Increased Health Care Spending Research Articles

Trauma Center Hospitals Charged Higher Prices For Some Nontrauma Care Than Non-Trauma Center Hospitals, 2012-18.

Rising prices are a major cause of increased health care spending and health insurance premiums in the US. Hospital prices, specifically-for both inpatient and outpatient care-are the largest driver of rising health care spending in the commercial insurance market. As a result, policy makers and employers are increasingly interested in understanding the determinants of hospital prices. Hospitals serving as trauma centers are often endowed by regulators with monopoly power over trauma services in their geographic areas, and this monopoly power may spill over to nontrauma services. This study focused on the growing number of designated trauma centers and how trauma center status affects hospital prices for other, nontrauma services. We found that hospitals designated as trauma centers charged higher prices for nontrauma inpatient admissions and nontrauma emergency department visits when compared with hospitals that were not designated as trauma centers, even after controlling for potential confounders.

Area-Level Socioeconomic Disadvantage and Health Care Spending

Publicly available, US Census-based composite measures of socioeconomic disadvantage are increasingly being used in a wide range of clinical outcomes and health services research. Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) are 2 of the most commonly used measures. There is also early interest in incorporating area-level measures to create more equitable alternative payment models. To review the evidence on the association of ADI and SVI with health care spending, including claims-based spending and patient-reported barriers to care due to cost. A systematic search for English-language articles and abstracts was performed in the PubMed, Web of Science, Embase, and Cochrane databases (from inception to March 1, 2023). Peer-reviewed articles and abstracts using a cross-sectional, case-control, or cohort study design and based in the US were identified. Data analysis was performed in March 2023. This review included 24 articles and abstracts that used a cross-sectional, case-control, or cohort study design. In 20 of 24 studies (83%), ADI and SVI were associated with increased health care spending. No association was observed in the 4 remaining studies, mostly with smaller sample sizes from single centers. In adjusted models, the increase in spending associated with higher ADI or SVI residence was $574 to $1811 for index surgical hospitalizations, $3003 to $24 075 for 30- and 90-day episodes of care, and $3519 for total annual spending for Medicare beneficiaries. In the studies that explored mechanisms, postoperative complications, readmission risk, and poor primary care access emerged as health care system-related drivers of increased spending. The findings of this systematic review suggest that both ADI and SVI can play important roles in efforts to understand drivers of health care spending and in the design of payment and care delivery programs that capture aspects of social risk. At the health care system level, higher health care spending and poor care access associated with ADI or SVI may represent opportunities to codesign interventions with patients from high ADI or SVI areas to improve access to high-value health care and health promotion more broadly.

How healthy is the health budget of Amrit Kaal: 2023-24?

Political will is the key to public health policy-making and a major driving force for the attainment of Universal Health Coverage (UHC) in any nation. To achieve UHC, the Indian government laid down National Health Policy in 1983 and updated it in 2002 and recently in 2017. This recent policy emphasized increasing healthcare spending and economic growth. In the current budget, there is an increment in the share of GDP of 0.34% from the previous year's allocation, but still staggering for the envisaged 2.5% to achieve UHC. Enthusiastic announcements of opening 157 new nursing colleges, a separate programme for eliminating sickle cell anemia by 2047, and Centers of excellence establishment for pharma companies for promoting research and development and focusing on Particularly Vulnerable Tribal Groups (PVTGs) are the few overarching and new highlights in the current budget. But, in a country so huge and varied in terms of its needs in every sector, the announcements in the financial budget speech taking India forward in becoming a "shining star" is a matter of debate. This is an attempt to review the budget for this financial year in the healthcare sector and what it means: is the country willing to build a self-driven healthcare sector in the Amrit Kaal with strong public finances and a robust financial sector through "efforts by all"?

The Relationship Between Aging, Economic Development and Healthcare Expenditure in Japan: An Empirical Analysis

This paper investigates the relationship between ageing, economic development, and healthcare expenditure in Japan, considering the challenges posed by an ageing population. The study utilizes a VAR and ARMAX modelling approach to analyse the complex dynamics among these variables. The empirical results reveal interesting findings that contrast with previous literature. While population ageing is often assumed to lead to increased healthcare spending, this study finds no significant correlation between population ageing and healthcare expenditure as a percentage of GDP. The analysis suggests that factors such as advancements in medical technology, healthcare system efficiency, and cultural variations in healthcare utilization patterns may have mitigated the expected rise in healthcare expenditure associated with an ageing population. These findings have implications for policymakers and investors. Policymakers should consider a broader range of factors beyond population ageing when projecting future healthcare expenditures and developing strategies for managing healthcare costs. Investors can benefit from a nuanced understanding of the healthcare sector, focusing on areas such as medical technology, innovation, and healthcare delivery models that are likely to be influenced by population ageing and changing healthcare needs. Overall, this research contributes to the existing knowledge base, offering insights for addressing the challenges of population ageing and healthcare sustainability.

