The American journal of managed care
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Patients who revisit the emergency department (ED) shortly after discharge are a high-risk group for complications and death, and these revisits may have been seriously affected by the COVID-19 pandemic. Detecting suspected COVID-19 cases in EDs is resource intensive. We examined the associations of screening workload for suspected COVID-19 cases with in-hospital mortality and intensive care unit (ICU) admission during short-term ED revisits. ⋯ This is the first study to our knowledge to identify that screening for suspected COVID-19 cases in EDs can adversely affect patient outcomes during short ED revisits. Identifying this association could enable ED providers and policy makers to optimize emergency service delivery during an epidemic and help patients.
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To describe the outcomes of a partnership between a drug plan and pharmacists to switch patients from brand name dipeptidyl-peptidase-4 inhibitors to the generic alogliptin. ⋯ The use of pharmacists was beneficial in switching patients to alogliptin and yielded cost savings without compromising patient outcomes.
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Observational Study
Cancellations in primary care in the Veterans Affairs Health Care System.
Unused medical appointments affect both patient care and clinic operations, and the frequency of cancellations due to clinic reasons is underreported. The prevalence of these unused appointments in primary care in the Veterans Affairs Health Care System (VA) is unknown. This study examined the prevalence of unused primary care appointments and compared the relative frequency of cancellations and no-shows for patient and clinic reasons. ⋯ Although this study shows that same-day cancellations of primary care appointments in the VA are common, comparisons with other providers and health care systems indicate similar or lower levels of unused appointments in the VA.
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Medicaid is the largest payer of mental health (MH) services in the US, and more than 80% of its enrollees are covered by Medicaid managed care (MMC). States are required to establish quantitative network adequacy standards (NAS) to regulate MMC plans' MH care access. We examined the association between quantitative NAS and MH care access among Medicaid-enrolled adults and among those with MH conditions. ⋯ Current quantitative NAS requirements may have few impacts on improving MH care access for adults and those with MH conditions without the implementation of additional interventions. States should consider adjusting enforcement strategies and adopting other interventions alongside NAS.
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To assess the effects of a nurse-led personalized care plan on the duration of olaparib therapy among patients with cancer. ⋯ A nurse-led personalized care approach effectively increased medication persistence among patients receiving olaparib for treatment of cancer, and the effect was more apparent among care plan patients who experienced symptom resolution or dose modification.