Journal of Comparative Effectiveness Research, 2022
Aim: To assess healthcare utilization (HCRU) among patients with incident telehealth visit during... more Aim: To assess healthcare utilization (HCRU) among patients with incident telehealth visit during the COVID-19 pandemic. Materials & methods: Retrospective pre-post analyses was conducted using HealthJump data. Adults continuously enrolled with an incident telehealth visit between Feb and April 2020 were identified. Demographics, clinical characteristics, proportion of patients with ≥1 HCRU visits and post-index trends in HCRU were analyzed. Results: Sample constituted 2799 patients, 60.34% female and 46.23% white with mean age 59.70. Significant increase in patients with outpatient visits (5.36%, p < 0.005; only established), non-face-to-face visits (99.50%, p < 0.005) and prescription use (12.86%, p < 0.005) was reported. Conclusion: Among patients utilizing telehealth during COVID-19 pandemic, HCRU changed significantly. Better deployment policies and adoption techniques of telehealth could potentially act as a strong tool to revolutionize the healthcare delivery, with o...
The United States (US) is grappling with a severe opioid epidemic. Marijuana is emerging as a the... more The United States (US) is grappling with a severe opioid epidemic. Marijuana is emerging as a therapy for pain management and an alternative to opioids, but little evidence supports its long-term benefits. This study aims to examine the association of marijuana use among patients on prescription pain relievers in a retrospective cross-sectional study using zero-inflated negative binomial regression. The recipients of prescription pain medicines were identified using National Survey on Drug Use and Health (2015-2017). Irrespective of the state marijuana laws, marijuana use days were 34% higher and odds of having zero days of marijuana use were 73% lower in those using nonmedical prescription opioids vs. not (IRR = 1.34, p < 0.0001; OR = 0.27, p < 0.0001, respectively). In the absence of consequential evidence supporting marijuana for pain management and more states venturing into legalizing it, there needs to be more caution as the country struggles to recover from one epidemic.
Journal of the Association for Vascular Access, 2021
Highlights Background: Insertion of peripheral vascular access devices (PIVC) is fundamental to p... more Highlights Background: Insertion of peripheral vascular access devices (PIVC) is fundamental to patient care and may affect patient outcomes. Baseline data of PIVC insertions at a large medical center revealed that catheters required multiple insertion attempts, catheter hubs were manipulated to place extension sets, increasing the risk of complications, dwell times did not meet current standards, nurses experienced blood-exposure risk, and overall compliance with the hospital documentation policy was suboptimal. A 3-phase quality improvement project was conducted to address these concerns. Methods: In Phase 1, an assessment of the current state of PIVC insertions and care was conducted using a mixed-methods approach consisting of an observational audit of insertion and maintenance practices, and retrospective chart reviews. In Phase 2, PIVC policies and practices were updated to reflect current standards. A new advanced design PIVC device was adopted, and education was provided to ...
Background: There are significant costs associated with proper controlled substance disposal, man... more Background: There are significant costs associated with proper controlled substance disposal, management, and regulatory compliance. Given the high abuse potential of fentanyl, hydromorphone, and morphine it is imperative that (1) product waste is minimized; and (2) waste procedures are followed to ensure safe disposal. Research is needed to better understand the financial and workforce impacts of drug waste on inpatient hospital units. The primary objective of this study was to quantify the waste associated with administering fentanyl, hydromorphone, and morphine via the intravenous push route. Two categories of waste were evaluated: (1) the quantity (mg/µg) of drug disposed; and (2) workforce time associated with the waste disposal process. Methods: A workflow time study design, a sub-set of continuous direct observation time motion studies, was employed to achieve the research objectives. A data collection tool was developed to capture medication type, waste amount, activity time...
Journal of Comparative Effectiveness Research, 2019
Aim: Comparative effectiveness research (CER) can help ascertain value of new drugs; however, lim... more Aim: Comparative effectiveness research (CER) can help ascertain value of new drugs; however, limited research assesses the translation of CER into clinical practice. The objective of this study was to analyze the association between CER evidence and prescribing trends within two markets of Type 2 diabetes mellitus. Methods: A retrospective analysis to determine the prescribing trends from 2006 to 2016 and an electronic literature search to identify CER comparing different drugs was conducted. Results: In glucagon-like peptide-1 (GLP-1) agonists market, CER showed superiority of Liraglutide. Prescribing of Exenatide twice daily dropped by 50% points as Liraglutide entered the market. In dipeptidyl peptidase-4 (DPP4) inhibitors market, CER did not suggest conclusive superiority. Nevertheless, Sitagliptin, the first entrant, continued to dominate throughout. Conclusion: CER evidence appeared to be associated with prescribing trends in GLP-1 agonists market; however, no associations we...
