Inhaled Corticosteroid Adherence and Emergency Department Utilization Among Medicaid-enrolled Children with Asthma [article]

J Asthma. 2013 Jun 5. [Epub ahead of print], Rust G, Zhang S, Reynolds J.

Abstract
Objectives: Asthma is the most prevalent chronic disease among children enrolled in Medicaid. This study measured real-world adherence and outcomes after an initial prescription for inhaled corticosteroid therapy in a multi-state Medicaid population.

Methods: We conducted a retrospective study among Medicaid-enrolled children aged 5-12 with asthma in 14 southern states using 2007 Medicaid Analytic Extract (MAX) file claims data to assess adherence and outcomes over the three months following an initial prescription drug claim for inhaled corticosteroids (ICS-Rx). Adherence was measured by the long-term controller to total asthma drug claims ratio.

Results: Only one-third of children (33.4%) with an initial ICS-Rx achieved a controller to total drug ratio greater than 0.5 over the next 90-days. Children for whom long-term control drugs represented less than half of their total asthma drug claims had a 21% higher risk of emergency department visit (AOR 1.21 [95% CI 1.14, 1.27]), and a 70% higher risk of hospital admission (AOR 1.70 [95% CI 1.45, 1.98]) than those with a controller to total asthma drug ratio greater than 0.5.

Conclusion: Real-world adherence to long-term controller medications is quite low in this racially-diverse, low-income segment of the population, despite Medicaid coverage of medications. Adherence to long-term controller therapy had a measurable impact on real-world outcomes. Medicaid programs are a potential surveillance system for both medication adherence and emergency department utilization.

Posted online on June 5, 2013. (doi:10.3109/02770903.2013.799687)

Two things to consider:
Continue reading Inhaled Corticosteroid Adherence and Emergency Department Utilization Among Medicaid-enrolled Children with Asthma [article]

NFC medication tracking system

Well, well, well, here’s one page in my idea book that I can put a big read “X” through [December 6 2011 – Page #42]. And for all those people that told me it was a stupid idea – you know who you are – I have one word for you: Harvard. Yeah, that’s right, Harvard. It seems that some intelligent, forward thinking people over at Harvard Medical School have developed an NFC system for medication administration at the bedside.

Ah, justification. Feels good. Sorry, sometimes being petty feels good.

NFC World: “Harvard Medical School’s teaching affiliate Brigham and Women’s Hospital (BWH) has developed an NFC system aimed at making it easier for nurses to track and administer each patient’s medication.

The new bedside system uses a combination of Google Nexus 7 NFC devices, which run the new application and store details of each patient and their prescribed medications, and NFC tags attached to patient wristbands, medication packages and employee ID badges.

When administering medication, nurses use the NFC tablet to tap the tags on the patient’s wristband, on the medication and on their ID badge. The application running on the tablet then checks to see if the medication and dosage is the correct one for the patient and records which medication was administered to the patient and by whom.”

Booyah!

Research: Dr. Adam Landman: Near-Field Communication Technology at the Patient Bedside from BWH Public Affairs on Vimeo.

Cool Pharmacy Tech – T-Haler

The T-Haler is a training device developed by Cambridge Consultants to help asthma patients learn how to use their inhalers. Why is this such a cool piece of technology? Because patients invariably do a crapy job using their inhalers.

I used to ask asthma patients to demonstrate how they used their inhalers, and I was almost always disappointed by what I saw. Most patients don’t understand how to properly use these simple little devices, which ultimately leads to treatment problems, and in worst case scenarios poor control of their asthma.  This is especially true in pediatric patients. Asthma education was a big part of the pharmacist’s job when I worked in a pediatric hospital.

From the Cambridge Consultants site:

Cambridge Consultants developed the T-Haler concept, a simple training device. Interactive software, linked to a wireless training inhaler, monitors how a patient uses their device and provides real-time feedback via an interactive video ‘game’. T-Haler provides visual feedback to the user on their performance and the areas that need improvement. These tools could help the estimated 235 million asthma sufferers worldwide to get the most from their inhaler, and potentially reduce the millions spent annually on asthma-related emergency room admissions.

More than 50 healthy participants, aged 18-60, took part in a recent study conducted by Cambridge Consultants to test the efficacy of T-Haler. Before using the training system, the average success rate of the group in using an inhaler correctly was in the low 20% range – in line with numerous other studies carried out. The participants had no prior experience with asthma or inhalers and were given no human instruction beyond being handed the T-Haler and told to begin. The on-screen interface walked the group through the process, which takes just three minutes to complete.

The T-Haler measures three key factors for proper inhaler use. First, whether the patient has shaken the inhaler prior to breathing in; second, the force with which they breathed in; third, when they pressed down on the canister (the step which releases the drug). These three variables can determine the efficacy with which drugs are delivered in a real metered dose inhaler (MDI) device.

As healthcare trends toward a focus on preventive care and devices which offer greater consumer appeal and compliance, innovations such as the T-Haler may soon become the norm in doctors’ offices, pharmacies and clinics.

Contact lenses loaded with anesthetic medication

When I think of technological advances these are the things that come to mind.

medGadget “…researchers at University of Florida are reporting that they developed a way to load topical anesthetics into contact lenses to provide extended delivery of pain relief in a uniform fashion.  And since many of the patients that undergo eye procedures have been wearing contacts prior, they’re already used to putting them on. From the study abstract in Langmuir:

Here we focus on creating dispersion of highly hydrophobic vitamin E aggregates in the lenses as barriers for drug diffusion for increasing the release durations. This approach has been shown previously to be successful in extending the release durations for some common hydrophilic ophthalmic drugs. The topical anesthetic drugs considered here (lidocaine, bupivacaine, and tetracaine) are hydrophilic at physiologic pH due to the charge, and so these cannot partition into the vitamin E barriers. However, these surface active drug molecules adsorb on the surface of the vitamin E barriers and diffuse along the surface, leading to only a small decrease in the effective diffusivity compared to non-surface-active hydrophilic drugs. The drug adsorption can be described by the Langmuir isotherm, and measurements of surface coverage of the drugs on the vitamin E provide an estimate of the available surface area of vitamin E, which can then be utilized to estimate the size of the aggregates. A diffusion controlled transport model that includes surface diffusion along the vitamin E aggregates and diffusion in the gel fit the transport data well. In conclusion, the vitamin E loaded silicone contact lens can provide continuous anesthetics release for about 1–7 days, depending on the method of drug loading in the lenses, and thus could be very useful for postoperative pain control after corneal surgery such as the photorefractive keratectomy (PRK) procedure for vision correction.

Cool, simply cool.

Check out the image and rest of the article “Transport of Topical Anesthetics in Vitamin E Loaded Silicone Hydrogel Contact Lenses” at the Langmuir site.