Vj Willey

The Pharmacists’ Role in the Patient-Centered Medical Home (PCMH) A white paper created by the Health Policy Committee of the Pennsylvania Pharmacists Association (PPA)

Thefollowing are contributors to the writing of this paper (in alphabetical order): Hildegarde Berdine, PharmD, BCPS,CDE Associate Professor ofPharmacy Practice, Duquesne University, Mylan School of Pharmacy; Tanya Dougherty, PharmD, BCPS, Clinical Pharmacy Coordinator, Penn Presbyterian Medical Center; Jonathan Ference, PharmD, BCPS, Associate Professor, Wilkes University School ofPharmacy and Nursing; Kelly Karpa, PhD, RPh, Director, Medical Pharmacology Instruction, Penn State University College ofMedicine; Jacqueline Klootwyk, PharmD, BCPS, Assistant Professor, Thomas Jefferson University School ofPharmacy; Melinda Kozminski, PharmD, BCACP, Clinical Pharmacist, Gateway Health Plan; Nicholas Leon, PharmD, BCPS, BCACP, Thomas Jefferson University School of Pharmacy; Maria Osborne, PharmD, Clinical Pharmacist-Family Practice, UPMC St. Margaret; Adam C. Welch, PharmD, MBA, BCACP, Associate Professor, Wilkes University School of Pharmacy and Nursing; and Vincent J. Willey, PharmD, Associate Professor and Vice Chair, Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences.

Therapy modifications and low-density lipoprotein cholesterol goal attainment rates associated with the initiation of generic simvastatin

Abstract Objective: The availability of generic simvastatin has changed the relative cost structure within the statin marketplace and has been associated with third-party payer changes to formularies and statin utilization policies. The current study examines simvastatin therapy modification patterns and associated low-density lipoprotein cholesterol (LDL-C) goal attainment rates. Methods: This retrospective, observational study utilized administrative claims linked to laboratory result data from a national health plan. Patients newly initiated on generic simvastatin from January 2007 to March 2008 were identified. National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) risk categories and goal LDL-C targets were assigned. Simvastatin dose titrations and switches to other statins were described, as were changes in LDL-C values and NCEP ATP III goal attainment rates both before and after therapy modifications. Results: Of the 1654 patients newly initiated on simvastatin, 84% had no simvastatin therapy modification in the >1-year follow-up period. For patients with no therapy modification, 54.4% did not achieve their LDL-C NCEP ATP III goal at their first lipid panel and goal attainment was strongly associated with the level of cardiovascular risk (goal attainment rateu2009=u200975.1%, 51.7%, and 28.6% for low-, moderate- and high-risk categories, respectively). Of patients not achieving NCEP ATP III LDL-C goals (nu2009=u2009885), 85.4% had no therapy modification. Goal was achieved after therapy modification in 36% (dose titration) and 42% (switchers); high-risk patients goal attainment rates were 23% and 38%, respectively. Limitations: Limitations of the study include the observational design, use of an administrative claims database to assess cardiovascular risk, relatively short follow-up time (slightly more than 1 year) and the lack of assessment of adherence to therapy. Conclusions: This study found that the majority of patients initiated on generic simvastatin stayed on their initial starting dose regardless of NCEP ATP III goal attainment status. The findings of low rates of therapy modification irrespective of baseline CV risk and associated low rates of goal attainment, especially in high risk patients treated with simvastatin, indicate an opportunity to encourage clinical decision making based on the needs of the individual patient.

Epidemiologic study of aripiprazole use and the incidence of suicide events

Because second generation antipsychotics (SGA) might affect the risk of suicide, systematic assessment of suicide risk associated with SGA in the postmarketing setting is important and of interest to regulatory authorities. To fulfill a postmarketing request, our objective was to determine suicide event (attempted or completed) incidence in patients with schizophrenia or bipolar disorder, prescribed aripiprazole.

Efficiency and economic benefits of a payer-based electronic health record in an emergency department

