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Objective: Recent evidence suggests that children are increasingly diagnosed as having bipolar disorder, yet no studies have quantified treatment costs for pediatric patients. The objectives of the study were to identify one-year health services utilization and treatment costs among youths newly diagnosed as having bipolar disorder.Methods: MarketScan administrative claims from 2005 to 2007 were used to construct a retrospective person-level cohort of children ages zero to 17 to identify one-year health services utilization and costs among privately insured youths with a bipolar diagnosis. Inpatient and outpatient services were categorized as mental health related or non–mental health related. Pharmacy costs were classified as psychotropic or nonpsychotropic.Results: In the sample (4,973 youths), one-year mean reimbursements for health services were $10,372, and patient out-of-pocket spending was $1,429 per child. Mental health services accounted for 71% of all health care spending, with psychotropic medications and inpatient care contributing the largest proportions of total spending (24% and 27%, respectively) .Conclusions: The costs of care among privately insured children with bipolar disorder are similar to those of adults. However, spending on children is concentrated on mental health–related services. Because private insurance plans have historically limited mental health service benefits, the concentration of spending on mental health services may place a greater burden on families for out-of-pocket payments. As mental health parity is adopted by private insurers, monitoring its impact on patient utilization and costs of health services will be important, particularly for children with serious mental illness. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study examined the extent to which children with bipolar I disorder received recommended treatment of mood-stabilizer or second-generation antipsychotic monotherapy and factors associated with its receipt. METHODS: Administrative claims data collected from January 1, 2005, to December 31, 2007, were used to construct a cohort of 412 privately insured children with bipolar I disorder. The primary outcome measure was the receipt of mood-stabilizer or second-generation antipsychotic monotherapy within 90 days of an index diagnosis of bipolar disorder. RESULTS: Only 82 (20%) children received recommended first-line treatment for bipolar I disorder within 90 days of the index diagnosis, and 130 (32%) received no psychotropic medications. Of children receiving any medications, 200 (71%) received nonrecommended pharmacotherapy, most commonly antidepressant monotherapy (N=67, 24%) and combination pharmacotherapy (N=51, 18%). Youths who had been treated by a psychiatrist on the day of or 180 days before the fill date of medication were more likely to receive guideline-recommended care (risk ratio [RR]=1.64, 95% confidence interval [CI]=1.10-2.45) and to receive any psychotropic medications (RR=1.13, CI=1.02-1.24). Nevertheless, only 51 of the 209 (24%) children who visited a psychiatrist and 31 of the 203 (15%) who visited a nonpsychiatrist received recommended pharmacotherapy. CONCLUSIONS: This study highlights significant gaps in the treatment of pediatric bipolar disorder. Most children in this sample received either no medications or nonrecommended pharmacotherapies. Additional research is needed to further assess factors related to the nonuse of recommended psychotropic medications and to the persistent use of nonrecommended pharmacotherapies for children with bipolar disorder. (Psychiatric Services 62:1443-1449, 2011). [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine whether medication refill behavior varies by the number of prescribers of antipsychotic medication a patient has.Methods: A total of 7,868 patients with schizophrenia were identified from North Carolina Medicaid records for the period 2001-2003. Medication switching and adherence outcomes in 2003 were constructed from Medicaid pharmacy claims. Adherence was categorized into four levels (nonadherence, partial adherence, full adherence, or excess filler). Patients were stratified into four groups on the basis of the number of providers who prescribed antipsychotics in 2002 (one prescriber, two prescribers, three prescribers, or four or more prescribers). Medication switching was modeled via logistic regression, and the four-level adherence outcome was modeled via ordered logistic regression, with both regressions controlling for the number of prescribers, age, gender, race, and comorbidity. Medication switching in 2003 was also controlled for in the adherence regression. Predicted probabilities of being in the four adherence groups were estimated to examine the impact of the number of prescribers on adherence.Results: Fifty-seven percent of Medicaid patients with schizophrenia had one prescriber for antipsychotic medication, 29% had two prescribers, 10% had three prescribers, and 4% had four or more prescribers in 2002. Patients with more prescribers were significantly more likely than patients with one prescriber to switch medications (p<.01 for patients with three prescribers) and to be either fully adherent or excess fillers (p<.001).Conclusions: Patients with schizophrenia who received medication from multiple prescribers frequently changed medications and filled prescriptions too soon. Care coordination, such as with medical homes, may be effective in improving medication use in this vulnerable population. [ABSTRACT FROM AUTHOR]

