Patient Support Program Research Articles

Effectiveness of a Patient Support Program in Supporting Access to Therapy for Solid Tumor Malignancies.

Background: Certain governmental agencies, patient advocacy organizations, and pharmaceutical manufacturers have implemented programs to assist patients in overcoming barriers to accessing healthcare. Recently, such programs have expanded their services, helping both uninsured and insured patients to navigate the complex healthcare system, and assisting with increasing out-of pocket costs and copays for the drugs. Objective: To better understand the effect of patient support programs on access to therapy for solid tumor malignancies, this study evaluated service use, case outcomes, and patient characteristics from a manufacturer-sponsored program in the United States. Methods: Sociodemographic characteristics, services use rates, and outcomes by case and insurance type were evaluated at the patient- and case-level in a random sample of patients prescribed nab-paclitaxel for solid tumor malignancies who enrolled in the Celgene Patient Support (CPS) program (April 2011-November 2013). Results: This analysis included 4566 patients (8134 cases); most patients were female (64.7%), aged <65 years (59.2%), in the South (53.9%), and treated in community settings (87.9%). Patients were primarily insured by Medicare (38.5%) or commercial plans (37.3%), or were uninsured (16.6%). Following benefits investigations for new patients entering the program (98.5%), CPS provided support to obtain free medicine (29.4%), appeal denial of coverage (15.0%), receive commercial co-payment assistance (8.1%), or obtain prior payer authorization (1.3%). Nab-paclitaxel was provided at no cost in 89.4% of cases where patients sought financial support; payer reimbursement was obtained in 63.2% of reimbursement appeals. Of commercially-insured patients who required assistance with co-payments and met financial criteria, 93.3% received a mean of $597 in co-payment support. Conclusion: The CPS program was successful in gaining access to therapy. Healthcare providers and both insured or uninsured patients accessed CPS for prior authorization/precertification, appeals support, and financial support through the Free Medication Program and the Commercial Co-Pay program.

Achieve control: a pragmatic clinical trial of insulin glargine 300 U/mL versus other basal insulins in insulin-naïve patients with type 2 diabetes

ABSTRACTObjective: This study aims to compare the effectiveness of insulin glargine 300 U/mL (Gla-300) with its accompanying patient support program with that of other basal insulin and available patient support programs in patients with type 2 diabetes (T2D) in a real-world setting in terms of achieving HEDIS (Healthcare Effectiveness Data and Information Set) individualized glycemic targets without documented symptomatic hypoglycemia.Methods: Achieve Control is a US-based, multicenter, randomized, open-label, active-controlled, parallel group pragmatic Phase IV trial in insulin-naïve patients with T2D uncontrolled on ≥2 oral antidiabetes drugs (OAD) and/or glucagon-like peptide-1 receptor antagonists (GLP-1 RA). Inclusion criteria include a diagnosis of T2D, age ≥18 years, and glycated hemoglobin (HbA1c) between 8.0% and 11.0%. Patients will be assigned to either the Gla-300 or other basal insulin group. The primary end point is the proportion of patients achieving HEDIS HbA1c targets (<8.0% [64 mmol/mol] in patients with comorbidities or aged ≥65 years; <7.0% [58 mmol/mol] in all other patients) without occurrence of symptomatic hypoglycemia (blood glucose ≤70 mg/dL) from baseline to 6 months. Secondary end points include rates of documented symptomatic nocturnal hypoglycemia and severe hypoglycemia; change from baseline in HbA1c, fasting glucose, and body weight; treatment persistence; patient-reported outcomes; and healthcare resource utilization. Planned enrollment is 3270 patients across approximately 400 clinical sites.Conclusion: Pragmatic clinical trials offer the potential to assess comparative effectiveness in broadly based patient populations receiving care (with or without a corresponding educational support program) in real-world clinical settings. The results of Achieve Control should elucidate the benefits of management of T2D with Gla-300 versus other basal insulins in terms of patient outcomes, experiences, and perceptions, and its impact on healthcare resource utilization and cost.Clinical trial registration: www.clinicaltrials.gov identifier is NCT02451137.

