Anthony Staresinic

Triple therapy initiation within 30 days after a COPD hospitalization may improve patient outcomes in the following year. Benefits include lower risk of future exacerbations and avoiding thousands of dollars in health care costs. Triple therapy should be considered as an alternative to other treatments after a severe COPD exacerbation.

This study highlights the potential risks of oral corticosteroids in COPD treatment, including prolonged use among complex Medicare patients, and reinforce the importance of preventive treatment strategies and therapy optimization early in the disease course.

Prompt initiation of triple therapy decreases risk of future exacerbations and is associated with lower all-cause and COPD-related healthcare utilization and costs, including lower prescription drug costs.

Objectives: To determine (1) the frequency of the different types of drug therapy modification claims paid by a pharmacy benefits manager (PBM), (2) PBM cost savings and return on investment (ROI), and (3) patient savings from pharmacist-reimbursed drug therapy modifications.

Results: Claims were paid to pharmacists for drug therapy modifications to allow tablet splitting, drug therapy changes, and switching noncovered drugs. Tablet splitting provided the largest cost savings to the PBM,… Show more

Objectives: To determine (1) the frequency of the different types of drug therapy modification claims paid by a pharmacy benefits manager (PBM), (2) PBM cost savings and return on investment (ROI), and (3) patient savings from pharmacist-reimbursed drug therapy modifications.

Results: Claims were paid to pharmacists for drug therapy modifications to allow tablet splitting, drug therapy changes, and switching noncovered drugs. Tablet splitting provided the largest cost savings to the PBM, accounting for slightly more than one-third of the claims and representing more than one-half of the prescription fills. Switching drugs not covered provided the largest cost savings to patients. Overall, the PBM saved a mean of $20.31 per prescription fill, and patients saved $14.76 per prescription fill. Mean overall ROI to the PBM was 3.55. Show less

The first year of Medicare Part D's medication therapy management program at a midwest PBM identified a high number of drug therapy problems. A pharmacist intervention resulted in communication of these drug related problems to the beneficiary's prescriber and education of the beneficiary in the safe and effective use of medications.

This article reports on the development of a personalized, Web-based asthma-education program for parents whose 4- to 12-year-old children have moderate to severe asthma. Personalization includes computer-based tailored messages and a human coach to build asthma self-management skills. Computerized features include the Asthma Manager, My Calendar/Reminder, My Goals, and a tailored home page. These are integrated with monthly asthma-education phone calls from an asthma nurse case manager. The… Show more

This article reports on the development of a personalized, Web-based asthma-education program for parents whose 4- to 12-year-old children have moderate to severe asthma. Personalization includes computer-based tailored messages and a human coach to build asthma self-management skills. Computerized features include the Asthma Manager, My Calendar/Reminder, My Goals, and a tailored home page. These are integrated with monthly asthma-education phone calls from an asthma nurse case manager. The authors discuss the development process and issues and describe the current randomized evaluation study to test whether the yearlong integrated intervention can improve adherence to a daily asthma controller medication, asthma control, and parent quality of life to reduce asthma-related healthcare utilization. Implications for health education for chronic disease management are raised. Show less

Background: Studies demonstrate the effectiveness of anticoagulation management service (AMS) in providing antithrombotic therapy for eligible patients. We sought to extend this concept by determining whether an interim telephone model (IT) is comparable to our current AMS model at achieving optimal therapeutic outcomes.

Methods: The 36-month trial (24-month study plus 12-month extension) enrolled 192 eligible patients receiving long-term warfarin therapy at a Veterans Affairs hospital… Show more

Background: Studies demonstrate the effectiveness of anticoagulation management service (AMS) in providing antithrombotic therapy for eligible patients. We sought to extend this concept by determining whether an interim telephone model (IT) is comparable to our current AMS model at achieving optimal therapeutic outcomes.

Methods: The 36-month trial (24-month study plus 12-month extension) enrolled 192 eligible patients receiving long-term warfarin therapy at a Veterans Affairs hospital. Consenting participants were randomly assigned to either our current face-to-face clinic model (AMS), or our IT model. The primary outcome was the percentage of time individuals’ international normalized ratios (INRs) were maintained within their target INR range (2.0-3.0
or 2.5-3.5). Secondary outcomes included the number of adverse events (eg, thromboembolism or hemorrhage) experienced during the study.

Results: We found no statistically significant difference between the 2 groups in the percentage of time maintained within INR target range overall (55.1% for AMS; 57.8% for IT; P=.28) nor over the course of the study. There were no statistically significant differences in the rate of thromboembolic or serious bleeding events between IT and AMS participants. Nevertheless, we did note differences related to intensity of anticoagulation. The IT group receiving treatment at a higher intensity (INR, 2.5-3.5) experienced greater anticoagulation control (P=.04) and fewer complications than the AMS group. The IT participants, however,
reported a significantly higher rate of minor bleeding events, experienced mainly by those at an INR range of 2.0 to 3.0.

Conclusion: Our IT model is a viable modification of our AMS model for the management of patients undergoing chronic anticoagulant therapy. Show less

Objective: For children aged 1–5 years, the authors used the Delphi method to determine (1) the most important injury hazards in each area of the home; (2) the most important injury prevention behaviors; and (3) feasible and efficacious safety devices and behaviors to reduce injury risks.

Results: The overall response rate for each survey ranged from 82% to 97%. Initially, 330 unique hazards and prevention behaviors/devices were identified in seven areas of the home. The 126 home injury… Show more

Objective: For children aged 1–5 years, the authors used the Delphi method to determine (1) the most important injury hazards in each area of the home; (2) the most important injury prevention behaviors; and (3) feasible and efficacious safety devices and behaviors to reduce injury risks.

Results: The overall response rate for each survey ranged from 82% to 97%. Initially, 330 unique hazards and prevention behaviors/devices were identified in seven areas of the home. The 126 home injury hazards were rated based on frequency, severity, and preventability of injury; and the 204 behaviors and devices were rated by efficacy and feasibility. These experts rated firearms and pools as the most significant hazards, and smoke alarms and safe water temperature as the most important preventions. Show less

Objective: To determine the validity of face to face, self reported responses to questions about the presence of safety devices and use of safety practices in the home aimed at preventing unintended injuries to preschool aged children.

Conclusions: Use of safety devices and practices by parents of preschool aged children reported in a face to face interview are generally reliable. Reliability increases if the interview is conducted in the home. Parents may also be more willing to report… Show more

Objective: To determine the validity of face to face, self reported responses to questions about the presence of safety devices and use of safety practices in the home aimed at preventing unintended injuries to preschool aged children.

Conclusions: Use of safety devices and practices by parents of preschool aged children reported in a face to face interview are generally reliable. Reliability increases if the interview is conducted in the home. Parents may also be more willing to report potential problems if they perceive they may receive corrective assistance. Show less

Invited Guest Editorial to discuss child passenger safety in vehicles. Inspiration of the article arose from personal experiences while also working on a Department of Housing and Urban Development grant as part of the Health Homes Initiative.