This study examined medication use among Medicare beneficiaries and dually eligible beneficiaries before and after the implementation of Medicare Part D on January 1, 2006. Nationally representative 2004-2006 data from the Medical Expenditure Panel Survey were used. Two large classes of psychotropic medications (antidepressant and antipsychotic medications) and two large classes of nonpsychotropic medications (lipid-lowering and antihypertensive agents) were examined to determine whether changes in prescription patterns occurred as a result of the implementation of Part D. There was no strong evidence that Part D was associated with large changes in access to medications in the four classes of medications examined here. [ABSTRACT FROM AUTHOR]

Nonrigid forms of motion are commonplace in everyday life. Given previously documented age-related deteriorations in various tasks involving motion (discriminating speed, identifying motion direction, etc.), an experiment was conducted to evaluate the potential effect of age upon the visual ability to detect rigid and nonrigid object motion. Thirty younger and older observers participated in the experiment (mean ages were 19.9 and 75.8 years, respectively). As has been done multiple times in the past, the individual motions of object vertices were manipulated to simulate either rigid motion (rotation in depth, with or without precession) or two different types of nonrigid motion (also rotation in depth with or without precession, but with added object deformation). In confirmation of previous research, there were large effects of nonrigid motion type and precession upon the ability to differentiate between rigid and nonrigid object motion. There was also a large effect of age, such that the discrimination performance of the younger observers was 49.6% higher than that exhibited by the older observers. In this first ever study of aging and nonrigid object motion perception, we thus find that aging is associated with a substantial impairment in the ability to visually perceive object nonrigidity., Competing Interests: Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Increasingly, pharmacists are asked to incorporate social determinants of health (SDoH) identification and referral into clinical practice. However, to date, no studies have evaluated clinical changes from embedding SDoH screening into the delivery of comprehensive medication management (CMM) in patients with chronic conditions., Objective: To examine the clinical effectiveness of implementing a clinical pharmacist-led SDoH screening and referral process as part of CMM encounters across a network of 7 Federally Qualified Health Centers (FQHCs)., Methods: We used a retrospective cohort design to evaluate the effectiveness of integrating SDoH screening into CMM across a network of 7 FQHCs. A difference-in-difference approach was used to compare the effectiveness of CMM between patients with and without SDoH needs on the probability of achieving clinical control for blood pressure (<140 systolic/90 diastolic mm Hg) and diabetes (<9% hemoglobin A1c)., Results: Among 807 patients receiving CMM in 2023, 595 (74%) were screened for SDoH. 55.1% of patients screened had 1 or more SDoH, most commonly facing barriers related to insurance (22.0%), language (11.3%), transportation (9.1%), health behaviors (7.1%), income/employment (5.9%), and food insecurity (5.6%). Comparing patients with SDoH needs with those without, the proportion of patients controlled at baseline was 66.3% vs 72.3% for hypertension and 39.0% vs 75.4% for diabetes, respectively. Following a CMM encounter, the proportion of patients who achieved blood pressure control increased 7.6% more ( P = 0.225) among patients with SDoH needs than in those without SDoH, whereas diabetes control rates increased 13.3% more ( P = 0.143)., Conclusions: Although not statistically significant, the results of this pilot evaluation suggest the potential for meaningful clinical improvements from screening and referral of SDoH needs as a part of CMM encounters. These results should be corroborated using a larger, more robust study design.

