Influence of Pharmaceutical Marketing on Prescribing for Medicare patients in the District of Columbia

Influence of Pharmaceutical Marketing on Prescribing for Medicare patients in the District of Columbia Raveendran JA1, Podrasky JP2, McMonagle MA3, Fugh-Berman A4, Hogenmiller A5, Wood SF6 1The George Washington University School of Medicine and Health Sciences 2, 3, 6The George Washington University Milken Institute School of Public Health 4,5Georgetown University Medical Center (602) 738-6566, [email protected], M2 Importance: Pharmaceutical marketing efforts may complicate the decision-making process for prescribers by influencing them to prefer newer, more expensive drugs that may have limited information on efficacy and adverse effects. Objective: Analyze the potential impact of pharmaceutical marketing on prescribing for Medicare patients in DC. Design: Analysis of correlation between pharmaceutical marketing gifts and Medicare Part D claims data in DC in 2013. Setting: Data accessed from: DC AccessRx database (gifts annually reported to the DC Department of Health, January-July); Open Payments database (gifts reported to Centers for Medicare and Medicaid Services (CMS), August-December); and CMS database of Medicare Part D claims (January-December). Participants: Inclusion criteria were licensed healthcare providers in DC, who are Medicare Part D prescribers listed in CMS. Healthcare providers in specialties with five or less subjects were excluded. Of 2873 subjects, 1750 (60.9%) did not receive pharmaceutical marketing gifts reported in AccessRx or Open Payments (control), and 1123 (39.1%) did receive gifts reported in AccessRx or Open Payments (exposed). Main outcome(s) and measure(s): Two sample t-tests were run on average cost per Medicare Part D claim, number of total claims, number of claims per beneficiary, and frequency of branded claims for the control and exposed groups. Results: Compared to non-gift recipients, gift recipients spent an average of $56 more per claim (P=1.8E-9). Gift recipients also made an average of 503 more total claims (P=1.4E-17), 2.2 more claims per beneficiary (P=4.2E-12), and 8.4% more branded claims (P=1.4E-27). Conclusion and relevance: Results suggest that pharmaceutical marketing efforts in DC in 2013 influenced Medicare Part D prescribing by increasing average cost per claim, number of total claims, number of claims per beneficiary, and frequency of branded claims. Although this study does not establish causation, it is the first to analyze these datasets and provide unique insight into the potential impact of pharmaceutical marketing efforts on prescribing for Medicare patients in DC. We recommend: further research on the influence of pharmaceutical marketing on prescribing; continuous and robust pharmaceutical marketing requirements; and expanded public access to improve transparency of conflicts of interest in healthcare

Optimizing Nurse-Physician Communication During Morning Rounds

Introduction: The Joint Commission found that communication problems were the third most frequent root cause of reported sentinel events in 2015. Research on interdisciplinary rounds and protocols to improve communication has been limited. Structured communication tools have been shown to enhance collaboration between nurses and physicians. This study aims to analyze the impact of a combination of Trio Rounding - a collaborative rounding approach between nurses, physicians, and patients – and a structured communication protocol on interdisciplinary communication. Methods: To elicit existing gaps in communication, a free-text questionnaire was randomly administered to nurses and physicians in the Department of Medicine at George Washington University Hospital, a tertiary care center in the District of Columbia. Results were used to outline the satisfaction surveys and the structured communication protocol, which highlights plan for the day, preventative measures and placement plans (the “3 Ps”). Nurses and physician assistants (PAs) in the Department of Medicine enrolled in this before-and-after study. Trio Rounding and the structured communication protocol were implemented for 5 weeks. To assess satisfaction with communication, 5-point Likert Scale surveys were administered pre- and post-intervention to nurses and PAs, with a score of 5 indicating complete satisfaction and a score of 1 indicating complete dissatisfaction. Results: 8 nurses and 9 PAs completed the pre- and post- intervention surveys. For nurses, although paired T-tests revealed slightly increased satisfaction with combined communication aspects (plan of care, safety measures, discharge planning, and nurse-physician relationships) from pre- to post- intervention, these results were not statistically significant (11.88 vs. 12.13, p=0.8489). For PAs, paired T-tests revealed increased satisfaction with nurse-physician relationships from pre- to post-intervention (1.89 vs. 3.33, p=0.0117) and increased satisfaction with combined communication aspects from pre- to post-intervention (10.00 vs. 14.89, p=0.0254). Consistently pre- and post-intervention, majority of nurses and PAs believed that overlap of nursing duties was the greatest barrier to communication during rounds. Conclusions: Based on these results, our intervention had a significant impact on PA satisfaction with interdisciplinary communication. Limitations included the short duration of intervention and small sample size. Our study highlights that implementation of Trio Rounding in conjunction with a structured communication protocol improves satisfaction with interdisciplinary communication, and thus has the potential to mitigate communication problems that commonly lead to medical errors. Keywords: Quality improvement, communication, interdisciplinary rounds, structured communication protocols, provider satisfactio

