Continuity of medication management in Medicaid patients with chronic comorbid conditions: An examination by mental health status

Patients with serious mental illness (SMI) often have comorbid cardiometabolic conditions (CMCs) that may increase the number of prescribers involved in treatment. This study examined whether patients with SMI (depression and schizophrenia) and comorbid CMCs experience greater discontinuity of prescribing than patients with CMCs alone

Who Has Used Internal Company Documents for Biomedical and Public Health Research and Where Did They Find Them?

<div><p>Objective</p><p>To describe the sources of internal company documents used in public health and healthcare research.</p><p>Methods</p><p>We searched PubMed and Embase for articles using internal company documents to address a research question about a health-related topic. Our primary interest was where authors obtained internal company documents for their research. We also extracted information on type of company, type of research question, type of internal documents, and funding source.</p><p>Results</p><p>Our searches identified 9,305 citations of which 357 were eligible. Scanning of reference lists and consultation with colleagues identified 4 additional articles, resulting in 361 included articles. Most articles examined internal tobacco company documents (325/361; 90%). Articles using documents from pharmaceutical companies (20/361; 6%) were the next most common. Tobacco articles used documents from repositories; pharmaceutical documents were from a range of sources. Most included articles relied upon internal company documents obtained through litigation (350/361; 97%). The research questions posed were primarily about company strategies to promote or position the company and its products (326/361; 90%). Most articles (346/361; 96%) used information from miscellaneous documents such as memos or letters, or from unspecified types of documents. When explicit information about study funding was provided (290/361 articles), the most common source was the US-based National Cancer Institute. We developed an alternative and more sensitive search targeted at identifying additional research articles using internal pharmaceutical company documents, but the search retrieved an impractical number of citations for review.</p><p>Conclusions</p><p>Internal company documents provide an excellent source of information on health topics (e.g., corporate behavior, study data) exemplified by articles based on tobacco industry documents. Pharmaceutical and other industry documents appear to have been less used for research, indicating a need for funding for this type of research and well-indexed and curated repositories to provide researchers with ready access to the documents.</p></div

Source of documents for articles using internal documents from different types of companies (n = 361 articles).

1<p>The articles using documents from other companies were one article each using documents from a hospital, a physician practice management organization, a soft drinks distributor, and a nuclear plant, and one article using internal documents from six different companies including an agribusiness and a utility company.</p>2<p>The totals in this column equal the number of articles relying upon a particular source of documents, minus three instances of duplicate classification by type of company within category of document source. These instances were: one article with litigation source was classified as both tobacco and alcohol; one article with FOIA source was classified as both tobacco and transportation; and one article with unknown source was classified as both manufacturing and mining. The overall column total is not shown, as it is greater than the total number of included articles (n = 361) because several articles relied upon multiple sources for documents.</p>3<p>The litigation-related source of documents for one pharmaceutical article was a leak from legal proceedings.</p>4<p>The other sources of documents were: private archives of a company consultant (1 tobacco article) and records from a bankruptcy (1 transportation article).</p>5<p>The totals in this row equal the number of articles for each type of company, minus instances of duplicate sources of documents. Two tobacco articles relying upon FOIA for documents and one tobacco article relying upon other sources of company documents (the private archives of a company consultant) also relied upon documents from litigation, and one transportation article relied upon both litigation and FOIA. The totals for the tobacco and transportation article columns are therefore not equal to the sum of the classifications within the columns. The overall row total is not shown, as it is greater than the total number of included articles (n = 361) because three articles were classified with two types of companies.</p

Flow chart of articles through the screening process.

<p>Flow chart of articles through the screening process.</p

Types of internal company data/information in articles using internal documents from different types of companies (n = 361 articles).

1<p>The totals in this column equal the number of articles using a particular type of data, minus instances of duplicate classification by type of company within category of type of data. These instances were: Other types of data were used by articles classified as both tobacco and transportation, both mining and manufacturing, and both tobacco and alcohol, and quantitative data from internal company studies were used by the article classified as both mining and manufacturing. The overall column total is not shown, as it is greater than the total number of included articles (n = 361) because several articles used multiple types of internal documents.</p>2<p>The totals in this row equal the total number of articles for each type of company, minus instances where articles used multiple types of data, of which there are too many to list. The totals for the columns are therefore not equal to the sum of the classifications within the columns. The overall row total is not shown, as it is greater than the total number of included articles (N = 361) because three articles were classified with two types of companies.</p

Sources and location of pharmaceutical internal company documents.

1<p>Documents are grouped in rows where the articles are linked by a common set of authors working with the same set of documents.</p>2<p>Vedula and colleagues (Vedula et al 2009) included in their analysis internal company documents from a 2004 litigation that were also used by other authors in two articles (Steinman et al 2007 and Landefeld and Steinman 2009), and in addition analyzed documents from a 2008 litigation that were not used in other articles.</p

Research questions for articles using internal documents from different types of companies (n = 361 articles).

1<p>The totals in this column equal the number of articles asking a particular type of question, minus instances of duplicate classification by type of company within category of type of question. These instances were: Strategic behavior questions were asked by articles classified as both tobacco and transportation, both mining and manufacturing, and both tobacco and alcohol; a therapeutic intervention question was asked by the article classified as both tobacco and transportation. The overall column total is not shown, as it is greater than the total number of included articles (n = 361) because several articles posed multiple types of questions.</p>2<p>The totals in this row equal the total number of articles for each type of company, minus instances where articles asked multiple types of questions, of which there are too many to list. The totals for the columns are therefore not equal to the sum of the classifications within the columns. The overall row total is not shown, as it is greater than the total number of included articles (N = 361) because three articles were classified with two types of companies.</p