PCV3 How Does Gender Affect Pharmacotherapy Treatment Decisions for Hypercholesterolemia/Hyperlipidemia?

OBJECTIVE: To compare the rate of drug therapy initiation, and the time to treatment for men and women diagnosed with lipid disorders.
METHODS: From an electronic medical records database extracted from primary care doctors' systems, patients newly diagnosed with hypercholesterolemia/hyperlipidemia from October 1, 1993 through September 30, 1996 were selected. Patients were followed through September 30, 1997 resulting in a follow-up time of one to four years. Patients must have blood cholesterol readings recorded prior to initial diagnosis. Kaplan-Meier estimation and Cox regression were used for the analysis. Risl factors considered include age, estrogen replacement therapy, serum lipid levels, and comorbidities (hypertension, diabetes, CHD, obesity, and tobacco abuse disorder).
RESULTS: A total of 2,692 patients was included in the analysis, with 1,223 male and 1,469 female. Among these patients, 33.4% of the males and 34.5% of the females (p = 0.58) were prescribed drug therapy within a year of diagnosis. Time to treatment between males and females was not significantly different (Log-rank test, p = 0.83). Gender was not a significant predictor when controlling for other risk factors (Cox regression, p = 0.91). For patients in the two highest risk groups according to National Cholesterol Education Program (NCEP) guidelines, 48.7% of the males and 52.0% of the females (p = 0.29) were prescribed drug therapy within a year of diagnosis. Median time to treatment was 436 (95% C.I. 289, 774) and 318 (95% C.I. 176, 518) days for men and women, respectively.
CONCLUSIONS: In terms of both rate of drug therapy initiation and time to treatment for lipid disorders, our study showed no statistically significant difference between men and women.     

An HMO-Sponsored Primary Care-Based Disease Management and Case Management Initiative

Objective: To describe the cost savings achieved in a health maintenance organization (HMO)-sponsored primary care-based case management and disease management programs.Methods: The HMO-sponsored programs recruited patients in the primary care setting and relied on clinical guidelines and HMO-employed patient education nurses and case management nurses. Total per member per month (PMPM) charges for medical services and changes in selected clinical outcomes before and after entry into HMO-sponsored case management and disease management programs for actively enrolled participants were compared during the fiscal year January 1, 1998 to November 31, 2000.Interventions: The disease management programs addressed asthma, diabetes mellitus and congestive heart failure (CHF). These programs were based on a network of primary care-based nurse educators and case managers promoting clinical guidelines, appropriate use of the insurance benefit, community-based resources, and communication among all healthcare providers.Setting and participants: This initiative was based in 55 primary care sites serving 295 000 insureds across northeastern and central Pennsylvania, USA.Results: 396 patients with asthma had mean baseline PMPM charges of $US298, which decreased to $US276 PMPM after entry. In those with diabetes mellitus, 3556 patients had a mean baseline PMPM charge of $US367 that decreased to $US346. The mean baseline PMPM charge decreased from $US1877 to $US1541 for 1795 patients with CHF. For 3346 patients undergoing case management, the mean baseline PMPM charge was $US1991 and it decreased to $US1545. Total mean reductions in claims over one year of follow-up from the day of entry for patients with asthma, diabetes mellitus, CHF and for case management programs were $US105 544, $US896 112, $US7 237 440 and $US17 907 992, respectively.Additional data regarding asthma-only claims and pre-post days of work loss in the previous six months, diabetes mellitus-only claims and pre-post mean glycosylated hemoglobin A_1c values, inpatient and outpatient CHF total claims, ACE inhibitor use in CHF, and inpatient and outpatient total claims in case management are also provided.Conclusion: While these claims data may be limited by a lack of statistical significance and by regression to the mean, they suggest that case management and disease management programs in asthma, diabetes and congestive heart failure can be associated with significant financial savings compared with baseline levels of utilization. Clinical outcomes data also suggest this approach may be of benefit.     

