Biomedical subjects

Jerome Wilson

Publications and source records attributed to Jerome Wilson.

6 recordsLinked to original sources

PubMed2006

Population antibiotic susceptibility for Streptococcus pneumoniae and treatment outcomes in common respiratory tract infections.

PURPOSE: Antibiotic-resistant Streptococcus pneumoniae potentially threatens the successful treatment of common respiratory tract infections (RTIs); however, the relationship between antibiotic resistance and treatment outcomes remains unclear. We aimed to test the hypothesis that higher in vitro penicillin and erythromycin nonsusceptibility levels among clinical isolates of S. pneumoniae are associated with higher risk of treatment failure in suppurative acute otitis media (AOM), acute sinusitis, and acute exacerbation of chronic bronchitis (AECB). METHODS: We conducted a population-level analysis using treatment outcomes data from a national, managed-care claims database, and antibiotic susceptibility data from a national repository of antimicrobial susceptibility results between 1997 and 2000. Treatment outcomes in patients with suppurative AOM, acute sinusitis, or AECB receiving selected macrolides or beta-lactams were assessed. Associations between RTI-specific treatment outcomes and antibiotic nonsusceptibility were determined using Spearman correlation coefficients with condition-specific paired outcome and susceptibility data for each region and each year. RESULTS: There were 649 552 available RTI outcomes and 7252 susceptibility tests performed on S. pneumoniae isolates. There were no statistically significant trends across time for resolution proportions following treatment by either beta-lactams or macrolides among any of the RTIs. Correlation analyses found no statistically significant association between S. pneumoniae susceptibility and RTI treatment outcomes apart from a significant positive association between of erythromycin nonsusceptibility in ear isolates and macrolide treatment resolution for suppurative AOM. CONCLUSION: On the population level, in vitro S. pneumoniae nonsusceptibility to macrolide or beta-lactam antibiotics was not associated with treatment failure in conditions of probable S. pneumoniae etiology.

Acute Disease↗

PubMed2005

Assessing the costs of chronic obstructive pulmonary disease: the state medicaid perspective.

BACKGROUND: State Medicaid programs provide insurance coverage to over 40 million Americans. However, estimates of the annual cost of chronic obstructive pulmonary disease (COPD) from the Medicaid perspective are lacking. METHODS: This retrospective cohort study used Medicaid administrative claims data from California and Florida to estimate COPD expenditures using two alternative methods: (1) excess costs (comparing a COPD cohort to a matched comparison cohort); and (2) attributable costs (COPD-related expenditures within a COPD cohort, inclusive of respiratory medications). The COPD cohort in each state included Medicaid recipients not dually eligible for Medicare who were 40+ years of age with at least one medical claim for COPD during 2001. The comparison cohort consisted of patients with medical claims during 2001 for conditions other than chronic respiratory disease, matched by age, sex, and race to the COPD cohort. RESULTS: A total of 6,738 Medicaid recipients in California and 18,017 in Florida were included in the COPD cohort, with mean ages of 56 and 60 years, respectively. Comorbidities, especially congestive heart failure and vascular disease, were more common in the COPD cohort than among matched controls. The mean excess cost of COPD per-patient was estimated to be approximately 6,500 US dollars in California Medicaid and 5,200 US dollars in Florida Medicaid. Mean attributable costs of COPD were similar in the two Medicaid programs (approximately 2,200 US dollars and 2,300 US dollars per patient, respectively). CONCLUSIONS: COPD places a substantial financial burden on State Medicaid programs. These findings may be of interest to clinicians and policy-makers involved in preventing or managing this chronic disease.

Adult↗

PubMed2005

A cost-minimization analysis comparing azithromycin-based and levofloxacin-based protocols for the treatment of patients hospitalized with community-acquired pneumonia: results from the CAP-IN trial.

BACKGROUND: A randomized trial was performed comparing azithromycin and levofloxacin for treating moderately to severely ill patients hospitalized with community-acquired pneumonia. This is a cost-minimization analysis comparing those regimens. METHODS: The cost-minimization analysis compares 81 patients receiving sequential therapy with IV azithromycin plus IV ceftriaxone followed by oral azithromycin with 82 patients receiving IV levofloxacin followed by oral levofloxacin, all with complete economic data over approximately 30 days, including information about hospitalization, study medications, home care, postdischarge utilization, and lost productivity. Units of utilization were multiplied by unit prices in order to estimate cost per patient. These total costs were compared using a two-sample t test. RESULTS: Direct medical costs of the azithromycin group were 2,481 US dollars less than the corresponding costs in the levofloxacin group (p = 0.03; 95% confidence interval, 238 US dollars to 4,724 US dollars). Most of the cost difference (2,300 US dollars) is attributable to hospital days, with the majority of these days being spent on the general medicine wards. The precise magnitude of the cost advantage attributable to azithromycin, if any, depends on both the reduction in length of hospital stay and its associated daily cost. CONCLUSIONS: Azithromycin was no more costly than levofloxacin, and perhaps less so. Cost is but one of many factors that should be considered by clinicians in decisions involving any individual patient.

