Tag: pubmed

J Manag Care Spec Pharm. 2021 Mar;27(3):306-315. doi: 10.18553/jmcp.2021.27.3.306.

ABSTRACT

BACKGROUND: Community pharmacy participation in performance-based payment models has increased in recent years. Despite this, there has been neither much research done to evaluate the effect of these models on health care quality and spending nor is there extensive literature on the design of these models. OBJECTIVES: To (a) describe the types of measures used in performance-based pharmacy payment models (PBPPMs); (b) describe the financial impact of PBPPMs on pharmacies; (3) explore pharmacy owners’ perceptions of PBPPMs; and (4) describe any practice changes made in response to PBPPMs. METHODS: This is a cross-sectional study that surveyed independent community pharmacy owners between November 2019 and January 2020. The survey included 45 items split into 5 sections that covered respondent characteristics and the 4 domain objectives. Descriptive statistics were used for quantitative responses, and free-text responses were assessed for themes. RESULTS: Of the 68 individuals who responded to the survey, 42 were community pharmacy owners who met the study eligibility criteria, and 30 responded to most survey items. Owners expressed frustration at the design of PBPPMs, with 90% stating that they did not feel that the actions necessary to meet or exceed performance standards were within their control, and 90% also reported a loss of revenue because of these models. In addition, large numbers of respondents felt that they did not have enough information on how performance measures were computed (76.7%) or how cut-points were determined (86.7%). Despite negative feelings, most owners reported implementing changes in service offerings as a result of these models. CONCLUSIONS: PBPPMs appear to be commonplace and put substantial financial burden on community pharmacies. Study results suggest that greater education by payers could improve pharmacist engagement, as could involvement of pharmacies in the design and maintenance of PBPPMs. DISCLOSURES: This work was supported by a grant from the American Association of Colleges of Pharmacy, which was not involved in the collection, analysis, and interpretation of data; writing of the report; or the decision to submit this article for publication. Urick reports consulting fees from Pharmacy Quality Solutions. The other authors declare no conflicts of interest with respect to the research, authorship, and/or publication of this article.

PMID:33645246 | DOI:10.18553/jmcp.2021.27.3.306

J Manag Care Spec Pharm. 2021 Mar;27(3):392-398. doi: 10.18553/jmcp.2021.27.3.392.

ABSTRACT

BACKGROUND: Puerto Ricans are the Hispanic subgroup with the highest adjusted prevalence of statin-eligible patients. However, no study has described statin utilization and adherence among subjects living on the island of Puerto Rico. OBJECTIVES: To (a) estimate the prevalence of beneficiaries with diabetes aged between 40 and 75 years; (b) estimate the prevalence of statin utilization among beneficiaries with diabetes; and (c) estimate secondary adherence to statins among beneficiaries with diabetes. METHODS: With pharmacy claims data from a commercial pharmacy benefit manager (PBM) in the Commonwealth of Puerto Rico, this study used a retrospective longitudinal design to analyze all pharmacy claims generated by 115,674 beneficiaries aged between 40 and 75 years with continuous enrollment during 2018. Beneficiaries with diabetes were defined by having ≥ 2 pharmacy claims for antidiabetic agents during 2018. Statin utilization was defined by having ≥ 1 pharmacy claim for statins among beneficiaries with diabetes. The proportion of days covered (PDC) was used to measure secondary adherence to statins. Parametric and nonparametric statistics were used to describe statin utilization and adherence. RESULTS: The prevalence of beneficiaries with diabetes was 7.8%. Of the 8,975 beneficiaries with diabetes, 5,129 (57.1%) received ≥ 1 prescription for a statin. Older males with diabetes were more likely to receive prescriptions for statins. The median PDC for the 4,553 beneficiaries with ≥ 2 prescriptions for statins was 63.4%; 3,306 (72.6%) beneficiaries filled their statin prescriptions for a 30-day supply only; and 1,252 (27.5%) beneficiaries had a PDC ≥ 80%. The highest PDC (92.3%) was observed for beneficiaries who received statins for a 90-day supply only. CONCLUSIONS: This is the first study that has measured statin utilization and adherence among patients with diabetes living in Puerto Rico. The utilization and adherence to statins among privately insured beneficiaries with diabetes in Puerto Rico are suboptimal. Future studies should focus on understanding the reasons for the suboptimal use of statins and on potential interventions at the beneficiary and provider level to increase statin utilization. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest or financial disclosures to disclose related to this study.