Politician’s childhood experience and government policies: Evidence from the Chinese Great Famine

We analyze the impact of a politician’s childhood experience on their policy choices. By exploiting exogenous variations in exposure to China’s Great Famine, we find that a provincial leader’s childhood experience of the famine significantly increases the share of government expenditure allocated to health care during his term. This effect is observed only for those who were aged under five during the famine and is not found among older cohorts. The impact is substantial: our back-of-the-envelope calculation indicates that an increase of one standard deviation in exposure to the famine can lead to an increase of roughly 7.84 billion RMB (equivalent to about 1.19 billion US Dollars) in annual provincial health care expenditure for a province with average government spending in 2017. We provide evidence suggesting that this effect may be driven by a politician’s personal experience of negative health outcomes due to the famine. Furthermore, we observe that China’s political promotion system, which favors economic growth, incentivizes provincial leaders to counterbalance increased health care spending by reducing funding for less visible public services, particularly cultural activities. Such strategic allocations ensure the continuity of other policy areas that are more influential in their political career.

Substantive Representation, Women’s Health, and Regime Type

A large body of literature investigates whether increasing the number of women in legislative office translates into policies that benefit women in society. This research builds upon theories about descriptive and substantive representation. However, these theories may not travel well to authoritarian contexts, where we see some of the largest gains in women legislators in recent years. This article unpacks the link between women’s descriptive representation, healthcare spending, and health outcomes by regime type. Using a sample of 169 countries from 2000 to 2018, we find that the percentage of women legislators is associated with increased healthcare spending across all regimes. However, women’s health outcomes do not improve with women’s descriptive representation in closed autocracies. Meanwhile, the results for democracies and electoral autocracies are similar, suggesting that even limited vertical accountability through semi-competitive elections may facilitate substantive representation of women.

Predictors of Patient’s Survival after a Diagnosis of Cervical Cancer Patients at Moi Teaching and Referral Hospital

Cervical cancer is one of the most prevalent cancer in women. It is the fourth leading cause of cancer deaths in women worldwide after breast cancer, lung cancer and colorectal cancer. In Kenya, cervical cancer is the leading cause of death in women, and has been shown to have increased by 3 211 in the past 5 years. An increase in cervical cancer in Kenya, has resulted in an economic burden for patients and families. There is an increase in healthcare spending as well as productivity losses due to morbidity and mortality at a productive age. The purpose of the study was to determine the predictors of survival after a diagnosis of cervical cancer. A retrospective cohort design was used in the study. A total of 175 cervical cancer patients were studied over a five-year period, from January 1st to December 31st, 2014. A Cox regression model were used to assess the predictors of survival after cervical cancer diagnosis. The study findings revealed that age, marital status, employment status, family history, smoking status, comorbidity, cancer grade, staging of the disease and treatment plan were factors that increased the risk of death for cervical cancer patients. In conclusion, risk factors affecting the life expectancy of cervical cancer patients include age, marital status, employment status, family history, smoking status, comorbidity, cancer grade, staging of the disease and treatment plan. In an effort for an intervention on factors that increased the risk of death for cervical cancer patients, a collaboration between the Government, private organizations, and local communities is critical. This includes promoting and developing cervical cancer awareness among the public so that women adopt healthy lifestyles and early screening behaviours.