INTRODUCTION: In the pivotal Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) cli... more INTRODUCTION: In the pivotal Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) clinical trial, dabigatran was associated with lower rates of stroke and systemic embolism compared to adjusted-dose warfarin. However, real-world evidence comparing stroke- and bleed-specific healthcare resource utilization (HCRU), costs, length of stay (LOS) per hospitalization and readmissions in non-valvular atrial fibrillation (NVAF) patients newly treated with dabigatran or warfarin is limited. METHODS: Using a nationwide administrative claims database in the US, a retrospective matched-cohort of newly diagnosed NVAF patients aged ≥18 years treated with dabigatran or warfarin in 01/01/2011-12/31/2013 was evaluated. Index date was the first dabigatran or warfarin claim date. All patients had data for 12 months before the index date and a maximum follow-up of 12 months or until discontinuation or switch, disenrollment, end of study period, or inpatient death. Propensity scores were used...
Background: Past reports suggest that a near balance has been reached in the supply and demand fo... more Background: Past reports suggest that a near balance has been reached in the supply and demand for pharmacists in the US. Although data on the level of supply of pharmacists is available, there is no continuous and systematic tracking of the level of demand (unmet and latent) for pharmacists at state level. Unmet demand, an established construct in pharmacy workforce, is important to measure the number of vacancies and assess pharmacist shortage consistently over time. Latent demand or potential demand is a novel construct and has never been measured in pharmacy workforce. With the increase in supply, it is important to measure the potential demand that could be budgeted in pharmacies in the near future. Objective: The objective of this study was to measure the unmet and latent demand for pharmacists and explore the association between latent demand and workload characteristics in community and hospital pharmacies in Wisconsin in 2011-12. Methods: The study used a cross-sectional, d...
Journal of comparative effectiveness research, Jan 29, 2018
Factors influencing differences in persistence between dabigatran and warfarin in patients with n... more Factors influencing differences in persistence between dabigatran and warfarin in patients with nonvalvular atrial fibrillation (NVAF) remain unclear. Compare differences in persistence between new dabigatran and warfarin users in patients newly diagnosed with NVAF, adjusting for sociodemographics, clinical characteristics, patient out-of-pocket cost and other covariates. A retrospective matched-cohort study was conducted using a US claims database of Medicare and commercially insured patients with NVAF aged≥ 18 years. Persistence and monthly out-of-pocket costs for dabigatran or warfarin were calculated and adjusted for covariates using Cox proportional hazard models. Unadjusted persistence was significantly lower among dabigatran users (n = 1025) compared with matched warfarin users (38 vs 46%). Adjusting for covariates rendered this difference insignificant (hazard ratio = 0.930).
Expert review of pharmacoeconomics & outcomes research, Jan 26, 2017
We compared healthcare utilization outcomes and persistence among non-valvular atrial fibrillatio... more We compared healthcare utilization outcomes and persistence among non-valvular atrial fibrillation (NVAF) patients newly treated with dabigatran or warfarin. Using a nationwide, US administrative claims database, a retrospective matched-cohort of newly diagnosed NVAF patients (age≥18 years) treated with dabigatran or warfarin (propensity score matched 1:1) in 01/01/2011-12/31/2013 was evaluated. All-cause, stroke- and bleed-specific per-patient per-month (PPPM) HCRU, incidence rate of hospitalization for stroke or bleed, 30-day readmission, and persistence were reported. In total, 18,890 dabigatran patients were matched to corresponding warfarin patients. Compared to warfarin users, dabigatran users PPPM had significantly fewer all-cause hospitalizations (0.04 vs 0.05), total outpatient visits (3.98 vs 5.87), and lower 30-day readmissions (14.5% vs 17.4%, all p<0.001). Dabigatran users had lower incidence rate for stroke (0.65 vs 1.06) and bleed (1.69 vs 2.20), stroke (0.0006 vs ...
