The American journal of managed care
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Combination therapy with peginterferon alfa and ribavirin now eliminates detectable hepatitis C virus (HCV) from the blood of more than half of patients with long-term infections. However, many of those infected with HCV have low rates of response to therapy and/or are more susceptible to drug side effects that limit adherence to therapy. African Americans with HCV, for example, tend to be more difficult to cure with drug therapy. ⋯ In all patients remaining on therapy, efforts to boost adherence will also enhance the overall rate of sustained virologic response. Special attention should be paid to managing depression and cytopenias with patient education and either dose reduction or use of hematopoietic growth factors. These 2 basic treatment strategies--of stopping treatment early or, alternatively, of pressing for full patient compliance over the full course of therapy--are flip sides of the same management coin that health plans and clinicians can employ to optimize results and cost effectiveness with the current standard of therapy for chronic HCV infection.
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Review Comparative Study
A qualitative review of studies of diabetes preventive care among minority patients in the United States, 1993-2003.
To review existing data to determine whether ethnic disparities exist for diabetes-related preventive care among adults in the United States. ⋯ Despite the availability of evidence-based guidelines, rates of diabetes preventive care are low, particularly for some measures in ethnic minority groups. Additional data are needed to further elucidate these disparities.
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Characterized by chronic widespread joint and muscle pain, fibromyalgia is a syndrome of unknown etiology. The American College of Rheumatology's classification criteria for fibromyalgia include diffuse soft tissue pain of at least 3 months' duration and pain on palpation in at least 11 of 18 paired tender points. Symptoms are often exacerbated by exertion, stress, lack of sleep, and weather changes. ⋯ Once the diagnosis is made, providers should aim to increase patients' function and minimize pain. This can be accomplished through nonpharmacological ahd pharmacological interventions. With proper management, the rate of disability appears to be significantly reduced.
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Despite the fact that the Human Genome Project was completed only recently, genetic tests already have entered the marketplace, some with few or no long-term data to support their use. Managed care organizations will face reimbursement decisions for genetic tests on a growing scale, and they should have a framework in place to evaluate the clinical and economic outcomes of this new class of diagnostics. ⋯ When evaluating a genetic test for reimbursement, these criteria can help to: (1) quantify the potential clinical benefit and economic savings; (2) assess the robustness of a cost-effectiveness analysis; and (3) clarify areas where data are deficient. These criteria should be used to inform the decision-making process in the context of ethical, legal, and social issues related to genetic testing.
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Antiplatelet therapy, most notably aspirin, has been well documented to reduce risks of subsequent cardiovascular disease (CVD) in secondary prevention, acute myocardial infarction (MI), acute occlusive stroke, as well as in primary prevention. In secondary prevention, the most recent Antithrombotic Trialists' Collaboration reviewed 194 published randomized trials of antiplatelet therapy, mostly aspirin, involving more than 212 000 patients (ie, 135 000 using antiplatelet therapy or control and 77 000 using different antiplatelet regimens). In a very wide range of patients who have survived a prior occlusive vascular event-including MI, transient ischemic attacks, occlusive stroke, unstable and stable angina, percutaneous coronary interventions, and coronary artery bypass graft-aspirin prevents about 25% of serious vascular events. ⋯ Aspirin should be an adjunct, not an alternative, to managing other cardiovascular risk factors. Recently, the US Preventive Services Task Force and the American Heart Association recommended aspirin use for all men and women whose 10-year risks are > 6% and > or = 10%, respectively. In all these patient categories, including secondary prevention, acute MI and acute occlusive stroke, as well as primary prevention, increased and appropriate use of aspirin will prevent large numbers of premature deaths and MIs.