Prevalence and outcomes of comorbid metabolic and cardiovascular conditions in middle- and older-age adults

To estimate age group differences in the prevalence and outcomes of three common and often comorbid metabolic conditions (i.e., obesity, hypertension, and diabetes) and heart disease. DESIGN: Nationally representative prospective cohort study. SETTING: Participants' homes. Participants: 9825 adults aged 51 to 61 years (middle-age) in 1992, and 7370 adults aged 70 years and over (older-age) in 1993. MEASUREMENTS: Two-year dichotomous outcomes included: doctor visits, hospitalization, mobility difficulty, activity of daily living limitation, poor perceived health, and mortality. Odds ratios (OR) were adjusted for sociodemographic characteristics and history of cancer or lung disease. RESULTS: Those with one condition represented 80% and 70% of the middle- and older-age groups, respectively, while just 1-2% of each age group reported all three metabolic conditions. Thirteen percent and 32%, respectively, reported heart disease with or without metabolic conditions. Diabetes comorbid with other metabolic conditions, and particularly with heart disease, substantially elevated the risk of adverse outcomes such as health-related quality of life deficits, health services use, and mortality in both middle- and older-age adults. In the middle-age group, the OR was 6.81 for mortality in patients with a combination of obesity and diabetes and 6.10 in those with a combination of heart disease and diabetes. There also were significant ORs for mortality in middle-aged patients with heart disease (OR = 2.40), diabetes (OR = 2.63) and for those with a combination of obesity, hypertension, and diabetes (OR = 3.26). CONCLUSION: The impact of these often comorbid conditions underscores the importance of targeted and aggressive prevention, particularly among middle-age adults.     

No evidence for marked ethnic differences in accuracy of self-reported diabetes, hypertension, and hypercholesterolemia

OBJECTIVE: To assess whether the accuracy of self-reported diabetes, hypertension, and hypercholesterolemia in high-risk groups differs according to ethnicity. STUDY DESIGN AND SETTING: We analyzed data of 430 patients at high risk of cardiovascular disease from different ethnic origin, including Turkish, Surinamese, and Dutch. Risk factors based on self-reports were compared with data from medical records and with a gold standard based on clinical measurements. Proportions of concordance between self-reports and other methods and kappa statistics (kappa) were determined by ethnicity. RESULTS: Concordance between self-reports and other data sources was highest in diabetes and lowest for hypercholesterolemia. Agreement of self-reports was substantial to almost perfect for diabetes (kappa: 0.84-0.76), substantial to moderate for hypertension (kappa: 0.63-0.51), and moderate for hypercholesterolemia (kappa: 0.55-0.48). There was no statistically significant association between ethnicity and concordance, except for self-reporting of diabetes among Surinamese vs. Dutch indigenous patients (odds ratio=0.37; 95% confidence interval: 0.14-0.97). CONCLUSION: There are no marked ethnic differences in the accuracy of self-reports of diabetes, hypertension, and hypercholesterolemia in high-risk populations. Larger studies including multiple ethnic groups are needed to confirm these findings.     

Long-term adoption of a Mediterranean diet is associated with a better health status in elderly people; a cross-sectional survey in Cyprus

BACKGROUND: There is increasing evidence that there are protective health effects from diets which are high in fruits, vegetables, legumes, and whole grains, and which include fish, nuts, and low-fat dairy products. We sought to investigate the association of Mediterranean diet on clinical status of 150 elderly men and women. METHODS: During 2004 - 2005, we studied 53 men and 97 women, aged 65 to 100 years, from various areas of Cyprus. A diet score that assesses the inherent characteristics of the Mediterranean diet was developed for each individual (range 0-55). Adoption of the Mediterranean diet was evaluated against the presence of cardiovascular risk factors like hypertension, diabetes, hypercholesterolemia and obesity. RESULTS: 26% of men and 18% of women had diabetes, 60% of men and 58% of women had hypertension, 60% of men and 68% of women had hypercholesterolemia, and 34% of men and 52% of women were obese. More than 90% of the participants reported consistency in their dietary habits for at least the past 3-4 decades. A significant inverse correlation was observed between diet score and the number of the investigated risk factors (rho= -0.26, p< 0.001). When we took into account age, sex, smoking habits, and physical activity status, we observed that a 10-unit increase in the diet score was associated with 21% lower odds of having one additional risk factor in women (p< 0.001) and with 14% lower odds in men (p = 0.05). CONCLUSION: Adherence to a Mediterranean diet is associated with reduced odds of having hypercholesterolemia, hypertension, diabetes and obesity among elderly people.     