PMID:33645248 | DOI:10.18553/jmcp.2021.27.3.392

J Coll Physicians Surg Pak. 2021 Feb;31(2):197-201. doi: 10.29271/jcpsp.2021.02.197.

ABSTRACT

OBJECTIVE: To determine the pattern of histopathology in living-related, kidney transplant recipients (KTRs) from a transplant centre in Khyber Pakhtunkhwa (KPK), Pakistan.

STUDY DESIGN: Descriptive, observational study.

PLACE AND DURATION OF STUDY: Institute of Kidney Diseases, Peshawar, from August 2008 to July 2018.

METHODOLOGY: A retrospective review of graft biopsy reports and clinical charts from living-related, kidney transplant recipients was carried out. Allograft biopsies were done for graft dysfunction with no apparent cause. The biopsy pathology was classified according to updated Banff classifications. The descriptive statistics were used to tabulate the results.

RESULTS: Out of the 55 biopsies, 51 (92.73%) were from males with mean age of 34.35±9.40 years. Out of 52 percutaneous biopsies, 10 (19.23%) belonged to the normal category. Category 2 (borderline rejection) and 3 (acute/active cellular rejection) were seen in three (5.7%) and one (1.9%) cases, respectively. Interstitial fibrosis/tubular atrophy (Banff Category 5) was observed in 18 (34.62%) cases. Banff Category 6 (others) was seen in 19 (36.5%) cases, in which calcineurin inhibitors (CNI) toxicity was commonest (17 [89.4%] of 19 cases). Mixed lesions were found in 19 (36.5%) cases. Out of the 19 mixed category cases, 12 (63.16%) showed both Category 3 and Category 5 changes with most of the cases showing mild to moderate IF/TA; while one case had severe IF/TA. Three graft nephrectomies were done, one each for recurrent oxalosis, nephroblastoma and fungal infection.

CONCLUSION: Among the studied specimens, mixed lesions were the predominant findings, followed by others (mostly CNI toxicity) and IFTA categories. The frequency of acute/active rejections was low and that of chronic changes higher, in keeping with delayed biopsies. Key Words: Allograft biopsy, Graft dysfunction, Rejection, Kidney.

PMID:33645189 | DOI:10.29271/jcpsp.2021.02.197

Zhongguo Zhong Yao Za Zhi. 2021 Feb;46(4):902-906. doi: 10.19540/j.cnki.cjcmm.20201122.103.

ABSTRACT

The color characteristic information of Rhei Radix et Rhizoma powder was obtained by spectrophotometer, the feasibility of rapid identification of Rhei Radix et Rhizoma origin based on chromaticity value was studied by statistical analysis. The results of rank correlation analysis showed that a~*(P<0.01), b~*(P<0.01) had significantly correlation with the origin of medicinal herbs, which could be used as two important parameters to distinguish the origin of Rhei Radix et Rhizoma, the larger the a~* value, the more red the powder color,and the greater the b~* value, the more yellow the powder color. Meanwhile, through Fisher discriminant analysis, the linear discriminant functions of different genus Rhei Radix et Rhizoma were established, which was Rheum tanguticum=40.666a~*+0.019b~*-213.303, Rh. palmatum=34.121a~*+0.061b~*-151.770, Rh. officinale=28.071a~*+0.113b~*-104.604 3, the coincidence rate of cross-validation was over 95%, among them, the discriminant rate of Rh. tanguticum and Rh. officinale reached 100%;In addition, using the percentile method to analyze the 90% reference value range of three different origin of Rhei Radix et Rhizoma, as a result, Rh. tanguticum a~*(10.236 5-10.604 7), b~*(32.294 8-34.841 7); Rh. palmatum a~*(8.602 7-8.770 0), b~*(27.534 8-28.968 6), and Rh. officinale a~*(6.825 7-7.464 3),b~*(21.001 6-27.716 4). According to this study, rank correlation analysis and Fisher discriminant analysis are feasible to distinguish the base of Rhei Radix et Rhizoma in a certain range, and provide some theoretical basis for the identification of Rhei Radix et Rhizoma. It also provides a new method and idea for the identification of other multi-base Chinese medicine.

