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Drug Discount: Characteristics of Hospitals Participating and Not Participating in the 340B Program

The U.S. Government Accountability Office (GAO) released a report on the results of the study that analyzes the characteristics of hospitals that participate or do not participate in the 340B drug discount program. The GAO conducted this study due to the sixty percent increase from 2011 to 2016 in program participation, as well as the impact of Medicaid expansion on 340B participation.

The study was focused on three of the six hospital types, as they accounted for ninety five percent of U.S. hospitals participating in the 340B program. These three hospital types include:

  • Critical Access Hospitals (CAH)
  • Sole Community Hospitals (SCH)
  • General Acute Care Hospitals (Also Known As 340B DSH)

The full report can be found on the U.S. Government Accountability Office website, https://www.gao.gov/products/GAO-18-521R.

Posted by the AHA Resource Center, (312) 422-2050, rc@aha.org.

OPIOIDS: Drug overdose death rate doubles 2015 to 2016

These data on death rates from overdoses involving synthetic opioids other than methadone are drawn from the National Vital Statistics System, which is maintained by the U.S. National Center for Health Statistics (NCHS).  This includes fentanyl, fentanyl analogs and tramadol.

Synthetic Opioid Drug Overdose Death Rate (per 100,000 population)

  • 0.3  1999
  • 1.0  2013
  • 1.8  2014
  • 3.1  2015
  • 6.2 in 2016

Looking at the broader picture of drug overdose deaths from drugs of all types, the states with the highest overdose death rates in 2016 were: West Virginia, Ohio, New Hampshire and Pennsylvania.

Source: Hedegaard, H., Warner, M., and Minino, A.M. (2017, December). Drug overdose deaths in the United States, 1999-2016. NCHS Data Brief, 294.  Click herefor free full text: https://www.cdc.gov/nchs/data/databriefs/db294.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OPIOIDS: Prescribing guidelines found helpful in Ohio

…our analysis demonstrates that emergency physician opioid prescribing guidelines were associated with a decrease in the quantity of opioid prescriptions written by emergency physicians.”

In the two years before opioid prescribing guidelines were implemented in Ohio, emergency physicians were writing over 660,000 opioid prescriptions each year – of which roughly one-third of the prescriptions were for more than 3 days.  In 2012, statewide guidelines were issued.  By 2014, the most recent year studied, the total opioid prescriptions written by ED physicians had dropped to a little over 410,000.  Still about one-third were for more than 3 day prescriptions.

Source: Weiner, S.G., Baker, O., Poon, S.J., and others. (2017, December). The effect of opioid prescribing guidelines on prescriptions by emergency physicians in Ohio. Annals of Emergency Medicine, 70(6), 799-808.  Click here to purchased full text: http://www.sciencedirect.com/science/article/pii/S0196064417303530  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

OPIOIDS: Neonatal abstinence syndrome treatment

The national incidence of NAS [neonatal abstinence syndrome] increased from 3.4 to 5.8 per 1,000 hospital births between 2009 and 2012…”

Babies born to mothers who have taken opiates may experience withdrawal symptoms after they are born.  In Kentucky, care for these newborns is usually provided in the neonatal intensive care unit.  In 2014, a task force was convened to develop a best practice treatment protocol.  This study, done at the University of Louisville Hospital, evaluated this new protocol for babies carried to term, finding a decrease in the number of days that the infants needed morphine therapy and a decrease in the need for adjunctive pharmacologic therapy.  Length of stay was shortened by 9 days and hospital charges were about $27,000 lower per patient.

Source: Devlin, L.A., Lau, T., and Radmacher, P.G. (2017, October 10). Frontiers in Pediatrics. 5(216).  Click here for free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641300/pdf/fped-05-00216.pdf

CANCER: Immunotherapy holds hope and promise for some

Immunotherapy is a way to activate a cancer patient’s own immune system to kill cancer cells through drug therapy.  It has proved wildly successful with some types of advanced cancers – skin, Hodgkin’s lymphoma, lung, kidney, and bladder – shrinking tumors (so that they may become operable) or even eliminating tumors.  President Jimmy Carter is perhaps the most famous success story, having been treated with surgery, radiation therapy, and the immunotherapy drug Keytruda, which has now become popularly known as the “Jimmy Carter drug.”