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, Jan 15, 2016
To evaluate the impact of the Affordable Care Act's (ACA) dependent coverage mandate on insur... more To evaluate the impact of the Affordable Care Act's (ACA) dependent coverage mandate on insurance coverage among young adults in metropolitan and nonmetropolitan areas. A cross-sectional analysis was conducted using data from 2006-2009 and 2011 waves of the Medical Expenditure Panel Survey. A difference-in-difference analysis was used to compare changes in full-year private health insurance coverage among young adults aged 19-25 years with an older cohort aged 27-34 years. Separate regressions were estimated for individuals in metropolitan and nonmetropolitan areas and were tested for a differential impact by area of residence. Full-year private health insurance coverage significantly increased by 9.2 percentage points for young adults compared to the older cohort after the ACA mandate (P = .00). When stratifying the regression model by residence area, insurance coverage among young adults significantly increased by 9.0 percentage points in metropolitan areas (P = .00) and 10.1 ...
Research in Social and Administrative Pharmacy, 2016
The US Affordable Care Act (ACA) extended the age of eligibility for young adults to remain on th... more The US Affordable Care Act (ACA) extended the age of eligibility for young adults to remain on their parents&#39; health insurance plans in order to address the disproportionate number of uninsured young adults in the United States. Effective September 23, 2010, the ACA has required all private health insurance plans to cover dependents until the age of 26. However, it is unknown whether the ACA dependent coverage expansion had an impact on prescription drug insurance or the use of prescription drugs. To evaluate short-term changes in prescription health insurance coverage, prescription drug insurance coverage, prescription drug use, and prescription drug expenditures following implementation of the ACA young adult insurance expansion using national data from 2009 and 2011. Full-year health insurance coverage increased 4.9 percentage points during the study period, which was mainly due to increases in private health insurance among middle- and high-income young adults. In contrast, full-year prescription drug insurance coverage increased 5.5 percentage points and was primarily concentrated among high-income young adults. Although no significant short-term changes in overall prescription drug use were observed, a 30% decrease in out-of-pocket expenditures was seen among young adults. While the main goal of the ACA&#39;s young adult insurance expansion was to increase health insurance coverage among young adults, it also had the unintended positive effect of increasing coverage for prescription drug insurance. Additionally, young adults experienced substantial decreases in out-of-pocket spending for prescription drugs. It is important for evaluations of health care policies to assess both intended and unintended outcomes to better understand the implications for the broader health system.
Journal of Comparative Effectiveness Research, 2022
Aim: To assess healthcare utilization (HCRU) among patients with incident telehealth visit during... more Aim: To assess healthcare utilization (HCRU) among patients with incident telehealth visit during the COVID-19 pandemic. Materials & methods: Retrospective pre-post analyses was conducted using HealthJump data. Adults continuously enrolled with an incident telehealth visit between Feb and April 2020 were identified. Demographics, clinical characteristics, proportion of patients with ≥1 HCRU visits and post-index trends in HCRU were analyzed. Results: Sample constituted 2799 patients, 60.34% female and 46.23% white with mean age 59.70. Significant increase in patients with outpatient visits (5.36%, p < 0.005; only established), non-face-to-face visits (99.50%, p < 0.005) and prescription use (12.86%, p < 0.005) was reported. Conclusion: Among patients utilizing telehealth during COVID-19 pandemic, HCRU changed significantly. Better deployment policies and adoption techniques of telehealth could potentially act as a strong tool to revolutionize the healthcare delivery, with o...
The United States (US) is grappling with a severe opioid epidemic. Marijuana is emerging as a the... more The United States (US) is grappling with a severe opioid epidemic. Marijuana is emerging as a therapy for pain management and an alternative to opioids, but little evidence supports its long-term benefits. This study aims to examine the association of marijuana use among patients on prescription pain relievers in a retrospective cross-sectional study using zero-inflated negative binomial regression. The recipients of prescription pain medicines were identified using National Survey on Drug Use and Health (2015-2017). Irrespective of the state marijuana laws, marijuana use days were 34% higher and odds of having zero days of marijuana use were 73% lower in those using nonmedical prescription opioids vs. not (IRR = 1.34, p < 0.0001; OR = 0.27, p < 0.0001, respectively). In the absence of consequential evidence supporting marijuana for pain management and more states venturing into legalizing it, there needs to be more caution as the country struggles to recover from one epidemic.
