The Vitals - November 2015

Examining the News Affecting Pharmacy & Clinics
November 2015, Vol 3, No 11 - The Vitals

In This Article

Retail Clinic Use Linked to Fewer ED Visits, Low Healthcare Costs

Retail clinics may provide an affordable option for primary care services and lead to fewer emergency department (ED) visits, data suggest.

“It is projected that the Affordable Care Act and the associated patient demand will double the 1418 clinics in operation in 2012 to 2868 in 2015, with a projected savings of $800 million annually for the healthcare study,” the study authors explained in a poster presented at the Academy of Managed Care Pharmacy Nexus 2015 meeting.

As part of a retrospective, propensity-matched, cohort study, Bobby Clark, PhD, MSPharm, MHA, MS, MA, and colleagues sought to determine whether patients using retail healthcare clinics incurred lower healthcare costs and fewer ED visits than patients who did not visit these clinics as part of their medical care.

A 2-to-1 match sample was selected from >195,000 beneficiaries receiving employer healthcare insurance continually from January 2012 through December 2013 from a large healthcare company, and matched based on factors including age, number of chronic conditions, and level of insurance coverage.

Patients who were part of the healthcare clinic cohort had 7 fewer visits per 100 patients, compared with patients who did not use healthcare clinics. In addition, the study authors found that out-of-pocket costs, medical spending, and total healthcare costs were significantly lower among patients who used retail healthcare clinics, compared with patients who did not use them.

  1. Clark B, Hou J, Boghani S. Patients who utilized retail healthcare clinics have fewer emergency department visits and incur lower overall healthcare cost. Poster presented at: Academy of Managed Care Pharmacy Nexus 2015; October 26-29, 2015; Orlando, FL.

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1 in 5 Pediatricians in the United States Dismiss Unvaccinated Families

Despite recommendations from the American Academy of Pediatrics and the Centers for Disease Control and Prevention against this practice, one-fifth of pediatricians dismiss families who refuse to vaccinate their children, according to a recent survey. Significant regional variation exists in the practices with this policy, the study also noted.

“Although many have argued against dismissal on ethical and practical grounds, dismissing families appears to be relatively common,” explained Sean T. O’Leary, MD, MPH, from the Adult and Child Center for Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus, and colleagues, citing previous research.

To get a better understanding of this controversial practice, the investigators conducted a survey of pediatricians and family physicians between June and October 2012, to assess the prevalence of parental refusal of ≥1 vaccines in the infant series; physician response to refusal; and the association between family dismissal and characteristics of the practice and/or provider, as well as state exemption laws.

The survey was distributed via the Internet, and, if requested, by mail. Physicians who were practicing <50% primary care, not practicing in the United States, or in training were excluded from the survey. Overall, 66% (534/815) of family physicians and pediatricians responded to the survey.

Eighty-three percent of physicians reported that ≥1% of parents refused ≥1 infant vaccines in a typical month; 20% reported refusals by >5% of parents. More than 50% of the physicians reported always/often requiring parents to sign a form if they refused. Twenty-one percent of pediatricians and 4% of family physicians reported always/often dismissing families who refused ≥1 vaccines.

The study authors found that pediatricians who dismissed families were more likely to be in private practice (adjusted odds ratio [aOR], 4.90), from the South (aOR, 4.07), and reside in a state without philosophical exemption law (aOR, 3.70).

These data are important for pharmacists, and other healthcare providers should be aware of this practice and take a proactive approach to communicating with patients and caregivers about immunization.

  1. O’Leary ST, Allison MA, Fisher A, et al. Characteristics of physicians who dismiss families for refusing vaccines. Pediatrics. 2015 Nov 2. Epub ahead of print.

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Prescription Use Significantly Higher Now Than a Decade Ago

Overall prescription use increased among US adults, according to authors who compared data between 1999 and 2000, and 2011 and 2012. Polypharmacy was also significantly increased in that time period, they added.

“An updated comprehensive assessment of prescription drug use is important given that practice patterns are continually evolving to reflect the changing health needs of the population, advances in treatment, new clinical guidelines, the entrance or exit of drugs from the market, and shifts in policies regarding drug marketing and promotion,” explained Elizabeth D. Kantor, PhD, MPH, from the Department of Epidemiology at Harvard T.H. Chan School of Public Health, Boston, MA, and colleagues in the November 3 issue of JAMA.