PMD4 Outcomes Research Interests of a Community Pharmacist Research Network

OBJECTIVE: This purpose of this project was to document the outcomes research interests of members of a statewide Community Pharmacist Research Network (CPR-Net).
METHODS: Pharmacists electing to participate in the CPR-Net completed a survey in which they were asked to rank on a scale of 1 to 5 (1 = low interest, 5 = high interest) their interest in conducting outcomes-related research projects (Pharmacy Care, Health Related Quality of Life, Pharmacoeconomics, and Product Evaluation) in 21 disease states. These projects would be conducted in their pharmacies in conjunction with four faculty members from a college of pharmacy.
RESULTS: CPR-Net members ranked diabetes mellitus and hypertension as the most common disorders (93.8% each) in which they would be interested in conducting research projects. Other diseases in which a high interest level was demonstrated include asthma (85.4%), hypercholesterolemia (83.3%), and arthritis (81.2%). An intermediate level of interest was demonstrated with COPD (77%), allergic rhinitis (77%), child health issues (77%), and peptic ulcer disease (72.9%). Diseases in which a low interest level was expressed include AIDS/HIV (18.8%), epilepsy (12.5%), and thyroid disorders (12.5%). Additionally, 10.4% of pharmacists expressed low interest levels in conducting studies in patients with arrhythmias, congestive heart failure, depression, and anxiety.
CONCLUSION: Community pharmacists in this research network are most interested in conducting outcomes-related research projects in patients with common, expensive, chronic diseases.     

The Association Between Neighborhood Socioeconomic Status and Clinical Outcomes Among Patients 1 Year After Hospitalization for Cardiovascular Disease

Residing in lower socioeconomic status (SES) neighborhoods is associated with increased risk of morbidity and mortality. Few studies have examined this association for cardiovascular disease (CVD) outcomes in a treated population in New York City (NYC). The purpose of this study was to determine the relationship between neighborhood level poverty and 1-year clinical outcomes (rehospitalization and/or death) among hospitalized patients with CVD. Data on rehospitalization and/or death at 1-year were collected from consecutive patients admitted at a university medical center in NYC from November 2009 to September 2010. NYC residents totaled 2,198. U.S. Census 2000 zip code data was used to quantify neighborhood SES into quintiles of poverty (Q1 = lowest poverty to Q5 = highest poverty). Univariate analyses were used to determine associations between neighborhood poverty and baseline characteristics and comorbidities. A logistic regression analysis was used to calculate odds ratios for the association between quintiles of poverty and rehospitalization/death at 1 year. Fifty-five percent of participants experienced adverse outcomes. Participants in Q5 (9 %) were more likely to be female [odds ratio (OR) = 0.49, 95 % confidence interval (CI) 0.33–0.73], younger (OR = 0.50, 95 % CI 0.34–0.74), of minority race/ethnicity (OR = 18.24, 95 % CI 11.12–29.23), and have no health insurance (OR = 4.79, 95 % CI 2.92–7.50). Living in Q5 was significantly associated with increased comorbidities, including diabetes mellitus and hypertension, but was not a significant predictor of rehospitalization/death at 1 year. Among patients hospitalized with CVD, higher poverty neighborhood residence was significantly associated with a greater prevalence of comorbidities, but not of rehospitalization and/or death. Affordable, accessible resources targeted at reducing the risk of developing CVD and these comorbidities should be available in these communities.     

Body mass index and subsequent risk of hypertension, diabetes and hypercholesterolemia in a population-based sample of Japanese