Journal of the Association for Vascular Access, 2021
Highlights Background: Insertion of peripheral vascular access devices (PIVC) is fundamental to p... more Highlights Background: Insertion of peripheral vascular access devices (PIVC) is fundamental to patient care and may affect patient outcomes. Baseline data of PIVC insertions at a large medical center revealed that catheters required multiple insertion attempts, catheter hubs were manipulated to place extension sets, increasing the risk of complications, dwell times did not meet current standards, nurses experienced blood-exposure risk, and overall compliance with the hospital documentation policy was suboptimal. A 3-phase quality improvement project was conducted to address these concerns. Methods: In Phase 1, an assessment of the current state of PIVC insertions and care was conducted using a mixed-methods approach consisting of an observational audit of insertion and maintenance practices, and retrospective chart reviews. In Phase 2, PIVC policies and practices were updated to reflect current standards. A new advanced design PIVC device was adopted, and education was provided to ...
Background: There are significant costs associated with proper controlled substance disposal, man... more Background: There are significant costs associated with proper controlled substance disposal, management, and regulatory compliance. Given the high abuse potential of fentanyl, hydromorphone, and morphine it is imperative that (1) product waste is minimized; and (2) waste procedures are followed to ensure safe disposal. Research is needed to better understand the financial and workforce impacts of drug waste on inpatient hospital units. The primary objective of this study was to quantify the waste associated with administering fentanyl, hydromorphone, and morphine via the intravenous push route. Two categories of waste were evaluated: (1) the quantity (mg/µg) of drug disposed; and (2) workforce time associated with the waste disposal process. Methods: A workflow time study design, a sub-set of continuous direct observation time motion studies, was employed to achieve the research objectives. A data collection tool was developed to capture medication type, waste amount, activity time...
Journal of Comparative Effectiveness Research, 2019
Aim: Comparative effectiveness research (CER) can help ascertain value of new drugs; however, lim... more Aim: Comparative effectiveness research (CER) can help ascertain value of new drugs; however, limited research assesses the translation of CER into clinical practice. The objective of this study was to analyze the association between CER evidence and prescribing trends within two markets of Type 2 diabetes mellitus. Methods: A retrospective analysis to determine the prescribing trends from 2006 to 2016 and an electronic literature search to identify CER comparing different drugs was conducted. Results: In glucagon-like peptide-1 (GLP-1) agonists market, CER showed superiority of Liraglutide. Prescribing of Exenatide twice daily dropped by 50% points as Liraglutide entered the market. In dipeptidyl peptidase-4 (DPP4) inhibitors market, CER did not suggest conclusive superiority. Nevertheless, Sitagliptin, the first entrant, continued to dominate throughout. Conclusion: CER evidence appeared to be associated with prescribing trends in GLP-1 agonists market; however, no associations we...
INTRODUCTION: In the pivotal Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) cli... more INTRODUCTION: In the pivotal Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) clinical trial, dabigatran was associated with lower rates of stroke and systemic embolism compared to adjusted-dose warfarin. However, real-world evidence comparing stroke- and bleed-specific healthcare resource utilization (HCRU), costs, length of stay (LOS) per hospitalization and readmissions in non-valvular atrial fibrillation (NVAF) patients newly treated with dabigatran or warfarin is limited. METHODS: Using a nationwide administrative claims database in the US, a retrospective matched-cohort of newly diagnosed NVAF patients aged ≥18 years treated with dabigatran or warfarin in 01/01/2011-12/31/2013 was evaluated. Index date was the first dabigatran or warfarin claim date. All patients had data for 12 months before the index date and a maximum follow-up of 12 months or until discontinuation or switch, disenrollment, end of study period, or inpatient death. Propensity scores were used...
Background: Past reports suggest that a near balance has been reached in the supply and demand fo... more Background: Past reports suggest that a near balance has been reached in the supply and demand for pharmacists in the US. Although data on the level of supply of pharmacists is available, there is no continuous and systematic tracking of the level of demand (unmet and latent) for pharmacists at state level. Unmet demand, an established construct in pharmacy workforce, is important to measure the number of vacancies and assess pharmacist shortage consistently over time. Latent demand or potential demand is a novel construct and has never been measured in pharmacy workforce. With the increase in supply, it is important to measure the potential demand that could be budgeted in pharmacies in the near future. Objective: The objective of this study was to measure the unmet and latent demand for pharmacists and explore the association between latent demand and workload characteristics in community and hospital pharmacies in Wisconsin in 2011-12. Methods: The study used a cross-sectional, d...
