The American journal of managed care
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The price of analogue insulin has increased dramatically, making it unaffordable for many patients and insurance carriers. By contrast, human synthetic insulins are available at a fraction of the cost. The objective of this study was to examine whether patients with financial constraints were more likely to use low-cost human insulins compared with higher-cost analogue insulins and to determine whether outcomes differ between users of each type of insulin. ⋯ Patients with financial risk factors may be more likely to use low-cost human synthetic insulins compared with insulin analogues. Outcomes were similar, even when stratified by financial risk.
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Individuals with multiple chronic conditions (MCCs) represent a growing proportion of the adult population in the United States, particularly among lower-income individuals and people of color. Despite ongoing efforts to characterize this population and develop approaches for effective management, individuals with MCCs continue to contribute substantially to health care expenditures. Based on a review of recent literature, several identified barriers limit the effectiveness of care for patients with MCCs. ⋯ The COVID-19 pandemic has shed further light on inequities contributing to suboptimal MCC patient management. Awareness of the prevalence and demographic attributes of patients with MCCs and the identified barriers to care may help improve patient engagement and treatment outcomes for this high-cost population. This paper provides recommendations for enhancing MCC patient care outcomes in the current and post-COVID-19 health care delivery settings.
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Psoriasis is a complex immune disorder associated with substantial metabolic and psychological comorbidities, posing challenges to treatment. Interleukin (IL)-23 inhibitors, the newest class of biologics for the treatment of moderate to severe psoriasis, are more selective mechanistically than previous biologic classes and may have utility in management of patients with comorbidities, particularly those with metabolic syndrome (MetS). Moreover, recent long-term data suggest that IL-23 inhibitors offer unique advantages in both safety and efficacy. As the relationship between psoriasis and MetS continues to be elucidated, the availability of agents that are safe and effective in patients with and without comorbidities represents an important step in the spectrum of treatment.
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The COVID-19 pandemic has fundamentally changed the workflow of clinics. We applied Lean Six Sigma processes to optimize clinic workflow to reduce patient wait times and improve the patient experience. ⋯ Simple, inexpensive measures can improve patient engagement and provide a safe setting for patients for clinic visits in the wake of COVID-19. In the future, clinics' common wait areas could be reappropriated to increase the number of clinic exam rooms.
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As American clinicians have tried to reduce heart failure rehospitalizations and improve care for patients with heart failure with reduced ejection fraction (HFrEF), the population of patients who have heart failure with preserved ejection fraction (HFpEF) has emerged as needing attention. Although HFrEF and HFpEF share some characteristics, treatment approaches are different, and treatment options for HFpEF are more limited. All patients would benefit from guideline-directed medical treatment. ⋯ In addition, investigators are examining possible uses of omecamtiv mecarbil and nonsteroidal aldosterone antagonists in heart failure. Addressing heart failure is a team effort, and such teams need overlapping expertise, innovative approaches, and resources that support and sustain their efforts. Team members should familiarize themselves with the American College of Cardiology 2021 Update to the 2017 Expert Consensus Decision Pathway as a means to offer the best care to the patients that they serve.