Development of a site readiness framework to improve health system preparedness for potential new Alzheimer’s disease therapies

Background: There is lack of national studies that assess the risks associated with the drugs provided under the Brazilian public health system for treating Alzheimer’s disease. Then, this study determined the prevalence and severity of self-reported adverse drug reactions (ADRs) prescribed to patients with Alzheimer’s disease in the Brazilian public health system.Methods: A cross-sectional study was carried out based on public data from the MEDEX system (information on dispensing data, known as exceptional dispensing medications) and interviews with patients and/or caregivers who get access to Alzheimer’s drugs at a public pharmacy in a large Brazilian city, between July and September 2017, inquiring about ADRs and serious adverse events (SAEs).Results: The subjects were asked about ADRs and SAEs related to the use of donepezil, galantamine, rivastigmine and memantine. Out of 285 patients enrolled on the database, 250 participated in the study (87.7%). Among the participants, approximately 63.0% were female, 70.3% aged ≥75 years and 70.3% had comorbidities. Overall, 209 patients (83.6%) reported at least one ADR (total 1,149 ADRs) and rivastigmine was associated with the largest number of ADRs per patient (7.9 ADRs/patient). The predominant adverse effects were psychiatric disorders with common frequency (57.1%) and mild severity (89.0%). Six patients (2.4%) had SAEs that required hospitalization. The use of antipsychotics was the variable associated with ADR (OR = 4.95; 95% CI: 1.45–16.93; p = 0.011).Conclusion: There was a large number of reported ADRs and most of them were of common frequency and mild severity, being mainly related to psychiatric disorders. Considering the fragility of these patients, it is important to improve safety-related care in the use of drugs for treating this disease.

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Stakeholder Views on Solutions to Improve Health System Performance

Healthcare Policy | Politiques de Santé ◽

10.12927/hcpol.2018.25547 ◽

2018 ◽

Vol 14 (1) ◽

pp. 71-85 ◽

Cited By ~ 2

Author(s):

Astrid Brousselle ◽

Damien Contandriopoulos ◽

Jeannie Haggerty ◽

Mylaine Breton ◽

Michèle Rivard ◽

...

Keyword(s):

Health System ◽

System Performance ◽

Health System Performance ◽

Stakeholder Views ◽

Improve Health System ◽

Improve Health

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FEATURES

Asia-Pacific Biotech News ◽

10.1142/s0219030319000466 ◽

2019 ◽

Vol 23 (07) ◽

pp. 20-42

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Spinal Cord ◽

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Health System ◽

Cancer Treatment ◽

Western Medicine ◽

Spinal Cord Damage ◽

Emerging Treatments

Emerging treatments for spinal cord damage. Dementia, Alzheimer’s, Parkinson’s – Confusions, myths and tips. An update on Alzheimer’s disease. Integration of Traditional Chinese medicine and Western medicine in cancer treatment. TCM’s integration into modern health system.

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Improving the design of heart failure care from the perspective of frontline providers and administrators: A qualitative case study of a large, urban health system

Journal of Comorbidity ◽

10.1177/2235042x20924172 ◽

2020 ◽

Vol 10 ◽

pp. 2235042X2092417

Author(s):

Husayn Marani ◽

Hayley Baranek ◽

Howard Abrams ◽

Michael McDonald ◽

Megan Nguyen ◽

...

Keyword(s):

Heart Failure ◽

Health System ◽

Chronic Care ◽

Qualitative Case Study ◽

Heart Failure Patients ◽

Heart Failure Care ◽

System Functioning ◽

Improve Health System ◽

Improve Health

Background: Heart failure patients often present with frailty and/or multi-morbidity, complicating care and service delivery. The Chronic Care Model (CCM) is a useful framework for designing care for complex patients. It assumes responsibility of several actors, including frontline providers and health-care administrators, in creating conditions for optimal chronic care management. This qualitative case study examines perceptions of care among providers and administrators in a large, urban health system in Canada, and how the CCM might inform redesign of care to improve health system functioning. Methods: Sixteen semi-structured interviews were conducted between August 2014 and January 2016. Interpretive analysis was conducted to identify how informants perceive care among this population and the extent to which the design of heart failure care aligns with elements of the CCM. Results: Current care approaches could better align with CCM elements. Key changes to improve health system functioning for complex heart failure patients that align with the CCM include closing knowledge gaps, standardizing treatment, improving interdisciplinary communication and improving patient care pathways following hospital discharge. Conclusions: The CCM can be used to guide health system design and interventions for frail and multi-morbid heart failure patients. Addressing care- and service-delivery barriers has important clinical, administrative and economic implications.

