Biomedical subjects

Norman V Carroll

Publications and source records attributed to Norman V Carroll.

7 recordsLinked to original sources

PubMed2006

Outcomes associated with vasoactive therapy in patients with acute decompensated heart failure.

STUDY OBJECTIVES: To describe the clinical management of acute decompensated heart failure (ADHF) in patients receiving intravenous treatment with dobutamine, milrinone, or nesiritide, and to evaluate differences, based on treatment received, in the in-hospital mortality rate, length of stay (LOS), total health care costs, and 30-day hospital readmission rate. DESIGN: Retrospective cohort analysis. DATA SOURCE: University HealthSystem Consortium (UHC) Clinical Database Pharmacy, a database with information from 32 academic hospitals. PATIENTS: Two thousand one hundred thirty patients with ADHF who received dobutamine (1311 patients), milrinone (433), or nesiritide (386). MEASUREMENTS AND MAIN RESULTS: Patients with ADHF were categorized according to the vasoactive therapy received. To evaluate baseline characteristics, chi(2) analysis was used; logistic regression was employed to assess the relationships between drug therapy and in-hospital mortality rates, and multivariate linear regression was used to assess whether drug therapy was related to LOS and total health care costs. All regression analyses controlled for age, sex, race, region of the United States where the hospital was located, primary payer for the hospital stay, UHC patient severity class, and chronic renal failure. In-hospital mortality rates were 10.2%, 7.9%, and 2.9% in the dobutamine, milrinone, and nesiritide groups, respectively. This resulted in an adjusted odds ratio for death of 3.5 (95% confidence interval [CI] 1.8-6.8) for dobutamine and 3.9 (95% CI 1.8-8.3) for milrinone (p<0.0001). Compared with inotropic therapy (dobutamine and milrinone), mean LOS in the hospital and the intensive care unit were lower with nesiritide (p<0.001). Total health care costs were lowest with nesiritide, but this reached statistical significance only when compared with milrinone (p<0.001). Thirty-day hospital readmission rates with dobutamine, milrinone, and nesiritide were 5.0%, 9.5%, and 3.9%, respectively (p=NS). CONCLUSION: Nesiritide therapy was associated with a lower in-hospital mortality rate and shorter LOS compared with dobutamine and milrinone. In addition, total health care costs with nesiritide were decreased compared with milrinone. These observations need to be validated by a randomized controlled trial.

Acute Disease↗

PubMed2006

Evaluation of an automated system for prior authorization: a COX-2 inhibitor example.

OBJECTIVE: To evaluate the effectiveness of an automated prior authorization (PA) system (SmartPA) in reducing use of and expenditures for cyclooxygenase-2 (COX-2) inhibitors. STUDY DESIGN: Before and after with control group. METHODS: After implementation of SmartPA in Missouri, changes in use of and expenditures for COX-2 inhibitors, COX-2 substitutes (traditional nonsteroidal anti-inflammatory drugs [NSAIDs] and other products for pain), and gastrointestinal (GI) protective agents were compared between the Medicaid program of Missouri and that of a state with no PA program for COX-2 inhibitors. Subjects were continuously enrolled for the 24-month study period and had a claim for a COX-2 inhibitor in the 12-month baseline period. Analyses included comparison of means and linear regression. Regressions controlled for age, sex, risk for GI complications, severity of illness, and the interaction between state and risk. RESULTS: Changes in expenditures for COX-2 inhibitors, NSAIDs, other pain drugs, and GI-protective drugs were $256 higher, $56 lower, $21 higher, and $198 higher, respectively, in the control state among low-risk patients. Changes in expenditures were $102 higher, $12 lower, $21 lower, and $185 higher, respectively, in the control state among high-risk patients. Results were similar for drug utilization. CONCLUSION: Implementation of SmartPA resulted in reduced use of and expenditures for COX-2 inhibitors and reduced net expenditures for all pain and GI-protective medications. These effects were greatest for patients at low risk for GI complications.

Aged↗

PubMed2005

The cost of falls among the community-dwelling elderly.

OBJECTIVE: To estimate the direct medical costs of falls in the population of community-dwelling elderly. METHODS: Data from a sample of 4,025 consumers from the 1997 Medical Expenditure Panel Survey were used to make estimates that were representative of the population of civilian, noninstitutionalized elderly in the United States. RESULTS: In 1997, 9% of the noninstitutionalized elderly population of the United States reported medical conditions related to falls. The estimated total direct medical cost of these conditions was dollar 6.2 billion in 1997 dollars and dollar 7.8 billion in 2002 dollars. The mean cost per person who had fallen was dollar 2,039 in 1997 dollars and dollar 2,591 in 2002 dollars. Inpatient hospitalizations accounted for 65% of total costs, followed by office-based medical visits and home health care, each accounting for about 10% of total direct medical costs, and hospital outpatient visits for 7.6%. About 78% of fall-related costs were reimbursed by Medicare. CONCLUSION: Fall-related medical conditions affect a substantial number of the community-dwelling elderly and result in direct medical costs of dollar 6 to dollar 8 billion per year in the United States. The total economic burden of falls is significantly higher because this estimate does not include direct nonmedical, intangible, and indirect costs. The results of this study highlight the importance of research aimed at decreasing the incidence and severity of falls in the elderly.

Accidental Falls↗

PubMed2004

A comparison of the costs of manufacturer unit-dose and repackaged unit-dose in seven-day dispensing systems.

