The Effect of Information Disclosure on Industry Payments to Physicians

2020 ◽  
pp. 002224372097210
Author(s):  
Tong Guo ◽  
S. Sriram ◽  
Puneet Manchanda
Keyword(s):  
Health Care Providers ◽  
Information Disclosure ◽  
Unintended Consequences ◽  
Pharmaceutical Companies ◽  
Care Providers ◽  
Online Data ◽  
Heterogeneous Treatment Effects ◽  
State Laws ◽  
Disclosure Laws ◽  
Causal Impact

In 2019, U.S. pharmaceutical companies paid $3.6 billion to physicians in the form of gifts to promote their drugs. To curb inappropriate financial relationships between health care providers and firms, several state laws require firms to publicly declare the payments they make to physicians. In 2013, this disclosure law was rolled out to all 50 states. The authors investigate the causal impact of this increased transparency on subsequent payments between firms and physicians. While firms and physicians were informed of the disclosure regulation at data collection, complete transparency did not occur until the data were published online. The authors estimate the heterogeneous treatment effects of the online data disclosure exploiting the phased rollout of the disclosure laws across states, facilitated by recent advances in machine learning methods. Using a 29-month national panel covering $100 million in payments between 16 antidiabetic brands and 50,000 physicians, the authors find that the monthly payments changed insignificantly, on average, due to disclosure. However, the average null effect masks some unintended consequences of disclosure, wherein payments may have increased for more expensive drugs and among physicians who prescribed more heavily. The authors further explore potential mechanisms that can parsimoniously describe the data pattern.

scholarly journals Quality Improvement Opportunities in Caring for Patients with Nonepileptic Seizures

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Jasper J. Chen ◽  
Devendra S. Thakur ◽  
Krzysztof A. Bujarski ◽  
Barbara C. Jobst ◽  
Erik J. Kobylarz ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Care Providers ◽  
Barriers To Care ◽  
Care Pathway ◽  
Clinical Care ◽  
Unintended Consequences ◽  
Care Providers ◽  
Antiepileptic Medication ◽  
Nonepileptic Seizures ◽  
Clinical Care Pathway

Background. Patients with nonepileptic seizures (NES) are challenging to treat for myriad reasons. Often patients may be misdiagnosed with having epilepsy and then may suffer unintended consequences of treatment side effects with antiepileptic medication. In addition, patients may be maligned by health care providers due to a lack of ownership by both psychiatrists and neurologists and a dearth of dedicated professionals who are able to effectively treat and reduce severity and frequency of symptoms.Aims of Case Report. Many psychiatrists and neurologists are unaware of the extent of the barriers to care faced by patients with NES (PWNES) and the degree of perception of maltreatment or lack of therapeutic alliance at various stages of their care, including medical workup, video-EEG monitoring, and follow-up plans. We present the case of a patient with NES who experienced numerous barriers as well as incoordination to her care despite being offered a breadth of resources and discuss the quality improvement opportunities that may exist to improve care of patients with NES.Conclusion. No known literature has documented the extensive barriers to care of PWNES in parallel to quality improvement opportunities for improving their care. We endeavor to contribute to the overall formulation and development of a clinical care pathway for PWNES.

scholarly journals Walk the Line—The Importance of Well-Informed Interpretation of QT Prolongation

2020 ◽  
Vol 55 (1) ◽  
pp. 123-126 ◽  
Author(s):  
Zachary R. Noel ◽  
Vincent Y. See ◽  
Alexander H. Flannery
Keyword(s):  
Health Care ◽  
Drug Interactions ◽  
Health Care Providers ◽  
Qt Prolongation ◽  
Unintended Consequences ◽  
Qtc Interval ◽  
Care Providers ◽  
Qtc Prolongation ◽  
Integral Role ◽  
Medication Selection

Acute care pharmacists play an integral role in identifying drug-drug interactions that may predispose patients to QT prolongation. Although most pharmacists are equipped with a baseline understanding of drug interactions and the risks of QTc prolongation, few understand the limitations of QTc calculation and interpretation. In this commentary, we put forth the notion that at times health care providers, including pharmacists, place an overemphasis on the QTc interval. In the context of using the QTc to guide pharmacotherapy decisions, unintended consequences may include a cascade of effects leading to delays in treatment, suboptimal medication selection, alert fatigue, and overutilization of resources.