Aim: To compare the effectiveness of sodium-glucose co-transporter-2 inhibitors (SGLT2is) with dipeptidyl peptidase-4 inhibitors (DPP4is) on major liver outcomes (MLO) in patients with type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD)., Materials and Methods: We included adult patients with T2D and MASLD, using metformin without specific liver conditions or surgeries, from the Merative MarketScan database. Patients initiating SGLT2is or DPP4is from 1 January 2014 to 31 December 2022 were identified. The primary outcome was time to MLO diagnosis. Overlap weighting balanced covariates, integrated with a Cox proportional hazards model for survival analysis., Results: Among 44 651 patients, 22 100 initiated SGLT2is, and 22 551 began DPP4is. After weighting, the incidence rate of MLO in the SGLT2i group was 3.8 per 1000 person-years, and it was 3.9 per 1000 person-years in the DPP4i group, resulting in an adjusted hazard ratio (aHR) of 0.82 (95% CI, 0.60-1.10). SGLT2i initiation was not associated with cirrhosis (aHR: 0.77; 95% CI, 0.55-1.06) or hepatocellular carcinoma (aHR: 0.99; 95% CI, 0.47-1.83) separately. Subgroup and sensitivity analyses did not yield significant results., Conclusions: In patients with T2D and MASLD, SGLT2is did not show a lower risk of MLO compared with DPP4is. Clinicians should consider the overall patient conditions and the additional benefits of SGLT2is to support the decision to switch from DPP4is., (© 2024 The Author(s). Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

Introduction: Frailty assessments may help to identify patients at highest risk for treatment-related toxicity, early treatment discontinuation due to toxicity, and death in Multiple Myeloma. We aimed to compare the patient-reported frailty phenotype (PRFP) and a modified version of the International Myeloma Working Group frailty index (IMWG FI) in terms of their strengths, limitations, and classification of frailty in a cohort of patients with relapsed/refractory multiple myeloma (RRMM)., Materials and Methods: Data were pooled from six RRMM Phase 3 randomized clinical trials submitted to the Food and Drug Administration for regulatory review between 2010 and 2021. Patients were classified as fit, intermediate fit/pre-frail, or frail using both PRFP and the IMWG FI proxy. Agreement between the two approaches in classification of patient frailty was assessed using weighted Cohen's kappa. A contingency table and Venn diagram were generated to analyze overlap in categorization of patient frailty across the different severity groups. Descriptive statistics were used to summarize and compare the clinical and demographic characteristics of patients categorized as frail by PRFP vs. IMWG FI proxy., Results: Of the 2,750 patients included in this analysis, IMWG FI proxy classified 16.4% (452) patients as frail, 28.1% (772) as intermediate fit/pre-frail, and 55.5% (1,526) as fit. Meanwhile, PRFP classified 21.7% (597) of patients as frail, 24.5% (675) as intermediate fit/pre-frail, and 53.8% (1478) as fit. Fair agreement was observed between PRFP and IMWG FI proxy (weighted Cohen's Kappa = 0.34 [0.31-0.37]). On average, patients who were categorized as frail by IMWG FI proxy were older and had higher Charlson Comorbidity Index scores than patients classified as frail by PRFP. In contrast, patients who were classified as frail by PRFP had worse EORTC QLQ-C30 Physical Functioning subscale summary scores as compared to patients in the IMWG FI proxy frail group (median score of 40 vs. 47 out of 100)., Discussion: Our analysis found fair concordance between IMWG FI proxy and PRFP. This demonstrates that while both frailty models measure the same underlying construct, the variables that constitute each approach may result in differing frailty categorizations for the same patient. Further prospective studies are needed to establish and compare the predictive and prognostic abilities of the different frailty indices in MM., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Bellinda King-Kallimanis reports a relationship with AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Jazz Pharma, Genentech, Eli Lilly, Janssen, Takeda, Dachii Sankyo, Blueprint Medicines, Janssen, Amgen, Seagen, and Merck that includes: funding grants. Bellinda King-Kallimanis reports a relationship with Eli Lilly, Bristol Myers Squib, IQVIA, Gilead, and Abbvie that includes: consulting or advisory. David Stenehjem reports a relationship with Salarius Pharmaceuticals, Iterion Therapeutics, Dracen Pharmaceuticals, MTEM, Sonalensense, Aprea Therapeutics, and Bristol Myers Squibb that includes: consulting or advisory. David Stenehjem reports a relationship with AstraZeneca, Novartis, Bayer, Springworks, Grail, and Bristol Myers Squibb that includes: funding grants. Joel Farley reports a relationship with AstaLynx Global that includes: consulting or advisory. Joel Farley reports a relationship with Astra Zeneca that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Many previous studies have investigated visual distance perception, especially for small to moderate distances. Few experiments, however, have evaluated the perception of large distances (e.g., 100 m or more). The studies that have been conducted have found conflicting results (diametrically opposite conclusions). In the current experiment, the functions relating actual and perceived distance were obtained for sixteen adult observers using the method of equal appearing intervals. These functions relating perceived and actual distance were obtained for outdoor viewing in a typical University environment-the experiment was conducted along a sidewalk adjacent to a typical street where campus buildings, trees, street signs, etc., were visible. The overall results indicated perceptual compression of distances in depth so that the stimulus distance intervals appeared significantly shorter than the actual (physical) distance intervals. It is important to note, however, that there were sizeable individual differences-the judgments of half of the observers were relatively accurate, whereas the judgments of the remaining half were inaccurate to varying degrees. The results of the experiment demonstrate that there is no single function that describes how human observers visually perceive large distance intervals in outdoor environments., (© 2024. The Author(s).)

