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Biomedical subjects

Tami L Mark

Publications and source records attributed to Tami L Mark.

At least 19 recordsLinked to original sources
PubMed2006

Factors affecting detoxification readmission: analysis of public sector data from three states.

The objective of this study was to understand the rate of detoxification readmissions and the factors associated with readmission within a public sector population. The study sample was drawn from an integrated database that includes Medicaid and state mental health and substance abuse agency data from three states (Delaware, Oklahoma, and Washington) for 1996-1998. Clients with at least one state agency-sponsored detoxification event in 1996 or 1997 were included in the study. Twenty-seven percent of the sample was readmitted for detoxification within 1 year of their index detoxification. Clients who received two or more substance-abuse-related services within 30 days of their index detoxification were less likely to be readmitted and had a longer time until their second detoxification admission. Detoxification readmission is common in the public sector. Engaging patients in treatment following detoxification may reduce readmission rates and time to readmission.

Adult↗
PubMed2006

Drug administration frequency and provider office visit patterns for oncology patients during treatment with erythropoietic agents: an analysis of four observational studies.

BACKGROUND: Several drug administration regimens of epoetin alfa (EPO) and darbepoetin alfa (DARB) are used for the management of anemia in cancer patients in the clinical practice setting. OBJECTIVE: The purpose of the present analysis was to assess whether drug administration regimens were associated with differences in the number of provider office visits and hemoglobin assessments during treatment with these agents. METHODS: Data from 4 observational studies that examined treatment patterns of EPO and DARE and health care resource utilization were analyzed. These studies, selected based on the availability of office visit and/or hemoglobin determination data during the course of treatment, included a retrospective chart review, 2 retrospective claims analyses, and an ongoing prospective patient registry. The treatment patterns and oncology-related provider visits and/or the frequency of hemoglobin evaluations among the studies were reported. RESULTS: Data from 15,845 cancer patients were included in the analysis. The patient demographic and baseline characteristics were similar across all 4 studies; patients were predominantly women (62%-71%) with a mean age range of 56 to 63 years. Mean treatment duration ranged from 7.1 to 8.4 weeks without significant differences between EPO and DARE in any study. Weekly and extended (at least every 2 weeks [> or =Q2W]) drug administration frequencies were observed in both treatment groups. The most frequent drug administration schedule for EPO was once weekly (53%-75% of patients), and for DARE Q2W (67%-73%). Despite the difference in erythropoietic agent administration frequency, no significant differences were observed between EPO and DARB for either the number of oncology-related provider visits or the number of hemoglobin assessments. CONCLUSIONS: The frequency of oncology-related provider visits and hemoglobin assessments appears to be independent of the EPO and DARB administration frequency. These findings might provide useful information for health care providers and oncology patients in understanding patterns of care during treatment with erythropoietic agents.

Darbepoetin alfa↗
PubMed2006

Characterizing substance abuse programs that treat adolescents.

Few systematic studies have examined the characteristics of substance abuse treatment programs serving adolescents. An expert panel recently identified nine key elements of effective adolescent substance abuse treatment. We measured the percentage of treatment programs in the United States with at least 10 adolescent clients on a given day that reported these elements using data from the 2003 National Survey of Substance Abuse Treatment Services. This first look into the characteristics of facilities serving significant numbers of adolescents indicates that many facilities may be lacking in components considered important. The most significant measured potential areas for improvement occurred in the areas of including mental health as well as medical issues in comprehensive assessments and developing curricula to meet the developmental and cultural needs of clients. On a more encouraging note, many facilities were conducting discharge planning and providing aftercare, although the specifics of these services were not determined.

Adolescent↗
PubMed2006

Characteristics of U.S. youths with serious emotional disturbance: data from the National Health Interview Survey.

