Correction: A quality improvement initiative for COPD patients: A cost analysis.

[This corrects the article DOI: 10.1371/journal.pone.0235040.].

A quality improvement initiative for COPD patients: A cost analysis.

The objective of this analysis was to evaluate and report on the economic impact of implementing an integrated, quality, and operational improvement program on chronic obstructive pulmonary disease (COPD) care from acute through post-acute care settings. This initiative was established in a cohort of 12 hospitals in Alabama and sought to address COPD readmission through improved workflows pertaining to early diagnosis, efficient care transitions, and patient visibility across the entire care episode. Implementation of the initiative was influenced by lean principles, particularly cross-functional agreement of workflows to improve COPD care delivery and outcomes. A budget impact model was developed to calculate cost savings directly from objective data collected during this initiative. The model estimated payer annual savings over 5 years. Patients were classified for analysis based on whether or not they received noninvasive ventilation. Scenario analyses calculated savings for payers covering different COPD cohort sizes. The base case revealed annual per patient savings of $11,263 for patients treated through the quality improvement program versus traditional care. The model projected cumulative savings of $52 million over a 5-year period. Clinical incorporation of non-invasive ventilation (NIV) resulted in $20,535 annual savings per patient and projected $91 million over 5 years. We conclude that an integrated management program for COPD patients across the care continuum is associated with substantial cost savings and significantly reduced hospital readmissions.

Development of Prescription Drug Information Leaflets: Impact of Cognitive Effort and Patient Involvement on Prescription Medication Information Processing.

OBJECTIVE: The objective of this study was to develop a one-page (1-page) prescription drug information leaflet (PILs) and assess their impact on the information processing variables, across 2 levels of patient involvement. METHODS: One-page PILs were developed using cognitive principles to lower mental effort and improve comprehension. An experimental, 3 × 2 repeated measures study was conducted to determine the impact of cognitive effort, manipulated using leaflet type on comprehension across 2 levels (high/low) of patient involvement. Adults (≥18 years) in a university setting in Houston were recruited for the study. Each participant was exposed to 3 different types of prescription drug information leaflet (the current practice, preexisting 1-page text-only, and 1-page PILs) for the 3 drugs (Celebrex, Ventolin HFA, Prezista) for a given involvement scenario. A prevalidated survey instrument was used to measure product knowledge, attitude toward leaflet, and intention to read. RESULTS: Multivariate analysis of variance indicated significant positive effect of cognitive effort, involvement, and their interaction effect across all measured variables. Mean scores for product knowledge, attitude toward leaflet, and intention to read were highest for PILs ( P < .001), indicating that PILs exerted lowest cognitive effort. Univariate and post hoc analysis indicate that product knowledge significantly increases with high involvement. CONCLUSION: Patients reading PILs have higher comprehension compared with the current practice and text-only prototype leaflets evaluated. Higher levels of involvement further improve participant knowledge about the drug, increase their intention to read the leaflet, and change their attitude toward the leaflet. Implementation of PILs would improve information processing for consumers by reducing their cognitive effort.

Effect of warning placement on the information processing of college students reading an OTC drug facts panel.

OBJECTIVE: To compare three over-the-counter (OTC) Drug Facts panel versions for information processing optimization among college students. PARTICIPANTS: University of Houston students (N = 210) participated in a cross-sectional survey from January to May 2010. METHODS: A current FDA label was compared to two experimental labels developed using the theory of CHREST to test information processing by re-positioning the warning information within the Drug Facts panel. Congruency was defined as placing like information together. Information processing was evaluated using the OTC medication Label Evaluation Process Model (LEPM): label comprehension, ease-of-use, attitude toward the product, product evaluation, and purchase intention. RESULTS: Experimental label with chunked congruent information (uses-directions-other information-warnings) was rated significantly higher than the current FDA label and had the best average scores among the LEPM information processing variables. CONCLUSION: If replications uphold these findings, the FDA label design might be revised to improve information processing.

Abuse of over-the-counter medicines: a pharmacist's perspective.

Self-care and self-medication practices are essential components of any health care systems. The use of over-the-counter (OTC) medications is a part of the self-medication process. The popularity of OTC medication use among patients may increase the abuse potential of OTC medications. With pharmacists being as accessible as they are, they are often the first line of contact for patients, and have the opportunity to educate and counsel patients on appropriate OTC medication use. The presence of a pharmacist ensures safe and effective use of OTC medications. Pharmacists can liaise with other health care providers in the management of self-care practices by patients. However, a pharmacist has traditionally been underutilized in this role. This article provides a brief review on OTC medications with abuse potential and the effect of self-medication on OTC medication abuse. This review further describes the barriers faced by pharmacists in OTC medication abuse management, given the increased potential of prescription-to-OTC switch in recent years. In addition, the potential for a behind-the-counter drug category to boost patient-pharmacist interaction was discussed. The current review supports the positive role played by pharmacists in the management of OTC medication abuse. This review adds to the knowledge base of the barriers faced by pharmacists to prevent OTC medication abuse while developing appropriate intervention strategies. By expanding the role of pharmacists, OTC medication abuse may be controlled more effectively, thereby providing better patient medication therapy management and outcomes.

Improving Information Processing: The Effect of Label Format Among Current and Potential Over-the-Counter Medication Users.

OBJECTIVE: To test the effect of current versus 2 experimental label formats on information processing among current and potential over-the-counter (OTC) users. METHODS: A cross-sectional survey was conducted in a cohort of adults across a metropolitan community, Houston, Texas. Three labels were designed. We placed a chunk of like information together (uses, direction, other information). Label A (control) followed the format of the existing FDA Drug Facts panel format for an antiallergy medication, label B had warnings placed before, while label C had warnings placed after the chunk. The 2 label designs were compared using the information-processing constructs derived from the OTC Label Evaluation Process Model (LEPM). RESULTS: A multivariate analysis of covariance and Dunnett's test revealed that the mean scores for constructs of OTC LEPM were significantly better for label C compared to the control and label B ( P < .0001). CONCLUSION: Our label format improved information processing among consumers but only when warning placement was placed at the end in the Drug Facts panel, giving an opportunity for the FDA to consider revising the format of the OTC Drug Facts panel, to improve patient understanding and reciprocally enhance patient safety.