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1.
J Thromb Thrombolysis ; 44(2): 179-189, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28550629

ABSTRACT

The role of inferior vena cava filter (IVC) filters for prevention of pulmonary embolism (PE) is controversial. This study evaluated outcomes of IVC filter placement in a managed care population. This retrospective cohort study evaluated data for individuals with Humana healthcare coverage 2013-2014. The study population included 435 recipients of prophylactic IVC filters, 4376 recipients of therapeutic filters, and two control groups, each matched to filter recipients. Patients were followed for up to 2 years. Post-index anticoagulant use, mortality, filter removal, device-related complications, and all-cause utilization. Adjusted regression analyses showed a positive association between filter placement and anticoagulant use at 3 months: odds ratio (ORs) 3.403 (95% CI 1.912-6.059), prophylactic; OR, 1.356 (95% CI 1.164-1.58), therapeutic. Filters were removed in 15.67% of prophylactic and 5.69% of therapeutic filter cases. Complication rates were higher with prophylactic procedures than with therapeutic procedures and typically exceeded 2% in the prophylactic group. Each form of filter placement was associated with increases in all-cause hospitalization (regression coefficient 0.295 [95% CI 0.093-0.498], prophylactic; 0.673 [95% CI 0.547-0.798], therapeutic) and readmissions (OR 2.444 [95% CI 1.298-4.602], prophylactic; 2.074 [95% CI 1.644-2.616], therapeutic). IVC filter placement in this managed care population was associated with increased use of anticoagulants and greater healthcare utilization compared to controls, low rates of retrieval, and notable rates of device-related complications, with effects especially pronounced in assessments of prophylactic filters. These findings underscore the need for appropriate use of IVC filters.


Subject(s)
Managed Care Programs , Pulmonary Embolism/prevention & control , Vena Cava Filters/standards , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Case-Control Studies , Follow-Up Studies , Humans , Male , Middle Aged , Pulmonary Embolism/therapy , Retrospective Studies , Treatment Outcome , Vena Cava, Inferior
2.
Clin Infect Dis ; 54(8): e72-e112, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22438350

ABSTRACT

Evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed.


Subject(s)
Rhinitis/diagnosis , Rhinitis/drug therapy , Sinusitis/diagnosis , Sinusitis/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Infective Agents/administration & dosage , Bacterial Infections/diagnosis , Bacterial Infections/drug therapy , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult
3.
Clin Ther ; 33(12): 1914-31, 2011 Dec.
Article in English | MEDLINE | ID: mdl-22088416

ABSTRACT

BACKGROUND: Osteoarthritis (OA) is a debilitating condition characterized by chronic pain. Several pain medications are recommended, and patients frequently alternate among these medications. OBJECTIVES: The purpose of this study was to examine the use of pain medications in clinical practice with respect to recommended guidelines. This objective was accomplished by evaluating patterns of switching, augmentation, and discontinuation after treatment initiation with select medications in patients with OA. METHODS: The LifeLink Health Plan Claims Database was used to select patients with OA (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 715.XX) who were newly prescribed (index event) nonsteroidal antiinflammatory drugs (NSAIDs), cyclooxygenase (COX)-2 inhibitors, acetaminophen, tramadol, weak opioids, and strong opioids. Descriptive statistics, Kaplan-Meier analyses, and the COX proportional hazards model were used to assess therapy switching, augmentation, and discontinuation during the 12-month postindex period. Patterns of intraarticular injections and joint replacement surgeries among the cohorts were also evaluated. RESULTS: Substantial proportions of OA patients switched, augmented, or discontinued therapy during the postindex period. Rates of therapy switching, augmentation, and discontinuation, respectively, were significantly different (all P < 0.0001 for overall effects using log-rank tests) across the evaluated medication cohorts: NSAIDs, 22.3%, 6.7%, 93.2%; COX-2 inhibitors, 27.5%, 10%, 87.4%; acetaminophen, 46.0%, 6.5%, 98.7%; tramadol, 44.5%, 8.4%, 95.6%; weak opioids, 27.2%, 4.1%, 98.3%; and strong opioids, 41.1%, 3.3%, 97%. Therapy switching, augmentation, and discontinuation occurred within 2 months after treatment initiation in two thirds of patients and within 6 months in >90% of patients. The patterns of intraarticular injections were significantly different across treatment cohorts, as were the patterns of joint replacement surgeries (both P < 0.0001 for overall effects using log-rank tests), with average times to surgery that appeared longer with acetaminophen, NSAIDs, and COX-2 inhibitor initiators (416-447 days) than with tramadol and opioids (354-385 days). CONCLUSIONS: Results indicate that therapy switching and discontinuation were frequent among OA patients initiating treatment with the currently recommended medication classes and might suggest suboptimal pain relief or potentially intolerable therapy-related side effects.


Subject(s)
Analgesics/therapeutic use , Arthralgia/prevention & control , Chronic Pain/prevention & control , Drug Substitution , Osteoarthritis/drug therapy , Practice Patterns, Physicians' , Adolescent , Adult , Aged , Analgesics/adverse effects , Analgesics, Non-Narcotic/therapeutic use , Analgesics, Opioid/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Arthralgia/diagnosis , Arthralgia/etiology , Arthroplasty, Replacement , Chronic Pain/diagnosis , Chronic Pain/etiology , Cyclooxygenase 2 Inhibitors/therapeutic use , Drug Therapy, Combination , Female , Guideline Adherence , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Odds Ratio , Osteoarthritis/complications , Osteoarthritis/surgery , Pain Measurement , Practice Guidelines as Topic , Practice Patterns, Physicians'/statistics & numerical data , Proportional Hazards Models , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , United States , Young Adult
4.
Jt Comm J Qual Saf ; 30(6): 331-4, 2004 Jun.
Article in English | MEDLINE | ID: mdl-15208982

ABSTRACT

BACKGROUND: Despite widespread recommendations, the pneumococcal vaccination rate of patients 65 years of age or older is below target goals. A reminder system was instituted at the time of the scheduled primary care visit as a pilot quality improvement project. METHODS: Medical records staff used clinic schedules to identify patients 65 years of age or older, stamping that day's progress note with a reminder about pneumococcal vaccination. The physician could note previous vaccination or could order vaccination at the visit. If the patient was previously vaccinated or received a vaccine during that visit, an indicator was placed on the front of the chart. Staff at both clinics received an educational session on the indications and benefits of pneumococcal vaccination. RESULTS: Before implementing the reminder intervention, the pneumococcal immunization recording was comparable at the reminder clinic and at a second clinic that did not use reminders (x2 = 0.324, NS). At 6 months, 95/112 (85%) and 75/115 (65%) patients at the reminder and the second clinic had documentation of pneumococcal vaccination (x2 = 12.66, p < .005); at 12 months, 76% and 58% had such documentation. At the reminder clinic, the reminder stamp was found in 158/205 (77%) of the charts reviewed, with documentation of pneumococcal vaccination in 140/158 (89%) of these charts. DISCUSSION: The simple and inexpensive method of placing selective reminders in charts for elderly patients eligible for pneumococcal vaccination was highly effective in increasing the pneumococcal vaccination rate.


Subject(s)
Medical Records Systems, Computerized , Pneumococcal Infections/prevention & control , Pneumococcal Vaccines/administration & dosage , Reminder Systems , Florida , Humans , United States
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