OBJECTIVE: Although it is estimated that serious emotional disturbance affects 9 to 13 percent of children and adolescents in the United States, there are few national data on the characteristics of this group. METHODS: This study used data for 13,579 youths from the 2001 National Health Interview Survey (NHIS) to describe the sociodemographic features and insurance coverage of youths with serious emotional disturbance living in the United States. Youths with serious emotional disturbance were identified through their scores on the Strengths and Difficulties Questionnaire, which was added to the NHIS in 2001. RESULTS: A large majority of youths with serious emotional disturbance were white and had income at 200 percent of the poverty level or higher. About 40 percent of youths with serious emotional disturbance had private insurance coverage, whereas Medicaid and the State Children's Health Insurance Program provided coverage for about a third of youths with serious emotional disturbance. CONCLUSIONS: Although Medicaid is an important payer of mental health services for youths with serious emotional disturbance, private insurance is still the primary source of health coverage for youths with serious emotional disturbance and for the overall population of youths.

Adolescent↗
PubMed2006

The effects of prescription drug copayments on statin adherence.

BACKGROUND: High copayments may present a barrier to medication adherence among patients with chronic conditions such as hyperlipidemia. OBJECTIVE: To assess the effects of statin copayments on statin adherence among individuals with employer-based insurance. STUDY DESIGN: We used a cross-sectional time-series design, with patient as the cross section and month as the time unit. METHODS: Medical and pharmacy claims among continuously enrolled statin users were selected from the 2000-2003 Medstat MarketScan database. Generalized estimating equation models were used to estimate the effects of copayment changes on statin adherence. Adherence was derived from the medication possession ratio, which represents the percentage of days on therapy each month. Separate estimates were obtained for new statin users (n = 142 341) and for continuing statin users (n = 92 344). RESULTS: Higher copayments were associated with lower statin adherence rates. A 100% index copayment increase had a larger effect on monthly adherence (2.6 and 1.1 percentage point decreases in adherence among new users and continuing users, respectively [both P < .01]) than a 100% copayment increase over time (a 1.1 percentage point decrease among new users [P < .01] and a nonsignificant decrease among continuing users). In all models, new statin users were more price sensitive than continuing users. CONCLUSIONS: High copayments are a financial barrier to statin adherence. The index copayment amount can affect compliance with statin use. Given the relationship between statin use and decreased frequency of cardiovascular events and procedures, the implications of high copayments should be considered by policy makers.

Aged↗
PubMed2006

Impact of statin copayments on adherence and medical care utilization and expenditures.

OBJECTIVE: To examine the effects of statin cost-sharing (ie, copayments, coinsurance) on adherence to statin medications and the impact of adherence on healthcare utilization and spending. STUDY DESIGN: Retrospective, observational study of statin users receiving health benefits or supplemental coverage from employer-sponsored health plans. METHODS: Medical and pharmacy claims were selected from the Medstat MarketScan database for patients who were continuously enrolled from 2000 through 2003. Two-stage residual inclusion models were estimated. The first stage modeled adherence to statins, which was derived from the medication possession ratio, and represented the percentage of days on therapy in an 18-month time frame, July 2001 through December 2002. In the second stage, generalized linear models were used to estimate 2003 utilization and expenditures. Separate estimates were produced for new statin users (n = 24 113) and continuing statin users (n = 93 253). RESULTS: Lower statin copayments were associated with higher levels of statin adherence. In percentage terms, when holding all other variables at their mean value, a $10 increase in copayment resulted in a 1.8 percentage point reduction in the probability of adherence for new users and a 3 percentage point reduction in the probability of adherence for continuing users. For continuing users adherent to statins, total costs did not change, but fewer negative events (emergency department visits, hospitalizations, and coronary heart disease-related hospitalizations) occurred. CONCLUSIONS: Policy makers and plan managers should consider interventions that improve adherence to statins, such as lower copayments.

Aged↗
PubMed2005

Retrospective observational study of patients with chemotherapy-related anemia receiving erythropoietic agents.