OBJECTIVE: To compare the costs associated with manufacturer unit-dose and repackaged unit-dose in seven-day unit-dose dispensing systems to guide purchasing decisions. DESIGN: Retrospective observational economic evaluation. SETTING: Central Virginia long-term care pharmacy provider servicing 2,020 beds in 13 unit-dose facilities. MAIN OUTCOME MEASURES: Costs of manufacturer unit-dose and repackaged unit-dose for the 146 most frequently dispensed drugs. RESULTS: Total costs over six months for manufacturer unit-dose were found to be $1,428,248. This was $14,726 less than repackaged unit-dose at $1,442,974. The major factor contributing to the difference was the cost of inventory destroyed. Sensitivity analyses indicated that the manufacturer unit-dose system was less expensive as long as the acquisition cost of unit-dose drugs was no more than 5.1% higher than that of drugs purchased in bulk bottles. CONCLUSION: Manufacturer unit-dose was associated with a 1.0% cost-savings over repackaged unit-dose. Lower costs of inventory destroyed outweighed higher acquisition costs.

Journal Article↗

PubMed2002

How effectively do managed care organizations influence prescribing and dispensing decisions?

OBJECTIVE: To examine the extent to which managed care organizations (MCOs) use formularies, therapeutic interchange, and prior approval and to determine how effectively these tools influence prescribing and dispensing decisions. RESEARCH DESIGN: Literature review. PATIENTS AND METHODS: Studies relating to effectiveness were identified through a comprehensive literature review using the MEDLINE and International Pharmaceutical Abstracts databases. Only peer-reviewed studies done in outpatient settings were included. Studies measuring extent of use were taken primarily from published and widely available marketing research reports. RESULTS: Closed formularies were found to be effective in decreasing the utilization, but not necessarily the cost, of prescription drugs. Just under half of health maintenance organizations (HMOs) and 10% of employer-sponsored health plans use closed formularies. Prior approval programs have been shown to reduce use of target drugs and drug costs in a small number of drug classes. Nearly all HMOs and most employer-sponsored health plans use prior approval programs. How extensively the programs are used is not reported. About half of HMOs and employer-sponsored health plans use therapeutic interchange. Voluntary programs have been shown to be successful in staff-model HMOs. Mandatory, but not voluntary, programs have been shown to be successful in independent practice association-model HMOs. CONCLUSION: The literature indicates that most MCOs have had limited success using formularies, therapeutic interchange, and prior approval to influence prescribing and dispensing decisions. Although these tools have been effective in some situations, their impact has been limited by their low rate of utilization.

Cost Control↗

PubMedDate not supplied

Do community pharmacists influence prescribing?

OBJECTIVES: To evaluate whether community pharmacists have the ability to influence prescribing decisions and to determine the extent to which they do so. DATA SOURCES: International Pharmaceutical Abstracts was searched for articles published between January 1970 and September 2002 and MEDLINE was searched for articles published between January 1966 and September 2002 that contain the terms pharmaceutical care or pharmacist and intervention. STUDY SELECTION: Selected studies documented pharmacist interventions that resulted in a change in prescribing that required influencing the prescriber, included a complete description of methods and results, and were conducted in community pharmacies in the United States. DATA EXTRACTION: Selected studies were examined to determine whether, in what ways, and to what extent community pharmacists influenced prescribing. DATA SYNTHESIS: Community pharmacists in traditional practices regularly, but infrequently, recommend to prescribers that they initiate, discontinue, or change drug therapy. Prescribers usually accept and implement pharmacists' suggestions. Pharmacists are more likely to intervene to correct drug therapy problems when they have been trained to provide pharmaceutical care and have modified their practices to accommodate a more patient-centered style of practice. In the larger reviewed studies, pharmacists intervened to change therapy for the majority of their patients. CONCLUSION: Community pharmacists routinely intervene to influence prescribing. They do so, for the most part, to correct clinical problems or to provide their patients with more affordable therapy. In the majority of interventions, physicians accept and implement pharmacists' suggestions.

Community Pharmacy Services↗

PubMedDate not supplied

Comparison of costs of community and mail service pharmacy.

OBJECTIVE: To compare the costs of prescriptions dispensed through mail service and community pharmacies to quantify the comparative costs of the two types of pharmacies. DESIGN: Modeling study based on 1-year of claims data from a cohort of patients. SETTING: A health plan in the northeastern United States. PATIENTS: Approximately 100,000 members of the health plan. INTERVENTION: The plan used a small pharmacy benefits manager (PBM) and a mail service pharmacy that was not owned by a major PBM, a three-tier benefit design, and specified that patients could get a 90-day supply through mail service for the equivalent of two 30-day community pharmacy copayments. MAIN OUTCOME MEASURES: Actual total, ingredient, plan, and patient costs of prescriptions dispensed through a mail service pharmacy and the estimated costs of those same prescriptions at community pharmacies. RESULTS: Total costs for the 44,847 prescriptions dispensed through mail service were dollar 6,401,624. Had these prescriptions been dispensed at community pharmacies, costs would have been dollar 6,902,252. Ingredient costs were dollar 6,401,624 through mail versus dollar 6,633,170 at community pharmacies. Total costs to the health plan were dollar 4,726,637 through mail versus dollar 4,417,733 at community pharmacies. Member costs were dollar 1,674,987 through mail versus dollar 2,484,519 at community pharmacies. CONCLUSION: Compared with community pharmacies, the mail service pharmacy was less expensive overall, less expensive for patients, but more expensive to the health plan. From the health plan's perspective, the loss of copayments in the mail service benefit was greater than the savings on ingredient costs and dispensing fees.

Adolescent↗