Faster approvals?: Trends in the use of FDA’s expedited approval programs for oncology medications.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18270-e18270
Author(s):  
Lisa Ambrosini Vadola ◽  
Monique A Pond ◽  
Ann Winter-Vann ◽  
Robin Whitsell
Keyword(s):  
Health Care Providers ◽  
Fast Track ◽  
Priority Review ◽  
Pharmaceutical Companies ◽  
Care Providers ◽  
Regulatory Pathways ◽  
Oncology Drug ◽  
Accelerated Approval ◽  
Fast Track Designation ◽  
Speed To Market

e18270 Background: With the importance of speed-to-market and addressing unmet needs, pharmaceutical companies have sought accelerated approvals through the Food and Drug Administration (FDA). Introduced with the FDA Safety and Innovation Act (FDASIA) of 2012, Breakthrough Therapy Designation (BTD) has become an important mechanism for approval of serious and life-threatening conditions that do not have adequate therapies. Notably, these pathways have been ill-understood by both pharmaceutical companies and health care providers. This study assessed how BTD and other FDA designations have played a role in the approval of oncology drug marketing applications and evaluated trends in the use of these regulatory pathways. Methods: We analyzed publicly available data on novel oncology drug approvals by the FDA from 2012-2016, including the 4 expedited programs for serious conditions (BTD, Accelerated Approval, Fast Track, and Priority Review). Results: Of the 43 novel oncology drugs approved by the FDA between 2012-2016, 42 used at least 1 of the expedited approval programs, including 65% that used ≥2 programs and 35% that used ≥3 programs. The BTD has been used by 15 of the 43 (35%) approved novel oncology drugs since 2012. The use of the BTD, Accelerated Approval pathway, and Priority Review designation among approved oncology drugs has generally increased each year from 2012-2016, while the use of the Fast Track designation has decreased over the same time period. Conclusions: Companies seeking oncology approvals often use more than one expediting strategy. Alone or in combinations, the BTD, Accelerated Approval, and Priority Review have been shown to play an increasingly important role in oncology drug development. Data collected between 2012-2016 suggest that use of BTD is growing more common, while use of the Fast Track designation has decreased among approved oncology drugs. Additional expedited approval programs have remained steady or increased since the FDA introduced BTD. Based on these observations, we anticipate use of the BTD, Accelerated Approval, and Priority Review designation will grow in future oncology drug applications.

Direct-to-Docs Opioid Marketing

Pained ◽  
2020 ◽  
pp. 141-144
Author(s):  
Michael D. Stein ◽  
Sandro Galea
Keyword(s):  
Health Care Providers ◽  
Direct Marketing ◽  
Pharmaceutical Companies ◽  
Opioid Overdose ◽  
Care Providers ◽  
The Public ◽  
Opioid Prescribing ◽  
Overdose Mortality ◽  
The Relationship ◽  
Overdose Deaths

This chapter addresses the pharmaceutical industry’s direct-to-physician marketing of opioids, a factor that has fueled the current addiction epidemic. A 2019 study sought to understand the relationship between mortality from opioid overdose and the pharmaceutical industry’s direct marketing of opioids to physicians. The study analyzed the association between three factors in every US county: the amount of marketing payments pharmaceutical companies made to physicians, opioid prescribing rates, and the number of overdose deaths. Researchers found that direct marketing of opioids to physicians was associated with increased opioid prescribing rates and increased overdose mortality 1 year after marketing engagements. As such, the national response to the opioid epidemic has focused in part on reducing the number of opioids prescribed by physicians. Additionally, the Physician Payments Sunshine Act promotes financial transparency between pharmaceutical companies and health care providers. By increasing regulation around pharmaceutical direct-to-physician marketing, and by making reports of pharmaceutical company payments to physicians available to the public, states have the potential to reduce overdose mortality.