Background: Logistic regression-based signal detection algorithms have benefits over disproportionality analysis due to their ability to handle potential confounders and masking factors. Feature exploration and developing alternative machine learning algorithms can further strengthen signal detection., Objectives: Our objective was to compare the signal detection performance of logistic regression, gradient-boosted trees, random forest and support vector machine models utilizing Food and Drug Administration adverse event reporting system data., Design: Cross-sectional study., Methods: The quarterly data extract files from 1 October 2017 through 31 December 2020 were downloaded. Due to an imbalanced outcome, two training sets were used: one stratified on the outcome variable and another using Synthetic Minority Oversampling Technique (SMOTE). A crude model and a model with tuned hyperparameters were developed for each algorithm. Model performance was compared against a reference set using accuracy, precision, F1 score, recall, the receiver operating characteristic area under the curve (ROCAUC), and the precision-recall curve area under the curve (PRCAUC)., Results: Models trained on the balanced training set had higher accuracy, F1 score and recall compared to models trained on the SMOTE training set. When using the balanced training set, logistic regression, gradient-boosted trees, random forest and support vector machine models obtained similar performance evaluation metrics. The gradient-boosted trees hyperparameter tuned model had the highest ROCAUC (0.646) and the random forest crude model had the highest PRCAUC (0.839) when using the balanced training set., Conclusion: All models trained on the balanced training set performed similarly. Logistic regression models had higher accuracy, precision and recall. Logistic regression, random forest and gradient-boosted trees hyperparameter tuned models had a PRCAUC ⩾ 0.8. All models had an ROCAUC ⩾ 0.5. Including both disproportionality analysis results and additional case report information in models resulted in higher performance evaluation metrics than disproportionality analysis alone., Competing Interests: DGD, EL, TJA and RZ have no conflicts of interest to disclose. JFF reports receiving personal fees from Takeda for expert witness testimony and grant support from Astra Zeneca to the University of Minnesota for an unrelated research project., (© The Author(s), 2023.)

Background and Aims: The purpose of this study is to examine patterns of utilization for antidiabetic medications among a nationally representative sample of the US population following the introduction of SGLT2 inhibitors in 2013., Methods: The study utilized National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2020 to identify adult patients with diabetes using antidiabetic medication. The proportion of patients with diabetes using different antidiabetic medications, including SGLT2 inhibitors, was plotted over time. To assess the statistical significance of the utilization trend of SGLT2 inhibitors and other oral antidiabetics, logistic regression models were employed., Results: A weighted total of 26,421,357 individuals included in our study were diagnosed with diabetes. Among these, 18,751,659 diabetes patients were identified as medication users, with 1,058,686 (5.7 %) of them taking SGLT2 inhibitors. Over the 7-year study period, the percentage of patients taking SGLT2 inhibitors increased 21-fold, from 0.4 % in 2013-2014 to 9.4 % in 2017-2020. Despite this substantial increase, the utilization of other second-line antidiabetic agents, such as sulfonylureas, DPP-4 inhibitors, GLP-1 receptor agonists, and TZDs, remained relatively stable during the same period., Conclusions: SGLT2 inhibitor utilization has significantly increased among US diabetes patients; however, their rise has not substantially impacted the use of other second-line antidiabetic agents. Further research is needed to understand the social determinants and potential barriers affecting the broader adoption of these beneficial medications., Competing Interests: Declaration of competing interest Tsung-Hua Shen: none. Joel Farley: none., (Copyright © 2023 Elsevier Inc. All rights reserved.)

