Search

BACKGROUND: Based on data from 2003 to 2007, the prevalence of epilepsy was significantly higher in the institutionalized elderly population than in the noninstitutionalized population, but the recent prevalence and economic impact of epilepsy specifically in the institutionalized Medicare population have not been reported. OBJECTIVES: To estimate the prevalence and economic burden of epilepsy and inpatient utilization rates among institutionalized Medicare beneficiaries and to provide a 10-year projection of their population size and the associated costs. METHODS: We performed a cross-sectional analysis of the institutionalized Medicare population with and without epilepsy using Medicare 5% sample claims data from 2013 and 2014. The identification of epilepsy required ≥1 qualifying claims with an epilepsy diagnosis, or ≥2 qualifying claims ≥30 days apart with a diagnosis of convulsion, in 2014. Institutionalized status was identified by having ≥6 consecutive months of nursing facility claims in 2013 or 2014. Inpatient admissions and 30-day readmissions, average allowed costs, and risk-adjusted incremental costs of epilepsy were calculated and compared between the institutionalized population of Medicare beneficiaries with and without epilepsy. The 2015 Medicare 100% and 5% sample data and inputs from other external sources were used to project the 10-year trends in the size and cost of the institutionalized Medicare population with epilepsy. RESULTS: The prevalence of epilepsy in 2014 was 11.1% in the institutionalized Medicare population. The institutionalized population with epilepsy had significantly higher per-patient per-month (PPPM) costs ($3479 vs $2381, respectively; P <.001), inpatient admissions per 1000 beneficiaries (1105 vs 697, respectively; P <.001), and 30-day readmissions per 1000 beneficiaries (287 vs 145, respectively; P <.001) versus the institutionalized population without epilepsy. The risk-adjusted incremental cost of epilepsy for the institutionalized population was $507.33 PPPM. Based on our model, between 2017 and 2027 an 18% increase in size and a 72% increase in cost are projected for the institutionalized Medicare beneficiaries with epilepsy. CONCLUSION: The high cost and inpatient resource utilization, as well as the projected growth of the institutionalized Medicare population with epilepsy highlight the need for further investigation of care management opportunities to reduce the cost burden associated with this condition. [ABSTRACT FROM AUTHOR]

Objectives: To describe the development, implementation, and financial aspects of a sustainable osteoporosis screening service in a community pharmacy and report osteoporosis risk factors for women screened during the 48 months in which the screening service was in operation. Setting: An independent community pharmacy (Main at Locust Pharmacy Clinic) in Davenport, Iowa, beginning in 1999. Practice description: The osteoporosis screening service was provided by a staff pharmacist, a pharmacy resident, or a combination of a pharmacist and a resident. The service included use of the Hologic Sahara Bone Sonometer at the heel and education of the patient. Patient education consisted of a discussion of screening results, an overview of osteoporosis, and recommendations to address risk factors. Practice innovation: For patients who received osteoporosis screening, an overall cumulative risk score and a cumulative modifiable risk score were calculated. Patients were identified as having high (T-score ≤-1), moderate (-1 < T-score <0), or low (T-score ≥0) risk. An analysis was performed to determine the net financial gain or loss of osteoporosis screening. Intervention: Osteoporosis screening service. Main outcome measures: T-score, overall cumulative risk score, cumulative modifiable risk score, and net financial gain of service. Results: A total of 444 women received the osteoporosis screening service during 48 months. More than 90% of the women had an overall cumulative risk score of at least 3, and 83.3% had at least one modifiable risk factor. According to the bone density tests, about 58% of the women were at high risk for osteoporosis and 25.7% were at moderate risk. The service had a net gain if provided by a pharmacist ($4,823.72), a resident ($8,153.72), or a combination of a pharmacist and a resident ($6,488.72). Conclusion: This pharmacy-based osteoporosis screening service effectively identified patients at risk for osteoporosis and was sustainable for 48 months. Other community pharmacies are encouraged to offer similar services. [ABSTRACT FROM AUTHOR]