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Studying Workflow and Workarounds in Electronic Health Record–Supported Work to Improve Health System Performance

Annals of Internal Medicine ◽

10.7326/m19-0871 ◽

2020 ◽

Vol 172 (11_Supplement) ◽

pp. S116-S122 ◽

Cited By ~ 3

Author(s):

Kai Zheng ◽

Raj M. Ratwani ◽

Julia Adler-Milstein

Keyword(s):

Electronic Health Record ◽

Health System ◽

System Performance ◽

Health Record ◽

Health System Performance ◽

Electronic Health ◽

Supported Work ◽

Improve Health System ◽

Improve Health

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Budgeting practices to improve health system performance

OECD Journal on Budgeting ◽

10.1787/2fc826dd-en ◽

2019 ◽

Vol 19 (3) ◽

Author(s):

Chris James ◽

Ivor Beazley ◽

Luciana Rosato ◽

Caroline Penn

Keyword(s):

Health System ◽

System Performance ◽

Health System Performance ◽

Improve Health System ◽

Improve Health

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Does more investment in primary care improve health system performance?

Health Policy ◽

10.1016/j.healthpol.2021.03.004 ◽

2021 ◽

Author(s):

Kees van Gool ◽

Chunzhou Mu ◽

Jane Hall

Keyword(s):

Primary Care ◽

Health System ◽

System Performance ◽

Health System Performance ◽

Improve Health System ◽

Improve Health

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FROM BRAIN DISEASE TO BRAIN HEALTH: PRIMARY PREVENTION OF ALZHEIMER’S DISEASE AND RELATED DISORDERS IN A HEALTH SYSTEM USING AN ELECTRONIC MEDICAL RECORD-BASED APPROACH

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2017.3 ◽

2017 ◽

pp. 1-8

Author(s):

A.M. Fosnacht ◽

S. Patel ◽

C. Yucus ◽

A. Pham ◽

E. Rasmussen ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

At Risk ◽

Primary Prevention ◽

Health System ◽

Medical Record ◽

Electronic Medical Record ◽

Brain Disease ◽

Brain Health ◽

Risk Patients

Background: Alzheimer’s disease and aging brain disorders are progressive, often fatal neurodegenerative diseases. Successful aging, modern lifestyles and behaviors have combined to result in an expected epidemic. Risks for these diseases include genetic, medical, and lifestyle factors; over 20 modifiable risks have been reported. Objectives: We aim to primarily prevent Alzheimer’s disease and related disorders through electronic medical record (EMR)-based screening, risk assessments, interventions, and surveillance. Design: We identified modifiable risks; developed human, systems and infrastructural resources; developed interventions; and targeted at-risk groups for the intervention. Setting: A Community Based Health System. Participants: In year one (June 2015 to May 2016), 133 at-risk patients received brain health services with the goal of delaying or preventing Alzheimer’s disease and related disorders. Measurements: We created mechanisms to identify patients at high risk of neurodegenerative disease; EMR-based structured clinical documentation support tools to evaluate risk factors and history; evidence-based interventions to modify risk; and the capacity for annual surveillance, pragmatic trials, and practice-based and genomic research using the EMR. Results: This paper describes our Center for Brain Health, our EMR tools, and our first year of healthy but at-risk patients. Conclusion: We are translating research into primary prevention of Alzheimer’s disease and related disorders in our health system and aim to shift the paradigm in Neurology from brain disease to brain health.

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Relationship between single nucleotide polymorphisms in the 3′UTR of amyloid precursor protein and risk of Alzheimer’s disease and its mechanism

Bioscience Reports ◽

10.1042/bsr20182485 ◽

2019 ◽

Vol 39 (5) ◽

Cited By ~ 1

Author(s):

Qiong Zhou ◽

Lian Luo ◽

Xiaohang Wang ◽

Xiang Li

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Single Nucleotide Polymorphisms ◽

Amyloid Precursor Protein ◽

Protective Factor ◽

Precursor Protein ◽

Control Group ◽

Nucleotide Polymorphisms ◽

Single Nucleotide ◽

A Site

Abstract Background and objective: Deregulation of the expression of amyloid precursor protein (APP) can lead to the development of Alzheimer’s disease (AD). Recent studies have shown that many single nucleotide polymorphisms (SNPs) in the 3′ untranslated region (UTR) of APP are associated with the development of AD. Since microRNAs (miRNAs) are involved in the regulation of APP expression, we believe that the APP 3′UTR polymorphism may affect the regulation of APP expression in miRNAs. Results: The levels of miR-101-3p, miR-153-3p, miR-144-3p, miR-381-3p, and miR-383-5p in plasma of patients with AD were significantly lower than those in the control group. The APP-534G/A site A allele was a protective factor for AD risk (adjusted odds ratio (OR) = 0.700, 95% confidence interval (95% CI): 0.573–0.840, P<0.001). The APP-369C/G site variation was not associated with AD risk. The APP-118C/A site A allele was a protective factor for AD (adjusted OR = 0.762, 95% CI: 0.639–0.897, P=0.001). The APP-534G/A site mutation affects the regulation of APP protein expression by miR-101-3p, miR-144-3p, miR-153-3p, and miR-381-3p, and the mutation of the APP-118C/A site affects miR-101-3p, miR-144-3p, miR-153-3p, and miR-383-5p regulation of APP expression. Conclusion: APP 3′UTR polymorphisms can affect the regulation of APP expression by miRNAs and thus affect the occurrence of AD.

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