Virginia Scott

Depression in Patients with Type 2 Diabetes: Impact on Adherence to Oral Hypoglycemic Agents

Background: Adherence to oral hypoglycemic agents (OHAs) is important for adequate glycemic control and prevention of future complications in patients with type 2 diabetes. Objective: To examine the impact of depression on adherence to OHAs in patients newly diagnosed with type 2 diabetes. Methods: Patients newly diagnosed with type 2 diabetes during a 4 year period were identified from a Medicaid claims database. Presence of preexisting depression was determined on the basis of ICD-9-CM codes. Adherence to OHAs was computed using prescription refill data for a 12 month follow-up period from the date of the index OHA prescription. Two separate adherence indices (Medication Possession Ratio-1 [MPR-1], Medication Possession Ratio-2 [MPR-2]) were computed. The impact of depression on adherence was assessed after controlling for confounders such as demographics, comorbidity, provider interaction, complexity of regimen, and diabetes severity. Results: A total of 1326 newly diagnosed patients with type 2 diabetes were identified (depressed = 471; nondepressed = 855). Results of the study indicated that patients with depression had significantly lower adherence (MPR-1 86%; MPR-2 66%) to OHAs compared with patients without depression (MPR-1 89%; MPR-2 73%). Multivariate results indicated that depression was a significant predictor of adherence, with depressed patients being 3–6% less adherent to OHAs than nondepressed patients, after controlling for confounding factors. Conclusions: Depression significantly impacts adherence to OHAs in patients with type 2 diabetes. The study results imply that depression screening and treatment need to be included in the protocol for management of patients with type 2 diabetes.

Association of Medication Adherence with Workplace Productivity and Health-Related Quality of Life in Patients with Asthma

Objective. Examine the association of medication adherence with workplace productivity and health-related quality of life (HRQL) in asthma patients. Methods. Adult patients with asthma in a state health insurance program identified from medical claims (July 2001–June 2003) were mailed a three-part survey to measure HRQL (St. Georges Respiratory Questionnaire), workplace productivity (Workplace Productivity Short Inventory), and self-reported medication adherence (Morisky Scale). Results. The symptoms domain had the worst HRQL scores, followed by the activity and impacts domains; 39% of the participants reported themselves as “high” adherent, whereas 19% were “medium,” and 42% were “low” adherent. Asthma resulted in productivity losses of

Impact of Visual Impairment on Health-Related Quality of Life in Multiple Sclerosis

597 ±

Pharmacists’ Perceptions of Tobacco Sales in an Elevated-Risk Population

1,024 (absenteeism) and

Outcomes of Inappropriate Prescribing of β-Blockers After an Acute Myocardial Infarction in a Medicaid Population

658 ±

Quality of life, health status and clinical outcomes in Type 2 diabetes patients

1,808 (presenteeism) per enrollee per year. Conclusions. Asthma was associated with HRQL detriments and workplace productivity losses.

Use of tumor necrosis factor inhibitors in rheumatoid arthritis : a national survey of practicing United States rheumatologists

The aim of this study was to evaluate the impact of visual impairment on health-related quality of life (HRQOL) in patients with multiple sclerosis (MS). Patients at an outpatient MS clinic were as...

Medication therapy management services in West Virginia: Pharmacists' perceptions of educational and training needs

Background: Policies by the American Medical Association and the American Pharmacists Association advocate for the discontinuation of tobacco sales in pharmacies, yet tobacco sales remain lucrative for pharmacies in the United States. West Virginia has the highest smoking rate (29%) and the second highest lung cancer incidence in the country. Objective: This study examined pharmacists’ perceptions of tobacco sales in pharmacies and awareness of relevant policies. Methods: West Virginia pharmacists (n = 195) were surveyed to understand tobacco sales in West Virginia pharmacy, utilizing Diffusion of Innovations as a theoretical framework. Results: Eighty-one percent were community pharmacists, and 39% practiced at independent pharmacies. Sixty-two percent reported that their pharmacies did not sell tobacco. Pharmacists at independent pharmacies were more likely to be in rural areas/small towns, have decision-making control over tobacco sales, and not currently selling tobacco products. Other community pharmacists (ie, at regional and national chains) were more likely to sell tobacco products, not have decision-making control over tobacco sales, and perceive revenue loss from discontinuing tobacco sales. Other types of pharmacists (eg, hospital) estimated a greater number of patients who were smokers/tobacco users. A logistic regression showed that less perceived revenue loss was associated with greater likelihood of not selling tobacco products (all Ps < .05). Conclusions: Findings indicate a strong movement among community pharmacists to curtail the use of tobacco. Generating support for the elimination of tobacco sales and adoption of tobacco cessation initiatives in community pharmacy could help reduce smoking rates in elevated-risk populations.

Impact of depression on utilization patterns of oral hypoglycemic agents in patients newly diagnosed with type 2 diabetes mellitus: A retrospective cohort analysis

BACKGROUND: Acute myocardial infarction (AMI) is associated with high mortality. β-Blockers are known to reduce mortality and reinfarction rates when used for long-term prevention following an AMI. OBJECTIVE: To assess the prescribing patterns of β-blockers in patients after experiencing an AMI in the West Virginia Medicaid program and examine its impact on patient outcomes. METHODS: One-year pre- and post-AMI data were extracted for 488 Medicaid patients. Prescribing of β-blockers within 90 days after discharge was evaluated among these patients. Based on American Heart Association/American College of Cardiology guidelines, patients were divided into 2 groups: those prescribed therapy appropriately and those prescribed therapy inappropriately (underuse, misuse). One-year all-cause mortality, cardiac mortality, and cardiac morbidity were compared between the groups using survival analysis. RESULTS: Approximately 64% of the patients were appropriately prescribed β-blockers and illustrated significantly (p = 0.035%) lower all-cause mortality rates compared with the inappropriately prescribed group at the one-year follow-up. Cardiac mortality evaluation showed no significant findings. The groups differed significantly in morbidity outcome (time to first cardiac hospitalization), with the inappropriate group exhibiting later hospitalization at the end of the year (p = 0.019%). However, the appropriate group had a higher proportion of hypertensive patients, suggesting more severity compared with the inappropriate group. CONCLUSIONS: Inappropriate prescribing of β-blockers following AMI was observed in this Medicaid population. Data suggest that there were overall survival benefits associated with appropriate β-blocker prescribing. However, cardiac morbidity associated with inappropriate prescribing needs to be evaluated after adjusting for disease severity between the 2 groups.