PubMed Health⌕ Search

Biomedical subjects

Feride Frech

Publications and source records attributed to Feride Frech.

15 recordsLinked to original sources
PubMed2006

Methods for evaluation of medication adherence and persistence using automated databases.

PURPOSE: Our aim was to perform a systematic review of the methods currently being used to assess adherence and persistence in pharmacoepidemiological and pharmacoeconomic studies using automated databases. METHODS: A MEDLINE search of English language literature was performed to identify studies published between January 1, 1980 and March 31, 2004 that evaluated adherence, compliance, persistence, switching, or discontinuations of medications using automated dispensing data (pharmacy records). Two study investigators independently reviewed the abstracts and articles to determine relevant studies according to specified criteria. RESULTS: A total of 136 articles met the criteria for evaluation. The types of measures of adherence and persistence commonly reported include the medication possession ratio and related measures of medication availability (77 studies), discontinuation/continuation (58 studies), switching (34 studies), medication gaps (13 studies), refill compliance (7 studies), and retentiveness/turbulence (4 studies). Specific issues considered include the assessment of exposed time to drug therapy and specification of the follow-up period. CONCLUSIONS: The terminology, definitions, and methods to determine adherence and persistence differ greatly in the published literature. The appropriateness and choice of the specific measure employed should be determined by the overall goals of the study, as well as the relative advantages and limitations of the measures.

Databases, Factual↗
PubMed2005

International development of the Parents' Index of Quality of Life in Atopic Dermatitis (PIQoL-AD).

OBJECTIVE: The international development of the Parents' Index of Quality of Life in Atopic Dermatitis (PIQoL-AD), a quality of life (QoL) instrument specific to parents of children with atopic dermatitis (AD) is described. METHOD: The instrument was developed simultaneously in several countries. Its content was derived from 65 qualitative interviews with parents in the UK, Netherlands and Italy. The measure was then produced for the UK, Netherlands, Italy, Germany, France, US and Spain. Field-test interviews were conducted with approximately 20 patients in each country to assess face and content validity. A two time-point survey was conducted with between 45 and 328 parents in each country to finalise the instrument through application of the Rasch model and to evaluate the psychometric properties of the final instrument. RESULTS: Application of the Rasch model to the survey data identified the final 28-item version. All language versions had good item fit, test-retest reliability (above 0.85), internal consistency and promising validity. CONCLUSIONS: The PIQoL-AD is a valuable instrument for inclusion in clinical trials and routine clinical practice. It provides distinct and complementary information to that of existing dermatology-specific measures and has been shown to be responsive to changes in QoL in clinical trials.

Child↗
PubMed2005

The need for improved medical management of patients with concomitant hypertension and type 2 diabetes mellitus.

OBJECTIVES: To determine level of blood pressure (BP) control and to evaluate hypertension management strategies in patients with hypertension and type 2 diabetes mellitus. STUDY DESIGN: Retrospective review of 2 consecutive years of pharmacy and medical insurance claims data and medical charts from patients participating in 10 health plans in 9 states. PATIENTS AND METHODS: Patients 18 years and older with a medical or pharmacy claim related to hypertension were identified and assessed for inclusion in the database. A random sample of medical charts was reviewed to confirm the diagnoses of hypertension and diabetes mellitus and degree of BP control and to assess the prevalence of other cardiovascular disease risk factors and current antihypertensive treatment. RESULTS: Type 2 diabetes mellitus was documented in 977 patients. The mean age was 64.3 years, and 55.1% were women. A BP goal of less than 130/85 mm Hg was achieved in 192 patients (19.7%), and a BP goal of less than 130/80 mm Hg was achieved in 135 patients (13.8%). Fifty-two percent of patients had dyslipidemia, and 87.6% were overweight, obese, or morbidly obese; tobacco use was documented in 19.5%. CONCLUSIONS: Hypertensive diabetic patients are frequently not treated to their goal BP, which requires the use of 2 or more agents in most patients. Quality improvement programs should emphasize the importance of treating hypertensive diabetic patients to their goal BP, as well as controlling other major cardiovascular disease risk factors, such as smoking, dyslipidemia, and overweight or obesity, that are prevalent among these high-risk patients.

