Community pharmacy automatic refill program improves adherence to maintenance therapy and reduces wasted medication.

OBJECTIVES: Automatic prescription refill programs are a popular means of improving medication adherence. A concern is the potential for prescription drug wastage and unnecessary healthcare spending. We evaluated the impact of an automatic refill program on patterns of medication use. STUDY DESIGN: Retrospective propensity score matched cohort study with multivariable generalized linear modeling. METHODS: The setting of the study was a pharmacy benefit manager administering benefits for patients of retail pharmacies. Participants included patients on medication for chronic conditions; those receiving a 30-day supply (n = 153,964) and a 90-day supply (n = 100,394) were analyzed separately. The intervention was the automatic prescription refill program. Measures included medication possession ratio (MPR) and average days excess at the time of refill. The results are reported across 11 therapeutic classes. RESULTS: Overall, patients receiving 30-day supplies of medication in the automatic refill program had an MPR that was 3 points higher than those not in the refill program; among those receiving 90-day fills and in the refill program, the MPR was 1.4 points higher (P < .001 for both 30- and 90-day fills). The MPR was higher for members in the refill program across all therapeutic classes. Limiting our analysis to members receiving more than 365 days of medication, we found that patients who received 30-day fills and enrolled in the automatic refill program had 2.5 fewer days' oversupply than those in the control group, whereas automatic refill patients receiving 90-day supplies had 2.18 fewer days' oversupply than the controls (P < .001 for both 30- and 90-day fills). CONCLUSIONS: For this pharmacy provider, automatic refill programs result in improved adherence without adding to medication oversupply.

Comparison of acquisition parameters and breast dose in digital mammography and screen-film mammography in the American College of Radiology Imaging Network digital mammographic imaging screening trial.

OBJECTIVE: The purpose of our study was to compare the technical performance of full-field digital mammography (FFDM) and screen-film mammography. MATERIALS AND METHODS: The American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial enrolled 49,528 women to compare FFDM and screen-film mammography for screening. For quality assurance purposes, technical parameters including breast compression force, compressed breast thickness, mean glandular dose, and the number of additional views needed for complete breast coverage were recorded and analyzed for both FFDM and screen-film mammography on approximately 10% of study subjects at each site. RESULTS: Technical data were compiled on 5,102 study subjects at 33 sites. Clean data were obtained for 4,366 (88%) of those cases. Mean compression force was 10.7 dN for screen-film mammography and 10.1 dN for FFDM (5.5% difference, p < 0.001). Mean compressed breast thickness was 5.3 cm for screen-film mammography and 5.4 cm for FFDM (1.7% difference, p < 0.001). Mean glandular dose per view averaged 2.37 mGy for screen-film mammography and 1.86 mGy for FFDM, 22% lower for digital than screen-film mammography, with sizeable variations among digital manufacturers. Twelve percent of screen-film mammography cases required more than the normal four views, whereas 21% of FFDM cases required more than the four normal views to cover all breast tissue. When extra views were included, mean glandular dose per subject was 4.15 mGy for FFDM and 4.98 mGy for screen-film mammography, 17% lower for FFDM than screen-film mammography. CONCLUSION: Our results show that differences between screen-film mammography and FFDM in compression force and indicated compressed breast thickness were small. On average, FFDM had 22% lower mean glandular dose than screen-film mammography per acquired view, with sizeable variations in average FFDM doses by manufacturer.

Comparison of human observer performance of contrast-detail detection across multiple liquid crystal displays.

Appropriate selection of a display subsystem requires balancing the optimization of its physical parameters with clinical setting and cost. Recent advances in Liquid Crystal Display (LCD) technology warrant a rigorous evaluation of both the specialized and the mass market displays for clinical radiology. This article outlines step two in the evaluation of a novel 9.2 million pixel IBM AMLCD panel. Prior to these experiments, the panel was calibrated according to the DICOM Part 14 standard, using both a gray-scale and a pseudo-gray scale lookup table. The specific aim of this study is to compare human, contrast-detail perception on different computer display subsystems. The subsystems that we looked at included 3- and 5-million pixel "medical-grade" monochrome LCDs and a 9.2-million pixel color LCD. We found that the observer response was similar for these three display configurations.

Effect of viewing angle on luminance and contrast for a five-million-pixel monochrome display and a nine-million-pixel color liquid crystal display.

Digital imaging systems used in radiology rely on electronic display devices to present images to human observers. Active-matrix liquid crystal displays (AMLCDs) continue to improve and are beginning to be considered for diagnostic image display. In spite of recent progress, AMLCDs are characterized by a change in luminance and contrast response with changes in viewing direction. In this article, we characterize high pixel density AMLCDs (a five-million-pixel monochrome display and a nine-million-pixel color display) in terms of the effect of viewing angle on their luminance and contrast response. We measured angular luminance profiles using a custom-made computer-controlled goniometric instrument and a conoscopic Fourier-optics instrument. We show the angular luminance response as a function of viewing angle, as well as the departure of the measured contrast from the desired response. Our findings indicate small differences between the five-million-pixel (5 MP) and the nine-million-pixel (9 MP) AMLCDs. The 9 MP shows lower variance in contrast with changes in viewing angle, whereas the 5 MP provides a slightly better GSDF compliance for off-normal viewing.

Assessment of a novel, high-resolution, color, AMLCD for diagnostic medical image display: luminance performance and DICOM calibration.

This article documents the results of the first in a series of experiments designed to evaluate the suitability of a novel, high resolution, color, digital, liquid crystal display (LCD) panel for diagnostic quality, gray scale image display. The goal of this experiment was to measure the performance of the display, especially with respect to luminance. The panel evaluated was the IBM T221 22.2" backlit active matrix liquid crystal display (AMLCD) with native resolution of 3840 x 2400 pixels. Taking advantage of the color capabilities of the workstation, we were able to create a 256-entry grayscale calibration look-up table derived from a palette of 1786 nearly gray luminance values. We also constructed a 256-entry grayscale calibration look-up table derived from a palette of 256 true gray values for which the red, green, and blue values were equal. These calibrations will now be used in our evaluation of human contrast-detail perception on this LCD panel.