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Patterns of mental health service use among Medicaid-insured youths treated by nurse practitioners and physicians: A retrospective cohort study.

Int J Nurs Stud 2021 Aug 3;120:103956. Epub 2021 May 3.

Department of Health Sciences, Towson University, 8000 York Rd, Towson, MD 21252, USA.

Background: Despite the growing involvement of nurse practitioners in mental health services for children and adolescents, little is known about the patterns of mental health service use among youths treated by nurse practitioners compared to those by physicians.

Objectives: To identify new users of psychotropic medications initiated by nurse practitioners and physicians among Medicaid-insured youths and to assess if receiving psychosocial services prior to or concurrent with medication initiation differs among youths treated by provider and specialty type.

Design: A retrospective cohort study. Read More

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Effect of the Million Hearts Cardiovascular Disease Risk Reduction Model on Initiating and Intensifying Medications: A Prespecified Secondary Analysis of a Randomized Clinical Trial.

JAMA Cardiol 2021 Jun 2. Epub 2021 Jun 2.

US Centers for Medicare & Medicaid Services, Woodlawn, Maryland.

Importance: The Million Hearts Cardiovascular Disease (CVD) Risk Reduction Model pays provider organizations for measuring and reducing Medicare patients' cardiovascular risk.

Objective: To assess whether the model increases the initiation or intensification of antihypertensive medications or statins among patients with blood pressure or low-density lipoprotein (LDL) cholesterol levels above guideline thresholds for treatment intensification.

Design, Setting, And Participants: This prespecified secondary analysis of a cluster-randomized, pragmatic trial included primary care and cardiology practices, health care centers, and hospital-based outpatient departments across the US. Read More

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Defining and describing treatment heterogeneity in new-onset idiopathic lower back and extremity pain through reconstruction of longitudinal care sequences.

Spine J 2021 May 23. Epub 2021 May 23.

Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA. Electronic address:

Background Context: Despite established guidelines, long-term management of surgically-treated low back pain (LBP) and lower extremity pain (LEP) remains heterogeneous. Understanding care heterogeneity could inform future approaches for standardization of practices.

Purpose: To describe treatment heterogeneity in surgically-managed LBP and LEP. Read More

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Comparative Effectiveness of Machine Learning Approaches for Predicting Gastrointestinal Bleeds in Patients Receiving Antithrombotic Treatment.

JAMA Netw Open 2021 May 3;4(5):e2110703. Epub 2021 May 3.

Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.

Importance: Anticipating the risk of gastrointestinal bleeding (GIB) when initiating antithrombotic treatment (oral antiplatelets or anticoagulants) is limited by existing risk prediction models. Machine learning algorithms may result in superior predictive models to aid in clinical decision-making.

Objective: To compare the performance of 3 machine learning approaches with the commonly used HAS-BLED (hypertension, abnormal kidney and liver function, stroke, bleeding, labile international normalized ratio, older age, and drug or alcohol use) risk score in predicting antithrombotic-related GIB. Read More

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High prevalence of anal high-grade squamous intraepithelial lesions, and prevention through human papillomavirus vaccination, in young men who have sex with men living with HIV.

Clin Infect Dis 2021 May 15. Epub 2021 May 15.

Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH, USA.

Background: Men who have sex with men (MSM) are at high risk for HPV-related anal cancer. Little is known about the prevalence of low-grade squamous intraepithelial lesions (LSIL) and the anal cancer precursor, high-grade squamous intraepithelial lesions (HSIL), among young MSM living with HIV (MSMLWH). HPV vaccination is recommended in this group but its safety, immunogenicity and protection against vaccine-type HPV infection and associated LSIL/HSIL have not been studied. Read More

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Annual wellness visits and care management before and after dialysis initiation.

BMC Nephrol 2021 May 5;22(1):164. Epub 2021 May 5.

Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.

Introduction: Demands of dialysis regimens may pose challenges for primary care provider (PCP) engagement and timely preventive care. This is especially the case for patients initiating dialysis adjusting to new logistical challenges and management of symptoms and existing comorbid conditions. Since 2011, Medicare has provided coverage for annual wellness visits (AWV), which are primarily conducted by PCPs and may be useful for older adults undergoing dialysis. Read More

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Evaluation of Switch-to-Brand Rates as a Potential Signal for Therapeutic Equivalency of Generic Antidepressants: A Real-World Retrospective Cohort Study.

Clin Pharmacol Ther 2021 Apr 2. Epub 2021 Apr 2.

Center for Translational Medicine, School of Pharmacy, University of Maryland, Baltimore, Maryland, USA.