Aged↗
PubMed2005

Impairment in work productivity and health-related quality of life in patients with IBS.

Irritable bowel syndrome (IBS) is a long-term and episodic medical disorder shown to have an impact on work productivity and health-related quality of life (QOL). The objective of this study was to assess the impact of IBS on work productivity and on health-related QOL in an employed population in the United States and to quantify the cost of these factors to the employer. A 2-phase survey was sent to the workforce of a large US bank to assess the presence of IBS among employees and to measure their work productivity (absenteeism [time lost from work] and presenteeism [reduced productivity at work]) and health-related QOL. Forty-one percent of the 1776 employees responding to both phases of the survey met the Rome II criteria for IBS. Employees with IBS reported a 15% greater loss in work productivity because of gastrointestinal symptoms than employees without IBS and had significantly lower Medical Outcomes Study Short Form 36 (SF-36) scores than those without IBS. IBS was associated with a 21% reduction in work productivity, equivalent to working less than 4 days in a 5-day workweek. Employees with IBS also had significantly lower scores on all domains of the SF-36, indicating poorer functional outcomes. Reduced work productivity and diminished QOL of these magnitudes may have substantial financial impact on employers.

Absenteeism↗
PubMed2004

Quality of life in managed care patients with irritable bowel syndrome.

The relationship between the severity of abdominal discomfort/pain and generic and disease-specific quality of life (QoL) was explored in patients with irritable bowel syndrome in an MCO. Subjects were stratified into four symptom-severity groups. Descriptive and multivariate analyses were used to examine the relationship of QoL to severity of abdominal discomfort/pain. Generic and disease-specific QoL scores declined as severity of abdominal discomfort/pain increased. The lowest 36-Item Short-Form Health Survey scores for respondents with the most severe abdominal discomfort/pain were for role physical (24.2 +/- 35.4) and vitality (33.7 +/- 19.2). In multivariate regression models controlling for age, sex, work status and education, severity of abdominal discomfort/pain was a significant independent predictor of QoL.

Female↗
PubMed2003

The economic consequences of irritable bowel syndrome: a US employer perspective.

BACKGROUND: The objective of this study was to measure the direct costs of treating irritable bowel syndrome (IBS) and the indirect costs in the workplace. This was accomplished through retrospective analysis of administrative claims data from a national Fortune 100 manufacturer, which includes all medical, pharmaceutical, and disability claims for the company's employees, spouses/dependents, and retirees. METHODS: Patients with IBS were identified as individuals, aged 18 to 64 years, who received a primary code for IBS or a secondary code for IBS and a primary code for constipation or abdominal pain between January 1, 1996, and December 31, 1998. Of these patients with IBS, 93.7% were matched based on age, sex, employment status, and ZIP code to a control population of beneficiaries. Direct and indirect costs for patients with IBS were compared with those of matched controls. RESULTS: The average total cost (direct plus indirect) per patient with IBS was 4527 dollars in 1998 compared with 3276 dollars for a control beneficiary (P<.001). The average physician visit costs were 524 dollars and 345 dollars for patients with IBS and controls, respectively (P<.001). The average outpatient care costs to the employer were 1258 dollars and 742 dollars for patients with IBS and controls, respectively (P<.001). Medically related work absenteeism cost the employer 901 dollars on average per employee treated for IBS compared with 528 dollars on average per employee without IBS (P<.001). CONCLUSION: Irritable bowel syndrome is a significant financial burden on the employer that arises from an increase in direct and indirect costs compared with the control group.

Absenteeism↗
PubMed2003

Irritable bowel syndrome, health care use, and costs: a U.S. managed care perspective.