OBJECTIVE: To clarify relationships between BMI (body mass index) and the incidence of hypertension, diabetes and hypercholesterolemia among a community-based sample. METHOD: A 4.3-year follow-up study was conducted of 1,427 men and women aged 40-69 to examine the relationships between BMI (kg/m2) and the incidence of hypertension, diabetes and hypercholesterolemia. RESULTS: During the follow-up, there were 118 cases of incident hypertension diagnosed, 56 of diabetes and 136 of hypercholesterolemia. After adjusting for sex, age, cognitive physical activity, food intake, alcohol intake, smoking, and blood pressure level, blood glucose level and serum total cholesterol level at the baseline, excess risks with the BMI category of > or = 27.0 versus 21.0-22.9 were found for hypertension [relative risk (95% CI) = 1.9(1.0-3.6)] and diabetes [2.9(1.2-7.4)]. However, no excess risk was evident for the 23.0-24.9 or 25.0-26.9 categories. Multivariate relative risks (95%CI) of hypercholesterolemia compared with the BMI category of 21.0-22.9 were 1.5 (0.9-2.6) for 23.0-24.9, 1.7(0.9-3.2) for 25.0-26.9 and 1.6 (0.8-3.1) for > or = 27.0, none of which reached statistical significance. When we combined all three diseases, the relative risks (95%CI) compared with the BMI category of 21.0-22.9 were 0.9(0.6-1.5) for 23.0-24.9, 1.2(0.7-2.1) for 25.0-26.9 and 1.8 (1.0-3.3) for > or = 27.0. CONCLUSIONS: Increased risks of hypertension, diabetes and lifestyle-related disease were only evident with the BMI category > or = 27.0. Education for weight reduction should be less emphasized for persons with a BMI of 25.0-26.9 than for these with a value of > or = 27.0.     

Relationship between pulmonary hypertension and outcomes among patients with heart failure with reduced ejection fraction

ABSTRACT

Objectives: To identify predictors of pulmonary hypertension (PHT) and the predictive value of PHT for rehospitalization among patients with heart failure with reduced ejection fraction (HFrEF).

Methods: A retrospective study of 351 hospitalized patients with heart failure (HF). Patients 18 years and above with HFrEF secondary to non-ischemic cardiomyopathy were reviewed. Patients with coronary artery disease, preserved ejection fraction and other secondary causes of PHT apart from HF were excluded. PHT as a predictor of 30-day and six-month re-admission was assessed as well as important possible predictors of PHT. Cox regression analysis, multiple linear regression as well as other statistical tools were employed as deemed appropriate.

Results: Thirty-seven (37) and 99 patients were re-hospitalized within 30 days and 6 months after discharge for decompensated HF, respectively. After Cox regression analysis, higher hemoglobin reduced the odds of rehospitalization for decompensated HF (p = 0.015) within 30 days after discharge while higher pulmonary artery systolic pressure (PASP) (p = 0.002) and blood urea nitrogen (BUN) (p = 0.041) increased the odds of rehospitalization within 6 months of discharge. The predictors of the PHT among patients with HFrEF after multiple linear regression were low BMI (p = 0.027), increasing age (p = 0.006) and increased left atrial diameter (LAD) on echocardiography (p = 0.0001).

Conclusion: Patients with HFrEF have a high predisposition to developing PHT if at admission, they have low BMI, dilated left atrium or are older. Patients with one or more of these attributes may need more intensive therapy to reduce the risk of developing PHT and in turn reduce readmission rates.     

Beneficial impact of the Homelands Movement on health outcomes in central Australian Aborigines

Objective: This study compares prevalence of obesity, hypertension and diabetes in two groups of Aboriginal adults: those living in homelands versus centralised communities in central Australia. It also compares weight gain, incidence of diabetes, mortality and hospitalisation rates between the groups over a seven-year period.
Methods: Baseline survey of 826 Aboriginal adults in rural central Australian communities in 1987-88 with a follow-up survey of 416 (56% response rate, excluding deaths). Each time, they had a 75 g oral glucose tolerance test (OGTT), and blood pressure and anthropometry measurement. Deaths and hospitalisations for all of the original cohort were recorded for the seven-year period.
Results: Homelands residents had a lower baseline prevalence of diabetes (risk ratio [RR]=0.77, 0.59–1.00), hypertension (RR=0.66, 0.54–0.80) and overweight/ obesity (RR=0.70, 0.59–0.83). The incidence of diabetes was lower among homelands residents (RR=0.70, 0.46–1.06). They were less likely to die than those living in centralised communities (RR=0.56, 0.37–0.85) and less likely to be hospitalised for any cause (RR=0.79, 0.71–0.87), particularly infections (RR=0.70, 0.61–0.80), injury involving alcohol (RR=0.61, 0.47–0.79) and other injury (RR=0.75, 0.60–0.93). Mean age at death was 58 and 48 years for residents of homelands and centralised communities respectively.
Conclusion: Aboriginal people who live in homelands communities appear to have more favourable health outcomes with respect to mortality, hospitalisation, hypertension, diabetes and injury, than those living in more centralised settlements in Central Australia. These effects are most marked among younger adults.     