BACKGROUND: Medication costs for antidiabetic drugs have risen significantly in the United States, causing concerns about the affordability of these essential treatments. OBJECTIVE: To examine out-of-pocket spending for antidiabetic medication and evaluate what proportion of Americans reach catastrophic spending levels during the year. METHODS: This retrospective cohort analysis of nationally representative data from the 2020 Medical Expenditure Panel Survey (MEPS) was analyzed for respondents that reported a diabetes diagnosis. Prescription drug costs were identified from the MEPS Prescribed Medicines File, which included both total prescription payment and out-of-pocket payment for each medication fill. Catastrophic spending thresholds were evaluated based on the World Health Organization's definition, which is spending greater than 40% of a household's nonsubsistence income on health care payments. Statistical analysis was performed with Stata 17 and sample weights were applied adjusting for the MEPS complex survey design to produce national estimates. Descriptive statistics were reported as weighted counts and percentages for categorical variables and as medians with interquartile range for continuous variables. Comparisons of reaching catastrophic spending thresholds across study variables were evaluated with Pearson chi-square tests. A P value less than 0.05 was considered statistically significant in this study. RESULTS: The study included data from a weighted US population of 29.5 million Americans with diabetes. Among this group, 23.8 million (81%) reported use of a prescription medication to treat diabetes. Total reported out-of-pocket payments paid by the patient for antidiabetic medication surpassed $5.2 billion with the largest portion attributable to the insulin subclass, which accounted for 42% or $2.2 billion. The data suggest an estimated 3 million Americans (10.3%) experienced out-of-pocket spending for antidiabetic drugs that reached catastrophic spending thresholds in 2020. CONCLUSIONS: Affordability of prescribed medication in community-dwelling persons with diabetes remains a significant challenge for many Americans.

P2Y12 inhibitors (i.e., clopidogrel, prasugrel, or ticagrelor) are effective at reducing adverse cardiovascular outcomes post-revascularization in coronary artery disease (CAD). However, the choice of a specific P2Y12 inhibitor may vary according to the patient's characteristics, and trends in the use of different P2Y12 inhibitors are not well studied in real-world settings. The objective of this study is to determine trends in the prescription patterns of P2Y12 inhibitors in patients with CAD. We studied 137,073 patients with CAD cross-sectionally using the IBM MarketScan database (2013-2018). Patients with CAD prescribed P2Y12 inhibitors within 14 days of index revascularization were included to compare the utilization of P2Y12 inhibitors based on age and clinical characteristics. There were differences in prescription patterns by age. Among patients aged less than or equal to 65 years (N = 92,734), a continuously increased utilization of ticagrelor was observed from 13.7% to 45.6% replacing clopidogrel as the most prescribed medication by 2018. Similarly, ticagrelor was the choice of drug among patients undergoing percutaneous coronary intervention. Among the patients at high bleeding risk, clopidogrel remained the most prescribed medication with use in 50.6% of patients in 2018 in patients aged less than or equal to 65 years. Contrarily, among the older adults with age 65 or above (N = 44,339), although ticagrelor use increased with time, clopidogrel remained the most utilized drug and was used by 66.2% of patients in 2018. Additionally, clopidogrel was the preferred medication among patients with stroke history. With the increasing use of ticagrelor in real-world practice, further research is needed to observe its impact on cardiovascular outcomes., (© 2023 The Authors. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.)