Encouraging early discussion of life expectancy and end-of-life care: A randomised controlled trial of a nurse-led communication support program for patients and caregivers

BackgroundPatients are often not given the information needed to understand their prognosis and make informed treatment choices, with many consequently experiencing less than optimal care and quality-of-life at end-of-life. ObjectivesTo evaluate the efficacy of a nurse-facilitated communication support program for patients with advanced, incurable cancer to assist them in discussing prognosis and end-of-life care. DesignA parallel-group randomised controlled trial design was used. SettingsThis trial was conducted at six cancer treatment centres affiliated with major hospitals in Sydney, Australia. Participants110 patients with advanced, incurable cancer participated. MethodsThe communication support program included guided exploration of a question prompt list, communication challenges, patient values and concerns and the value of discussing end-of-life care early, with oncologists cued to endorse question-asking and question prompt list use. Patients were randomised after baseline measure completion, a regular oncology consultation was audio-recorded and a follow-up questionnaire was completed one month later. Communication, health-related quality-of-life and satisfaction measures and a manualised consultation-coding scheme were used. Descriptive, Mixed Modelling and Generalised Linear Mixed Modelling analyses were conducted using SPSS version 22. ResultsCommunication support program recipients gave significantly more cues for discussion of prognosis, end-of-life care, future care options and general issues not targeted by the intervention during recorded consultations, but did not ask more questions about these issues or overall. Oncologists’ question prompt list and question asking endorsement was inconsistent. Communication support program recipients’ self-efficacy in knowing what questions to ask their doctor significantly improved at follow-up while control arm patients’ self-efficacy declined. The communication support program did not impact patients’ health-related quality-of-life or the likelihood that their health information or shared decision-making preferences would be met. Satisfaction with the communication support program was high. ConclusionsGiven the importance of clarifying prognostic expectations and end-of-life care wishes in the advanced cancer context, the communication support program appears to be an effective and well-received solution to encourage early information seeking related to these issues though, its long-term impact remains unclear. The manualised nature of the intervention, designed with existing clinical staff in mind, may make it suited for implementation in a clinical setting, though additional work is needed to identify why question asking was unaffected and establish its impact later in the illness trajectory.

Patients' experience of receiving radiation treatment for head and neck cancer: Before, during and after treatment.

Most research to date in the area of head and neck cancer has focused on the efficacy of treatment modalities and the assessment and management of treatment side effects and toxicities. Little or no attention has been directed toward understanding patients' experience of receiving radiation treatment for the management of their cancer. The purpose of this qualitative study was to explore the experience of individuals receiving radiation treatment for a cancer of the head and neck. Face-to-face interviews were conducted with 17 individuals. Thorne's (1997) approach of interpretive description along with Giorgi's analytical technique for analysis were used. Experiences across interviews revealed five main themes: 1) making sense of the diagnosis, 2) distress from disrupted expectations, 3) heightened awareness of self, others and the health care system, 4) strategies to 'get through' treatment, and 5) living with uncertainty. Findings from the study have contributed to the development of head and neck cancer-specific patient support and education programs for patients and families.

Referral patterns and predictors of referral delays for patients with traumatic injuries in rural Rwanda

In developing countries, 9 out of 10 patients lack access to timely operative care. Most patients seek care at district hospitals that often lack operative capacity, creating a need for referral. Delays in referrals contribute to substantial disability and death. This study assessed the predictors of delayed referrals for injured patients. This retrospective cohort study included injured patients, recommended for referral between January 1, 2013, and December 31, 2013, from 3 rural district hospitals in Rwanda. We defined delay as nonexecution of referral 2days after referral recommendation. We performed a multivariate logistic regression using stepwise backward selection to identify the predictors of delayed referral. Of the 1,227 injured patients, 23.0% (n=282) were recommended for referral. Of these, 36.5% (n=103) had road traffic injuries and 53.6% (n=151) were diagnosed with closed fractures/dislocation. Among 231 patients, 108 (46.8%) had a delay in referral execution. The predictors of delay included age >35years (odds ratio=2.45, 95% confidence interval: 1.09-5.50), closed fractures/dislocation (odds ratio=16.37, 95% confidence interval: 3.13-85.78), admission to surgical wards (odds ratio=10.25, 95% confidence interval: 2.70-38.82), and a duration ≥7days from admission to referral recommendation (odds ratio=4.80, 95% confidence interval: 1.38-16.63). Over 50% of referrals were completed in a timely fashion due to a strong referral system and a patient support program. Empowering district hospitals with trained staff and appropriate equipment could reduce the need for referral, and increasing surgeons at referral hospitals could reduce referral delays.