PMID:33645095 | DOI:10.19540/j.cnki.cjcmm.20201122.103

Zhongguo Zhong Yao Za Zhi. 2021 Jan;46(2):454-466. doi: 10.19540/j.cnki.cjcmm.20200622.501.

ABSTRACT

In this study, Honghua Injection, Danshen Injection, Shenkang Injection, Shuxuetong Injection, Lulutong Injection, Shenxiong Glucose Injection and Chuanxiong Injection were compared for their clinical efficacy on chronic renal insufficiency by using the method of network Meta-analysis, with Western medicine as the common reference. The randomized controlled trial(RCT) of Hong-hua Injection, Danshen Injection, Shenkang Injection, Shuxuetong Injection, Lulutong Injection, Shenxiong Glucose Injection and Chuanxiong Injection for the treatment of chronic renal insufficiency were obtained by computer-based retrieval. The literature quality was evaluated by using the method in Cochrane Reviewer’s Handbook 5.1 after independent screening of the included literature by two reviewers. The RJAGS package and GEMTC package of RevMan 5.3, GEMTC software, R software were used for statistical analysis to compare and sort the different injections in terms of efficacy. A total of 6 197 patients with chronic renal failure were included in 79 RCTs, involving 8 treatment measures. The effective rates of conventional treatment combined with Shenxiong Injection(OR=3.55, 95%CI[1.98, 6.37], P<0.000 1), Honghua Injection(OR=3.77, 95%CI[2.45, 5.81], P<0.000 01), Shuxuetong Injection(OR=6.71, 95%CI[3.30, 13.65], P<0.000 01) and Shenkang Injection(OR=4.14, 95%CI[3.42, 5.03], P<0.000 01) were all better than that in control group, and the effective rate of Honghua Injection combined with conventional treatment(OR=3.89, 95%CI[1.73, 8.74], P=0.001) was better than that in Danshen Injection combined with conventional treatment, all with statistically significant differences. By comprehensive comparison, Shuxuetong Injection, Honghua Injection and Shenkang Injection combined with Western medicine had good clinical effect on the effective rate, serum creatinine reduction and urea nitrogen reduction in patients with chronic renal insufficiency. However, due to the relatively low quality of the included literature, the conclusion has yet to be verified clinically.

PMID:33645135 | DOI:10.19540/j.cnki.cjcmm.20200622.501

J Coll Physicians Surg Pak. 2021 Feb;31(2):144-149. doi: 10.29271/jcpsp.2021.02.144.

ABSTRACT

OBJECTIVE: To determine the pulmonary functions in patients with End Stage Renal Disease (ESRD) and the associated factors including the acute effects of hemodialysis.

STUDY DESIGN: Observational, cross-sectional study. Place and Duration of Study: Nephrology Department in collaboration with Pulmonology Department, Shalamar Hospital, Lahore, from October to November 2019.

METHODOLOGY: All patients of age 18-75 years, on regular hemodialysis (HD) for more than three months, who quitted smoking 10 years back and stable, were included in the study. Demographic data was collected and blood samples were sent for hematological and biochemical laboratory parameters. Pulmonary functions were assessed by spirometry for Forced Vital Capacity (FVC) and Forced Expiratory Volume in first second (FEV1) and FVC/FEV1 before and after dialysis.