Negative clinical outcomes after switching from brand to generic antidepressants have raised concerns regarding therapeutic equivalency. This research aims to estimate the prevalence of switching and to identify predictors for generic to brand switching for various antidepressants. This retrospective cohort study utilized data from a 10% random sample of enrollees in the IQVIA PharMetrics Plus claims database from 2007-2015. Read More

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Quality of Buprenorphine Care for Insured Adults With Opioid Use Disorder.

Med Care 2021 May;59(5):393-401

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Aim: The aim of this study was to characterize quality of buprenorphine care for opioid use disorder (OUD) by quantifying buprenorphine initiation, engagement, and maintenance for individuals in a large, diverse, real-world cohort in the United States.

Design: This was a retrospective cohort analysis.

Setting: OUD treatment in the outpatient setting. Read More

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Symptom Burden and GOLD Classification in Medicare Advantage Patients with COPD Initiating Umeclidinium/Vilanterol or Fluticasone Propionate/Salmeterol Therapy.

Int J Chron Obstruct Pulmon Dis 2020 29;15:2715-2725. Epub 2020 Oct 29.

US Medical Affairs, GlaxoSmithKline, Research Triangle Park, NC.

Background: Long-acting muscarinic antagonist/long-acting β-agonist (LAMA/LABA) provide greater improvements in lung function and symptoms than inhaled corticosteroid (ICS)/LABA in patients with chronic obstructive pulmonary disease (COPD). This study evaluated symptom burden and Global Initiative for Obstructive Lung Disease (GOLD) categorization among patients who recently initiated umeclidinium/vilanterol (UMEC/VI; LAMA/LABA) or fluticasone propionate/salmeterol (FP/SAL; ICS/LABA) single-inhaler dual therapy.

Methods: COPD-diagnosed Medicare Advantage enrollees aged ≥65 years were identified from the Optum Research Database (ORD). Read More

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Treatment for opioid use disorder in the Florida medicaid population: Using a cascade of care model to evaluate quality.

Am J Drug Alcohol Abuse 2021 03 15;47(2):220-228. Epub 2020 Oct 15.

Division of Public Mental Health and Population Sciences, Department of Psychiatry, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.

: A cascade of care (CoC) model may improve understanding of gaps in addiction treatment availability and quality over current single measure methods. Despite increased funding, opioid overdose rates remain high. Therefore, it is critical to understand where the health-care system is failing to provide appropriate care for people with opioid use disorder (OUD) diagnoses, and to assess disparities in receipt of medication for OUD (MOUD). Read More

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Evaluation of Medication Adherence and Rescue Medication Use in Non-Exacerbating Patients with COPD Receiving Umeclidinium/Vilanterol or Budesonide/Formoterol as Initial Maintenance Therapy.

Int J Chron Obstruct Pulmon Dis 2020 16;15:2207-2215. Epub 2020 Sep 16.

US Medical Affairs, GlaxoSmithKline, Research Triangle Park, Durham, NC, USA.

Background: Adherence to inhaled maintenance therapy is critical to managing chronic obstructive pulmonary disease (COPD), while increasing rescue medication usage may indicate worsening symptoms. This study evaluated adherence and rescue medication use in patients with COPD without a history of exacerbation who initiated combination therapy with budesonide/formoterol (B/F) or umeclidinium/vilanterol (UMEC/VI).

Methods: Retrospective observational study of commercially insured and Medicare Advantage with Part D enrollees who initiated UMEC/VI or B/F between January 1, 2014 and December 31, 2017 (earliest fill defined as index date). Read More

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Real-world cost of treatment for multiple sclerosis patients initiating and receiving infused disease-modifying therapies per recommended label in the United States.

J Med Econ 2020 Aug 18;23(8):885-893. Epub 2020 May 18.

Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.

The study evaluated the real-world cost of treatment in multiple sclerosis (MS) patients initiating infused disease-modifying-therapies (DMT) in the United States. This retrospective cohort study using administrative claims data included adult patients with MS initiating index infusion DMT (ocrelizumab (OCR), natalizumab (NTZ) or alemtuzumab (ATZ)) from April 2017-September 2018 with 6-months pre/12-months post-index continuous enrollment. The primary cohort included patients who had prescribed annual dosing visits indicated by the approved product label (PL): 3 OCR, 5 ATZ, and 12-13 NTZ infusion visits within the first year of initiation. Read More

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High Real-World Medication Adherence and Durable Clinical Benefit in Medicare Patients Treated with 5-Alpha Reductase Inhibitors for Benign Prostatic Hyperplasia.