Linkage between theory-based measurement of organizational readiness for change and lessons learned conducting quality improvement-focused research.

Organizations have different levels of readiness to implement change in the patient care process. The Hypertension Telemedicine Nurse Implementation Project for Veterans (HTN‐IMPROVE) is an example of an innovation that seeks to enhance delivery of care for patients with hypertension. We describe the link between organizational readiness for change (ORC), assessed as the project began, and barriers and facilitators occurring during the process of implementing a primary care innovation. Each of 3 Veterans Affairs medical centers provided a half‐time nurse and implemented a nurse‐delivered, telephone‐based self‐management support program for patients with uncontrolled hypertension. As the program was starting, we assessed the ORC and factors associated with ORC. On the basis of consensus of medical center and research partners, we enumerated implementation process barriers and facilitators. The primary ORC barrier was unclear long‐term commitment of nursing to provide continued resources to the program. Three related barriers included the need to address: (1) competing organizational demands, (2) differing mechanisms to integrate new interventions into existing workload, and (3) methods for referring patients to disease and self‐management support programs. Prior to full implementation, however, stakeholders identified a high level of commitment to conduct nurse‐delivered interventions fully using their skills. There was also a significant commitment from the core implementation team and a desire to improve patient outcomes. These facilitators were observed during the implementation of HTN‐IMPROVE. As demonstrated by the link between barriers to and facilitators of implementation anticipated though the evaluation of ORC and what was actually observed during the process of implementation, this project demonstrates the practical utility of assessing ORC prior to embarking on the implementation of significant new clinical innovations.

Cost analysis of a peer support programme for patients with type 2 diabetes: a secondary analysis of a controlled trial.

This study aimed to explore if group-based peer support as an additional component to a disease management programme (DMP) in type 2 diabetes can reduce the number of prescribed drugs; hospital admissions; and length of hospital stay and therefore be a cost-effective model. Controlled study based on a secondary data analysis of a cluster randomized trial. Our study population was general practitioners and patients in the province of Salzburg. The 24-months intervention consisted of regular group meetings facilitated by trained peer supporters. The groups exercised together, discussed diabetes related topics, and received support by professionals. Data was anonymously collected on clusters through the statutory health insurance. Data were available of 118 (82.5%,17 clusters of the patients in the original randomized trial) participants in the intervention and 143 (77.3%,19 clusters) in the control groups. The length of hospital stay was shorter in the intervention groups compared with controls. The mean difference during the 24-month study period was -40.13 days (95% CI - 78.54 to - 1.71, P = 0.041) in favour of the intervention groups. No differences were seen in the number of prescribed drugs and hospital admission. Estimated yearly savings by reducing the length of hospital stay was €1660.60 per patient. A group-based peer support programme as an additional component of a DMP in type 2 diabetes is a promising approach to optimize diabetes care and to enhance lifestyle interventions in primary care. Peer support seems to reduce length of hospital stay and could therefore be a cost-effective model.