Using nationally representative data from the National Health and Nutrition Examination Survey, the investigators evaluated the temporal trends in prescription drug use among 37,959 noninstitutionalized US adults aged ≥20 years between 1999 and 2000, and 2011 and 2012. The response rate for the survey was 73.6%.

Approximately 59% of US adults reported any prescription use in 2011 to 2012, and 51% in 1999 to 2000 (P <.001). In addition, the study authors found that the prevalence of polypharmacy (ie, use of ≥5 prescription drugs) increased by 6.6% between 1999 and 2000, and 2011 and 2012 (P <.001). Prevalence of use increased in most of the drug classes (11/18), including antihyperlipidemic agents, antidepressants, prescription proton pump inhibitors, and muscle relaxants.

These data may be useful to community pharmacists and other primary care providers to get a better sense of trends in the industry, as well as to potentially identify patients who may underuse, misuse, or be at risk for polypharmacy.

  1. Kantor ED, Rehm CD, Haas JS, et al. Trends in prescription drug use among adults in the United States from 1999-2012. JAMA. 2015;314:1818-1830.

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Children with Asthma Living in Low-Income Areas Benefit from Home Remediation

Findings from a recent study suggest that programs that combine home repairs to reduce asthma triggers, training, and comprehensive care can have a significant impact on childhood asthma in low-income communities.

In the October issue of Environmental Justice, Ray Lopez, Director of the Environ­mental Health and Family Asthma Program at Little Sisters of the Assumption Family Health Service, Inc, New York, NY, and colleagues reported on the impact of the Controlling Asthma Through Home Remediation program, which offers a combination of these services to the families of children with severe and/or persistent asthma who live in East Harlem, in NYC Housing Authority public housing. The services provided by the program were evaluated using a mixed-method pre-post design that focused on several factors, including household environmental conditions, child health status, and healthcare use. Data were collected from caregiver surveys at baseline and follow-up, caregiver interviews, and observation of housing conditions by community health workers.

Overall, 152 children took part in the program; 51.32% were boys, and the mean age of the group was 8.34 years. Among the children who were enrolled in the program for a minimum of 10 months, and completed the annual follow-up (n = 60), the study authors reported significant improvements, including decreased nighttime awakening (P <.001), use of rescue medication (P <.001), prescribed oral steroids P <.001), and asthma-related emergency department or urgent care visits (P <.001).

“Questions remain regarding intervention model and components most likely to lead to sustained improvements,” the study authors noted. “There is a need for greater reach, as the population level impact of family-focused interventions is likely inadequate.”

Community pharmacists and other healthcare providers can benefit from these data when providing education to the caregivers of children with asthma.

  1. Lopez R, Chantarat T, Bozack A, et al. Reducing childhood asthma triggers in public housing: implementation and outcomes from an East Harlem community health worker program. Environmental Justice. 2015;8:185-191.

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Walgreens Boots Alliance to Acquire Rite Aid

One of the main headlines this month was the announcement by Walgreens Boots Alliance that they had entered into a definitive agreement to acquire all outstanding shares of Rite Aid.

This combination creates a further opportunity to deliver a high-quality pharmacy choice for consumers in an evolving and increasingly personalized healthcare environment, according to a press release by Walgreens Boots Alliance. “Our complementary retail pharmacy footprints in the [United States] will create an even better network, with more health and wellness solutions available in stores and online,” according to Stefano Pessina, Walgreens Boots Alliance Executive Vice Chairman and Chief Executive Officer. “Walgreens Boots Alliance will provide to Rite Aid its global expertise and resources to accelerate the delivery of integrated frontline care, and to offer innovative solutions for providers, payers, and other entities in the US healthcare system.”

After the completion of the merger, Rite Aid will be a wholly owned subsidiary of Walgreens Boots Alliance, and is expected to initially operate under its existing brand name.

  1. Walgreens Boots Alliance to acquire Rite Aid for $17.2 billion in all-cash transaction [news release]. Deerfield, IL, and Camp Hill, PA; Business Wire; October 27, 2015. Accessed November 4, 2015.

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Last modified: December 29, 2015
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