Biomedical subjects

Neil Goldfarb

Publications and source records attributed to Neil Goldfarb.

5 recordsLinked to original sources

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

Association between primary care practice characteristics and emergency department use in a medicaid managed care organization.

BACKGROUND: Many patients use emergency departments (EDs) for primary care. Previous studies have found that patient characteristics affect ED utilization. However, such studies have led to few policy changes. OBJECTIVES: We sought to determine whether Medicaid patients' ED use is associated with characteristics of their primary care practices. RESEARCH DESIGN: This was a cohort study. SUBJECTS: A total of 57,850 patients, assigned to 353 primary care practices affiliated with a Medicaid HMO, were included. MEASURES: Predictor variables were characteristics of primary care practices, which were measured by visiting each practice. The outcome variable was ED use adjusted for patient characteristics. RESULTS: On average, patients made 0.80 ED visits/person/yr. Patients from practices with more than 12 evening hours/wk used the ED 20% less than patients from practices without evening hours. A higher ratio of the number of active patients per clinician-hour of practice time was associated with more ED use. When more Medicaid patients were in a practice, these patients used the ED more frequently. Other factors associated with ED use included equipment for the care of asthma and presence of nurse practitioners and physician assistants. DISCUSSION: Modifiable characteristics of primary care practices were associated with ED use. Because the observational design of this study does not allow definitive conclusions about causality, future studies should include intervention trials to determine whether changing practice characteristics can reduce ED use. CONCLUSIONS: Improving primary care access and scope of services may reduce ED use. Focusing on systems issues rather than patient characteristics may be a more productive strategy to improve appropriate use of emergency medical care.

Adolescent↗

PubMed2004

Impact of appropriate pharmaceutical therapy for chronic conditions on direct medical costs and workplace productivity: a review of the literature.

This paper presents the findings of a literature review investigating the economic impact of appropriate pharmaceutical therapy in treating four prevalent chronic conditions - asthma, diabetes, heart failure, and migraine. The goal of the review was to identify high-quality studies examining the extent to which appropriate pharmaceutical therapy impacts overall medical expenditure (direct costs) and workplace productivity (indirect costs). The working hypothesis in conducting the review was that the costs of pharmaceuticals for the selected chronic conditions are offset by savings in direct and indirect costs in other areas. The literature provides evidence that appropriate drug therapy improves the health status and quality of life of individuals with chronic illnesses while reducing costs associated with utilization of emergency room, inpatient, and other medical services. A growing body of evidence also suggests that workers whose chronic conditions are effectively controlled with medications are more productive. For employers, the evidence translates into potential direct and indirect cost savings. The findings also confirm the importance of pharmaceutical management as a cornerstone of disease management.

Aged↗

PubMedDate not supplied

Hospital organizational change and financial status: costs and outcomes of care in Philadelphia.

Two recent changes in Philadelphia-area hospital organizations are consolidation into systems and acquisition of 2 medical school hospitals by a for-profit chain. This study explored whether such consolidation and conversion affected costs and outcomes of care. The analysis included 1,617,581 discharges from 49 acute-care hospitals from 1997 to 1999. Analyses within and between medical school hospitals examined trends in discharges, case mix, length of stay, and mortality. The study addressed 2 questions: whether, as hospitals consolidate into medical school hospital-based systems, volume, severity, length of stay, and mortality increase in those hospitals; and whether for-profit conversion redistributes complex, high-cost admissions to nonprofit hospitals. The 2 medical school hospitals that became for-profit experienced decreases in volume and resource intensity, coupled at one with an increase in severity. However, these patterns were produced more by the system's financial instability than by consolidation or conversion.

Academic Medical Centers↗

PubMedDate not supplied

Interactive voice response reminder effects on preventive service utilization.

This study evaluated the effects of interactive voice response (IVR) system reminders to managed care organization (MCO) members to obtain mammograms, Papanicolaou (Pap) tests, and influenza immunizations. The MCO identified 3 member cohorts and sent IVR reminders to get preventive services. Analyses employed claims data to examine relationships between IVR reminders and preventive service use 5 to 9 months post-intervention among members without prior utilization. Multivariate logistic regressions controlling for age, gender (for influenza immunizations), and risk stratum confirmed hypothesized relationships between intervention and preventive services: mammograms, odds ratio (OR) = 1.263 (95% confidence interval [CI] = 1.104, 1.444); Pap tests, OR = 1.241 (1.107, 1.391); influenza immunizations, OR = 2.072 (1.665, 2.580). IVR reminders are associated with higher rates of mammograms, Pap tests, and influenza immunizations. Study limitations include unknown generalizability of results and possible self-selection. There is justification for more IVR interventions and research to enhance MCO members' preventive service utilization.

Adult↗