Canadian Study of Outcomes in Adalimumab Patients with Support for Adherence: Results from the COMPANION Study

Introduction: Adalimumab (ADA) is a TNF-alpha inhibitor indicated for use in various inflammatory autoimmune diseases including Crohn's disease (CD) and ulcerative colitis (UC). Patients receiving ADA in Canada are eligible to enroll in a patient support program (PSP) providing personalized services including tailored interventions. This retrospective cohort study assessed the impact of specific factors, including PSP services and patient characteristics, on persistence and adherence to ADA. Methods: A patient linkage algorithm based on probabilistic matching was developed to link the ADA PSP database to the IMS Health longitudinal pharmacy transaction database, LRx. Patients that started ADA therapy between July 2010 and August 2014 were selected and their prescriptions were evaluated for 12 months after the index date to calculate days until end of persistence (>90 days without therapy), censored for patients who remained on therapy through month 12. Cox proportional hazards modelling provided hazard ratios (HR) for the association between persistence and patient characteristics and PSP services. Adherence, measured by medication possession ratio (MPR), was calculated and multivariable logistic regression provided adjusted odds ratios (OR) for the relationship between high adherence (MPR >= 80%) and patient characteristics and PSP services. Results: The linkage algorithm yielded a final sample of 10,857 patients (4,230 CD, 347 UC). Statistically significant differences in the hazard rate of discontinuation and the odds of high adherence were identified across multiple variables. Relative to the 30-39 year category, older age groups had significantly greater odds of adherence (OR = 1.247, 1.234, 1.323, 1.411, p < 0.01). Patients receiving ongoing motivational interventions, in the form of nurse-provided phone calls, were 72% less likely to cease therapy when compared to those that did not receive the interventions (HR = 0.282, p < 0.0001) and were also more adherent (OR = 1.483, p < 0.0001). Treatment abandonment (failure to initiate therapy after enrolment in the PSP) was >80% more frequent in patients that did not receive a pre-ADA intervention (p < 0.0001). Conclusion: Ongoing motivational interventions, as provided by the ADA PSP, were found to have a large and statistically significant association to greater patient persistence and adherence over the first 12 months of treatment. These results may help refine interventions aiming at improving treatment adherence.

The effect of an e-health web-based support programme on psychological outcomes and health related quality of life among Chinese patients with coronary heart disease: a parallel-group randomised controlled trial

BackgroundCoronary heart disease is the leading global cause of death, and e-health web-based programmes are effective to support patients. However, fewstudieshave reported psychological outcomes and health related quality of life (HRQoL) in Chinese populations. This study aimed to investigate the effect of an e-health web-based support programme for patients with coronary heart disease on anxiety, depression, and HRQoL across six months. MethodsThis parallel-group, randomised controlled trial was conducted in two specialist clinics in Hong Kong, China. Chinese patients with coronary heart disease, older than 18 years who were able to use computer were randomly assigned 1:1 to control or intervention groups using block randomisation. All patients received standard care, but the intervention group also received the e-health web-based support programme to promote physical activity and general health monitoring. Data was collected at baseline, 3 months, and 6 months. The outcomes were Hospital Anxiety and Depression scale (HAD) and HRQoL as measured by SF12. The data was analysed by Generalised Estimating Equations Model in SPSS (version 22.0). Ethical approval was obtained from the The Chinese University of Hong Kong and Tung Wah Eastern Hospital Ethics Committee. Signed written consent was obtained from participants. The study was registered at Clinicaltrials.gov, number NCT02350192. Findings441 eligible patients (mean age 51·34 years [SD 5·02]; 66% (291) men) with coronary artery disease were randomly assigned to either control (N=221) or intervention (N=220) groups. We found significant differences in anxiety between groups (p=0·004); anxiety was also lower over time in the intervention group (β=–0·428, p=0·03 at 3 months; β=–0·806, p<0·0001 at 6 months). We found no significant effect on depression. Regarding HRQoL, a significant difference between the control and intervention groups was seen over time (β=1·377, p=0·01 at 3 months; β=2·99, p<0·0001 at 6 months), but there was no difference between groups or interaction effect between physical and mental health components. InterpretationThe findings indicate a trend of positive psychological outcomes and HQoL in patients with coronary heart disease over 6 months, although the changes did not depend on the type of intervention given. In a future study, a booster dose or more intensive approaches to enhance the intervention effect could be recommended. FundingHealth and Medical Research Fund, Food and Health Bureau of Hong Kong

308 Linking Suicide Attempt Patients With Community Support Programs: The Effect of a Crisis Intervention Team Operating in the Emergency Department