SAT109 Diabetic Ketoacidosis Due To Non-medical Switching

Abstract Disclosure: A.S. Can: None. Z. Zhang: None. F. Yeakley: None. Background/Objective: Non-medical switching is a change in treatment regimen for reasons other than efficacy, side effects, or adherence. Non-medical switching aims to decrease health care costs and is initiated by patient’s health insurance company. Case Report: A 20-year-old female with type 1 diabetes mellitus presented with diabetic ketoacidosis (DKA). She was having issues between her health insurance and pharmacy in filling her prescriptions. Both her standing prescription for long-acting (Basaglar, Eli Lilly and Company, Indianapolis, IN, USA) and rapid-acting (Admelog, sanofi-aventis U.S. LLC, Bridgewater, NJ, USA) insulin were no longer covered. The insulin treatment was switched as requested by her health insurance and Semglee (Mylan Pharmaceuticals Inc., a Viatris Company, Morgantown, WV, USA) as long-acting and Humalog (Eli Lilly and Company, Indianapolis, IN, USA) as rapid-acting insulin prescriptions were transmitted to the pharmacy electronically. The patient was confused on what she should be taking. This led to her thinking that her new long-acting insulin (Semglee) was her rapid-acting due to a name that she did not recognize from her past diabetes self-management education. The patient endorsed taking long-acting insulin Semglee three times daily before meals in place of rapid-acting insulin along with previously prescribed long-acting insulin Basaglar twice daily before breakfast and at bedtime. To make things worse, she could not fill her prescription for Semglee due to a Semglee shortage in the preceding three weeks before her admission. Patients with similar health plan were switched to the same insulin at the same time, causing a shortage in our service area. Even if Admelog was prescribed, she was under the impression that she was getting her rapid-acting insulin needs from Semglee. She did not fill her prescription for Admelog. After her discharge, her insurance covered her original regimen (Basaglar and Admelog) that she was on before her non-medical switching. Around the time of admission, wholesale acquisition cost of 5-pack of 3 ml (1500 Units) of Basaglar was $326.36 and unbranded Semglee $147.98 allowing a saving of $0.12 for one unit of insulin. Our patient takes 40 units of long-acting insulin daily, totaling 14600 units per year. Non-medical switching would achieve $1736 savings per year. But inpatient bill for this DKA was $17078. Discussion: In our case, non-medical switching defeated its purpose and increased health care spending. With the switches, patient became confused about her medical regimen. Non-medical switching did not only place additional financial burden but jeopardized patient safety by significantly contributing to an acute complication of diabetes. Further studies that compare health care utilization, not just drug prices are needed to find out if non-medical switching really saves money and is cost-effective. Presentation: Saturday, June 17, 2023

Impact of a Pharmacist-Led Telemedicine Visit in a Geriatric Primary Care Clinic.

Purpose: Unintentional medication discrepancies (UMD) are common amongst geriatric patients. If not addressed, these UMD can lead to suboptimal care and increased health care spending. Ambulatory care pharmacists are trained to identify and resolve UMD, and help tailor medication regimens to assure optimized and safe patient-centered care. The purpose of this retrospective study was to highlight the role of a remote, ambulatory care pharmacist in a geriatric primary care setting. Methods: This was a multicenter, single cohort, retrospective chart review of patients enrolled in a geriatric primary care initiative. Patients met with an ambulatory care pharmacist for a 60-minute telemedicine appointment. The primary endpoint was the percent of patients seen by the ambulatory care pharmacist with at least 1 medication discrepancy identified. Results: A total of 275 visits were scheduled with the ambulatory care pharmacist during the 6-month study period. At least 1 unintentional medication discrepancy (UMD) was identified in 151 patients (66%). At least 1 edit was made to the patient's medication list in 224 patients (97%). The ambulatory care pharmacist made recommendations to the provider in 210 patients (91%). The CPA was utilized in 75 patients (33%). Conclusion: This study highlights the utility of a remote, ambulatory care pharmacist in a geriatric primary care setting. Two-thirds of patients were noted to have at least 1 UMD, and more than 90% of patients were identified as having suboptimal regimens. This initiative shows the impact of a remote, ambulatory care pharmacist on patient care.

Prophylactic use of incisional negative pressure wound therapy for the prevention of surgical site occurrences in general surgery: Consensus document.

