Keys to successful management of patients with allergic rhinitis: focus on patient confidence, compliance, and satisfaction.

OBJECTIVE: The American Academy of Otolaryngic Allergy (AAOA) convened an expert, multidisciplinary Working Group on Allergic Rhinitis to discuss patients' self-treatment behaviors and how health care providers approach and treat the condition. PROCEDURES AND DATA SOURCES: Co-moderators, who were chosen by the AAOA Board of Directors, were responsible for initial agenda development and selection of presenters and participants, based on their expertise in diagnosis and treatment of allergic rhinitis. Each presenter performed a literature search from which a presentation was developed, portions of which were utilized in developing this review article. SUMMARY OF FINDINGS: Allergic rhinitis is a common chronic condition that has a significant negative impact on general health, co-morbid illnesses, productivity, and quality of life. Treatment of allergic rhinitis includes avoidance of allergens, immunotherapy, and/or pharmacotherapy (ie, antihistamines, decongestants, corticosteroids, mast cell stabilizers, anti-leukotriene agents, anticholinergics). Despite abundant treatment options, 60% of all allergic rhinitis patients in an Asthma and Allergy Foundation of America survey responded that they are "very interested" in finding a new medication and 25% are "constantly" trying different medications to find one that "works." Those who were dissatisfied also said their health care provider does not understand their allergy treatment needs and does not take their allergy symptoms seriously. Dissatisfaction leads to decreased compliance and an increased reliance on multiple agents and over-the-counter products. Furthermore, a lack of effective communication between health care provider and patient leads to poor disease control, noncompliance, and unhappiness in a significant portion of patients. CONCLUSIONS: Health care providers must gain a greater understanding of patient expectations to increase medication compliance and patient satisfaction and confidence.

Managing the expanded use of biologics across therapeutic areas: an example from b-cell targeted therapies.

Greater understanding of disease pathology at the molecular and cellular level has enhanced the roles of various proteins in disease pathogenesis. Because so many diseases have common physiologic pathways, many biologic therapies have been found to work in multiple therapeutic areas, particularly cancer, inflammation, infections, and metabolic and blood disorders. Thus, the search for agents to inhibit or block these critical therapeutic agents has been accelerated. This supplement reviews the factors contributing to the enormous growth of biotechnology drugs--both those currently marketed and those in late-stage development--from a clinical and managed care perspective. Specifically, the growth of expanded indications for drugs approved by the US Food and Drug Administration (FDA) will be examined, along with the challenges of managing biotechnology therapies being used beyond their original indications. A review of currently marketed biologics under investigation for new indications will be presented, along with a discussion of the implications of expanding indications and the resultant impact on managed care organizations in terms of cost, benefit design, access management strategy, safety and efficacy, and other pertinent issues. Managed care executives will face the challenge of making critical formulary decisions within the context of ever-increasing biologic options, including greater utilization of biotechnology drugs, more biologics for common conditions, and expanded indications for FDA-approved drugs.

Misadventures in insulin therapy: are your members at risk?

OBJECTIVE: The goal of this supplement is to increase awareness of and insight into the importance of preventing medication misadventures and provide new perspectives on effective management of diabetes through improved insulin therapy and review the issues that represent barriers to achieving treatment goals. Opportunities for managed care pharmacists and health care practitioners to influence enhanced quality of life, decrease mortality, and reduce health care costs will be highlighted. Attention will also be given to error prevention strategies, including improved preparation, storage, delivery, and administration of insulin products. SUMMARY: The prevalence of diabetes mellitus continues to increase at an alarming rate, spurring a corresponding increase in the use of insulin. Insulin therapy, although currently the most effective treatment for patients with type 1 diabetes and many patients with type 2 diabetes, is fraught with safety concerns, especially those associated with medication errors. As glycemic goals have become more rigorous (ie., glycosylated hemoglobin levels of <6.5%-7%), clinical studies have clearly shown that intensive insulin therapy (3 or more injections daily) is often a necessary step toward achieving satisfactory glycemic control. This supplement explores the current level of diabetic care; the barriers to optimal insulin therapy, including medication errors; and the myriad factors that can increase the risks for medication errors among physicians, managed care pharmacists, and patients. Strategies for reducing medication errors in the management of diabetes are also considered.