J Urol 2020 Aug 13;204(2):325-331. Epub 2020 Mar 13.

Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Purpose: Although clinical trials demonstrate 5-alpha reductase inhibitors are efficacious treatments for benign prostatic hyperplasia, they have low reported medication adherence outside of clinical trials. We evaluated real-world drug adherence and clinical outcomes in Medicare patients with lower urinary tract symptoms from benign prostatic hyperplasia managed with 5-alpha reductase inhibitor therapy.

Materials And Methods: Using health care and pharmacy claims from Partners Healthcare Medicare Accountable Care Organization enrollees (January 2009 to July 2018), we identified men initiating a 5-alpha reductase inhibitor for benign prostatic hyperplasia with more than 1 medication dispensation. Read More

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Medication Adherence, Health Care Utilization, and Spending Among Privately Insured Adults With Chronic Conditions in the United States, 2010-2016.

Am J Med 2020 06 24;133(6):690-704.e19. Epub 2020 Jan 24.

AARP Public Policy Institute, Washington, DC; Visiting Fellow, OptumLabs, Cambridge, Mass.

Background: Chronic conditions are common and costly for older Americans and for the health system. Adherence to daily maintenance medications may improve patient health and lead to lower health care spending.

Methods: To identify predictors of adherence and to quantify associations with health care utilization and spending among older adults with chronic conditions, we conducted a longitudinal retrospective analysis using the OptumLabs Data Warehouse. Read More

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Will savings from biosimilars offset increased costs related to dose escalation? A comparison of infliximab and golimumab for rheumatoid arthritis.

Arthritis Res Ther 2019 12 12;21(1):285. Epub 2019 Dec 12.

Massachusetts College of Pharmacy and Health Sciences University, Boston, USA.

Introduction: Biosimilar infliximab has the potential for appreciable cost savings compared to its reference biologic, but dose escalation is common and increases costs. We compared frequency of dose escalation and associated Medicare-approved amount so as to determine the break-even point at which infliximab dose escalation would offset the cost savings of using a biosimilar, referent to alternatively using golimumab.

Methods: We studied Medicare enrollees with rheumatoid arthritis (RA) initiating infliximab or golimumab. Read More

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December 2019

Adverse childhood experiences and reproductive strategies in a contemporary U.S. population.

Am J Phys Anthropol 2020 01 11;171(1):37-49. Epub 2019 Nov 11.

Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, SUNY, Albany, New York.

Objectives: Stressful experiences may initiate developmentally plastic responses toward a faster reproductive strategy. This study tests whether adverse childhood experiences (ACEs) are associated with characteristics of faster reproductive strategies: earlier menarche and reduced prenatal investment in offspring in a well-nourished, low-immune system burden population.

Materials And Methods: We analyzed the first 214 enrollees of the prenatal-birth Albany Infant and Mother Study. Read More

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January 2020

Associations Between the Specialty of Opioid Prescribers and Opioid Addiction, Misuse, and Overdose Outcomes.

Pain Med 2020 09;21(9):1871-1890

Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.

Objective: To examine associations between opioid prescriber specialty and patient likelihood of opioid use disorder (OUD), opioid misuse, and opioid overdose.

Design: Longitudinal retrospective study using Pennsylvania Medicaid data (2007-2015).

Methods: We constructed an incident cohort of 432,110 enrollees initiating prescription opioid use without a history of OUD or overdose six months before opioid initiation. Read More

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September 2020

Real-world effectiveness of umeclidinium/vilanterol versus fluticasone propionate/salmeterol as initial maintenance therapy for chronic obstructive pulmonary disease (COPD): a retrospective cohort study.

Int J Chron Obstruct Pulmon Dis 2019 1;14:1721-1737. Epub 2019 Aug 1.

US Medical Affairs, GSK, Durham, NC, USA.

Background And Objective: Retrospective claims data in patients with chronic obstructive pulmonary disease (COPD) initiating maintenance therapy with inhaled fixed-dose combinations of long-acting muscarinic antagonist/long-acting β-agonist (LAMA/LABA) versus inhaled corticosteroid (ICS)/LABA have not been reported.

Methods: Retrospective observational study in a COPD-diagnosed population of commercial and Medicare Advantage with Part D (MAPD) enrollees aged ≥40 years from a US health insurer database. Patients initiated umeclidinium/vilanterol (UMEC/VI [62. Read More

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Impact of a co-pay accumulator adjustment program on specialty drug adherence.