Surgical site occurrences pose a threat to patient health, potentially resulting in significant increases in health care spending caused by using additional resources. The objective of this study was to reach a consensus among a group of experts in incisional negative pressure wound therapy to determine the indications for using this type of treatment prophylactically and to analyze the associated risk factors of surgical site occurrences in abdominal surgery. A group of experts in incisional negative pressure wound therapy from Spain and Portugal was formed among general surgery specialists who frequently perform colorectal, esophagogastric, or abdominal wall surgery. The Coordinating Committee performed a bibliographic search to identify the most relevant publications and to create a summary table to serve as a decision-making protocol regarding the use of prophylactic incisional negative pressure wound therapy based on factors related to the patient and type of procedure. The patient risk factors associated with surgical site occurrence development such as age, immunosuppression, anticoagulation, hypoalbuminemia, smoking, American Society of Anesthesiologists classification, diabetes, obesity, and malnutrition were analyzed. For surgical procedure factors, surgical time, repeated surgeries, organ transplantation, need for blood transfusion, complex abdominal wall reconstruction, surgery at a contaminated site, open abdomen closure, emergency surgery, and hyperthermic intraperitoneal chemotherapy were analyzed. In our experience, this consensus has been achieved on a tailored set of recommendations on patient and surgical aspects that should be considered to reduce the risk of surgical site occurrences with the use of prophylactic incisional negative pressure wound therapy, particularly in areas where the evidence base is controversial or lacking.

Comparison of antibody responses before and after booster doses with the Pfizer-BioNTech or Oxford-AstraZeneca vaccines in healthcare workers in Thailand.

The severe acute respiratory syndrome 2 (SARS-CoV-2) has spread rapidly worldwide, not only causing significant morbidity and mortality but also dramatically increasing health care spending. To manage this in Thailand, healthcare workers first received two doses of the CoronaVac vaccine followed by a booster vaccine with either BNT162b2 vaccine (Pfizer-BioNTech; PZ) or ChAdOx1 nCoV-19 vaccine (Oxford-AstraZeneca; AZ). Given that the difference in anti-SARS-CoV-2 levels following vaccination may vary depending on the vaccine and on demographic characteristics, we measured the antibody response after the second CoronaVac dose and after the booster with either the PZ or AZ vaccine. Our results in 473 healthcare workers show that the variation in antibody response to the full CoronaVac dose depends on demographic characteristics such as age, gender, body mass index, and underlying disease. After receiving a booster dose, anti-SARS-CoV-2 levels were significantly higher in participants who received the PZ vaccine than in people who received the AZ vaccine. Overall, however, receiving a booster dose of either the PZ or AZ vaccine promoted strong antibody responses, even in the old and those with obesity or diabetes mellitus. In conclusion, our results support the use of a booster vaccination program after full vaccination with the CoronaVac vaccine. This approach effectively enhances immunity against SARS-CoV-2, especially in clinically vulnerable groups and healthcare workers.

The Utility of Echocardiogram in the Workup of Ischemic Stroke Patients.

Cardiac sources of emboli can be identified by transthoracic echocardiogram (TTE). The Canadian Best Practice Guidelines recommend routine use of TTE in the initial workup of ischemic stroke when an embolic source is suspected. However, TTEs are commonly ordered for all patients despite insufficient evidence to justify cost-effectiveness. We aim to evaluate the TTE ordering pattern in the initial workup of ischemic stroke at a regional Stroke Center in Central South Ontario and determine the proportion of studies which led to a change in management and affected length of stay (LOS). Hospital records of 520 patients with a discharge diagnosis of TIA or ischemic stroke between October 2016 and June 2017 were reviewed to gather information. 477 patients admitted for TIA or ischemic stroke met inclusion criteria. 67.9% received TTE, out of which 6.0% had findings of cardiac sources of emboli including left ventricular thrombus, atrial septal aneurysm, PFO, atrial myxoma, and valvular vegetation. 2.5% of all TTE findings led to change in medical management. The median LOS of patients who underwent TTE was 2 days longer (p < 0.00001). TTE in the initial workup of TIA or ischemic stroke remains common practice. The yield of TTEs is low, and the proportion of studies that lead to changes in medical management is minimal. TTE completion was associated with increased LOS and may result in increased healthcare spending; however, additional factors prolonging the LOS could not be excluded.

Nutraceuticals: Regulatory process across the world

Nutraceuticals are the products isolated from foods that are generally sold in medicinal form. They are of particular interest to reduce the expensive and high-tech disease treatment approaches currently employed in developed countries. Nutraceuticals show increase in shift towards preventive therapies and increasing disposable income, favourable pricing environment growth in pharma retail chain and increase in healthcare spending is mainly responsible for increasing market for nutraceuticals, but lack of standardisation and awareness, high pricing, marketing and distribution are some challenges. Nutraceuticals are a clear example of advancement in biotechnological products with a disproportionate and inadequate input into generating quality scientific evidence to back or refute their validity. To achieve better quality of life people started eating more vegetables, fruits, dietary supplements, nutraceuticals, phyto therapeutical substances and other plant foods. With the advancements in the qualitative and quantitative determining parameters, the requisition of these products has been found to be amplified. Due to this, the nutraceutical market has become a million-dollar industry at a global level. Urbanization, market globalization and economic development have led to changes in diet and lifestyle. Development of better characterized and research proven products will help to enhance the customer confidence in nutraceutical and functional food products in global market.

