The American journal of managed care
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Randomized Controlled Trial
Leveling the field: addressing health disparities through diabetes disease management.
To examine the relationships among patient characteristics, labor inputs, and improvement in glycosylated hemoglobin (A1C) level in a successful primary care-based diabetes disease management program (DDMP). ⋯ Among intervention patients in a successful DDMP, improvement in A1C level was achieved regardless of age, race/ethnicity, sex, income, education, or insurance status. Labor inputs were similar regardless of age, race/ethnicity, sex, or education and may reflect the nondiscriminatory nature of providing algorithm-based disease management care.
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To investigate whether patients who use mail-order pharmacies were more likely to have good medication adherence than patients who use local pharmacies. ⋯ Compared with patients who obtained medication refills at local pharmacies, patients who received them by mail were more likely to have good adherence. The association between mail-order use and medication adherence should be evaluated in a randomized clinical trial.
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To evaluate the effects of switching from multiple daily injection (MDI) therapy to insulin pump therapy, also called continuous subcutaneous insulin infusion (CSII), on antidiabetic drug and healthcare resource utilization. ⋯ CSII was associated with significant decreases in antidiabetic drug and healthcare resource utilization, contributing to stability of care. The evidence from this study indicates that CSII should be considered as an option for patients with type 2 diabetes mellitus who are using MDI and are experiencing a high degree of antidiabetic drug and healthcare resource utilization.
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To evaluate the impact of Medicare Part D coverage gap (donut hole) on adherence to diabetes medications. ⋯ The coverage gap in the Medicare Part D program has a significant negative impact on medication adherence among beneficiaries with diabetes. Availability of brand-name drug coverage in the donut hole is critical to adherence to diabetes medications.
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Major depressive disorder: psychosocial impairment and key considerations in functional improvement.
Patients with major depressive disorder (MDD) can experience persistent and substantial functional impairment, and the extent of psychosocial impairment often varies with symptom severity. Factors that may contribute to restoration of psychosocial functioning include the patient's lifetime functional trajectory, the overall effectiveness of depression therapy, and the duration and quality of remission. ⋯ The more effective the therapeutic approach employed to resolve symptoms of depression (eg, long-term duration of treatment, monitoring of patient adherence to treatment, maintenance of asymptomatic remission), the more likely it is that patients with MDD will experience a full restoration of premorbid psychosocial functioning. The goals of this article are to discuss the potential origins of psychosocial impairment, provide literature-based evidence that achieving asymptomatic remission (ie, remission without residual symptoms) is crucial so that functional improvement continues beyond acute-phase treatment, and emphasize the need for an expanded assessment of the illness that fundamentally includes an evaluation of psychosocial functioning, since the restoration of psychosocial functioning does not always accompany the resolution of symptoms in MDD.