According to the World Health Organization (WHO), suicide rates in South Korea are the highest in the world. Suicide prevention is one of the most important public health and social issues in South Korea. To this end, there are many community support programs for patients who attempt suicide or self-harm, with the purpose of reducing re-attempt rates. In line with such trends, the Department of Emergency Medicine (ED) at Korea University Ansan Hospital (KUAH), in conjunction with the Ministry of Health, launched a Crisis Intervention Team (CIT) for suicide attempt patients. This study analyzes the effect of the CIT on community support program linkage for suicide attempt patients that visited the ED. This is a before-and-after analysis, which was conducted in the ED of a tertiary academic teaching hospital in Ansan, Korea. Data on suicide attempt patients was collected using ED medical records and was matched against the database of community mental health care centers, where patients were referred for follow-up. The intervention group was defined as suicide attempt patients visiting the ED from Jan to Dec 2015 and the control group was defined as suicide attempt patients visited the ED from Aug 2014 to July 2015. Before the creation of the CIT, suicide attempt patients were referred to community mental health care centers directly from the ED for counselling after ED discharge. Patients are followed up for at least 8 weeks. Comprised of two social workers, the CIT began active counselling in the ED, with regular contact post-discharge to guide suicide attempt patients to maintain longer-term counselling with community suicide prevention centers. Primary outcome was completion of 8-week follow-up by community mental health care centers. A multivariable logistic regression analysis was used to compared outcome between two groups adjusting for potential risks; sex, age, insurance level, initial mental status, suicide mechanism, ED result. Of the total 47,911 patients visiting ED during the pre-intervention period, 318 (0.7%) patients (control group) attempted suicide, and among the 49,534 patients from the post-intervention period, 360 (0.7%) patients (intervention group) attempted suicide. The most common suicide attempt method was drug ingestion in both groups (control group N=174, 54.7%, intervention group N=197, 54.7%). Completion rates of the 8-week follow-up was 19.6% in the control group and 88.4% in the intervention group. (p<0.001) The adjusted odds ratio (95% confidence interval) of the intervention group compared to the control group for completion of follow up was 6.47 (3.08-13.60). Intervention with the CIT showed higher rates of completion of the 8-week follow-up counselling program provided by community suicide prevention centers. Further study to investigate the long term outcome of the suicide attempt patients is warranted.

Diagnósticos enfermeros en pacientes ingresados en la Unidad de Epilepsia

IntroductionEpilepsy is a neurological disease consisting of abnormal electrical discharges in the brain that produce a clinical condition, affecting 1-3% of the population. The Multidisciplinary Epilepsy Unit of the Hospital Universitario y Politécnico La Fe de Valencia, since 2006, has conducted studies with prolonged video-EEG monitoring of patients diagnosed with refractory epilepsy. The role of the unit is to provide these patients with both a diagnostic and a treatment solution. ObjectiveThis study aims to determine, using NANDA-NIC-NOC language, the basic needs of these patients and to assess how the quality of nursing care can be improved in this type of patient, during their admission and afterwards. MethodologyData were collected from a sample of 46 patients monitored in the unit between May and September 2013, and by using nursing assessment, data was obtained on the percentage occurrence of diagnosis. Results and conclusionsThe patients are very limited socially and occupationally, with added risks specific to the disease that we must not forget. The nursing role should be to standardise their situation as much as possible so that they can lead as full a life as possible, have proper health education, and prevent further injuries during admission (falls, etc.). From our experience, the epileptic patient support program from the Epilepsy Association of the Community of Valencia, and its incorporation into the Programa Respira for admission to the monitoring unit, gives good results.

