Clinical

An estimated 350,000 to 600,000 American patients experience venous thromboembolism (VTE) annually, which includes deep-vein thrombosis and pulmonary embolism.1-5 Patients undergoing total hip replacement (THR) or total knee replacement (TKR) surgery are at high risk for VTE, because the large veins in the legs carrying blood back to the heart are significantly injured during these procedures.6,7 As a result of the aging and increasingly obese US population, an estimated 500,000 THR operations and 3.5 million TKR operations are expected to be performed by 2030.8

Anticoagulation Bridging Therapy after Total Hip or Knee Replacement: A Missed Opportunity?

Factor replacement therapy is the standard treatment for hemophilia. However, some patients with hemophilia develop inhibitors (alloantibodies) against the clotting factor administered. The development of these clotting inhibitors may render replacement therapy ineffective and, consequently, increase morbidity because of the inability to control or prevent hemorrhages. Inhibitor development has been reported to occur in as many as 33% of patients with hemophilia A, and as many as 7.5% of patients with hemophilia B.1-3

Potential Cost-Savings Using a Treatment Algorithm for Problem Bleeding Episodes in Patients with Hemophilia and Inhibitors

The Harris County Hospital District (HCHD) is an integrated public healthcare system for Harris County, TX, the nation’s third most populous county.1 More than 27% of Harris County residents are uninsured, and Texas state law requires counties to serve the indigent; therefore, most of these uninsured patients receive care at HCHD.2 HCHD is comprised of 3 hospitals, 13 community health centers, 13 satellite homeless shelter clinics, 8 school-based clinics, 4 mobile health clinics, and a free-standing dental center.

A Collaborative Approach to Drug Selection, Driven by Clinical Outcomes Excellence

It is well known that the use of prescription opioid medications, more than other medications, is associated with risks for misuse, abuse, and diversion.1-3 The government and pharmaceutical companies have addressed this issue by implementing specific strategies to minimize the risks associated with prescription drugs in general and with opioids in particular.

According to the World Health Organization (WHO), “Without a system that addresses the determinants of adherence, advances in biomedical technology will fail to realize their potential to reduce the burden of chronic illness.”1 The WHO has recommended that adherence challenges are most effectively solved by individualized interventions addressing multiple factors impeding adherence.1 In its report, Adherence to Long-Term Therapies: Evidence for Action, the WHO has identified 5 interactive “dimensions” or factors affecting adherence, including1:<

Health Plans Must “COPE” with Chronic Diseases

Drugs don’t work in patients who don’t take them.”1—C. Everett Koop, MD, ScD, former US Surgeon General

Stakeholder Integration Crucial to Improved Patient Outcomes: Lessons from a Health Plan’s Experience

The National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines and 2004 update stress the importance of achieving low-density lipoprotein cholesterol (LDL-C) goals in patients with dyslipidemia.1,2 Patients at higher coronary heart disease (CHD) risk have lower LDL-C goals and require more aggressive lipid-modifying therapy to achieve these goals than patients at lower CHD risk.

Appropriate Medication Selection Key to Cost-Effective Therapy, Patient Adherence

Anti-tumor necrosis factor (TNF) therapy has emerged as a major advancement in the management of rheumatoid arthritis (RA). The anti-TNF agents adalimumab, etanercept, and infliximab are often used with conventional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, and have been shown in clinical trials to be effective in reducing the signs and symptoms of RA and in preventing the progression of joint damage.1-6

Effectiveness of Anti-TNFs in Patients with RA, and Coverage Considerations

"Comparative effectiveness" research is the best tool available today for making decisions about which new medication, medical device, or diagnostic test is most supported by the evidence.1 The purpose of a systematic review is to synthesize the results of multiple primary studies using explicit and reproducible methods.2,3 Meta-analysis is a form of systematic review that goes one step further.

Meta-Analyses and Patient Care

Among adults responding to the 2006 National Health Interview Survey, 11% reported having feelings of sadness during all, most, or some of the time in the 30 days before the interview; 6% reported feeling hopeless; 5% felt worthless; and 14% felt that everything was an effort.1 Women were more likely to report such symptoms than men (13% vs 9%, respectively). Non-Hispanic black adults and Hispanic adults were more likely to report feelings of sadness or hopelessness than non-Hispanic white adults.

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