Trends in financial relationships between industry and individual medical oncologists in the United States from 2014 to 2017: A cohort study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6520-6520
Author(s):  
Deborah Catherine Marshall ◽  
Elizabeth Stieglitz Tarras ◽  
Kenneth Rosenzweig ◽  
Deborah Korenstein ◽  
Susan Chimonas
Keyword(s):  
Cohort Study ◽  
Conflicts Of Interest ◽  
The United States ◽  
Absolute Number ◽  
Medical Oncologists ◽  
Trends Over Time ◽  
Inappropriate Relationships ◽  
Open Payments ◽  
Over Time ◽  
Financial Relationships

6520 Background: Industry-physician financial relationships in medical oncology are common and introduce conflicts of interest. The Open Payments (OP) program collects and discloses data on industry payments to physicians, in part to discourage inappropriate relationships. However, the effect of OP on how oncologists engage with industry is unknown. Our aim was to evaluate trends in physician-level payments to test whether the implementation of OP has resulted in fewer physicians engaging with industry and has shifted the nature of interactions towards those considered more appropriate. Methods: We performed a retrospective cohort study of US medical oncologists in 2014 from the National Plan and Provider Enumeration System. OP data for general (non-research) payments between 2014-2017 were matched to physician to evaluate receipt of payments over time. We calculated the percentage of physicians receiving payments, annual value and number of payments, and average annual trends over time, including by nature of payment. Results: From 2014-2017, medical oncologists received 1.4 million industry payments totaling $330.6 million. The absolute number of medical oncologists receiving payments decreased 4% on average annually ( P= .006), and proportionally from 67.2% to 59.6% overall. The value and number of payments have not significantly changed. The value and number of payments increased for accredited/certified CME (+821% and +209% annually) and decreased for non-accredited/certified CME (-18% and -25% annually). The value and number of food/beverage payments remained the same. The value and number of royalty/licensing payments increased. Conclusions: Fewer oncologists are receiving payments, but spending has not decreased suggesting that physicians are less likely to engage and industry is more selective. Increased payments for accredited CME suggest that less appropriate speaker’s fees are being avoided. Food/beverage payments are not decreasing, thus these interactions may not be recognized as problematic. Increasing royalty/licensing payments require ongoing scrutiny. Changes in physician payments since the inception of OP highlight the importance of transparency in policymaking.

Scope and nature of financial conflicts of interest between neurologists and industry

Neurology ◽  
2019 ◽  
Vol 93 (10) ◽  
pp. 438-449 ◽  
Author(s):  
Nathaniel M. Robbins ◽  
Mark J. Meyer ◽  
James L. Bernat
Keyword(s):  
Medical Device ◽  
Conflicts Of Interest ◽  
Public Trust ◽  
Trends Over Time ◽  
Financial Conflicts Of Interest ◽  
Open Payments ◽  
Over Time ◽  
Financial Relationships

ObjectiveTo detail the scope and nature of financial conflicts of interest (COIs) between neurologists and the pharmaceutical and medical device industries (Industry) using the Centers for Medicare and Medicaid Services Open Payments (OP) database, with a focus on trends from 2013 to 2016.MethodsPayments from Industry to US neurologists were categorized into research payments, general (nonresearch) payments, and value of ownership in Industry. We performed descriptive analyses to detail the scope and nature of these relationships and trends over time.ResultsAt least 9,505 neurologists received at least one payment from Industry each year. From 2013 to 2016, 1.6 million payments totaled $354 million, of which 99.5% of payments and 85.6% of payment value were for general/nonresearch-related payments. Most neurologists (between 65% and 80%) received less than $1,000 per year, but over 200 neurologists each received more than $100,000 during some years. Several received over $1 million. General payments are increasing, research payments are steady, and neurologists' ownership and investments are decreasing.ConclusionsNeurologists have extensive financial relationships with Industry, though this is driven by a well-paid minority. As a profession, we must work to establish firm rules to manage these potential COIs, ensuring that relationships with Industry yield synergistic advances while minimizing bias and maintaining public trust.