Bioinformatik-Tools für die Systembiologie von Dysferlin-Mangel

The aim of this project was to build and apply tools for the analysis of muscle omics data, with a focus on Dysferlin deficiency. This protein is expressed mainly in skeletal and cardiac muscles, and its loss due to mutation (autosomal-recessive) of the DYSF gene, results in a progressive muscular dystrophy (Limb Girdle Muscular Dystrophy type 2B (LGMD2B), Miyoshi myopathy and distal myopathy with tibialis anterior onset (DMAT)). We have developed various tools and pipelines that can be applied towards a bioinformatics functional analysis of omics data in muscular dystrophies and neuromuscular disorders. These include: tests for enrichment of gene sets derived from previously published muscle microarray data and networking analysis of functional associations between altered transcripts/proteins. To accomplish this, we analyzed hundreds of published omics data from public repositories. The tools we developed are called CellWhere and MyoMiner. CellWhere is a user-friendly tool that combines protein-protein interactions and protein subcellular localizations on an interactive graphical display. It accepts a list of genes and generates a protein-protein interaction network graph organized into subcellular locations to mimic the structure of the cell. Localization annotations acquired from the manually curated public repositories, Gene Ontology and UniProt (Swissprot), are mapped to a smaller number of CellWhere localizations. Protein-protein interactions and their scores are acquired from the Mentha interactome server. CellWhere can be accessed freely at https://sys-myo.com/cellwhere MyoMiner is a muscle cell- and tissue-specific database that provides co-expression analyses in both normal and pathological tissues. Many gene co-expression databases already exist and are used broadly by researchers, but MyoMiner is the first muscle-specific tool of its kind. High-throughput microarray experiments measure mRNA levels for thousands of genes in a biological sample and most microarray studies are focused on differentially expressed genes. Another way of using microarray data is to exploit gene co-expression, which is widely used to study gene regulation and function, protein interactions and signaling pathways. These co-expression analyses will help muscle researchers to delineate muscle pathology specific protein interactions and pathways. Changes in co-expression between pathologic and healthy tissue may suggest new disease mechanisms and therapeutic targets. MyoMiner is a powerful muscle specific database for the discovery of genes that are associated in related functions based on their co-expression and is available at https://sys-myo.com/myominer. These tools will be used in the analysis and interpretation of transcriptomics data from dysferlinopathic muscle and other neuromuscular conditions and will be important to understand the molecular mechanisms underlying these pathologies

Average cost per claim and proportion of branded claims by gift value.

<p>Average cost per claim and proportion of branded claims by gift value.</p

Proportion of branded claims by specialty for gift and non-gift recipients.

<p>Proportion of branded claims by specialty by gift and non-gift recipients. ¶ Internal Medicine Specialties includes Cardiology, Endocrinology, Gastroenterology, Infectious Disease, Pulmonary Disease. ♯ Psychiatric Specialties includes Psychiatry, Psychiatry & Neurology, Neuropsychiatry, Geriatric Psychiatry. ⌃ Other Surgery includes Cardiac, Colorectal, Maxillofacial, Oral and Maxillofacial, Plastic and Reconstructive, Plastic, Neurological, Thoracic and Vascular Surgery. *Statistically Significant (p<0.05).</p

Average cost of claims by specialty for gift and non-gift recipients.

<p>Average cost of claims by specialty for gift and non-gift recipients. ¶ Internal Medicine Specialties includes Cardiology, Endocrinology, Gastroenterology, Infectious Disease, Pulmonary Disease. ♯ Psychiatric Specialties includes Psychiatry, Psychiatry & Neurology, Neuropsychiatry, Geriatric Psychiatry. ⌃ Other Surgery includes Cardiac, Colorectal, Maxillofacial, Oral and Maxillofacial, Plastic and Reconstructive, Plastic, Neurological, Thoracic and Vascular Surgery. *Statistically Significant (p<0.05).</p

Average cost per claim and proportion of branded claims by gift value.

<p>Average cost per claim and proportion of branded claims by gift value.</p

Average number of claims per prescriber, claims per patient, cost per claim, and proportion of branded drugs.

<p>Medicare Prescribers by Gift Status.</p

Included specialties and subspecialties.

<p>Included specialties and subspecialties.</p