Chronic disease risk in central New York dairy farmers: results from a large health survey 1989-1999

BACKGROUND: The agricultural workplace presents a variety of health and safety hazards; it is unknown whether farm work may be a risk factor for certain chronic diseases. METHODS: The health survey data from a large rural population in central New York were used from two studies (1989, 1999) to assess both 1999 prevalence and 10-year incidence of self-reported diabetes, heart disease, hypercholesterolemia, and hypertension among farm (predominantly dairy) and non-farm residents. The 1999 asthma prevalence was also assessed. RESULTS: Multiple logistic regression models for 1999 prevalence found statistically significant protective effects of farming for hypertension (OR=0.83, P=0.0105) and hypercholesterolemia (OR=0.853, P=0.0522). Non-significant results were seen for heart disease (OR=0.67, P=0.128) and diabetes (OR=0.856, P=0.1358). The model for 1999 asthma prevalence showed a significantly elevated risk for farming (OR=1.542, P=0.0004). Logistic models created for the 10-year incidence of hypertension, hypercholesterolemia, diabetes, and heart disease did not show a significant effect for farming. CONCLUSIONS: The protective effect of farming observed for the 1999 prevalence of hypertension and hypercholesterolemia was not seen for the 10-year incidence of these diseases.     

Association between mental health conditions and rehospitalization,mortality, and functional outcomes in patients with stroke following inpatient rehabilitation

Background

Limited evidence exists regarding the association of pre-existing mental health conditions in patients with stroke and stroke outcomes such as rehospitalization, mortality, and function. We examined the association between mental health conditions and rehospitalization, mortality, and functional outcomes in patients with stroke following inpatient rehabilitation.

Methods

Our observational study used the 2001 VA Integrated Stroke Outcomes database of 2162 patients with stroke who underwent rehabilitation at a Veterans Affairs Medical Center.Separate models were fit to our outcome measures that included 6-month rehospitalization or death, 6-month mortality post-discharge, and functional outcomes post inpatient rehabilitation as a function of number and type of mental health conditions. The models controlled for patient socio-demographics, length of stay, functional status, and rehabilitation setting.

Results

Patients had an average age of 68 years. Patients with stroke and two or more mental health conditions were more likely to be readmitted or die compared to patients with no conditions (OR: 1.44, p = 0.04). Depression and anxiety were associated with a greater likelihood of rehospitalization or death (OR: 1.33, p = 0.04; OR:1.47, p = 0.03). Patients with anxiety were more likely to die at six months (OR: 2.49, p = 0.001).

Conclusions

Patients with stroke with pre-existing mental health conditions may need additional psychotherapy interventions, which may potentially improve stroke outcomes post-hospitalization.

     

Cut-off point of BMI and obesity-related comorbidities and mortality in middle-aged Koreans

OBJECTIVE: The need for a lower BMI to classify overweight in Asian populations has been controversial. Using both disease and mortality outcomes, we investigated whether lower BMI cut-off points are appropriate for identifying increased health risk in Koreans. RESEARCH METHODS AND PROCEDURES: We conducted a cohort study among 773,915 men and women from 30 to 59 years old with 8- to 10-year follow-up periods. Primary outcomes were change of obesity prevalence, obesity-related disease incidence, and all-cause mortality. RESULTS: Prevalence of overweight (BMI of 25.0-29.9) has steadily increased (1.3% annually), whereas obesity (BMI > or = 30) showed a lower prevalence and only a slight increase (0.1%-0.2% annually). Our study revealed that dose-response relationships exist between obesity and related disease incidences (hypertension, type 2 diabetes, and hypercholesterolemia) beginning at lower BMI levels than previously reported. Compared with those in the healthy weight range, Koreans with a BMI > or = 25 were not at greater risk of hypertension, type 2 diabetes, or hypercholesterolemia than has been reported for whites in similar studies. Obesity-related all-cause mortality also did not seem so different from that of whites. DISCUSSION: Our findings did not support the use of a lower BMI cut-off point for defining overweight in Koreans compared with whites for the purpose of identifying different risks. However, populations with BMI > or = 25 are rapidly increasing and have substantial risks of diseases. To preempt the rapid increases in obesity and related health problems that are occurring in Western countries, Korea should consider using a BMI of 25 as an action point for obesity prevention and control interventions.     

