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Rowan C.G.,American Medical Group Association | Turner J.R.,Quintiles | Shah A.,REAL WORLD | Spaeder J.A.,Quintiles
Pharmacoepidemiology and Drug Safety | Year: 2014

Purpose: To describe initial antihypertensive management relative to important aspects of JNC7 hypertension guidelines, to identify predictors of receiving JNC7 discordant therapy, and to determine the association between receiving JNC7-concordant antihypertensive treatment and achieving blood pressure (BP) control. This study focused on aspects of the JNC7 guidelines which are consistent with other guidelines that have been published since JNC7. Methods: EMR data from eleven multi-specialty medical groups in the US were retrospectively collected between 2008-2011. The study cohort included incident hypertensive patients who received an antihypertensive prescription during the 6-month follow-up period. Patients with existing hypertension were excluded. JNC7-concordance of the prescribed antihypertensive regimen was evaluated. Using multivariable logistic regression, we determined the association between JNC7-concordance and achieving BP control. Additionally, we determined predictors of receiving JNC7-discordant treatment. Results: 14,910 incident hypertensive patients who were treated with an antihypertensive during the 6-month follow-up period were included. Overall, 79.4% patients were prescribed antihypertensive therapy concordant with JNC7; however among patients with stage 2 hypertension, the concordance was found to be 50%. BP control was achieved by 64.1% and 48.5% of patients who received JNC7-concordant and JNC7-discordant therapy, respectively. The overall adjusted odds ratio (95% CI) for BP control and JNC7-concordance was 1.53 (1.40, 1.68). The association was attenuated for cohort members with diabetes, chronic kidney disease (CKD), and stage 2 hypertension. Predictors of receiving JNC7-discordant therapy were congestive heart failure, CKD, and diabetes. Conclusion: JNC7-concordance is high overall, but drops substantially when JNC7 recommendations are more demanding (e.g., among patients with stage 2 hypertension and/or CKD, CHF, diabetes). Overall, patients who are prescribed an antihypertensive regimen that is JNC7-concordant are more likely to achieve BP control. © 2014 John Wiley & Sons, Ltd.


Kay S.,REAL WORLD | Ferreira A.,Novartis
Ophthalmic Epidemiology | Year: 2014

Purpose: To develop a mapping algorithm for the estimation of EQ-5D-based utility scores from observed 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) scores, a disease-specific, patient-reported outcome measure used in several retinal disorders to evaluate vision-specific functioning. Methods: The dataset comprised 951 paired EQ-5D/NEI VFQ-25 observations from 344 patients in RESTORE, a 12-month, randomized, double-blind trial in individuals with visual impairment due to diabetic macular edema. EQ-5D index scores (utilities) were calculated based on the UK tariff. We evaluated 11 models using predictor sets based on the NEI VFQ-25 subscales to estimate utility as a function of NEI VFQ-25 score, based on four modeling techniques. Model performance was assessed by 10-fold cross-validation comparing root mean squared error (RMSE), mean absolute error (MAE) and correlation with EQ-5D score (Pearson and Spearman correlation coefficients). Results: Mapping results were similar across all techniques and predictor sets. The reverse two-part generalized estimating equation model used fewest predictors and had the best predictive performance (RMSE 0.200, MAE 0.140). Predicted and original EQ-5D values were not strongly correlated (squared Spearman correlation coefficient, 0.34). Conclusions: Although mapping disease-specific instruments to EQ-5D utilities is a preferred method by some reimbursement bodies, finding an appropriate mapping equation is not straightforward. In this study, mapping NEI VFQ-25 scores to EQ-5D utilities provided low predictive power, independent of the modeling methodology applied, suggesting an inability of the EQ-5D to discriminate vision-related activities, and highlighting that mapping exercises may lead to inaccurate utility values that do not represent patients' preferences. © 2014 Informa Healthcare USA, Inc. All rights reserved: reproduction in whole or part not permitted.