OBJECTIVE: We performed an evaluation of patient symptoms, health care use, and costs to define the burden of illness of irritable bowel syndrome (IBS) and the relation to the severity of abdominal pain/discomfort in a large health maintenance organization. METHODS: All 6500 adult health maintenance organization members who had undergone flexible sigmoidoscopy in the year 2000 were mailed a questionnaire that elicited Rome I symptom criteria and severity ratings for abdominal pain/discomfort. Multiple health care use measures were obtained from various administrative databases. IBS patients were compared with a control group of non-IBS subjects, and analyses were adjusted for age and sex. RESULTS: We received 2613 (40.2%) responses. Compared with non-IBS subjects over 2 yr, IBS patients had more outpatient visits (medical, surgery, and emergency, p < 0.05), were hospitalized more often (p < 0.05), and had more total outpatient prescriptions (p < 0.05) and IBS-related prescriptions (p < 0.05). Over 1 yr, total costs were 51% higher in IBS patients, who also had higher costs for outpatient visits, drugs, and radiology and laboratory tests (p < 0.05). Total costs were increased by 35%, 52%, and 59% in IBS patients with mild, moderate, and severe symptoms of abdominal pain/discomfort compared with non-IBS subjects (p < 0.05). CONCLUSIONS: Using Rome I symptom criteria, we found that IBS is associated with a broad pattern of increased health care use and costs. The severity of abdominal pain/discomfort is a significant predictor of health care use and costs for patients with IBS compared with non-IBS subjects.

Adult↗
PubMed2003

Utilization patterns and net direct medical cost to Medicaid of irritable bowel syndrome.

BACKGROUND: Patients with irritable bowel syndrome are frequent users of the health care system. DESIGN AND METHODS: This retrospective matched case-control study assessed the economic impact of irritable bowel syndrome on the Medicaid program by comparing the health care utilization and expenditures of Medicaid patients with irritable bowel syndrome in California and North Carolina with age-, sex-, and race-matched control groups without the syndrome. RESULTS: Average annual Medicaid expenditures per case of diagnosed irritable bowel syndrome were 2952 dollars and 5908 dollars in California and North Carolina, respectively; corresponding unadjusted net incremental expenditures were 962 dollars and 2191 dollars, respectively. In both states, patients with irritable bowel syndrome incurred greater costs than controls for physician visits, outpatient visits, and prescription drugs. CONCLUSIONS: Irritable bowel syndrome was shown to impose an economic burden on the Medicaid program. The cost of treating patients with irritable bowel syndrome is higher than the cost of treating matched ambulatory Medicaid recipients without the condition.

Adolescent↗
PubMed2002

Health-related quality of life in patients treated for hypertension: a review of the literature from 1990 to 2000.

BACKGROUND: The goals of antihypertensive therapy are to achieve and maintain blood pressure control by the least intrusive means possible to prevent future cardiovascular and renal events. To achieve these goals, pharmacologic agents must be chosen so as to minimize drug-related adverse events, increase patient adherence to treatment regimens, and minimize the negative impact on health-related quality of life (HRQL). Although the effects of antihypertensive therapy on HRQL have been extensively investigated, there is little synthesis of the research findings. OBJECTIVE: This review was undertaken to provide a synthesis of the available data on the impact of antihypertensive therapy on HRQL and to provide recommendations for future research. METHODS: A MEDLINE literature search was conducted to identify English-language articles published from 1990 to 2000 that included random assignment to antihypertensive treatment and HRQL as an outcome. In addition, reference lists of published reviews and other trials were reviewed to identify other studies of HRQL and antihypertensive therapy. RESULTS: A total of 48 articles were included in the review. Results among studies were frequently inconsistent, which is likely due to the wide variety of dimensions studied and instruments used as well as a number of methodological weaknesses, including small sample sizes, short-term assessments, and failure to account for missing data. CONCLUSION: A standardized approach to the assessment of HRQL in hypertensive patients is needed so that research in this area can be of value to clinical practice and to hypertensive patients and their families.

Antihypertensive Agents↗
PubMed2002

A comparison of office-based physician visits for irritable bowel syndrome and for migraine and asthma.

Three years of data from the National Ambulatory Medical Care Survey were analyzed to assess resource utilization for patients with irritable bowel syndrome (IBS), asthma, and migraine. Adjusted for prevalence, IBS-related physician visits occurred at approximately the same rate as those for asthma and 2.6 times the rate of visits for migraine. Specialist consultations for IBS were of similar frequency to those for migraine and more frequent than those for asthma. Diagnostic and screening tests were ordered more often during IBS-related visits than during migraine- or asthma-related visits. Prescription rates were similar for all three conditions. In terms of resource consumption, this chronic disorder places a burden on patients that is comparable with that of such costly conditions as asthma and migraine.