scholarly journals Trends over time in enrollment in non-group health insurance plans by tobacco use in the United States

2017 ◽  
Vol 7 ◽  
pp. 46-49 ◽  
Author(s):  
Michael F. Pesko ◽  
Johanna Catherine Maclean ◽  
Cameron M. Kaplan ◽  
Steven C. Hill
Keyword(s):  
United States ◽  
Health Insurance ◽  
Tobacco Use ◽  
The United States ◽  
Group Health ◽  
Trends Over Time ◽  
Group Health Insurance ◽  
Over Time

scholarly journals Absolute Insurer Denial of Direct-Acting Antiviral Therapy for Hepatitis C: A National Specialty Pharmacy Cohort Study

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
Charitha Gowda ◽  
Stephen Lott ◽  
Matthew Grigorian ◽  
Dena M Carbonari ◽  
M Elle Saine ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hepatitis C ◽  
The United States ◽  
Public And Private ◽  
Commercial Insurance ◽  
Direct Acting Antiviral ◽  
Insurance Type ◽  
Specialty Pharmacy ◽  
Direct Acting ◽  
Over Time

Abstract Background Despite the availability of new direct-acting antiviral (DAA) regimens, changes in DAA reimbursement criteria, and a public health focus on hepatitis C virus (HCV) elimination, it remains unclear if public and private insurers have increased access to these therapies over time. We evaluated changes in the incidence of absolute denial of DAA therapy over time and by insurance type. Methods We conducted a prospective cohort study among patients who had a DAA prescription submitted from January 2016 to April 2017 to Diplomat Pharmacy, Inc., which provides HCV pharmacy services across the United States. The main outcome was absolute denial of DAA prescription, defined as lack of fill approval by the insurer. We calculated the incidence of absolute denial, overall and by insurance type (Medicaid, Medicare, commercial), for the 16-month study period and each quarter. Results Among 9025 patients from 45 states prescribed a DAA regimen (4702 covered by Medicaid, 1821 Medicare, 2502 commercial insurance), 3200 (35.5%; 95% confidence interval, 34.5%–36.5%) were absolutely denied treatment. Absolute denial was more common among patients covered by commercial insurance (52.4%) than Medicaid (34.5%, P < .001) or Medicare (14.7%, P < .001). The incidence of absolute denial increased across each quarter of the study period, overall (27.7% in first quarter to 43.8% in last quarter; test for trend, P < .001) and for each insurance type (test for trend, P < .001 for each type). Conclusions Despite the availability of new DAA regimens and changes in restrictions of these therapies, absolute denials of DAA regimens by insurers have remained high and increased over time, regardless of insurance type.

Financial relationships between neurologists and industry

Neurology ◽  
2019 ◽  
Vol 92 (21) ◽  
pp. 1006-1013 ◽  
Author(s):  
Aditi Ahlawat ◽  
Pushpa Narayanaswami
Keyword(s):  
Conflicts Of Interest ◽  
The United States ◽  
Prescribing Practices ◽  
Regional Trends ◽  
Food And Beverage ◽  
Data Book ◽  
Retrospective Database Analysis ◽  
Incorrect Information ◽  
Open Payments ◽  
Retrospective Database

ObjectiveTo analyze research and nonresearch payments from the pharmaceutical and device industry to neurologists in 2015 using the Centers for Medicare and Medicaid Services (CMS) Open Payments Database.MethodsIn this retrospective database analysis, we computed the percentage of neurologists in the United States receiving payments, the median/mean payments per neurologist, payment categories, regional trends, and sponsors. We computed the number of practicing neurologists from the Association of American Medical Colleges State Physician Workforce Data Book, 2015.ResultsIn 2015, approximately 96% of US neurologists received nonresearch payments totaling $93,920,993. The median payment per physician was $407. The highest proportion of neurologists (24%) received between $1,000 and $10,000. Food and beverage was the most frequent category (83% of the total number of payments). The highest amount was paid for serving as faculty/speaker for noncontinuing medical education activities (49%). The top sponsor of nonresearch payments was Teva Pharmaceuticals ($16,461,055; 17.5%). A total of 412 neurologists received $2,921,611 in research payments (median $1,132). Multiple sclerosis specialists received the largest proportion ($285,537; 9.7%). Daiichi Sankyo paid the largest amount in research payments ($826,029; 28%).ConclusionsThe Open Payments program was established to foster transparent disclosure of physician compensations from industry, in response to legislative and public concerns of the effect of conflicts of interest on practice, education, and research. The effects of this program remain unclear and studies of changes in prescribing practices, costs, and other outcomes are necessary. CMS should ensure that incorrect information can be rectified quickly and easily.