RESULTS: Out of 102 patients, 62 (60.8%) were males and 79 (77.5%) were on twice-weekly dialysis. DM 44 (43.1%) and chronic glomerulonephritis 21 (19.5%) were the major causes of ESRD in these patients. In this study, FVC and FEV1 were abnormal in majority of the patients 73 (71.6%) and 76 (74.5%), which was statistically significant (p<0.05) supporting restrictive lung disease (RLD). Factors associated with RLD were male gender (p=0.006) and diabetes mellitus (p=0.003). Hemodialysis did not improve pulmonary functions significantly. FEV1 and FVC had a negative correlation with age and body mass index (BMI).

CONCLUSION: Restrictive lung disease is the most common pulmonary dysfunction among ESRD patients. Factors associated with pulmonary dysfunctions were male gender and diabetes mellitus. Hemodialysis did not improve pulmonary functions. Key Words: ESRD, Pulmonary functions, Restrictive lung disease, Fluid overload.

PMID:33645179 | DOI:10.29271/jcpsp.2021.02.144

J Coll Physicians Surg Pak. 2021 Feb;31(2):182-187. doi: 10.29271/jcpsp.2021.02.182.

ABSTRACT

OBJECTIVE: To find out various organizational, personal, and systemic factors influencing the performance of the postgraduate trainee doctors in managing COVID-19 pandemic.

STUDY DESIGN: Analytical cross-sectional study.

PLACE AND DURATION OF STUDY: Conducted in various medical institutions of Pakistan from 15th April to 30th June, 2020.

METHODOLOGY: An analytical cross-sectional study was conducted on 11,656 postgraduate doctors. They were contacted through the e-log system of College of Physicians and Surgeons Pakistan. Semi-structured questionnaire was used consisting of demographic details, presenting symptoms, systemic involvements, clinical features, diagnostic tests, management of cases, authenticity of the information used, telemedicine services, practice of preventive measures, training and interactive educational activities, performance-based tasks and details about workplace environment. Mean and standard deviation was reported for continuous variables. Bivariate and multivariate analyses were used to report p values.

RESULTS: Among 11,656 postgraduate doctors, 3,193 (27.4%) were directly involved in the management of COVID-19 patients in designated special corona facilities. Multivariate analysis was performed to control confounders. The risk factors, found statistically significant with performance, were presence of comorbidity (OR 1.261; 95% C.I.1.06-1.50), allergic and autoimmune disorders (OR 1.18; 95% C.I.1.03-1.35), confirmed COVID-19 status due to exposure (OR 0.570; 95% C.I.0.41-0.81), and care provision to old parents (OR 1.299; 95% C.I.1.19-1.42).

CONCLUSION: The effect of COVID-19 on performance of postgraduate doctors was multi-factorial. Significant risk factors were presence of a comorbidity, allergic and autoimmune disorders, and confirmed COVID-19 due to exposure. Key Words: COVID 19, Postgraduate trainee, Pandemic, Comorbidity, PCR.

PMID:33645186 | DOI:10.29271/jcpsp.2021.02.182

Zhongguo Zhong Yao Za Zhi. 2021 Feb;46(4):767-771. doi: 10.19540/j.cnki.cjcmm.20201113.601.

ABSTRACT

Based on the characteristics of clinical symptoms of secretory otitis media in traditional Chinese and Western medicine,by reference to clinical diagnostic criteria,efforts were made to analyze and establish the Western medical diagnostic criteria and traditional Chinese medicine( TCM) syndrome differentiation criteria for secretory otitis media,and summarize the modeling methods and model characteristics of secretory otitis media animal models. According to the clinical diagnostic criteria and symptom characteristics,the coincidence degree between the existing animal models and clinical symptoms was evaluated,and its advantages and disadvantages were defined. On the basis of the statistical results,there were fewer methods for modeling secretory otitis media animal models,and only a specific relevant pathogenic mechanism could be revealed. Among them,the model with a higher coincidence degree was genetic engineering technology modeling and injection into the middle ear vesicles. The two modeling methods of bacterial factors highly coincided with the clinical symptoms of Western medicine,but both failed to reflect the TCM syndrome type. Therefore,establishing an animal model that simultaneously reflects the characteristics of clinical symptoms of secretory otitis media in traditional Chinese and Western medicine,and improving the evaluation criteria of secretory otitis media based on animal models are the main tasks of future studies on secretory otitis media.