Comparative Effectiveness and Cost Effectiveness of a Multitarget Stool DNA Test to Screen for Colorectal Neoplasia

We developed a model to determine whether a multitarget stool DNA (MT-sDNA) test that detects colorectal cancer (CRC) and polyps with higher sensitivity and lower specificity, but at a higher cost, than the fecal immunochemical test (FIT) can be used in screening. We used a Markov model of average-risk CRC screening to compare the effectiveness and cost effectiveness of screening with the MT-sDNA test vs FIT or colonoscopy. We accounted for the complex longitudinal participation patterns observed in organized programs vs opportunistic screening, as well as organized programs' patient support costs and differential payment rates by commercial insurers vs Medicare. With optimal adherence, yearly FIT and colonoscopy every 10 years were dominant (more effective and less costly) than MT-sDNA every 3 years. Compared with successful organized FIT programs (50% consistent and 27% intermittent participation; patient support costs, $153/cycle), the patient support program for the MT-sDNA test would need 68% of subjects to participate consistently and 32% to participate intermittently every 3 years, or the MT-sDNA test would need to cost 60% less than in the base case ($260 commercial payment and $197 Medicare payment), for the MT-sDNA test to be preferred over FIT at a threshold of $100,000 per quality-adjusted life-year (QALY) gained. Compared with opportunistic yearly FIT screening (15% consistent and 30% intermittent participation), performing the MT-sDNA test every 3 years would cost less than $100,000 per QALY gained if the MT-sDNA test achieved a participation rate more than 1.7-fold that of FIT. The results were robust in sensitivity analyses. Assuming equal participation across strategies and a threshold of $100,000 per QALY gained, FIT was preferred in 99.3% of iterations in Monte Carlo simulation. In a Markov model, we found FIT and colonoscopy to be more effective and less costly than the MT-sDNA test when participation rates were equal for all strategies. For the MT-sDNA test to be cost effective, the patient support program included in its cost would need to achieve substantially higher participation rates than those of FIT, whether in organized programs or under the opportunistic screening setting that is more common in the United States than in the rest of the world.

Burden on Caregivers of Patients with Schizophrenia and Related Factors.

Caregivers of patients with schizophrenia are under the burden of continuous and difficult processes. Determination of the factors related to caregiver burden in schizophrenia may help find strategies to decrease the burden. This study aimed at investigating the factors associated with caregiver burden among relatives of patients with schizophrenia. Eighty-eight caregivers of patients under treatment for schizophrenia for at least 1 year were included in the study. The Zarit Caregiver Burden Interview was used for the assessment of caregiver burden. Sociodemographical data, the level of knowledge about schizophrenia, clinical impression scale, and global assessment of functioning were used to evaluate the related factors. Caregiver burden was negatively correlated with income level and functionality of the patient and was positively correlated with the age of the caregiver, the daily time spent with the patient, and the number of hospitalizations of the patient (p<0.05). There was no significant correlation between the caregivers' knowledge about schizophrenia and caregiver burden (p<0.05). Living in the same house with the patient was a positive predictor, whereas functionality and income level of the patient and education level of the caregiver were negative predictors (p<0.05). This study highlighted the importance of setting targets for improving the functionality of patients in the design and implementation of rehabilitation and support programs for patients with schizophrenia. Additionally, providing higher income for patients, creating conditions for an independent life, and increasing incentives for younger caregivers with a higher educational level may help decrease caregiver burden.

Nutritional Screening Tool for In-Hospital Patients

Malnutrition is a common problem in hospital settings. A poor nutritional status has been associated with higher rates of infection, poor wound healing, longer hospital stays, and higher hospital costs. Therefore, early recognition and timely treatment of malnutrition is vital. To identify malnourished individuals or those at risk of becoming malnourished, selecting and validated a uniform screening tool is clearly an important issue. Both the Nutritional Risk Screening-2002 (NRS-2002) and Malnutrition Universal Screening Tool (MUST) are recommended by the European Society for Parenteral and Enteral Nutrition (ESPEN) for a hospital setting. For older patients, the Mini Nutritional Assessment (MNA) is the recommended tool. Short Nutrition Assessment Questionnaire (SNAQ) and Malnutrition Screening Tools (MST) are brief and simple screening tools that use self-reported queries of variables that include weight loss and poor appetite. On the other hand, many of those require considerable time and labor to administer and may not be highly applicable to a Korean population. In Korea, most hospitals use a computerized nutritional screening system with a self-developed nutrition screening index. The variables for the tools, which are based on each hospital setting, include the objective data available in the patient's medical records and limited information collected from the nursing admission questionnaire. The application of different tools hampers any comparison of the malnutrition prevalence between different settings and patients groups. In addition, the absence of a widely accepted malnutrition screening tool hinders both effective recognition and the treatment of malnutrition. Therefore, the development of uniform and valid screening tools and effective nutritional support programs for Korean malnourished patients is needed.