scholarly journals Trends over Time in Adolescent Emotional Wellbeing in the Netherlands, 2005-2017: Links with Perceived Schoolwork Pressure, Parent-Adolescent Communication and Bullying Victimization

2020 ◽  
Vol 49 (10) ◽  
pp. 2124-2135
Author(s):  
M. E. De Looze ◽  
A. P. Cosma ◽  
W. A. M. Vollebergh ◽  
E. L. Duinhof ◽  
S. A. de Roos ◽  
...  
Keyword(s):  
The Netherlands ◽  
The United States ◽  
High Income ◽  
Bullying Victimization ◽  
Emotional Wellbeing ◽  
Emotional Symptoms ◽  
Cross Sectional ◽  
Dutch Health ◽  
Trends Over Time ◽  
Over Time

Abstract In some Scandinavian countries, the United Kingdom and the United States, there is evidence of a dramatic decline in adolescent emotional wellbeing, particularly among girls. It is not clear to what extent this decline can be generalised to other high-income countries. This study examines trends over time (2005-2009-2013-2017) in adolescent wellbeing in the Netherlands, a country where young people have consistently reported one of the highest levels of wellbeing across Europe. It also assesses parallel changes over time in perceived schoolwork pressure, parent-adolescent communication, and bullying victimization. Data were derived from four waves of the nationally representative, cross-sectional Dutch Health Behaviour in School-aged Children study (N = 21,901; 49% girls; Mage = 13.78, SD = 1.25). Trends in emotional wellbeing (i.e., emotional symptoms, psychosomatic complaints, life satisfaction) were assessed by means of multiple regression analyses with survey year as a predictor, controlling for background variables. Emotional wellbeing slightly declined among adolescent boys and girls between 2009 and 2013. A substantial increase in perceived schoolwork pressure was associated with this decline in emotional wellbeing. Improved parent-adolescent communication and a decline in bullying victimization may explain why emotional wellbeing remained stable between 2013 and 2017, in spite of a further increase in schoolwork pressure. Associations between emotional wellbeing on the one hand and perceived schoolwork pressure, parent-adolescent communication, and bullying victimization on the other were stronger for girls than for boys. Overall, although increasing schoolwork pressure may be one of the drivers of declining emotional wellbeing in adolescents, in the Netherlands this negative trend was buffered by increasing support by parents and peers. Cross-national research into this topic is warranted to examine the extent to which these findings can be generalised to other high-income countries.

US academic libraries' staffing and expenditure trends (1996–2016)

2020 ◽  
Vol 41 (4/5) ◽  
pp. 247-268 ◽  
Author(s):  
Starr Hoffman ◽  
Samantha Godbey
Keyword(s):  
Academic Libraries ◽  
The United States ◽  
Data Sets ◽  
Size Category ◽  
Data Set ◽  
Content Type ◽  
Education Statistics ◽  
Trends Over Time ◽  
Doctoral Institutions ◽  
Over Time