Non-adherence to antihypertensive medications in Lebanese adults hospitalized for hypertensive urgency and its cost

BackgroundDrug non-adherence is assumed to play an important role in development of hypertensive urgency, which is a common health problem resulting in frequent emergency department admissions and thus increased healthcare spending wastage. The objective of this study is to assess the rate of non-adherence to antihypertensives and to evaluate influencing factors predicting this behavior in Lebanese hypertensive adults. In addition, this study aim to estimate the cost of hospitalization for hypertensive urgency covered by the Ministry of Public Health in patients’ non-adherent to their antihypertensives.MethodsA multi-methods approach is used comprising a cross-sectional study, additionally to an observational, retrospective, cost of illness study. A cross-sectional questionnaire based study is conducted from May to Dec, 2019 to address the study objective. Using the Ministry of Public Health hospitalization data during 2019, the cost of hospitalization for hypertensive urgency is assessed. Multivariable analysis is performed to calculate the adjusted odd ratios by fitting a logistic regression model.ResultsThe cross-sectional study includes 494 participants and shows that 43.0% of patients hospitalized and covered by the Ministry of Public Health are non-adherent. The univariate regression model shows that adherence to antihypertensive medications is significantly associated with age (p-value = 0.005) and follow-up visits (p-value = 0.046). The odds of adherence for participants earning more than USD 2000 was 3.27 times that for those who earn less than USD 1000 (p = 0.026). The estimated cost of hospitalization for non-adherent patients is USD 452,353 in 2019.ConclusionNon-adherence associated hospitalization costs represents a financial burden to Lebanese health system.

Assessment of Spending for Patients Initiating Dialysis Care

Despite a widespread belief that private insurers spend large amounts on health care for enrollees receiving dialysis, data limitations over the past decade have precluded a comprehensive analysis of the topic. To examine the amount and types of increases in health care spending for privately insured patients associated with initiating dialysis care. A cohort study covering calendar years 2012 to 2019 included patients with kidney failure who had employer-sponsored insurance for 12 months following dialysis initiation. Data analysis was performed from August 27, 2021, to August 18, 2022. The data cover the entirety of the US and were obtained from the Health Care Cost Institute. The data include all medical claims for enrollees in employer-sponsored health insurance plans offered by multiple major health care insurers within the US. Participants included patients younger than 65 years who were continuously enrolled in these plans in the 12 months before and after their first claim for dialysis care. Patients also had to have nonmissing documented key characteristics, such as sex, race and ethnicity, and health characteristics. A claim for dialysis care. Out-of-pocket, inpatient, outpatient, physician services, prescription medication, and total health care spending. The hypothesis tested was formulated before data collection. The sample included 309 800 enrollee-months, which was a balanced panel of 25 months for 12 392 enrollees. At baseline, 7534 patients (61%) were male, 5415 (44%) were aged 55 to 64 years, and patients had been enrolled with their insurer for a mean of 30 months (95% CI, 29.9-30.1 months). In the 12 months before initiating dialysis care, total monthly health care spending was $5025 per patient per month (95% CI, $4945-$5106). Dialysis care initiation was associated with an increase in total monthly spending of $14 685 (95% CI, $14 413-$14 957). This increase occurred across all spending categories (dialysis, nondialysis outpatient, inpatient, physician services, and prescription drugs). Monthly patient out-of-pocket spending increased by $170 (95% CI, $162-$178). These spending increases occurred abruptly, beginning about 2 months before dialysis initiation, and remained increased for the subsequent 12 months. In this cohort study, evidence that private insurers experience significant, sustained increases in spending when patients initiated dialysis was noted. The findings suggest that proposed policies aimed at limiting the amount dialysis facilities charge private insurers and the enrollees has the potential to reduce health care spending in this high-cost population.