Aged↗

PubMed2005

Medicaid prescription drug access restrictions: exploring the effect on patient persistence with hypertension medications.

OBJECTIVE: To compare rates of discontinuation of prescription therapy for hypertension in Medicaid patients with and without medication access restrictions. STUDY DESIGN: Retrospective cohort study. METHODS: Prescription data were extracted from a pharmacy claims database in a large state that implemented a Medicaid preferred drug list (PDL), both before and after the PDL was implemented. Prescriptions filled between June 2000 and May 2003 were included. RESULTS: Medicaid patients taking prescription medications commonly used to treat hypertension were 39% (odds ratio = 1.39; 95% confidence interval, 1.21, 1.6) more likely to discontinue hypertension therapy after the restriction was implemented compared with Medicaid patients 1 year earlier when there were no restrictions. Patients were classified as "discontinued" if they had therapy available less than 50% of the time during the 12 months after implementation of the PDL. Before the PDL, 17% of patients receiving treatment with hypertension medication discontinued therapy. After the PDL, 21% of Medicaid patients taking hypertension medication discontinued therapy. After the PDL, Medicaid patients were significantly more likely to switch medications from a restricted to an unrestricted drug. Those patients also were less likely to have a restricted drug added to their therapy regimen. CONCLUSIONS: After implementation of the PDL, Medicaid patients were more likely to discontinue filling prescriptions for antihypertensive medication. Because hypertension management is an important challenge within the Medicaid community, the potential connection between access restrictions and patient adherence to medication therapy is a worthy topic for further exploratory studies and quantitative outcomes research.

Adult↗

PubMed2003

Ethnicity-related variation in breast cancer risk factors.

BACKGROUND: A variety of factors are predictors of breast cancer risk. However, the studies conducted to establish these risk factors have rarely included African American women. The few studies with sufficient numbers of African-American women suggest that risk factors for breast cancer among African-American women are similar to those of white women. Although risk factors may be similar for African-American and white women, differences in the prevalence of risk factors may explain the differences in patterns of incidence. METHODS: The authors reviewed the epidemiologic studies of breast cancer among African-American women and identified resources with information regarding the prevalence of risk factors among African American and white women. RESULTS: Considerable variation exists in the studies of breast cancer risk factors among African American women. Because few studies have included sufficient numbers of African-American women, no firm conclusions can be drawn regarding whether risk estimates for African American women differ from those of white women. Estimates of the prevalence of breast cancer risk factors indicate that African American and white women differ in terms of their ages at menarche, menstrual cycle patterns, birth rates, lactation histories, patterns of oral contraceptive use, levels of obesity, frequency of menopausal hormone use, physical activity patterns, and alcohol intake. CONCLUSIONS: The risk factor profile of African-American women appears to differ from that of white women. This may explain in part, the higher incidence rates for African Americans before age 45 years and the lower incidence rates at older ages. Discussions of these data at a workshop highlighted the need for future research on breast cancer risk among African Americans. This research should acknowledge the heterogeneous heritage, cultural beliefs, and cultural knowledge of African-American women. Studies conducted in collaboration with the African-American community of women and with the breast cancer advocacy community can benefit from assistance in the design of questionnaires and recruitment of participants.

Adolescent↗

PubMedDate not supplied

Excess mortality, length of stay, and costs associated with serious fungal infections among elderly cancer patients: findings from linked SEER-Medicare data.

OBJECTIVE: To calculate the excess mortality, length of stay, and costs attributable to serious fungal infections in hospitalized elderly patients with selected cancers. METHODS: This study involved a retrospective cohort analysis using linked data from the Surveillance, Epidemiology and End Results Program of the National Cancer Institute (SEER) and Medicare claims data. Study cohorts included patients aged 65 years and older who newly received a diagnosis of a selected cancer (acute myeloid leukemia [AML] or squamous cell carcinoma of the head and neck [SCCHN]) in a SEER registry between 1991 and 1996 and who had a subsequent diagnosis of a serious fungal infection during an inpatient hospitalization, and hospitalized controls without a fungal infection matched 1:1 by age, geographic region, receipt of recent chemotherapy, concomitant bacterial infection, timing of the index hospitalization, and cancer stage at diagnosis (for SCCHN patients only). RESULTS: Eighty AML patients and 52 SCCHN patients experienced a serious fungal infection involving hospitalization. Relative to matched controls, SCCHN patients with fungal infections had significantly higher all-cause mortality (40% vs. 14%, P = 0.002), while mortality rates did not differ between AML cohorts. Patients with fungal infections had significantly longer index hospitalizations regardless of cancer type (mean: 30 days vs. 19 days for AML patients; 20 days vs. 9 days for SCCHN patients), and correspondingly higher Medicare payments (mean +/- SD: 34,268 dollars +/- 31,811 dollars vs. 21,416 dollars +/- 22,449 dollars among AML patients, P < 0.0001; 25,942 dollars +/- 29,122 dollars vs. 10,131 dollars +/- 10,686 dollars among SCCHN patients, P < 0.0001). CONCLUSIONS: Efforts to prevent these infections and/or initiate early treatment may yield both clinical and economic benefits.

Aged↗