PurposeThis paper explores trends over time in library staffing and staffing expenditures among two- and four-year colleges and universities in the United States.Design/methodology/approachResearchers merged and analyzed data from 1996 to 2016 from the National Center for Education Statistics for over 3,500 libraries at postsecondary institutions. This study is primarily descriptive in nature and addresses the research questions: How do staffing trends in academic libraries over this period of time relate to Carnegie classification and institution size? How do trends in library staffing expenditures over this period of time correspond to these same variables?FindingsAcross all institutions, on average, total library staff decreased from 1998 to 2012. Numbers of librarians declined at master’s and doctoral institutions between 1998 and 2016. Numbers of students per librarian increased over time in each Carnegie and size category. Average inflation-adjusted staffing expenditures have remained steady for master's, baccalaureate and associate's institutions. Salaries as a percent of library budget decreased only among doctoral institutions and institutions with 20,000 or more students.Originality/valueThis is a valuable study of trends over time, which has been difficult without downloading and merging separate data sets from multiple government sources. As a result, few studies have taken such an approach to this data. Consequently, institutions and libraries are making decisions about resource allocation based on only a fraction of the available data. Academic libraries can use this study and the resulting data set to benchmark key staffing characteristics.

Evolution of methodology and reporting of emergency medicine quantitative research over a 20-year period

2020 ◽  
Vol 37 (6) ◽  
pp. 324-329 ◽  
Author(s):  
Jesse Smith ◽  
Patrick Date ◽  
William Spencer ◽  
Erik de Tonnerre ◽  
David McDonald Taylor
Keyword(s):  
Emergency Medicine ◽  
Sample Size ◽  
Research Methodology ◽  
Quantitative Research ◽  
Conflicts Of Interest ◽  
Data Extraction ◽  
Research Literature ◽  
Original Research ◽  
Trends Over Time ◽  
Over Time

ObjectiveWe aimed to determine trends over time in article origin, and article and methodology characteristics.MethodWe examined original research articles published every fifth year over a 20-year period (1997–2017) in six emergency medicine (EM) journals (Ann Emerg Med, Acad Emerg Med, Eur J Emerg Med, Emerg Med J, Am J Emerg Med, Emerg Med Australas). Explicit data extraction of 21 article characteristics was undertaken. These included regional contributions, specific article items and research methodology.Results2152 articles were included. Over the study period, the proportional contributions from the USA and the UK steadily fell while those from Australasia, Europe and ‘other’ countries increased (p<0.001). All specific article items increased (p<0.01). Institutional Review Board/Ethics Committee approval and conflicts of interest were almost universal by 2017. There were substantial increases in the reporting of keywords and authorship contributions. The median (IQR) number of authors increased from 4 (2) in 1997 to 6 (3) in 2017 (p<0.001) and the proportion of female first authors increased from 24.3% to 34.2% (p<0.01). Multicentre and international collaborations, consecutive sampling, sample size calculations, inferential biostatistics and the reporting of CIs and p values all increased (p<0.001). There were decreases in the use of convenience sampling and blinding (p<0.001). The median (IQR) study sample size increased from 148 (470) to 349 (2225) (p<0.001).ConclusionTrends over time are apparent within the EM research literature. The dominance in contributions from the US and UK is being challenged. There is more reporting of research accountability and greater rigour in both research methodology and results presentation.

scholarly journals Trends in Instrument Flight Rules (IFR) Conditions at Major Airports in the United States

2019 ◽  
Vol 58 (3) ◽  
pp. 615-620 ◽  
Author(s):  
Scott E. Stevens
Keyword(s):  
United States ◽  
The United States ◽  
Meteorological Conditions ◽  
Low Visibility ◽  
Timely Fashion ◽  
Trends Over Time ◽  
Over Time ◽  
Surface Observations

AbstractWeather-related delays are among the most common in aviation and are frequently the result of low visibility or cloud ceilings, which cause landing aircraft to be spaced farther apart for safety, reducing the capacity of an airport to land aircraft in a timely fashion. Using 45 years of archived surface observations from 30 of the busiest airports across the United States, the prevalence of low-visibility and low-ceiling conditions is examined, along with the meteorological conditions that support them and the associated trends over time. It is shown that these conditions are becoming less frequent at most locations—for many significantly so—and that this decrease can be seen at all times of day and in all seasons.