OBJECTIVE: Epoetin alfa (EPO) and darbepoetin alfa (DARB) are approved for the treatment of chemotherapy-related anemia (CRA) in patients with nonmyeloid malignancies. This study examined dosing and hematologic outcomes with these agents in community oncology clinics. METHODS: Medical charts were abstracted retrospectively for 1005 patients (527 EPO, 478 DARB) with CRA (hemoglobin [Hb] < or = 11 g/dL) who received EPO or DARB at 10 U.S. oncology clinics between January 2002 and March 2003. MAIN OUTCOME MEASURES: Outcome measures included dose and frequency of erythropoietic therapy, change in Hb at 4, 8, and 12 weeks after initiation of therapy, and transfusion of packed red blood cells. RESULTS: Baseline characteristics were generally similar between groups. Most EPO-treated patients received EPO once weekly, but 25% received EPO every 2-3 weeks, with 40,000 U the predominant dose. DARB was usually given every 1-2 weeks in doses ranging from 200-400 mcg/injection. Mean treatment duration was relatively short (< 8 weeks) in both groups, with a similar number of Hb determinations and similar incidence of red blood transfusion between groups. Hb increased from baseline in the EPO and DARB groups at 4 weeks (0.99 vs. 0.69 g/dL, p = 0.003), 8 weeks (1.39 vs. 1.06 g/dL, p = 0.011), and 12 weeks (1.43 vs. 1.11 g/dL, p = 0.055). Early Hb response (> or = 1 g/dL increase by 4 weeks) was more common with EPO than DARB (48% vs. 38%, p = 0.008). CONCLUSIONS: EPO was superior to DARB for early hematologic outcomes in patients with CRA in community oncology clinics. Retrospective data collection and relative inexperience with DARB at the time of the study may limit the generalization of these results. Randomized, controlled trials comparing EPO and DARB are warranted.

Aged↗
PubMed2004

Using stated preference and revealed preference modeling to evaluate prescribing decisions.

The use of stated preference analyses to evaluate choice of health care products has been growing in recent years. This paper shows how revealed preference data can be enriched with stated preference data and highlights the relative advantages of revealed and stated preference data. The techniques were applied to a study of determinants of physicians' prescriptions of alcoholism medications. Analyses were conducted on the relationship between physicians' perceptions of existing alcoholism medication attributes and their prescribing rates of those medications. Analyses were also conducted on physicians' decisions to prescribe hypothetical alcoholism medications with varying attributes such as efficacy, side effects, compliance, mode of action, and price. Finally, analyses were conducted on the combined stated and revealed preference data. Joint estimation suggests that parameters from the revealed and stated preference data are equal, up to scale. Joint analyses highlight how stated preference data can be used to estimate parameters for attributes that are not observed in the marketplace, that do not vary in the marketplace, or that are highly collinear with other attributes in actual markets.

Alcoholism↗
PubMed2003

Understanding US addiction physicians' low rate of naltrexone prescription.

Naltrexone was approved by the US Food and Drug Administration (FDA) in December 1994. Although it is one of only two medications for alcohol rehabilitation approved in the US, naltrexone is not frequently prescribed. This paper examines the factors limiting physicians' use of naltrexone. Data were collected through a survey of US physician members of two addiction medicine professional associations. Logistic regression analysis was conducted with the dependent variable being any prescription of naltrexone. Independent variables consisted of physician practice characteristics, physician ratings of naltrexone's attributes (e.g. efficacy), physicians' patient characteristics, and physicians' exposure to information about naltrexone. On average, addiction medicine physicians prescribed naltrexone to 13% of their alcoholism patients. The two main self-reported reasons why physicians did not prescribe the medication to more patients were that patients refused to take the medication or comply with prescribing regimes (23%), and that patients could not afford the medication (21%). Multivariate results indicated that physician perceptions of naltrexone's effectiveness and safety were significantly associated with prescribing. Physicians who had more exposure to information about the product (e.g. by reading more journal articles about naltrexone) were more likely to prescribe it. In summary, multiple factors are contributing to the relatively low naltexone prescription rate.

Data Collection↗
PubMed2003

Factors associated with the receipt of treatment following detoxification.

This paper examines the determinants of whether an individual received continuing treatment/rehabilitation services 30 days after receiving inpatient substance abuse detoxification. Data came from 1997-1999 employer health insurance claims. Only 49.4% of detoxification episodes were followed by continuing mental health or substance abuse treatment within 30 days after discharge. Some of the factors positively associated with receiving continuing treatment after receiving detoxification included: female gender, being in a behavioral health carve-out plan, and lower cost-sharing requirements for an outpatient substance abuse visit.

Adult↗
PubMed2003

Examination of treatment pattern differences by race.

