Economic benefits of implementing patient-centered medical home among patients with hypertension

Ziyad S Almalki,1 Abrar A Alotaibi,2 Wejdan S Alzaidi,2 Afnan A Alghamdi,2 Abdulrahman M Bahowirth,3 Noura M Alsalamah4 1Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia; 2Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Mecca, Saudi Arabia; 3Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Mecca, Saudi Arabia; 4Department of Clinical Pharmacy, College of Pharmacy, Qassim University, Buraydah, Qassim, Saudi Arabia Introduction: Despite the strong evidence of an association between adoption of the patient-centered medical home (PCMH) and improved clinical outcomes among patients with hypertension, evidence for associations between the PCMH and health care utilization and cost reduction within the general adult population with hypertension is less developed.Objective: This study was designed to examine the effect of PCMH on health service expenditures and utilization in a national sample of the US adult population who were diagnosed with hypertension.Methods: The 2010–2015 Medical Expenditure Panel Survey data were used. The study sample was limited to adults (≥18 years) diagnosed with essential hypertension. We investigated the impact of PCMH on the direct hypertension-related total and on the costs of inpatient stays, prescription medications, outpatient visits, emergency room visits, office-based services, and other medical expenditures by using log-transformed multiple linear regression models and the propensity score method.Results: Of the 18,630 adults identified with hypertension, 19.2% (n=3,583) of them had received PCMH care from 2010 to 2015. After matching, the no PCMH group showed greater mean in all hypertension-related health service costs and utilization. After adjusting for the remaining confounders, the PCMH group showed a significant association with lower total costs, office-based services, number of office-based visits, and outpatient visits compared with the control group.Conclusion: A significant relationship between experiencing PCMH care and a lower total health care expenditure was found in patients with hypertension. Keywords: PCMH, hypertension, health care expenditure, MEP

The association between bacterial infections and the risk of coronary heart disease in type 1 diabetes

Background Diabetes increases the risk of infections as well as coronary heart disease (CHD). Whether infections increase the risk of CHD and how this applies to individuals with diabetes is unclear. Objectives To investigate the association between bacterial infections and the risk of CHD in type 1 diabetes. Methods Individuals with type 1 diabetes (n = 3781) were recruited from the Finnish Diabetic Nephropathy Study (FinnDiane), a prospective follow-up study. CHD was defined as incident events: fatal or non-fatal myocardial infarction, coronary artery bypass surgery or percutaneous coronary intervention, identified through national hospital discharge register data. Infections were identified through national register data on all antibiotic purchases from outpatient care. Register data were available from 1.1.1995-31.12.2015. Bacterial lipopolysaccharide (LPS) activity was measured from serum samples at baseline. Data on traditional risk factors for CHD were collected during baseline and consecutive visits. Results Individuals with an incident CHD event (n = 370) had a higher mean number of antibiotic purchases per follow-up year compared to those without incident CHD (1.34 [95% CI: 1.16-1.52], versus 0.79 [0.76-0.82],P <0.001), as well as higher levels of LPS activity (0.64 [0.60-0.67], versus 0.58 EU mL(-1)[0.57-0.59],P <0.001). In multivariable-adjusted Cox proportional hazards models, the mean number of antibiotic purchases per follow-up year was an independent risk factor for incident CHD (HR 1.21, 95% CI: 1.14-1.29,P <0.0001). High LPS activity was a risk factor for incident CHD (HR 1.93 [1.34-2.78],P <0.001) after adjusting for static confounders. Conclusion Bacterial infections are associated with an increased risk of incident CHD in individuals with type 1 diabetes.Peer reviewe

Access and Disparities in the Use of Telemedicine Among Patients with Chronic Conditions in Saudi Arabia: A Cross-Sectional Study