Am J Manag Care 2019 07;25(7):335-340

Conduent HR Services, 117 Kemp Rd E, Greensboro, NC 27410. Email:

Objectives: To assess the impact of a co-pay accumulator adjustment program (CAAP) on usage patterns of autoimmune specialty drugs, comparing health savings account (HSA) or preferred provider organization (PPO) plan enrollees before and after implementation of the CAAP.

Study Design: Retrospective cohort analysis.

Methods: Data on HSA and PPO patients with autoimmune specialty drug use were drawn from the Conduent pharmacy benefit manager for January 2016 to October 2017 from 15 self-insured employers initiating a CAAP in January 2017. Read More

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Healthcare resource utilization and costs in patients with HIV-1 who switched first-line antiretroviral therapy.

Curr Med Res Opin 2019 11 22;35(11):1945-1953. Epub 2019 Aug 22.

Merck and Co Inc. - Center for Observational and Real World Evidence , Kenilworth , NJ , USA.

This study compared healthcare utilization and costs associated with switching the first-line protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI) based antiretroviral (ARV) regimen due to reasons other than virologic failure among patients with HIV-1. This was a retrospective analysis of commercial and Medicare Advantage with Part D enrollees in two US administrative claims databases. The study population comprised adults with HIV-1 infection initiating antiretroviral therapy (ART) on PI- or NNRTI-containing regimens from 1 January 2006 to 31 December 2015. Read More

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November 2019

Pharmacist Provision of Hormonal Contraception in the Oregon Medicaid Population.

Obstet Gynecol 2019 06;133(6):1231-1237

Oregon State University, College of Pharmacy, Corvallis, the Oregon State University, College of Pharmacy, Portland, and the Oregon Health & Science University, Obstetrics and Gynecology, Portland, Oregon.

Objective: To describe early utilization of pharmacist prescription of contraception in Oregon's Medicaid program.

Methods: Using Oregon Medicaid claims data, we conducted a retrospective analysis and quantified overall and monthly trends in pharmacist-prescribed contraceptives from January 1, 2016, to December 31, 2017. Our population was restricted to patients obtaining a new prescription for oral and transdermal methods and who had continuous Medicaid coverage during the study period. Read More

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High prevalence of Mycoplasma genitalium infection and macrolide resistance in patients enrolled in HIV pre-exposure prophylaxis program.

Med Mal Infect 2019 Aug 23;49(5):347-349. Epub 2019 Mar 23.

Infectious and tropical diseases department, Pellegrin hospital, Bordeaux university hospital, 33000 Bordeaux, France; USC EA 3671, Mycoplasma and chlamydia human infections, Bordeaux university, 33000 Bordeaux, France; USC EA 3671, Mycoplasma and chlamydia human infections, French National Institute for Agricultural Research, 33000 Bordeaux, France. Electronic address:

Objectives: Limited data on Mycoplasma genitalium infection has been reported among PrEP users. The aim of this study was to estimate the prevalence and macrolide resistance of M. genitalium infection among enrollees in a French PrEP program. Read More

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Effectiveness and safety of oral anticoagulants in older adults with non-valvular atrial fibrillation and heart failure.

PLoS One 2019 25;14(3):e0213614. Epub 2019 Mar 25.

New York City College of Technology, City University of New York, New York, New York, United States of America.

Direct oral anticoagulants (DOACs) are at least as efficacious and safe as warfarin among non-valvular atrial fibrillation (NVAF) patients; limited evidence is available regarding NVAF patients with heart failure (HF). US Medicare enrollees with NVAF and HF initiating DOACs (apixaban, rivaroxaban, dabigatran) or warfarin were selected. Propensity score matching and Cox models were used to estimate the risk of stroke/systemic embolism (SE), major bleeding (MB), and major adverse cardiac events (MACE) comparing DOACs versus warfarin and DOACs versus DOACs. Read More

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December 2019

Initial Opioid Prescriptions among U.S. Commercially Insured Patients, 2012-2017.

N Engl J Med 2019 03;380(11):1043-1052

From the Department of Health Care Policy, Harvard Medical School (W.Z., M.E.C., N.M.), RAND (T.B.S.), and the Department of Medicine, Brigham and Women's Hospital (T.B.S.) - all in Boston.

Background: The United States is undergoing a crippling opioid epidemic, spurred in part by overuse of prescription opioids by adults 25 to 64 years of age. Of concern are long-duration and high-dose initial prescriptions, which place the patients and their friends and relatives at heightened risk for long-term opioid use, misuse, overdose, and death.