Mo1859 Patient Support Programme Is Well Accepted And Could Help Adherence In IBD Patients

Mo1859 Patient Support Programme Is Well Accepted And Could Help Adherence In IBD Patients

P636. Patient support programme is well accepted and could help adherence in inflammatory bowel disease patients

P636. Patient support programme is well accepted and could help adherence in inflammatory bowel disease patients

P-041 Impact of a Patient Support Program on Resource Costs in Inflammatory Bowel Disease

P-041 Impact of a Patient Support Program on Resource Costs in Inflammatory Bowel Disease

Optimizing insulin initiation in primary care: the Diabetes CoStars patient support program.

PurposeThe purpose of this study was to evaluate the optimization of fasting blood glucose (FBG) levels in patients with type 2 diabetes mellitus newly initiated on insulin glargine who were enrolled in the Australian Diabetes CoStars Patient Support Program (PSP).Patients and methodsA retrospective analysis of data from 514 patients with type 2 diabetes mellitus who completed the 12-week Diabetes CoStars PSP was performed. All patients were initiated on insulin glargine in primary care and enrolled by their general practitioner, who selected a predefined titration plan and support from a local Credentialled Diabetes Educator. The data collected included initial and final insulin dose, self-reported FBG, and glycated hemoglobin (A1c) levels.ResultsThe insulin dose increased in 81% of patients. Mean FBG was reduced from 208.8 mg/dL (11.6 mmol/L) to 136.8 mg/dL (7.6 mmol/L) after 12 weeks. Initial and final A1c values were available for 99 patients; mean A1c was reduced from 9.5% (80 mmol/mol) to 8.1% (65 mmol/mol). The reductions in mean FBG and A1c were similar irrespective of titration plan. Overall, 27.2% of patients achieved FBG levels within the titration plan target range of 72–108 mg/dL (4–6 mmol/L) and an additional 43.4% of patients achieved FBG within the range recommended by current Australian guidelines (110–144 mg/dL [6.1–8.0 mmol/L]). Overall, 23.3% of patients achieved the A1c target of ≤7%.ConclusionThese data demonstrate that the majority of patients enrolled in the Diabetes CoStars PSP achieved acceptable FBG levels 12 weeks after starting insulin therapy irrespective of titration plan.

Intervention Mapping을 적용한 지역사회기반의 골관절염 자기관리지지 프로그램 개발

Purpose: The purpose of this study was to apply intervention mapping (IM) to develop a community-based disease self-management support program for patients with osteoarthritis. Methods: IM was applied as follows: i) a needs assessment has been carried out by a literature review, survey and interview with osteoarthritis patients; ii) on the basis of the needs assessment, identification of expected outcomes and change objectives for the target population; iii) selection of theory-based methods and practical applications to influence self-management and the determinants of behavior; iv) design of the intervention by developing activities and materials such as osteoarthritis self-management guide and smart patient pocket book. The activities were integrated into an existing healthcare activities; v) implementation and evaluation plan has been developed. Results: The program is aimed at improving health status through activating patients by a patient-centered and tailored intervention for patients with osteoarthritis; consists of 8 sessions with coaching and cognitive emotional psychological skills; includes smart patient, communication, osteoarthritis, medication adherence, pain control, depressive mood control, physical activity and healthy diet. Conclusion: The IM is a systematic and feasible method for developing the program. The next step is to evaluate the impact of the intervention on activation, and health status.

Rates of Adverse Events and Multiple Sclerosis Relapses Before and After Introduction of a Purported Generic Glatiramer Acetate in mexico: Results from a Large Patient Support Program in Mexico

Rates of Adverse Events and Multiple Sclerosis Relapses Before and After Introduction of a Purported Generic Glatiramer Acetate in mexico: Results from a Large Patient Support Program in Mexico