BACKGROUND: Acute coronary syndrome includes life-threatening clinical conditions ranging from unstable angina to non-Q-wave myocardial infarction and Q-wave myocardial infarction that are a major cause of emergency medical care and hospitalization in the United States. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the management of patients with unstable angina and non-ST-segment elevation myocardial infarction (2002)(2003)(2004) recommend (1) angiotensinconverting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) for ACE inhibitor intolerance, (2) beta-blockers, and (3) statins for long-term treatment of patients after an acute coronary event.OBJECTIVE: To examine rates of use of 3 key evidence-based drug therapies (ACE inhibitors/ARBs, beta-blockers, and statins) after hospital discharge for patients with acute coronary syndromes (ACS).METHODS: The study cohort was identified using medical claims from commercial health plans within a managed care organization located in the Mid-Atlantic states, with approximately 3.4 million members with medical benefits of whom 1.2 million members (35.3%) had pharmacy benefits. Members were included if they were (1) aged ≥ 18 years, (2) Pharmacy claims for ACE inhibitors, ARBs, beta-blockers, and statins were obtained for 18 months following each index date, defined as the earliest ACS diagnosis date during the identification period. Utilization was defined as the member having at least 1 pharmacy claim within each class from index date to 3 months post-index date. Five time periods were examined to assess therapy: -180 to 0 days (6 months prior), 0 to 90 days (3 months), 0 to 180 days (6 months), 0 to 365 days (12 months), and 0 to 548 days (18 months) following the index date. ACE inhibitors and ARBs were considered together (i.e., a patient had to have at least 1 pharmacy claim for an ACE inhibitor or an ARB). Logistic regression analyses were used to predict use of the 3 drug classes for patients with different clinical (diagnosis and prior use) and demographic (sex and age) characteristics.RESULTS: The study cohort included 1,135 patients (0.27% of 424,526 continuously enrolled members) with ACS as defined by ICD-9-CM codes in medical claims from July 1, 2003, to June 30, 2004. Nearly 65% of the sample patients were men (n = 734 men and n = 401 women), with a mean (standard deviation [SD]) age of 63.8 (SD 13.1) years. Of the 1,135 members with ACS, 588 (51.8%) had at least 1 pharmacy claim for an ACE inhibitor or ARB, 725 (63.9%) for a beta-blocker, and 710 (62.6%) for a statin during the 3-month follow-up period; receipt of at least 1 prescription in all 3 classes was found in 339 (29.9%) of patients. Patients who were aged < 45 years, 65-79 years, and ≥ 80 years were significantly less likely than patients aged 45-64 years to receive statins (P < 0.05). In addition, patients who were aged ≥ 80 years were significantly less likely to receive ACE inhibitors/ARBs (P = 0.003), beta-blockers (P < 0.001), or ...

Persistence was low for injectable antidiabetics at 1 year among treatment-naïve patients. Patients who received insulin glargine, insulin detemir, or exenatide were more likely to persist than patients receiving NPH insulin. Older patients were more likely to persist, but sex, copayment and number of oral antidiabetic medications at initiation of the injectable antidiabetic were not associated with persistence.

We investigated the role of mothers’ references to mental states and behaviors and children’s emotion situation knowledge (ESK) in a prospective, cross-cultural context. European American mothers ( n = 71) and Chinese immigrant mothers ( n = 60) and their children participated in the study. Maternal references to mental states and behaviors were assessed at Time 1 when children were three years of age. ESK was assessed when children were 3, 3.5, and 4.5 years of age. Multi-group latent growth curve analyses were used to model children’s growth in ESK over time, as well as relations between mental state language and references to behaviors on children’s trajectories. Results indicated that maternal references to mental states were associated with concurrent levels of ESK for European American children, and change over time for the Chinese immigrant children. Maternal references to behaviors were negatively associated with concurrent ESK for both groups.

H ealth information technology (HIT), the secure transmission and management of health information, is relatively new. Despite its availability, acceptance and use of HIT in the United States has been slow and lags behind many industrialized countries.1 Forces within the current environment-rising health care expenditures, high adverse event rates, and government and private initiatives-are increasing the speed of acceptance of HIT. Challenges to the adoption of HIT in the United States have included the high costs of the technology, general resistance to change, misaligned incentives, and the fractured payment system. Believing that HIT will improve the quality and safety of health care, President George W. Bush set a goal for most Americans to have an electronic health record (EHR) by 2014.2 The Centers for Medicare & Medicaid Services (CMS) has followed through on this directive by instituting programs aimed at increasing the adoption and use of HIT, starting with e-prescribing and EHR.■■ Benefits of HIT Increased use of HIT can benefit all members of the health care system: patients, payers, prescribers, physicians, office staff, and pharmacies.3 While one particular technology may provide a more apparent benefit to a particular segment, the overall improvement in patient care that can be realized affects all stakeholders in the process. Improvements in Quality of CareData drive the measurement of quality in health care. Collecting data can be cumbersome in a paper and pencil world. Capturing information electronically is a major asset of HIT and facilitates quality measurement. Data that are mined through HIT applications provide continuous feedback to providers and plans and are an invaluable tool for guiding future care decisions.E-prescribing E-prescribing uses technology to allow prescribers to electronically transmit prescriptions. The intent of this technology is to reduce medication errors and improve patient care by eliminating the need for interpreting handwritten prescriptions. 4 Through the increased use of e-prescribing, physicians have the benefit of receiving real-time formulary, drug-drug and drugallergy information as well as a history of drugs dispensed for the patient. The elimination of handwriting interpretation decreases medication error rates and reduces communication time between pharmacies and office staff. Payers are better able to promote increased utilization of generic and preferred brand drugs, as well as avoid costs resulting from adverse drug events. However, , notably e-prescribing and electronic health records (EHR), have the potential to improve the quality of care, reduce medication errors and adverse events, and decrease overall health care utilization and costs. However, the United States continues to lag behind other countries in the adoption and use of HIT.OBJECTIVE: To review the various issues surrounding the implementation of HIT in the United States and potential drivers that will influence the use of e-prescribing and EHR.SUMMARY: The United States has been slow t...

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