Clara E. Dismuke

Medication Nonadherence in Diabetes: Longitudinal effects on costs and potential cost savings from improvement

OBJECTIVE To examine the longitudinal effects of medication nonadherence (MNA) on key costs and estimate potential savings from increased adherence using a novel methodology that accounts for shared correlation among cost categories. RESEARCH DESIGN AND METHODS Veterans with type 2 diabetes (740,195) were followed from January 2002 until death, loss to follow-up, or December 2006. A novel multivariate, generalized, linear, mixed modeling approach was used to assess the differential effect of MNA, defined as medication possession ratio (MPR) ≥0.8 on healthcare costs. A sensitivity analysis was performed to assess potential cost savings at different MNA levels using the Consumer Price Index to adjust estimates to 2012 dollar value. RESULTS Mean MPR for the full sample over 5 years was 0.78, with a mean of 0.93 for the adherent group and 0.58 for the MNA group. In fully adjusted models, all annual cost categories increased ∼3% per year (P = 0.001) during the 5-year study time period. MNA was associated with a 37% lower pharmacy cost, 7% lower outpatient cost, and 41% higher inpatient cost. Based on sensitivity analyses, improving adherence in the MNA group would result in annual estimated cost savings ranging from ∼

Serious Psychological Distress and Diabetes: A Review of the Literature

661 million (MPR <0.6 vs. ≥0.6) to ∼

Earnings among people with spinal cord injury.

1.16 billion (MPR <1 vs. 1). Maximal incremental annual savings would occur by raising MPR from <0.8 to ≥0.8 (

Trends in Health Care Expenditure in U.S. Adults With Diabetes: 2002–2011

204,530,778) among MNA subjects. CONCLUSIONS Aggressive strategies and policies are needed to achieve optimal medication adherence in diabetes. Such approaches may further the so-called “triple aim” of achieving better health, better quality care, and lower cost.

Delayed entry into employment after spinal cord injury: factors related to time to first job.

With the development of a measure of serious psychological distress (SPD) in 2002, more attention is being paid to the association of SPD with diabetes outcomes and processes of care. We review the literature on the relationship between SPD and diabetes processes of care and outcomes, as well as the literature on the relationship between specific mental health diagnoses and diabetes processes of care and outcomes during the 2010 to 2011 period. There is an extensive literature on the association of mental health diagnoses with diabetes outcomes, especially for depression. Because the Kessler scale measures a much broader range of mental health issues than any specific DSM-IV/Structured Clinical Interview for DSM Disorders diagnosis and is designed to assess SPD at the population level, additional research needs to be conducted both in clinical settings and using large administrative datasets to examine the association between SPD and diabetes outcomes and processes of care.

Association of serious psychological distress with health services expenditures and utilization in a national sample of US adults

OBJECTIVE To identify differences in conditional and unconditional earnings among participants with spinal cord injury (SCI) attributable to biographic, injury, educational, and employment factors by using a 2-part model (employment, earnings). DESIGN A secondary analysis of cross-sectional survey data. SETTING A Midwestern university hospital and a private hospital in the Southeastern United States. PARTICIPANTS All participants (N=1296) were adults between the ages of 18 and 64 who had a traumatic SCI at least 1 year before study initiation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Earnings were defined by earnings within the previous 12 months and were measured by a single categoric item. Conditional earnings reflect the earnings of employed participants, whereas unconditional earnings reflect all participants with

Medical care expenditures associated with chronic kidney disease in adults with diabetes: United States 2011

0 in earnings recorded for those unemployed. RESULTS Sex and race were significantly related to conditional earnings, even after controlling for educational and vocational variables. Additionally, conditional earnings (employed participants only) were related to 16 or more years of education, number of years employed, the percentage of time after SCI spent employed, and working in either government or private industry (not self-employed or family business). There was a greater number of significant variables for unconditional earnings, largely reflective of the influence of the portion employed (those not working having

Association between major depression, depressive symptoms and personal income in US adults with diabetes

0 in earnings). CONCLUSIONS Efforts to improve employment outcomes should focus on facilitating return to work immediately after injury, returning to preinjury job, maintaining regular employment, and working for placement in government or private industry. Special efforts may be needed to promote vocational outcomes among women and nonwhites.

Factors associated with labor force participation after spinal cord injury

OBJECTIVE Direct medical cost of diabetes in the U.S. has been estimated to be 2.3 times higher relative to individuals without diabetes. This study examines trends in health care expenditures by expenditure category in U.S. adults with diabetes between 2002 and 2011. RESEARCH DESIGN AND METHODS We analyzed 10 years of data representing a weighted population of 189,013,514 U.S. adults aged ≥18 years from the Medical Expenditure Panel Survey. We used a novel two-part model to estimate adjusted mean and incremental medical expenditures by diabetes status, while adjusting for demographics, comorbidities, and time. RESULTS Relative to individuals without diabetes (

Trends in Costs of Depression in Adults with Diabetes in the United States: Medical Expenditure Panel Survey, 2004-2011.

5,058 [95% CI 4,949–5,166]), individuals with diabetes (