PMID:33645079 | DOI:10.19540/j.cnki.cjcmm.20201113.601

Zhongguo Zhong Yao Za Zhi. 2021 Feb;46(4):777-781. doi: 10.19540/j.cnki.cjcmm.20201123.601.

ABSTRACT

Based on the clinical characteristics of chronic atrophic gastritis in traditional Chinese and Western medicine, the domestic and foreign relevant literature reports and animal models of chronic atrophic as well as the clinical diagnostic indicators of traditional Chinese and western medicine, chronic atrophic gastritis evaluation standard was summarized to evaluate and analyze the coincidence degree of clinical symptoms of the existing chronic atrophic gastritis animal models. The statistical results found that modeling methods with a higher coincidence degree with the existing chronic atrophic gastritis animal models are disease and syndrome combination mode-ling, surgical modeling, multifactor comprehensive modeling and MNNG modeling. Although the animal models were reproduced by such methods as etiology, pathogenesis and disease and syndrome combination similar to those of human beings, there is still a big gap with the natural disease state. Further in-depth studies and improvement shall be made in clinical practice in the hope to provide refe-rence for clinical practice and experimental studies of chronic atrophic gastritis.

PMID:33645081 | DOI:10.19540/j.cnki.cjcmm.20201123.601

Zhongguo Zhong Yao Za Zhi. 2021 Jan;46(1):237-246. doi: 10.19540/j.cnki.cjcmm.20200701.501.

ABSTRACT

To systematically evaluate the clinical efficacy and safety of Danhong Injection combined with conventional therapy in improving diabetes mellitus complicated with coronary heart disease. Based on the online literature database(CNKI, Wanfang, VIP, PubMed, Web of Science, Cochran Library), the Chinese and English papers about the randomized controlled trial(RCT) of Danhong Injection in the treatment of diabetes mellitus complicated with coronary heart disease were searched comprehensively from the establishment of the databases to January 1, 2020. The papers were screened strictly according to the inclusion and exclusion criteria. Based on Jadad scale, the risk assessment of literature was carried out, and Meta-analysis was performed by STATA 12.0 software. Seventeen RCTs were included, involving 1 453 patients. The results of Meta-analysis showed that the combination of Danhong Injection and conventio-nal treatment could improve the clinical comprehensive effective rate(RR=1.47, 95%CI[1.38, 1.58], P&lt;0.000 1), electrocardiogram(ECG) efficiency(RR=1.30, 95%CI[1.16, 1.46], P&lt;0.000 1), efficiency of the angina pectoris(RR=1.41, 95%CI[1.25, 1.58], P&lt;0.000 1), cholesterol level(SMD=-1.05, 95%CI[-1.95,-0.16], P=0.02), low-density lipoprotein(LDL) level(SMD=-0.50, 95%CI[-0.79,-0.21], P&lt;0.000 1), coronary angina attack frequency(SMD=-3.71, 95%CI[-4.05,-3.36], P&lt;0.000 1) and duration of angina pectoris(SMD=-2.96, 95%CI[-3.25,-2.66], P&lt;0.000 1), with statistically significant differences. But the differences in fasting plasma glucose(FPG)(SMD=-0.19, 95%CI[-0.45, 0.08], P=0.16), plasma glucose of two hours after meal(2 hPG)(SMD=0.19, 95%CI[-0.11, 0.49], P=0.22), and high-density lipoprotein(HDL) level(SMD=0.10, 95%CI[-0.30, 0.49], P=0.62) after treatment were not statistically significant. Compared with the control group, there was no significant difference in adverse reactions(SMD=-2.96, 95%CI[-3.25,-2.66], P=0.75). The existing evidence shows that the combination of Western medicine and Danhong Injection can improve the clinical effect for diabetes mellitus complicated with coronary heart disease and has no obvious adverse reactions. However, due to the low level of overall literature evidence, high risk and some kind of publication bias, it still needs more high-quality randomized controlled trials and low-bias studies for further verification.

PMID:33645075 | DOI:10.19540/j.cnki.cjcmm.20200701.501