Journal of comparative effectiveness research, Jan 29, 2018
Factors influencing differences in persistence between dabigatran and warfarin in patients with n... more Factors influencing differences in persistence between dabigatran and warfarin in patients with nonvalvular atrial fibrillation (NVAF) remain unclear. Compare differences in persistence between new dabigatran and warfarin users in patients newly diagnosed with NVAF, adjusting for sociodemographics, clinical characteristics, patient out-of-pocket cost and other covariates. A retrospective matched-cohort study was conducted using a US claims database of Medicare and commercially insured patients with NVAF aged≥ 18 years. Persistence and monthly out-of-pocket costs for dabigatran or warfarin were calculated and adjusted for covariates using Cox proportional hazard models. Unadjusted persistence was significantly lower among dabigatran users (n = 1025) compared with matched warfarin users (38 vs 46%). Adjusting for covariates rendered this difference insignificant (hazard ratio = 0.930).
Expert review of pharmacoeconomics & outcomes research, Jan 26, 2017
We compared healthcare utilization outcomes and persistence among non-valvular atrial fibrillatio... more We compared healthcare utilization outcomes and persistence among non-valvular atrial fibrillation (NVAF) patients newly treated with dabigatran or warfarin. Using a nationwide, US administrative claims database, a retrospective matched-cohort of newly diagnosed NVAF patients (age≥18 years) treated with dabigatran or warfarin (propensity score matched 1:1) in 01/01/2011-12/31/2013 was evaluated. All-cause, stroke- and bleed-specific per-patient per-month (PPPM) HCRU, incidence rate of hospitalization for stroke or bleed, 30-day readmission, and persistence were reported. In total, 18,890 dabigatran patients were matched to corresponding warfarin patients. Compared to warfarin users, dabigatran users PPPM had significantly fewer all-cause hospitalizations (0.04 vs 0.05), total outpatient visits (3.98 vs 5.87), and lower 30-day readmissions (14.5% vs 17.4%, all p<0.001). Dabigatran users had lower incidence rate for stroke (0.65 vs 1.06) and bleed (1.69 vs 2.20), stroke (0.0006 vs ...
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, Jan 15, 2016
To evaluate the impact of the Affordable Care Act's (ACA) dependent coverage mandate on insur... more To evaluate the impact of the Affordable Care Act's (ACA) dependent coverage mandate on insurance coverage among young adults in metropolitan and nonmetropolitan areas. A cross-sectional analysis was conducted using data from 2006-2009 and 2011 waves of the Medical Expenditure Panel Survey. A difference-in-difference analysis was used to compare changes in full-year private health insurance coverage among young adults aged 19-25 years with an older cohort aged 27-34 years. Separate regressions were estimated for individuals in metropolitan and nonmetropolitan areas and were tested for a differential impact by area of residence. Full-year private health insurance coverage significantly increased by 9.2 percentage points for young adults compared to the older cohort after the ACA mandate (P = .00). When stratifying the regression model by residence area, insurance coverage among young adults significantly increased by 9.0 percentage points in metropolitan areas (P = .00) and 10.1 ...
Research in Social and Administrative Pharmacy, 2016
The US Affordable Care Act (ACA) extended the age of eligibility for young adults to remain on th... more The US Affordable Care Act (ACA) extended the age of eligibility for young adults to remain on their parents&#39; health insurance plans in order to address the disproportionate number of uninsured young adults in the United States. Effective September 23, 2010, the ACA has required all private health insurance plans to cover dependents until the age of 26. However, it is unknown whether the ACA dependent coverage expansion had an impact on prescription drug insurance or the use of prescription drugs. To evaluate short-term changes in prescription health insurance coverage, prescription drug insurance coverage, prescription drug use, and prescription drug expenditures following implementation of the ACA young adult insurance expansion using national data from 2009 and 2011. Full-year health insurance coverage increased 4.9 percentage points during the study period, which was mainly due to increases in private health insurance among middle- and high-income young adults. In contrast, full-year prescription drug insurance coverage increased 5.5 percentage points and was primarily concentrated among high-income young adults. Although no significant short-term changes in overall prescription drug use were observed, a 30% decrease in out-of-pocket expenditures was seen among young adults. While the main goal of the ACA&#39;s young adult insurance expansion was to increase health insurance coverage among young adults, it also had the unintended positive effect of increasing coverage for prescription drug insurance. Additionally, young adults experienced substantial decreases in out-of-pocket spending for prescription drugs. It is important for evaluations of health care policies to assess both intended and unintended outcomes to better understand the implications for the broader health system.
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