Kenneth C. Jackson

An interdisciplinary expert consensus statement on assessment of pain in older persons

This paper represents an expert-based consensus statement on pain assessment among older adults. It is intended to provide recommendations that will be useful for both researchers and clinicians. Contributors were identified based on literature prominence and with the aim of achieving a broad representation of disciplines. Recommendations are provided regarding the physical examination and the assessment of pain using self-report and observational methods (suitable for seniors with dementia). In addition, recommendations are provided regarding the assessment of the physical and emotional functioning of older adults experiencing pain. The literature underlying the consensus recommendations is reviewed. Multiple revisions led to final reviews of 2 complete drafts before consensus was reached.

Opioid-Related Adverse Drug Events in Surgical Hospitalizations: Impact on Costs and Length of Stay

Background: Opioid analgesics remain a mainstay in the treatment of pain associated with surgical procedures. Such use is associated with adverse drug events (ADEs). Objective: To investigate the impact of opioid-related ADEs on total hospital costs and length of stay (LOS) in adult surgical patients. Methods: This was a retrospective matched cohort study using data from computerized medical records. ADE cases were prospectively detected using computerized surveillance and verified by pharmacists. Surgical patients treated at LDS Hospital in Salt Lake City from January 1, 1998, to December 31, 2003, were included. The primary outcomes were costs and hospital LOS associated with opioid-related ADEs and the relationship of opioid dose to ADE events. Results: Patients experiencing opioid-related ADEs had significantly increased median total hospital costs (7.4% increase; 95% CI 3.83 to 10.96; p < 0.001) and increased median LOS (10.3% increase; 95% CI 6.5 to 14.2; p < 0.001) compared with matched non-ADE contrals. The increased costs attributable to ADEs, by surgery type, were general surgery (

Assessment of adherence, persistence, and costs among valsartan and hydrochlorothiazide retrospective cohorts in free-and fixed-dose combinations

676.51; 95% CI 351.50 to 1001.50), orthopedics (

Role of Corticosteroids in Palliative Care

861.50; 95% CI 448.20 to 1274.80), and obstetrics/gynecology (

Pharmacotherapy for neuropathic pain.

540.90; 95% CI 281.40 to 800.40). Similarly, increased LOS attributable to ADEs, by surgery type, were general surgery (0.64 days; 95% CI 0.40 to 0.88), orthopedics (0.52 days; 95% CI 0.33 to 0.71), and obstetrics/gynecology (0.53 days; 95% CI 0.33 to 0.72). Higher doses of opioids were associated with increased risk of experiencing ADEs (OR 1.3; 95% CI 1.07 to 1.60; p = 0.01). Conclusions: Opioid-related ADEs following surgery were associated with significantly increased LOS and hospitalization costs. These ADEs occurred more frequently in patients receiving higher doses of opioids.

An employer-based cost-benefit analysis of a novel pharmacotherapy agent for smoking cessation

ABSTRACT Objectives: To assess medication adherence, persistence, and costs between cohorts of patients in managed care settings using a fixed-dose combination (FDC) or individual components (IC) of valsartan and hydrochlorothiazide in an insurance claims database. Methods: Medical and prescription claims for hypertensive patients using a combination of valsartan and HCTZ were identified from the IHCIS National Managed Care Benchmark Database via a retrospective cohort analysis. Study subjects had at least 110 days prior to start of study medications during which no other antihypertensive medications were prescribed, and were followed for 12 months. Claims for 8711 adult patients were analyzed for adherence, persistence and costs. General linear regression was conducted to detect differences in adherence among groups. Covariates included age, gender, persistence, number on concomitant cardiovascular drugs, and number of cardiovascular diagnoses. Results: Most subjects used an FDC product (N = 8150, 93.6%) vs. the IC (N = 561, 6.4%). The FDC group had a larger portion of males and less concomitant cardiovascular medications or disease. A random sample of 1628 of the FDC subjects had improved values for medication adherence compared to the IC group (62.1 vs. 53.0%, p < 0.001) and persistence values were improved at both 180 days (73 vs. 28%, p < 0.001) and 365 days (54 vs. 19%, p < 0.001). Both prescription drug costs (

Dexmedetomidine: a novel analgesic with palliative medicine potential.

1587 vs.

Faculty Perceptions of Appropriate Faculty Behaviors in Social Interactions With Student Pharmacists

2050, p < 0.001) and medical costs (

Novel Opioid Antagonists for Opioid-Induced Bowel Dysfunction and Postoperative Ileus

3343 vs.

Anxiety in Palliative Care Patients

3817, p < 0.001) were lower in the FDC cohorts. Conclusions: The use of fixed-dose therapy in hypertension may lead to increased adherence and persistence with a positive financial impact on both prescription and total medical costs. As with any retrospective claims database analysis, unobserved systematic differences between the two medication groups may exist.