Empowering Patient Self-Management: A Community Paramedicine Model of Care in Ontario

Community Paramedicine Remote Patient Monitoring (CPRPM) was launched in Ontario in April 2015 to address high health system usage in vulnerable patients living with chronic disease.  CPRPM expands on the home visit model of community paramedicine (CP) to bridge gaps in patient care and address inefficiencies in resource utilization.  At patient and systems levels, CPRPM aims to promote patient self-management of chronic diseases. Several reports driving the development of the Ontario Seniors Strategy, which include key recommendations for expanding CP programs, provided the impetus for government to deliver on their electoral platform promise to increase health care spending. The Local Health System Integration Act, 2006 gave Local Health Integration Networks the authority to make home and community care services accessible to Ontario residents, including the supplies and equipment required by patients and their caregivers to support their care at home.  Outcome measures of CPRPM point to positive benefits for encouraging patient self-management of chronic diseases and reducing health system strain, with a return on investment of 542%.  The variety of options for patient interaction and ability to lessen health system burden makes CPRPM a desirable model of care.

Association Between Buprenorphine Treatment Gaps, Opioid Overdose, and Health Care Spending in US Medicare Beneficiaries With Opioid Use Disorder

Nonadherence to buprenorphine may increase patient risk of opioid overdose and increase health care spending. Quantifying the impacts of nonadherence can help inform clinician practice and policy. To estimate the association between buprenorphine treatment gaps, opioid overdose, and health care spending. This longitudinal case-control study compared patient opioid overdose and health care spending in buprenorphine-treated months with treatment gap months. Individuals who were US Medicare fee-for-service beneficiaries diagnosed with opioid use disorder who received at least 1 two-week period of continuous buprenorphine treatment between 2010 and 2017 were included. Analysis took place between January 2010 and December 2017. A gap in buprenorphine treatment in a month lasting more than 15 consecutive days. Opioid overdose and total, medical, and drug spending (combined patient out-of-pocket and Medicare spending). Of 34 505 Medicare beneficiaries (17 927 [520%] male; 16 578 [48.1%] female; mean [SD] age, 49.5 [12.7] years; 168 [0.5%] Asian; 2949 [8.5%] Black; 2089 [6.0%] Hispanic; 266 [0.8%] Native American; 28 525 [82.7%] White; 508 [1.5%] other race), 11 524 beneficiaries (33.4%) experienced 1 or more buprenorphine treatment gaps. Treatment gap beneficiaries, compared with nontreatment gap beneficiaries, were more likely to be younger, be male, have a disability, and be Medicaid dual-eligible while less likely to be White, close to a buprenorphine prescriber, and treated with buprenorphine monotherapy (ie, buprenorphine hydrochloride). Beneficiaries were 2.89 (95% CI, 2.20-3.79) times more likely to experience an opioid overdose during buprenorphine treatment gap months compared with treated months. During treatment gap months, spending was $196.41 (95% CI, $110.53-$282.30) more than in treated months. Patients who continued to take buprenorphine dosages of greater than 8 mg/d and 16 mg/d were 2.61 and 2.84 times more likely to overdose in a treatment gap month, respectively, while patients taking buprenorphine dosages of 8 mg/d or less were 3.62 times more likely to overdose in a treatment gap month (maintenance of >16 mg/d: hazard ratio (HR), 2.64 [95% CI, 1.80-3.87]; maintenance of >8 mg/d: HR, 2.84 [95% CI, 2.13-3.78]; maintenance of ≤8 mg/d: HR, 3.62 [95% CI, 1.54-8.50]). Buprenorphine monotherapy was associated with greater risk of overdose and higher spending during treatment gaps months than buprenorphine/naloxone. Medicare patients treated with buprenorphine between 2010 and 2017 had a lower associated opioid overdose risk and spending during treatment months than treatment gap months.

Medication Adherence and Compliance: Recipe for Improving Patient Outcomes.

The indices of patients’ health outcomes have historically included recurrence of symptoms, number of emergency visits, hospitalization and re-admission rates, morbidity, and mortality. As significant healthcare players, providers can influence these events, including the timeliness of diagnosis and disease management, the cost of treatment, access to health insurance, and medication adherence. Beyond healthcare availability and access, the ability of patients to adhere to providers’ treatment recommendations goes a long way to serve as a recipe for improving patient outcomes. Unfortunately, medication nonadherence has been prevalent, culminating in worsened health conditions, increased cost of care, and increased healthcare spending. This article provides some innovative ideas and good considerations for encouraging medication adherence. Improving providers’ and patients’ education and adopting active and passive communication, including consented reminders, could enhance compliance. Embracing partnerships between providers’ organizations and faith-based and community organizations could drive adherence. Adopting an income-based cap on out-of-pocket spending and adapting the physical properties, bioavailability, and dosage regimen of medications to accommodate diverse patient population preferences could encourage refills and compliance. Good medication adherence can culminate in improved patient outcomes.