OBJECTIVESnThe objective was to evaluate the use of a payer-based electronic health record (P-EHR), which is a clinical summary of a patients medical and pharmacy claims history, in an emergency department (ED) on length of stay (LOS) and plan payments.nnnMETHODSnA large urban ED partnered with the dominant health plan in the region and implemented P-EHR technology in September 2005 for widespread use for health plan members presenting to the ED. A retrospective observational study design was used to evaluate this previously implemented P-EHR. Health plan and electronic hospital data were used to identify 2,288 ED encounters. Encounters with P-EHR use (n = 779) were identified between September 1, 2005, and February 17, 2006; encounters from the same health plan (n = 1,509) between November 1, 2004, and March 31, 2005, were compared. Outcomes were ED LOS and plan payment for the ED encounter. Analyses evaluated the effect of using the P-EHR in the ED setting on study outcomes using multivariate regressions and the nonparametric bootstrap.nnnRESULTSnAfter covariate adjustment, among visits resulting in discharge (ED-only), P-EHR visits were 19 minutes shorter (95% confidence interval [CI] = 5 to 33 minutes) than non-P-EHR visits. Among visits resulting in hospitalization, the P-EHR was associated with an average 77-minute shorter ED LOS (95% CI = 28 to 126 minutes), compared to non-P-EHR visits. The P-EHR was associated with an average of

A Patient's Guide to Taking Dabigatran Etexilate

1,560 (95% CI =

Clinical and economic outcomes in patients switched to simvastatin in a community-based family medicine practice

43 to

Use and cost of erythropoiesis-stimulating agents in patients with cancer

2,910) lower total plan expenditures for hospitalized visits. No significant difference in total payments was observed among discharged visits.nnnCONCLUSIONSnIn the study ED, the P-EHR was associated with a significant reduction in ED LOS overall and was associated with lower plan payments for visits that resulted in hospitalization.

Impact of optimal lipid value achievement between 2005 and 2009 in patients with mixed dyslipidaemia on cardiovascular event rates

Dabigatran etexilate is a prescription medication used to slow and inhibit the formation of blood clots. Dabigatran is known by the trade name Pradaxa in the United States and all other countries in which it is marketed except Japan (Prazaxa) and Canada (Pradax). Although forming blood clots is a normal and important body function needed to stop bleeding, for some people the blood clot formation process can become harmful. For example, people with an irregular heart rhythm known as atrial fibrillation are at an increased risk of stroke because of the formation of harmful blood clots. Dabigatran is an anticoagulant type of medication. Anticoagulants prevent blood clots from forming. The medication warfarin (Coumadin) is another example of an anticoagulant. Anticoagulants are also commonly called blood thinners, although they work by preventing blood clot formation and not by making the blood thinner.nnThe formation of blood clots in the body is a very complex process that requires multiple steps occurring in a particular order. Substances known as clotting factors are used and produced in each step in the process. One of the final steps of clot formation involves a clotting factor known as thrombin. Dabigatran works in the blood by blocking the action of thrombin, which inhibits the clot-making process.nnDabigatran has been approved in the United States to reduce the risk of stroke and other harmful blood clots in people with nonvalvular atrial fibrillation. Dabigatran is available as a capsule in doses of 75 and 150 mg (Figure, A and B). The usual dose of dabigatran is a 150-mg capsule twice a day by mouth. For people with certain types of kidney problems, the dose may be decreased to 75 mg twice a day. The dabigatran capsule may …

Spirometry: Tool for pharmacy practitioners to expand direct patient care services

Background:u2002 The introduction of a generic formulation of simvastatin has created the potential to provide significant low‐density lipoprotein cholesterol (LDL‐C) reduction in a highly cost‐effective manner.

PCN34 ANALYSIS OF DOSE, COST AND USE PATTERNS OF ERYTHROPOIETIN STIMULATING AGENTS IN CANCER PATIENTS

ABSTRACT Objective: To compare the baseline characteristics, episodes of care, and cost of erythropoiesis-stimulating agents among cancer patients in a US managed-care population. Research design and methods: Retrospective analysis of administrative claims data. Episodes of care for patients with cancer receiving erythropoiesis-stimulating agents between January 1, 2004 and January 17, 2006 included all claims for erythropoiesis-stimulating agents with ≤42 days’ gap between claims, plus the duration of therapeutic benefit based on median days between consecutive doses. Main outcome measures: Main outcome measures were average weekly dose of erythropoiesis-stimulating agents and costs of therapy. Results: A total of 15u2009007 eligible episodes of care (darbepoetin alfa, 7769 episodes [5587 patients]; epoetin alfa 7238 episodes [5157 patients]) were identified. Fewer claims were observed per episode of care for darbepoetin alfa than for epoetin alfa (mean [SD] 3.7 [4.1] vs. 5.3 [6.4]). The median time between consecutive claims was 15 days (darbepoetin alfa) and 8 days (epoetin alfa). The mean (SD) weekly doses were 105 (56)u2009μg (darbepoetin alfa) and 34u2009242 (28173) U (epoetin alfa), a dose-comparison ratio of 326u2009:u20091. Dose-comparison ratios were sensitive to assumptions about duration of clinical benefit. The mean (95% CI) weekly costs were significantly lower for darbepoetin alfa (