Ambulatory Care↗
PubMed2002

Determinants of uncontrolled hypertension in an African-American population.

OBJECTIVES: The purpose of this study was to assess blood pressure control and the determinants of uncontrolled blood pressure among African-American hypertensive patients. DESIGN: Baseline clinical data were collected as part of a nationwide hypertension quality improvement initiative. An analysis of determinants of uncontrolled blood pressure was conducted using logistic regression for the following variables: angina, congestive heart failure, coronary artery disease, diabetes, family history of cardiovascular disease or stroke, hyperlipidemia, left ventricular hypertrophy, and tobacco use. SETTING: 10 managed care/advanced physician organizations. PATIENTS: Pharmacy and medical claims covering 1,965,000 lives were reviewed and 292,996 members with a hypertension-related claim were identified between June 1, 1998 and July 1, 2001. A random sample (N = 5,935) was selected for chart review. The present analysis was conducted on the subset of African-American patients (N = 440) included in this sample. RESULTS: Approximately 66% of the African-American patients were female, the mean age was 60.4 years, 47.8% had dyslipidemia, and 31.4% had diabetes. Approximately 64% had uncontrolled hypertension. Patients with diabetes were 3 times more likely to have uncontrolled blood pressure as were patients without diabetes (OR = 2.92; P < .0001). CONCLUSIONS: Blood pressure control in the African-American population is lower than the Healthy People 2010 goal of 50%. African Americans with hypertension and diabetes are at an increased risk for uncontrolled blood pressure. Treating this high-risk population more aggressively may reduce long-term complications and decrease mortality.

Adult↗
PubMedDate not supplied

The effect of atopic dermatitis on total burden of illness and quality of life on adults and children in a large managed care organization.

OBJECTIVE: To assess the impact of atopic dermatitis (AD) on total burden of illness and quality of life in a managed care population. METHODS: This study included retrospective evaluation of electronic claims, patient surveys of financial burden and quality of life (QOL), and medical chart review. A total of 962 AD patients had 12 months of claims data available. Of these, the Dermatology Life Quality Index (DLQI), SF-36, and Children's Dermatology Life Quality Index (CDLQI) were mailed to 400 participants (42%) who consented to take part in the prospective evaluation, 298 of whom returned evaluable questionnaires (75% response rate to survey and 31% of eligible patients). Survey responders comprised the cohort used for determination of economic and humanistic burden of illness. Additionally, socioeconomic demographics, out-of-pocket expenses, and clinical history (including disease severity) were collected via survey. Provider assessments of disease severity were collected via chart review. RESULTS: The patient mean age was 17.22+/-0.94 years, which was not unexpected considering AD is the eighth most common disease in people younger than 25 years. Mean 167 dollars per person, or only 27.4% of the total burden. A vast majority of the direct medical expenditures occurred in the outpatient setting and were composed primarily of clinic visits and medications. Approximately 50% of the total burden of illness associated with AD resulted from days lost from work. The remainder of the burden was out-of-pocket costs to the patients and their families. More than 75% of the out-of-pocket costs resulted from household items and medications. The mean DLQI score for the 107 adults was 6.6+/-5.4, and the mean CDLQI score among the 132 children aged 4 to 16 years was 5.8+/-5.9, compared with adults without skin disease (0.5+/-1.1) and children without skin disease (0.38+/-0.71) in the validation populations. Patient-assessed severity demonstrated a stronger correlation with CDLQI and DLQI than did provider-assessed severity. CONCLUSION: Atopic dermatitis, while not a life-threatening illness, imposes a financial burden on the health care system, but even more so on the individual. Indirect costs, such as the purchase of special household items and days lost from work, comprise a great proportion of this burden and should not be overlooked when evaluating this disease.

Journal Article↗
PubMedDate not supplied

Patient adherence with amlodipine, lisinopril, or valsartan therapy in a usual-care setting.

