated with these costs. DESIGN: Retrospective cohort study. DATA SOURCE: Linked Surveillance, Epidemiology, and End Results Program-Healthcare Cost and Utilization Project databases for Iowa from 1993-1998. PATIENTS: Patients with newly diagnosed non-Hodgkin's lymphoma who received all inpatient care at Iowa hospitals during their first course of chemotherapy. MEASUREMENTS AND MAIN RESULTS: Neutropenia-related hospitalization costs were estimated from discharge abstracts found within the earliest of the following: 6 months after the diagnosis month, the date of bone marrow transplantation, or date of death. We performed univariate tests of differences in neutropenia-related hospitalization costs in all patients in the sample, as well as tests for neutropenia-related hospitalization costs, length-of-stay, and cost/inpatient day for patients with at least one hospitalization for neutropenia. We modeled total inpatient charges over the period for patients with at least one neutropenia-related hospitalization (multiple regression). A total of 1636 patients with non-Hodgkin's lymphoma had chemotherapy in Iowa and met inclusion criteria; of these, 316 had at least one hospitalization for neutropenia. The 316 patients had 418 stays. Patients with advanced stage (vs limited stage), previous anemia (vs no anemia), positive Charlson comorbidity score (vs score of 0), and diffuse large cell histology (vs follicular) had higher mean neutropenia-related hospitalization cost/patient with non-Hodgkin's lymphoma (p<0.05). Among those with neutropenia-related hospitalizations, a longer length of stay was associated with nonfollicular histologies, previous anemia, and positive Charlson score (p<0.05). CONCLUSION: When estimating expected payments for neutropenia-related hospitalization in patients with non-Hodgkin's lymphoma, payers need to be aware of the distribution of clinical characteristics in these patients.

Adult↗

PubMed2004

Population-based medication reviews: a descriptive analysis of the medication issues identified in a medicare not-for-profit prescription discount program.

BACKGROUND: Medication reviews may be an important strategy to improve medication use, especially for individuals receiving many drugs. OBJECTIVE: To describe the types of medication issues and recommendations identified in the Iowa Priority Brown Bag Medication Reviews, compare individuals with medication issues with those without medication issues, and describe Iowa Priority enrollees' experiences with and satisfaction of the review. METHODS: A retrospective review of enrollment forms and medication review records and a survey of Iowa Priority members were conducted in 2002. Subjects were Medicare-eligible individuals who joined the Iowa Priority Prescription Savings Program. Frequency distributions and descriptive statistics were calculated. Analysis using t-test and chi(2) test determined differences between individuals with and without issues regarding use of drug therapy. RESULTS: Almost 13% of Iowa Priority enrollees received a review. There were 1167 individuals with 2123 medication issues identified. Nonprescription medications accounted for one-third of drug interactions and >40% of duplications. People with issues had poorer health, more chronic conditions, and took more drugs than people without medication issues. One-third of survey respondents discussed the review with their physicians, and 17.7% reported medication changes. Satisfaction with the review was good; however, only 24% were likely to have received an annual review. CONCLUSIONS: Iowa Priority Brown Bag Medication Reviews showed that individuals with fair/poor health, higher numbers of medications, and more chronic conditions were likely to have medication issues. Reviews generated discussions between physicians and patients, produced some medication changes, and helped individuals save money.

Aged↗

PubMed2003

Health care resource utilization associated with treatment of penicillin-susceptible and -nonsusceptible isolates of Streptococcus pneumoniae.

Despite failure to correlate in vitro susceptibility with clinical outcomes for respiratory tract infections and bacteremia, resistance affects management of patients with pneumococcal infections. The economic impact of resistance among pneumococci has not been evaluated. We conducted a single-center, retrospective, observational, cohort study of hospitalized patients infected with Streptococcus pneumoniae isolated from blood or a respiratory source between January 1, 1995, and December 31, 1998. Data were collected for 36 days surrounding the day that the first positive culture was collected. Patients were grouped according to isolate penicillin-susceptibility profile [susceptible minimum inhibitory concentration (MIC) < or = 0.06 microg/ml, nonsusceptible MIC > or = 0.125 microg/ml), and data were analyzed with respect to health care resource utilization patterns. Of 231 patients identified, 142 and 89 had susceptible and nonsusceptible isolates, respectively. Groups were similar with respect to demographics and comorbidities, except that patients infected with a nonsusceptible isolate were more likely to have the isolate obtained from a respiratory source and to have a history of recent antibiotic therapy. No difference was noted with respect to clinical outcome; however, patients infected with a nonsusceptible isolate had a longer median stay (14 vs 10 days, p<0.05). They also had significantly higher total median costs (1600 dollars, 95% confidence interval 257-2943 dollars) due to room and nursing services. Infections caused by penicillin-nonsusceptible pneumococci were not associated with a worse outcome in hospitalized patients but were associated with increased cost of care.

Adult↗

PubMed2002

Pitfalls associated with commonly used methods for pharmacoeconomic analyses.

Demonstrating the economic value of treatment has become an important objective of many clinical trials. Awareness of the limitations of the methods used in pharmacoeconomic studies of infectious diseases will help in understanding why improved methods are needed to adequately describe the costs associated with infectious episodes. Current analyses generally consider three levels of cost and use three methods to determine costs associated with an infectious episode. However, these costs and the methods for obtaining them may not be appropriate in all studies. Future pharmacoeconomic research needs to adhere to established principles but embrace new methodologies to improve the validity and usefulness of these studies.

Anti-Infective Agents↗

PubMed2002

The dynamics of health care resource utilization.

Many pharmacoeconomic studies suffer from issues relating to the sensitivity of data and ability to accurately determine treatment-related costs. In addition, cost data generally are treated as static or constant variables. Our goal was to develop an approach to cost analysis that would allow us to appreciate the dynamic nature of health care resource utilization. By collecting detailed cost data on a daily basis and focusing on a narrow interval encompassing the infectious process, we were able to detect changes in resource utilization associated with management of the infectious process. This method also allowed us to assess and compare the dynamics of resource utilization among various patient groups.

Communicable Diseases↗

PubMedDate not supplied

An evaluation of managing and educating patients on the risk of glucocorticoid-induced osteoporosis.

OBJECTIVE: To assess the impact of risk management activities on patient risk of glucocorticoid-induced osteoporosis. METHODS: Ninety-six adult patients taking chronic glucocorticoid therapy in 15 community pharmacies. Patients in the control group received usual and customary care. Patients in the treatment pharmacies received education and an educational pamphlet about the risks of glucocorticoid-induced osteoporosis. In addition, the treatment group pharmacists monitored the patients' drug therapy, to identify and address drug-related problems. Data including the glucocorticoid taken by the patient, medications, and osteoporosis risk factors were collected at baseline and after 9 months of monitoring, via Web-based survey completed in the pharmacy. Using an intent to treat approach, the pre-post frequency changes were compared with contrasts for presence of bisphosphonate therapy, presence of estrogen therapy, presence of calcium supplement, discussion of glucocorticoid-induced osteoporosis risk, discussion of bone density test, presence of bone mineral density test, reported inactivity, and reported low calcium diet. RESULTS: The contrast was significant in favor of the treatment pharmacies for the frequency of patients taking a calcium supplement (Control [-6.9%] vs. Treatment [17.1%], P < 0.05). No other contrast was significant. CONCLUSIONS: Community pharmacists are capable of increasing calcium supplementation among patients at risk for glucocorticoid-induced osteoporosis. Pharmacists who educate at-risk patients can impact the self-care of these patients.

Adult↗