Researchers are not yet sure why immunotherapy works with some patients and not others, with some types of cancer and not others.  Nor are they sure yet how long to continue to administer immunotherapy.  The Grady article is a major story in the New York Times and the first in a series on immunotherapy.  The Fox article provides additional information about a clinical trial of Keytruda in the treatment of lung cancer, which was found to be so effective that the trial was halted so that the control patients could also benefit by it.

Sources:

Grady, D. (2016, July 31). A sickened body as cancer weapon. The New York Times, 165(57310), 1, 20-22.  Click here: http://www.nytimes.com/images/2016/07/31/nytfrontpage/scannat.pdf

Fox, M. (2016, June 16). Lung cancer trial stopped after Jimmy Carter drug shrinks tumors. NBC News.  Click here: http://www.nbcnews.com/health/cancer/lung-cancer-trial-stopped-after-jimmy-carter-drug-stops-tumors-n593726  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

CHIEF PHARMACY OFFICERS (CPOs): Who has them? What is the value added?

It’s possible to begin to compile a list of chief pharmacy officers by using this search strategy on LinkedIn: https://www.linkedin.com/title/chief-pharmacy-officer.  We notice right away that CPOs are employed at the big insurance companies and at large hospitals and health systems, among other organizations.

Here are some recent articles that address the value of creating a CPO position.

Gittlen (2016) is a brief news story about the experiences of the CPOs at RWJBarnabas Health (New Jersey), Ascension Health (St. Louis), and Froedtert Hospital (Milwaukee).

ASHP (2015) reviews the characteristics of pharmacists that make them good candidates for leadership positions.

ASHP (2004) pinpoints the beginning of the trend towards naming CPOs at health system headquarters.

Sources:

Gittlen, S. (2016, June). The value of the chief pharmacy officer. HealthLeaders, 19(5), 32-34.  Click here: http://www.healthleadersmagazine-digital.com/healthleadersmagazine/june_2016?pg=34#pg34

American Society of Health-System Pharmacists (ASHP). (2015, Jan. 9). Pharmacists in the c-suite offer new perspectives on patient care. ASHP Intersections. http://www.ashpintersections.org/2015/01/pharmacists-in-the-c-suite-offer-new-perspectives-on-patient-care/

American Society of Health-System Pharmacists (ASHP). (2004, Sept. 15). Hail to the chief…pharmacy officer. Pharmacy News. http://www.ashp.org/menu/News/PharmacyNews/NewsArticle.aspx?id=1658  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Most costly adverse drug-related hospitalizations: top 10 by type among Medicare patients

This was a study of national data from 2000 to 2008 of the types of medication that cause older people to be admitted to hospitals due to adverse drug reactions.  The database was the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample, and focuses on Medicare beneficiaries only.  The study looks at the overall cost to the nation as well as the average charge per patient.

Here are the top 10 classes of drugs and the average hospital charge per patient.

Principal drug-related diagnoses (2000-2008)

  1. $20,918  Central nervous system stimulants (for example, opiate antagonists)
  2. $20,279  Analgesics, antipyretics, and antirheumatics
  3. $19,287  Drug-induced hemorrhagic gastritis
  4. $19,026  Neuropathy due to drugs
  5. $18,296  Systemic agents
  6. $17,417  Allergic dermatitis
  7. $16,884  Sedatives and hypnotics
  8. $16,796  Muscle relaxants and related
  9. $16,444  Agents that affect blood constituents
  10. $16,019  Water, mineral, and uric acid metabolism drugs

Source: Shamliyan, T.A., and Kane, R.L. (2016, June). Drug-related harms in hospitalized Medicare beneficiaries: Results from the Healthcare Cost and Utilization Project, 2000-2008. Journal of Patient Safety, 12(2), 89-107.  Click here to go to publisher’s website: http://journals.lww.com/journalpatientsafety/Pages/default.aspx   Posted by AHA Resource Center (312) 422-2050, rc@aha.org