Impact of Diabetes Mellitus (DM) on the Health-Care Utilization and Clinical Outcomes of Patients with Stroke in Singapore

Objective:  This study aims to assess the impact of diabetes mellitus (DM) on the health-care utilization and clinical outcomes of patients with acute stroke.
Methods:  This is a retrospective cohort study. All patients who were admitted for the first time to one of the three public hospitals in the National Healthcare Group in Singapore from January 2005 to June 2007 with a primary diagnosis of acute stroke were included and were followed up for 1 year after the index hospitalization. The study population was divided into two groups: with DM and without DM. Both univariate and multivariate analyses were applied to compare the hospital length of stay (LOS), hospitalization costs, mortality, as well as the 1-year hospital readmissions between the DM and non-DM groups.
Results:  There were 9766 study patients, and 38.5% of them had DM. DM patients with ischemic stroke (IS) and transient ischemic attack (TIA) stayed 1-day and 0.6-day longer, and incurred 10% and 26% higher hospital cost during index admission, respectively, compared with their counterparts in the non-DM group. They also had more hospital readmission within 1 year. The mortality rate in IS patients with diabetes was 24% higher. After risk adjustment, subarachnoid hemorrhage patients with diabetes had more hospitalizations. Intracerebral hemorrhage (ICH) and IS patients in the DM group had all worse outcomes but the 1-year stroke recurrence; TIA patients with DM incurred longer LOS and hospital costs.
Conclusion:  DM predicts worse clinical outcomes and higher health-care expenditures in the 1-year poststroke especially for the IS, ICH, and TIA stroke subtypes.     

Characteristics of comorbidity in adult asthma.

BACKGROUND: Although asthma in adult patients is responsible for a large proportion of the morbidity in primary care practice, there is minimal published information on comorbid conditions associated with asthma. The objective of this study was to compare the prevalence of common medical conditions in adult asthmatic and non-asthmatic subjects. METHODS: A case control study was conducted on a population of 4341 men and women aged 18 years or older. The prevalence of 17 medical conditions was measured in asthmatics (n = 141) and non-asthmatic subjects (n = 423) registered with a primary care practice. RESULTS: The most prevalent conditions among asthmatics were: hypertension (22.7%), diabetes (16.3%), and hiatal hernia with or without gastroesophageal reflux (13.5%), while cerebrovascular accident (1.0%) and depression (0.7%) had the lowest prevalence. The most common conditions among non-asthmatics were: hypertension (25.1%), obesity (13.9%), and diabetes (12.5%), while sinusitis, and glaucoma (1.4%) had the lowest prevalence. The odds ratios in asthmatics vs. non-asthmatics were for hiatal hernia 5.83 (95% confidence interval [CI] 2.56-13.5, p < 0.0001), chronic bronchitis 6.31 (95% CI 2.58-15.70, p < 0.001), gastric ulcer 2.55 (95% CI 0.95-6.81, p < 0.04), sinusitis 6.3 (95% CI 1.69-25.29, p < 0.001), and glaucoma 3.1 (95% CI 0.90-11.0, p < 0.04). CONCLUSIONS: A different pattern of comorbid conditions was observed. Recognition of these conditions is essential for the proper management of asthma and coexisting disorders.     