Examine differences in treatment patterns among Blacks and non-Blacks in the U.S. Schizophrenia Care and Assessment Program. Baseline data from medical record abstraction, participant self-report and clinical assessment used to examine differences by race (race-gender pairings) (n = 2,239). Descriptive and multivariate (logistic) analysis employed. More Blacks were diagnosed with paranoid subtype. Blacks exhibited a more negative PANSS composite score, lower quality of life scores, and higher AIMS scores than non-Blacks. There was no statistically significant difference in the number of outpatient visits or inpatient admissions between Blacks and non-Blacks. Blacks had lower medication adherence and received less second-generation agents and more antiparkinson/anticholinergic agents. Proportion of Black males receiving depot was greater than other race-gender pairings. Regression results indicate Blacks more likely to be prescribed only first-generations after controlling for depot (OR = 1.64; CI = 1.27-2.12; p = 0.0002). Schizophrenia is, on average, accompanied by different diagnoses and symptoms in Blacks. Symptom profiles indicate that second-generation antipsychotics may be underprescribed to Black patients.

Black or African American↗
PubMed2003

Physicians' opinions about medications to treat alcoholism.

AIMS: Medications play a limited role in the treatment of alcoholism. This paper examines physicians' opinions about and use of two alcoholism medications currently approved in the US--disulfiram and naltrexone--and one alcoholism medication--acamprosate--that might be approved. DESIGN: A total of 1388 substance abuse specialist physicians who were members of the American Academy of Addiction Psychiatry or the American Society of Addiction Medicine completed a questionnaire in 2001 (65% response rate). FINDINGS: The average percentages of physicians' patients with alcoholism who were prescribed the following medications were: 13% (naltrexone), 9% (disulfiram), 46% (antidepressants) and 11% (benzodiazepines). Almost all physicians had heard of naltrexone and disulfiram, but their self-reported level of knowledge about these medications was lower than for antidepressants. Physicians estimated that naltrexone had a small-to-medium effect size, which was similar in magnitude to the effect size reported in recent meta-analyses of randomized clinical trials. Physicians identified the following three courses of action as the most likely to result in greater use of medications to treat alcohol dependence: more research to develop new medications (33%), more education of physicians about existing medications (17%), and increased involvement of physicians in alcoholism treatment (17%). CONCLUSIONS: Physicians' low rate of use of naltrexone may reflect its small-to-medium effect size.

Acamprosate↗
PubMed2003

Relationships between urinalysis testing for substance use, medical expenditures, and the occurrence of injuries at a large manufacturing firm.

Drug use among employees continues to be a serious concern for American employers. Over 80% of the large employers in the United States use some form of testing to detect drug use, but this practice is controversial and the cost-effectiveness of drug testing remains largely unknown. This study begins an empirical investigation of the consequences of drug testing by estimating its impact on medical care expenditures and injury rates at a large manufacturing firm in 1996-1999. Multiple regression analyses of a pooled cross-sectional time-series data set were used to separate the impact of drug testing from other factors and to help find the optimal level of testing that was associated with minimum medical expenditures. Results indicated that medical expenditures would be minimized when 42% of the employees in a calendar quarter were drug tested. This implies that, on average, employees should be tested 1.68 times a year. The results also indicated that doubling the testing rate would reduce the odds of incurring any injuries on the job by over half, but the injury rate was already so low that this impact was very small. Hopefully the results of this study will inform the policy debate over drug testing by focusing on real data, as opposed to supposition or political considerations that seem to dominate many discussions.

Adult↗
PubMed2003

Medicaid expenditures on behavioral health care.

OBJECTIVE: The authors reviewed studies of Medicaid spending on mental health and substance abuse services. METHODS: Studies were identified through a search of MEDLINE and bibliographies of known articles on mental health and substance abuse spending and by searching Web sites of or contacting key government and private organizations. Of 448 studies identified, the 14 that included Medicaid expenditure percentages for 1984 or later were compared. RESULTS AND CONCLUSIONS: The most comprehensive studies of such spending suggest that between 9.3 and 13 percent of all Medicaid dollars are spent on behavioral health services. The most comprehensive estimates came from claims-based studies or studies based on the National Health Accounts. Studies based on provider or consumer surveys missed large portions of Medicaid spending. Policy makers need to ensure that they use the most accurate data to track mental health and substance abuse spending, an important part of total Medicaid expenditures.

Behavior Therapy↗