Methods: We estimated the incidence of initial opioid prescriptions in each month between July 2012 and December 2017 using administrative-claims data from across the United States (accessed through Blue Cross-Blue Shield [BCBS] Axis); monthly incidence was estimated as the percentage of enrollees who received an initial opioid prescription among those who had not used opioids (i. Read More

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Comparative effectiveness of generic and brand-name medication use: A database study of US health insurance claims.

PLoS Med 2019 03 13;16(3):e1002763. Epub 2019 Mar 13.

Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.

Background: To the extent that outcomes are mediated through negative perceptions of generics (the nocebo effect), observational studies comparing brand-name and generic drugs are susceptible to bias favoring the brand-name drugs. We used authorized generic (AG) products, which are identical in composition and appearance to brand-name products but are marketed as generics, as a control group to address this bias in an evaluation aiming to compare the effectiveness of generic versus brand medications.

Methods And Findings: For commercial health insurance enrollees from the US, administrative claims data were derived from 2 databases: (1) Optum Clinformatics Data Mart (years: 2004-2013) and (2) Truven MarketScan (years: 2003-2015). Read More

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Outdoor temperature and survival benefit of empiric potassium in users of furosemide in US Medicaid enrollees: a cohort study.

BMJ Open 2019 02 18;9(2):e023809. Epub 2019 Feb 18.

Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman of School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Objective: Heat is associated with elevated all-cause mortality, and furosemide-induced potassium depletion might be worsened by heat-induced sweating. Because empiric potassium is associated with a marked survival benefit in users of furosemide at a dose of ≥40 mg/day, we hypothesised that this empiric potassium's survival benefit would increase with higher temperature (≥24°C).

Design: Cohort study. Read More

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February 2019

Assessment of Adherence and Asthma Medication Ratio for a Once-Daily and Twice-Daily Inhaled Corticosteroid/Long-Acting β-Agonist for Asthma.

J Allergy Clin Immunol Pract 2019 May - Jun;7(5):1488-1496.e7. Epub 2019 Jan 10.

Health Economics and Outcomes Research, Optum, Inc, Eden Prairie, Minn.

Background: Although efficacy and safety of fluticasone furoate/vilanterol (FF/VI) and budesonide/formoterol (BUD/F) have been demonstrated in clinical studies, real-world comparisons of utilization have not been performed.

Objective: To compare similar patients with asthma initiating FF/VI or BUD/F on measures of adherence, persistence, and the asthma medication ratio (AMR).

Methods: This was a retrospective cohort study of commercial and Medicare Advantage with Part D enrollees initiating FF/VI or BUD/F for asthma. Read More

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Impact of metformin use on the cardiovascular effects of dipeptidyl peptidase-4 inhibitors: An analysis of Medicare claims data from 2007 to 2015.

Diabetes Obes Metab 2019 04 18;21(4):854-865. Epub 2018 Dec 18.

Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, North Carolina.

Aims: To examine the outcomes of dipeptidyl peptidase-4 (DPP-4) inhibitor initiation with and without concurrent metformin treatment.

Materials And Methods: We identified Medicare enrollees initiating a DPP-4 inhibitor, a sulphonylurea or a thiazolidinedione. Using propensity-score-weighted Poisson models, we evaluated 1-year cardiovascular (CV) outcome incidence among initiators of DPP-4 inhibitors versus comparators in subgroups with and without concurrent metformin use, and assessed the interaction between initiation drug and metformin. Read More

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Retention in care among clinically stable antiretroviral therapy patients following a six-monthly clinical consultation schedule: findings from a cohort study in rural Malawi.

J Int AIDS Soc 2018 11;21(11):e25207

Epicentre, Paris, France.

Introduction: Longer intervals between clinic consultations for clinically stable antiretroviral therapy (ART) patients may improve retention in care and reduce facility workload. We assessed long-term retention among clinically stable ART patients attending six-monthly clinical consultations (SMCC) with three-monthly fast-track drug refills, and estimated the number of consultations "saved" by this model of ART delivery in rural Malawi.

Methods: Stable patients (aged ≥18 years, on first-line ART ≥12 months, CD4 count ≥300 cells/mL , without opportunistic infections, not pregnant/breastfeeding) were eligible for SMCC, with three-monthly drug refills from community health workers. Read More

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November 2018

Risk factors for discontinuation of buprenorphine treatment for opioid use disorders in a multi-state sample of Medicaid enrollees.

J Subst Abuse Treat 2018 12 7;95:9-17. Epub 2018 Sep 7.

Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 112 Paterson St., New Brunswick, NJ 08901, United States of America. Electronic address:

Introduction: Recent U.S. trends demonstrate sharp rises in adverse opioid-related health outcomes, including opioid use disorder (OUD), overdose, and death. Read More

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December 2018