Depression and Geographic Status as Predictors for Coronary Artery Bypass Surgery Outcomes

Purpose: To examine the relationships between depression, geographic status, and clinical outcomes following a coronary artery bypass grafting (CABG) surgery.
Methods: Using the 2004 Nationwide Inpatient Sample database, we identified 63,061 discharge records of patients who underwent a primary CABG surgery (urban 57,247 and rural 5,814). We analyzed 7 demographic variables, 19 preoperative medical and psychiatric variables, and 2 outcome variables (ie, in-hospital mortality and length of stay). Logistic regression and multivariable regression analyses were used to assess urban-rural status and depression as independent predictors of in-hospital mortality and length of stay.
Findings: Rural patients were more likely to have a comorbid depression diagnosis compared to urban patients (urban = 19.4%, rural = 21.4%, P < .001). After adjusting for confounding factors, having a comorbid depression diagnosis ( B = 1.10, P < .001) and residing in a rural area ( B = .986, P < .05) were associated with an increased length of in-hospital stay following CABG surgery. Furthermore, having a depression diagnosis (OR = 1.63, 95% CI = 1.45-2.21) and residing in a rural area (OR = 1.43, 95% CI = .896-1.45) were associated with an increased likelihood of in-hospital mortality.
Conclusions: Rural patients were more likely than urban ones to have a depression diagnosis. Depression was a significant independent predictor of both in-hospital mortality and length of stay for patients receiving CABG surgery. Also, rural patients had increased lengths of in-hospital stay as well as in-hospital mortality rates compared to those who resided in urban areas.     

Direct medical costs of type 2 diabetes and its complications in Switzerland

BACKGROUND: This paper analyses the direct medical costs of type 2 diabetes and its complications in Switzerland. METHODS: Individual healthcare resource consumption related to type 2 diabetes and its complications was determined retrospectively in 1479 non-incident and non-dying patients over 12 months (1998-1999). Literature-derived attributable risks were used to correct for non-diabetes related macrovascular disease. RESULTS: A total of 111 primary care physicians from 19 cantons throughout Switzerland participated. Their diabetic patients on average had 10.3 consultations per year related to this disease (95% CI: 10.0-10.7). Patients spent on average 2.7 days (95% CI: 2.2-3.3) per year in hospital due to diabetes and diabetes-related complications. Mean annual type 2 diabetes-related direct medical costs per patient amounted to CHF 3,508 / Euro 2,323 (95% CI: CHF 3,140-3,876 / Euro 2,080-2,567). They were particularly high in patients with insulin treatment or with complications. After application of attributable risks and a correction for the use of adjuvant materials, costs were CHF 3,324 / Euro 2,201. Assuming 250,000 patients with type 2 diabetes in Switzerland leads to an estimate of CHF 0.88 billion spent for this disease and its complications in 1998. This represents a share of about 2.2% of the country's total healthcare expenditures. CONCLUSION: These findings demonstrate the high economic importance of type 2 diabetes and its complications in Switzerland.     

Medication adherence among recipients with chronic diseases enrolled in a state medicaid program

Abstract Limited information is currently available about medication adherence for common chronic conditions among the Medicaid population. The primary objective of this study was to assess medication adherence among Medicaid recipients with depression, diabetes, epilepsy, hypercholesterolemia, and hypertension. Factors influencing adherence were determined. The authors also assessed whether adherence influences the utilization of acute care services. The target population included nonelderly adult recipients (ages 21-64 years) who were continuously enrolled in the Mississippi (MS) Medicaid fee-for-service program from January 1, 2006 to December 31, 2007. Recipients were identified who had a medical services claim with a diagnosis of depression, diabetes, epilepsy, hypercholesterolemia, or hypertension in calendar year 2006. Within each chronic disease sample, medication adherence was determined using calendar year 2007 data for recipients who met inclusion and exclusion criteria. Recipients with adherence ≥80% were classified as adherent. Logistic regression analyses were used to determine the factors that predict medication adherence and the effect of adherence on concurrent all-cause acute care service (ie, hospitalization, emergency room visit) utilization. Approximately 24% of recipients with depression, 35.9% with diabetes, 53.6% with epilepsy, 32% with hypercholesterolemia, and 42.2% with hypertension were adherent. Within each chronic disease sample, males and whites had higher adherence than females and blacks. After controlling for demographic and disease-related covariates, recipients who were adherent had lower concurrent acute care service utilization than nonadherent recipients. Given the inverse relationship between adherence and acute care service utilization, policy makers should consider implementing educational interventions aimed at improving adherence in this underprivileged population. (Population Health Management 2012;15:253-260).