Urine-Derived Stem Cells for Epithelial Tissues Reconstruction and Wound Healing.

Epithelial tissue injury can occur on any surface site of the body, particularly in the skin or urethral mucosa tissue, due to trauma, infection, inflammation, and toxic compounds. Both internal and external body epithelial tissue injuries can significantly affect patients’ quality of life, increase healthcare spending, and increase the global economic burden. Transplantation of epithelial tissue grafts is an effective treatment strategy in clinical settings. Autologous bio-engineered epithelia are common clinical skin substitutes that have the specific advantages of avoiding tissue rejection, obviating ethical concerns, reducing the risk of infection, and decreasing scarring compared to donor grafts. However, epithelial cells are often obtained from the individual’s skin and mucosa through invasive methods, which cause further injury or damage. Urine-derived stem cells (USC) of kidney origin, obtained via non-invasive acquisition, possess high stemness properties, self-renewal ability, trophic effects, multipotent differentiation potential, and immunomodulatory ability. These cells show versatile potential for tissue regeneration, with extensive evidence supporting their use in the repair of epidermal and urothelial injuries. We discuss the collection, isolation, culture, characterization, and differentiation of USC. We also discuss the use of USC for cellular therapies as well as the administration of USC-derived paracrine factors for epidermal and urothelial tissue repair. Specifically, we will discuss 3D constructions involving multiple types of USC-loaded hydrogels and USC-seeded scaffolds for use in cosmetic production testing, drug development, and disease modeling. In conclusion, urine-derived stem cells are a readily accessible autologous stem cell source well-suited for developing personalized medical treatments in epithelial tissue regeneration and drug testing.

Health Care Resource Utilization in Management of Opioid-Naive Patients With Newly Diagnosed Neck Pain

Research has uncovered heterogeneity and inefficiencies in the management of idiopathic low back pain, but few studies have examined longitudinal care patterns following newly diagnosed neck pain. To understand health care utilization in patients with new-onset idiopathic neck pain. This cross-sectional study used nationally sourced longitudinal data from the IBM Watson Health MarketScan claims database (2007-2016). Participants included adult patients with newly diagnosed neck pain, no recent opioid use, and at least 1 year of continuous postdiagnosis follow-up. Exclusion criteria included prior or concomitant diagnosis of traumatic cervical disc dislocation, vertebral fractures, myelopathy, and/or cancer. Only patients with at least 1 year of prediagnosis lookback were included. Data analysis was performed from January 2021 to January 2022. The primary outcome of interest was 1-year postdiagnosis health care expenditures, including costs, opioid use, and health care service utilization. Early services were those received within 30 days of diagnosis. Multivariable regression models and regression-adjusted statistics were used. In total, 679 030 patients (310 665 men [45.6%]) met the inclusion criteria, of whom 7858 (1.2%) underwent surgery within 1 year of diagnosis. The mean (SD) age was 44.62 (14.87) years among nonsurgical patients and 49.69 (9.53) years among surgical patients. Adjusting for demographics and comorbidities, 1-year regression-adjusted health care costs were $24 267.55 per surgical patient and $515.69 per nonsurgical patient. Across all health care services, $95 379 949 was accounted for by nonsurgical patients undergoing early imaging who did not receive any additional conservative therapy or epidural steroid injections, for a mean (SD) of $477.53 ($1375.60) per patient and median (IQR) of $120.60 ($20.70-$452.37) per patient. On average, patients not undergoing surgery, physical therapy, chiropractic manipulative therapy, or epidural steroid injection, who underwent either early advanced imaging (magnetic resonance imaging or computed tomography) or both early advanced and radiographic imaging, accumulated significantly elevated health care costs ($850.69 and $1181.67, respectively). Early conservative therapy was independently associated with 24.8% (95% CI, 23.5%-26.2%) lower health care costs. In this cross-sectional study, early imaging without subsequent intervention was associated with significantly increased health care spending among patients with newly diagnosed idiopathic neck pain. Early conservative therapy was associated with lower costs, even with increased frequency of therapeutic services, and may have reduced long-term care inefficiency.