Ziyad S Almalki,1 Mohammad T Imam,1 Nada F Abou Chahin,2 Naheda S ALSammak,2 Shahad M Entabli,2 Shatha K Alhammad,2 Ghuyudh F Alanazi,2 Rama A Kharsa,2 Layla A Alonazi,2 Rasha A Mandil,2 Ahmed A Albassam,1 Ahmed M Alshehri,1 Abdullah K Alahmari,1 Ghada M Alem,1 Abdullah A Alalwan,1 Ahmad Alamer1 1Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia; 2Collage of Pharmacy, Almaarefa University, Riyadh, Saudi ArabiaCorrespondence: Ziyad S Almalki, Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia, Tel +966 11 588 7315, Email [email protected]: This study investigated the access to and disparities in telemedicine use among patients with chronic conditions in Riyadh, Saudi Arabia.Patients and Methods: A cross-sectional study of randomly selected primary healthcare centers was conducted to ensure that each of the 17 municipalities in Riyadh were represented. Three hundred and forty-two participants who completed the questionnaire were interviewed using a standardized questionnaire. The relationship between demographic and socioeconomic factors and telemedicine utilization was evaluated using the chi-square test and multivariable mixed-effects logistic regression model.Results: Among the 342 participants, the study revealed that 25.73% of the patients utilized telemedicine. Older participants had lower odds of telemedicine use than did those aged ≤ 30 years [adjusted odds ratio (AOR) = 0.112, 95% confidence interval (CI) = 0.045– 0.279 for 50– 59 years; AOR = 0.19, 95% CI = 0.076– 0.474 for 60– 69 years; AOR = 0.223, 95% CI = 0.092– 0.542 for ≥ 70 years]. Female sex (AOR = 2.519, 95% CI = 1.44– 4.408), having a higher education level (AOR = 3.434, 95% CI = 1.037– 7.041 for secondary education and AOR = 5.87, 95% CI = 2.761– 8.235 for higher education), and living in urban areas (AOR = 2.721, 95% CI = 1.184– 6.256) were associated with higher odds of telemedicine use. Among socioeconomic factors, employed participants had higher odds of telemedicine use (AOR = 4.336, 95% CI = 2.3– 8.174). Furthermore, compared to those with the highest socioeconomic status (SES) index, those with the lowest SES were less likely to use telemedicine than those with the highest SES index (AOR = 0.193, 95% CI = 0.055– 0.683 for the lower bottom (poorest).Conclusion: This study highlights a significant disparity in the utilization of telemedicine services across different populations, primarily due to demographic and socioeconomic factors.Keywords: healthcare system, socioeconomic, digital health, inequitie

Effectiveness of a patient-centered medical home model of primary care versus standard care on blood pressure outcomes among hypertensive patients

Patients with hypertension and other comorbidities have complex health care needs that are challenging to manage in primary care. However, there is strong evidence suggesting that patient-centered approaches in primary care are effective in managing complex multimorbidity. We aim to evaluate the effectiveness of a patient-centered medical home model called ‘WellNet’ versus that of standard care on blood pressure (BP) outcomes among hypertensive patients. We used a cohort study design with a comparison group and case-series design to assess the ‘between-group’ and ‘within-group’ effectiveness of the WellNet program delivered across six general practices in Sydney, Australia. The treatment group included 447 eligible patients who provided consent and who received general practitioner-led care with the integration of care coordinators. The comparison group included 5237 matched patients receiving usual care at four geographically comparable general practices. To assess changes over time, paired, and independent samples t-tests were used to determine significant differences. In addition, analysis of covariance (ANCOVA) was used to identify any significant differences after adjusting for potential covariates. The adjusted model showed significant reductions in systolic BP (−3.4 mmHg; 95% CI −5.1, −1.7; p value < 0.001) in the treatment group at follow-up. However, no significant mean change was observed in diastolic BP. The proportion of patients within the recommended range was found to be significantly higher in the treatment group than in the comparison group (13.6% versus 6.4%). WellNet patients experienced statistically significant and clinically meaningful improvement in BP during the follow-up. The findings of this study may be beneficial to both patients and providers in terms of improved health outcomes and delivery of care, respectively