OBJECTIVE: To compare the persistence and compliance in a usual-care setting with 3 drugs (amlodipine, lisinopril, or valsartan) from 3 different pharmaceutical classes.calcium-channel blocker, angiotensin-converting enzyme inhibitor, and angiotensin receptor blocker, respectively, commonly used to treat hypertension. METHODS: This retrospective observational study included a cohort of 142,945 continuously benefit-eligible patients from a pharmacy benefit manager drug claims database who began therapy with lisinopril, valsartan, or amlodipine. Concurrent use of other cardiovascular medications was assessed as a proxy for cardiovascular disease severity. Chronic Disease Score (CDS), derived from pharmacy claims data, was used to classify patient chronic disease burden as mild, moderate, or severe. Drug utilization measures included compliance, persistence, medication possession ratio (MPR), duration of therapy, and drug discontinuation. Multiple linear regression techniques were used to assess the impact of various predictor variables on study outcomes and to compare compliance among treatment groups, adjusted for age, gender, and CDS. RESULTS: The mean age of the study cohort was 63.1 years; 53% were female. Just over one half (51%, n=73,148) received amlodipine, 28% (n=40,238) received lisinopril, and 21% (n=29,669) received valsartan. Significantly more valsartan patients (63%) remained persistent on therapy at 12 months past the index date of the first prescription, compared with amlodipine (53%) and lisinopril (50%) patients (P<0.001). Both crude and adjusted compliance rates also were greatest for valsartan patients, reflected by an adjusted mean MPR of 75%, compared with 67% for amlodipine and 65% for lisinopril (P<0.0001, both comparisons). CONCLUSION: These results suggest that, in a usual-care setting, patients receiving valsartan (relative to amlodipine or lisinopril) appear to be more compliant and persistent with pharmacologic therapy, independent of patient chronic disease burden.

Amlodipine↗
PubMedDate not supplied

Assessment of drug therapy management and the prevalence of heart failure in a managed care population with hypertension.

OBJECTIVES: To (1) determine the prevalence of heart failure (HF) and cardiovascular risk factors within a hypertensive managed care population, (2) measure blood pressure goal attainment in patients with concurrent HF and hypertension (HTN), and (3) assess the use of drug therapy for diabetic and nondiabetic patients with concurrent HF and HTN, particularly regarding the use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). METHODS: Eligible patients were identified through a review of medical and pharmacy claims data from 10 managed care organizations (MCOs) and 2 specialty medical groups (4.6 million total members) from June 1998 through July 2001. From approximately 850,000 members in the claims database identified as hypertensive, 7,226 were randomly selected for medical chart review. Of these, 6,935 medical charts had a confirmed diagnosis of HTN but not HF, and 291 (4%) had confirmed HTN and HF. The study population--291 patients with HTN and HF--provided information on demographic characteristics, prevalence of cardiovascular risk factors and relevant comorbidities, and systolic and diastolic blood pressure. Current antihypertensive therapy prescription fill rate was evaluated using pharmacy claims. RESULTS: Patients with diagnoses of HTN and HF confirmed in the medical chart (N=291) were included in the present analysis. HF prevalence among hypertensive patients was 4% (291 of 7,226). Mean age of the study patients was 68.3 years, and 52.9% of the patients were female. Key cardiovascular risk factors included gender (men and postmenopausal women) (89.3%), age > 60 years (73.5%), hyperlipidemia (47.4%), and diabetes (38.8%). Of the total sample, only 30.1% of the diabetic (34 of 113) and 26.4% of the nondiabetic (47 of 178) patients with HF had their blood pressure controlled to the goal level of < 130/85 mm Hg recommended by the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the national guideline in effect at the time. Overall, 64.7% of HF patients for whom we had pharmacy claims were receiving an ACE inhibitor or an ARB. CONCLUSIONS: The study results indicate a deficit in the treatment of HTN among HF patients with and without diabetes, including failure to achieve blood pressure goals (< 130/85 mm Hg at the time of this study period). More aggressive quality improvement programs are necessary to educate providers and patients on the importance of treating blood pressure to nationally accepted goal using antihypertensives proven beneficial for hypertensive patients with HF.

Adult↗