The Need to Educate Nursing Home Administrators about Variations in State Legislation Affecting Patients' Rights to Refuse Treatment

2003 ◽  
Vol 11 (2) ◽  
pp. 148-161 ◽  
Author(s):  
Cynthia K. Hosay
Keyword(s):  
Nursing Home ◽  
Advance Directives ◽  
Health Care Providers ◽  
The United States ◽  
Direct Care ◽  
Care Providers ◽  
State Laws ◽  
Nursing Home Administrators ◽  
Nursing Home Patients ◽  
Right To Refuse Treatment

Nursing home patients in the United States have a constitutional right to refuse treatment. The federal Patient Self-Determination Act confirms that right. State laws address the obligations of health care providers and facilities to honor those rights. But state laws vary, and nursing home administrators may not know the laws of their states. In this article, areas of significant variation in state laws are identified so that educators of nursing home administrators and direct care providers can address providers' statutory obligations concerning end-of-life issues. The advance directives statutes of the fifty states and the District of Columbia were reviewed and analyzed to determine the principal areas of variation in state requirements. Three key areas with high levels of variation were identified. Recommendations for teaching about state requirements on advance directives were developed. Education of nursing home administrators is needed to alert them to their states' requirements, benefiting them and the patients they serve.

scholarly journals First, Do No Harm: Understanding Primary Care Providers’ Perception of Risks Associated With Discussing Weight With Pediatric Patients

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110409
Author(s):  
Katie A. Loth ◽  
Jocelyn Lebow ◽  
Marc James Abrigo Uy ◽  
Samantha M. Ngaw ◽  
Dianne Neumark-Sztainer ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care Providers ◽  
Pediatric Patients ◽  
Primary Care Providers ◽  
Unintended Consequences ◽  
Future Research ◽  
Care Providers ◽  
Perceived Risks ◽  
Negative Impacts ◽  
Pediatric Weight Management

Many health care providers struggle with if- and how-to discuss weight with their pediatric patients. This study used one-on-one interviews with primary care providers (n = 20) to better understand their: (1) perception of risks associated with talking about weight with pediatric patients, (2) commitment to adhering to best practices of pediatric weight management, and (3) approaches to mitigate perceived risks. Providers felt concerned that discussing weight with children during clinic visits may have unintended negative impacts. Despite perceived risks, providers continued regular BMI screening and weight-focused conversations, but took care with regard to language and approach with the goal of mitigating perceived risks. Findings suggest that pediatric primary care providers perceive that engaging in weight-related discussions with their patients has the potential to lead to negative, unintended consequences. Future research is needed to understand if weight-focused conversations should be avoided altogether or if there are approaches that can effectively mitigate risks.

Parents as Agents for Change in Health and Risk Messaging

2017 ◽  
Author(s):  
Natoshia Askelson ◽  
Erica Spies
Keyword(s):  
Risk Behaviors ◽  
Communication Skills ◽  
Health Care Providers ◽  
Unintended Consequences ◽  
Health Messages ◽  
Childhood And Adolescence ◽  
Care Providers ◽  
Parent Child Communication ◽  
Message Development ◽  
Parent Child