Jones P.W.,St Georges, University of London | Small M.,REAL WORLD
Respiratory Medicine | Year: 2014

GOLD proposed a COPD assessment framework focussed on symptoms measured by the COPD Assessment Test™ (CAT) or the mMRC and on exacerbation risk based on poor lung function (FEV1 <50%) or a history of ≥2 exacerbations in the previous year. This analysis examined the characteristics of COPD patients recruited from routine clinical settings and classified using the GOLD framework. 1041 European COPD patients (38.5% from primary care) from the Adelphi Respiratory Disease Specific Programme with information on CAT, mMRC, spirometry and exacerbation history in the previous year were analysed. Their mean age was 64.9 ± 9.9 years and mean FEV1 was 62.5 ± 17.8% predicted; 80% were in GOLD 2 spirometric grade or milder. CAT and mMRC cut points identified different groups of patients; using CAT, the composition was: Group A 9.3%, Group B 48.5%, Group C 0.7% and Group D 41.5%. 80% were classified as high risk based on exacerbation history and 25% of patients in a low risk category (GOLD A and B) had 1 exacerbation in the previous year. The incidence of diabetes, hypertension and hyperlipidaemia rose with worsening GOLD group (all p < 0.0001); diabetes GOLD A 4%, GOLD B 16%, GOLD D 29%; hypertension GOLD A 38%, GOLD B 55%, GOLD D 65%; hyperlipidaemia GOLD A 13%, GOLD B 30%, GOLD D 37%. In patients seen in routine clinical settings, 25% of GOLD low risk patients had one exacerbation per year and the incidence of cardio-vascular and metabolic diseases increases with worsening GOLD group. © 2013 The Authors. Published by Elsevier Ltd. All rights reserved.


Bradley M.,REAL WORLD
British Journal of Health Care Management | Year: 2016

This article aims to illustrate the potential impact of 12-hour shifts on teamworking by focusing on the restrictions such shifts create in developing effective and engaging team communication processes. It does this through presenting research on work with multiprofessional mental health teams, both community- and ward-based. It is proposed that 12-hour shifts can contribute to teams being 'pseudo' teams rather than 'real teams', and draws on the input-process-output model of team effectiveness to illustrate the points made. The premise of the paper is that team shift patterns (as an input) mediate the extent to which teams can participate in effective and engaging communication processes, which, in turn, impacts on the outputs of team effectiveness, including outcomes for patients, such as quality of care, and outcomes for staff, such as staff wellbeing. © 2016 MA Healthcare Ltd.


Vestbo J.,University of Southern Denmark | Vestbo J.,University of Manchester | Vogelmeier C.,Universitatsklinikum Giessen und Marburg | Small M.,REAL WORLD | Higgins V.,REAL WORLD
Respiratory Medicine | Year: 2014

Study objectives The aim of this analysis was to understand the implications of the GOLD 2011 multidimensional system for the assessment and management of COPD, using data from a real-world observational study. Methods Data were drawn from the Adelphi Respiratory Disease Specific Programme, a cross-sectional survey of consulting patients in five European countries and in the US undertaken between June and September 2011. Patients were classified using both the GOLD 2010 and revised GOLD 2011 criteria, and profiled with regards to demographics, disease characteristics and treatment patterns. Results Information on 3813 COPD patients was collected. Disease characteristics showed a general tendency to worsen in parallel with worsening of symptoms. When comparing dual versus single risk criteria, the inclusion of exacerbation history resulted in an increase in the number of patients in high risk groups. The highest proportions of patients receiving inhaled corticosteroids (ICS) were in group D. However, a considerable proportion of patients in low risk groups were receiving ICS/long-acting β2 agonists. Conclusions Our analysis confirmed the relationship between higher symptomatic burden, increased airflow limitation and exacerbation, and further illustrated the importance of including exacerbation history in the assessment of COPD to identify patients at high risk. As based on data from current clinical practice, this study also highlighted the frequent and potentially inappropriate use of ICS and bronchodilators in patients at low risk of experiencing exacerbations. © 2014 Elsevier Ltd. All rights reserved.

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