Can “Seven Be The New Ten” - Adoption Of Restrictive Transfusion Strategies In a Community Hospital

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2935-2935
Author(s):  
Rahul Singh ◽  
Charin Hanlon
Keyword(s):  
Conflicts Of Interest ◽  
The United States ◽  
General Medical Service ◽  
Published Data ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Pre Treatment ◽  
New Guidelines ◽  
The Impact ◽  
Over Time

Abstract Background An estimated 13,785,000 units of packed red blood cells (PRBC) were transfused in the United States in 2011 of which an estimated 57.9% were found to be from the general medical service, the ICU or hematology/oncology. Risks of blood transfusion include infections, transfusion reactions circulatory overload, and transfusion-related immunomodulation. Furthermore, there is an economic cost to the administration of blood and a personal cost to those volunteers who give their time. There have been a number of guidelines published for the administration of PRBCs. In the past year, the American Association of Blood Banks released new guidelines for PRBC transfusion in hospitalized, hemodynamically stable patients. These guidelines set a threshold Hb of ≤7 g/dL in critically-ill patients, and a Hb ≤8 g/dL for surgical patients, for patients with pre-existing cardiovascular disease, or for patients with relevant symptoms. Symptoms were defined as tachycardia, chest pain or hypotension not corrected by crystalloids. We studied the potential impact on our inpatient hospital utilization of PRBC over time in relation to the publication of recent guidelines. Methods With IRB approval, a retrospective study of PRBC transfusion at New Hanover Regional Medical Center in Wilmington, NC was conducted. The primary endpoint of the study was to evaluate the impact of the new AABB guidelines on the transfusion utilization in the first 12 months. Secondary endpoints included a cost analysis, an evaluation of the use of PRBC for two pre-specified Hb levels, and a quantification of the number of units transfused. A total of 337 patients were reviewed. 116 were excluded due to one of the following reasons: anemia attributed to active blood loss, the presence of stage 5 chronic kidney disease, the presence of an acute coronary syndrome, the recent administration of outpatient transfusions, the use of blood products besides PRBCS, and the timing of a transfusion in the postoperative period. We randomly assigned two separate timeframes to review transfusions at ≤ 4 months and 8-12 months after the AABB guidelines were published. Data was analyzed using Chi-square and T tests. Results The average pre-treatment hemoglobin for the group ≤4 months was 7.82 ± 0.85 and 7.42 ± 0.92 for the 8-12 month group (p=0.0009). The average number of units transfused were 1.66 ± 0.53 and 1.78 ± 0.58 (P=0.1133), respectively. For those patients whose Hb was ≤ 7.0, there was a 21.6% reduction in inappropriate transfusions 8-12 months after the guidelines were released compared with the first 4 months (Chi-Square p = 0.0070). For those patients whose Hb was ≤ 8.0, the number of inappropriate transfusions went from 40.7% in the first group to 17.3% in the second group (Chi-Square p=0.0001). The total cost of transfusions to the patients was estimated to be $102,400 and $55,600 to the hospital. The potential savings if all transfusions were given according to the new guidelines is estimated to be $66,389 to the patients and $36,037 to the hospital. A total of 11,577 transfusions were given between 6/12/12-3/13/13. If the guidelines had been strictly followed, the number of transfusions would have been reduced to 3,855 transfusions. Discussion An improvement in adherence to AABB guidelines with a more restrictive PRBC transfusion strategy was found over time. This can be attributed to physicians practicing evidenced-based medicine. Data of transfusions at pre-treatment Hb ≤7, suggest that physicians are becoming more restrictive in their threshold for transfusions with a statistically significance in the drop of the average pre-treatment hemoglobin. Despite this restrictive pattern, physicians are still uncomfortable at transfusing 1 unit at a time. Although it was not statistically significant between the two groups, the average number of units transfused were ≥1.5, and 67% of the time 2 units were given. Overtransfusion with PRBCs is a problem that needs to be addressed. Physicians should give one unit and reassess for an appropriate response. This strategy will reduce cost to the patient and hospital. We feel that additional improvement is still possible and we are forming a blood management committee to promote better PRBC transfusion practice guidelines. We plan a series of educational presentations to each department along with a new Computerized Physician Order Set to improve patient care and reduce overall cost to the health care system. Disclosures: No relevant conflicts of interest to declare.

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