Parents can be the target of health and risk messages about their children and can be a channel by which children hear health messages. This dual role can make parents powerful agents for change in children’s health. Parents receive health messages from a variety of sources including health care providers, schools, the media, the government, and family. Parents tend to be a more frequent target for health messages when their children are infants or young. They receive many messages related to keeping their children safe. Most of these messages are not developed as part of a rigorous data-driven and theory-based intervention and often lack sophisticated message development and design. Furthermore, instead of segmenting parents and tailoring messages, parents are frequently treated as a monolith, with no diversity related to behavior or communication. As children age, parents can become the channel by which children can hear a health message. Parents of school-age children and adolescents are continually communicating messages to their children and are often targeted to communicate messages related to health or risk behaviors. Intentional efforts to encourage parents to talk to their children are often related to risk behaviors among older children. Specifically, parents are asked to convey messages about sexual health, alcohol and drug use, and driving. Evidence points to parent–child communication in general and communication about specific risk behaviors as protective for children. Research has also suggested that adolescents want to hear health messages from their parents. Parents are a natural choice to communicate about health and risk throughout childhood and adolescence due to the parent–child relationship and the influence parents can have over children. However, this special relationship does not automatically translate into parents having good communication skills. Messages designed to encourage parents to communicate with their children about a health topic have often been developed with the assumption that parents know what to communicate and how to effectively communicate with their children. Deficits in communication skills among parents have been recognized by some campaign developers, and an emphasis on developing those skills has been a significant part of some messages targeting parents. Health communication campaigns have been developed to inform parents about when and how to talk to their children about health issues such as alcohol, drugs, and sex. Unfortunately, not all parent–child communication is positive or effective and this can have potential unintended consequences. Treating parents as an audience in a more nuanced manner, with greater emphasis on evidence-based message development, could result in more effective messages and better health outcomes.

A Discursive Approach to Organizational Health Communication

2016 ◽  
Author(s):  
Peter Kjær ◽  
Anne Reff Pedersen ◽  
Anja Svejgaard Pors
Keyword(s):  
Health Care ◽  
Health Communication ◽  
Health Care Providers ◽  
Organizational Health ◽  
Unintended Consequences ◽  
Care Providers ◽  
Health Care Managers ◽  
Clinical Communication ◽  
New Ideas ◽  
Management Roles

With the increased interest in communication in the fields of health care and health care management research, it is important to begin to explore and consider the consequences of this engagement with new ideas in communication. In this chapter we describe the expansion of organizational health communication, identifying three distinct types of communication ideas and tools: clinical communication, extra-clinical communication and corporate communication. In order to assess the wider implications of health communication, we elaborate a discursive perspective, illustrated by presenting exemplary analyses of a) the institutionalization of communication ideals, b) the communicative management of meaning and c) communication tools as organising technologies. The discursive perspective highlights that organizations and individual health care providers should not only look for the desired outcomes of communication initiatives but also focus on unintended consequences in terms of changes to management roles, challenges to professional values and the reshaping of demands on patients. Attention to those implications is a key task for health care managers.

scholarly journals Aerobiology in South Africa: A new hope!

2020 ◽  
Vol 116 (7/8) ◽  
Author(s):  
Linus Ajikah ◽  
Frank H. Neumann ◽  
Dilys Berman ◽  
Jonny Peter
Keyword(s):  
South Africa ◽  
Health Care Providers ◽  
Fungal Spores ◽  
Care Providers ◽  
Online Data ◽  
Fungal Allergens ◽  
Life Threatening ◽  
History Of ◽  
Considerable Morbidity ◽  
Effective Diagnosis

Pollen and fungal spores (aerospora) are the major atmospheric bioaerosols. Aerospora occurrence and concentration vary by geographical region and blossoming period, and with meteorological factors. Allergic respiratory diseases affect about 20 million South Africans, with pollen and fungal allergens amongst the leading triggers. Asthma triggered by aerospora can be life threatening; allergic rhinitis causes considerable morbidity and carries financial implications for individuals and health systems. Thus, knowledge about geographical variation, seasonal timing and intensity, as well as annual aerospora fluctuations in South Africa, where climate and vegetation are exceptionally diverse, is essential for effective diagnosis and treatment of allergies. Unfortunately, there is a lack of continuous aeropalynological data from South Africa. The longest annual monitoring exists for Cape Town (~20 years), with almost no data out of the Cape since the 1990s, and many parts of South Africa have never been monitored. In this brief review, we highlight the cross-disciplinary need for strengthened and expanded continuous aeropalynological study in South Africa, the history of efforts to date, and the introduction of the interdisciplinary South African Pollen Network (SAPNET). SAPNET was launched in seven major cities in August 2019 in order to monitor weekly variations of aerospora, and provide online data for allergy sufferers and health-care providers (www.pollencount.co.za) with the aim to establish regional pollen calendars.

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