It has been known for more than 160 years that highly occluded objects that would normally be visually unrecognizable can be successfully identified when they move. This anorthoscopic perception relies on the visual system's ability to integrate information over time to complete the perception of an entire object's shape. In this experiment, 16 younger and older adults (mean ages were 20.5 and 74.6 years, respectively) were familiarized with the (unoccluded) shapes of five naturally-shaped objects (bell peppers, Capsicum annuum) until they could be easily identified (i.e., with accuracies of at least 90 percent correct). All observers then viewed the stimulus objects anorthoscopically as they moved behind narrow slits; only small object fragments could be seen at any given time, because the objects were almost totally occluded from view. Even though the object identification performance for all observers was equivalent when whole object shapes were visible, a large age-related deficit in object identification emerged during anorthoscopic viewing such that the younger adults' identification performance was 45.4 percent higher than that of the older adults. This first ever study of aging and anorthoscopic perception demonstrates that there is an age-related deficit in performing the temporal integration needed for successful object recognition., (© 2023. Springer Nature Limited.)

Purpose: The objective of this retrospective study was to determine the feasibility of measuring frailty using patient responses to relevant EORTC QLQ-C30 items as proxy criteria for the Fried Frailty Phenotype, in a cohort of patients with Relapsed/Refractory Multiple Myeloma (RRMM)., Methods: Data were pooled from nine Phase III randomized clinical trials submitted to the FDA for regulatory review between 2010 and 2021, for the treatment of RRMM. Baseline EORTC QLQ-C30 responses were used to derive a patient-reported frailty phenotype (PRFP), based on the Fried definition of frailty. PRFP was assessed for internal consistency reliability, structural validity, and known groups validity., Results: This study demonstrated the feasibility of adapting patient responses to relevant EORTC QLQ-C30 items to serve as proxy Fried frailty criteria. Selected items were well correlated with one another and PRFP as a whole demonstrated adequate internal consistency reliability and structural validity. Known groups analysis demonstrated that PRFP could be used to detect distinct comorbidity levels and distinguish between different functional profiles, with frail patients reporting more difficulty in walking about, washing/dressing, and doing usual activities, as compared to their pre-frail and fit counterparts. Among the 4928 patients included in this study, PRFP classified 2729 (55.4%) patients as fit, 1209 (24.5%) as pre-frail, and 990 (20.1%) as frail., Conclusion: Constructing a frailty scale from existing PRO items commonly collected in cancer trials may be a patient-centric and practical approach to measuring frailty. Additional psychometric evaluation and research is warranted to further explore the utility of such an approach., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Background: Many signal detection algorithms give the same weight to information from all products and patients, which may result in signals being masked or false positives being flagged as potential signals. Subgrouped analysis can be used to help correct for this., Research Design and Methods: The publicly available US Food and Drug Administration Adverse Event Reporting System quarterly data extract files from 1 January 2015 through 30 September 2017 were utilized. A proportional reporting ratio (PRR) analysis subgrouped by either age, sex, ADE report type, seriousness of ADE, or reporter was compared to the crude PRR analysis using sensitivity, specificity, precision, and c-statistic., Results: Subgrouping by age (n = 78, 34.5% increase), sex (n = 67, 15.5% increase), and reporter (n = 64, 10.3% increase) identified more signals than the crude analysis. Subgrouping by either age or sex increased both the sensitivity and precision. Subgrouping by report type or seriousness resulted in fewer signals (n = 50, -13.8% for both). Subgrouped analyses had higher c-statistic values, with age having the highest (0.468)., Conclusions: Subgrouping by either age or sex produced more signals with higher sensitivity and precision than the crude PRR analysis. Subgrouping by these variables can unmask potentially important associations.

Objective: Although the delivery of comprehensive medication management (CMM) in community pharmacies has been shown to improve health outcomes, inconsistent adoption hinders the benefit patients receive. Our objective was to examine the implementation of a novel value-based care model and the impact of educational and coaching support for pharmacists on patient access to CMM. The underlying care model provides a payment for CMM services combined with incentives to document and improve clinical outcomes and patient engagement., Design: Cross-sectional study., Setting and Participants: In addition to fee-for-service payments, performance-based incentives were provided to 12 participating pharmacy organizations to promote pharmacist documentation of clinical values (blood pressure and tobacco status for patients with vascular disease and additionally hemoglobin A1c [HbA1C] for patients with diabetes). To promote patient engagement, pharmacies that engaged a higher proportion of attributed patients received additional incentives., Outcome Measures: Implementation outcomes included penetration (the proportion of eligible patients who received CMM), adoption (variation in penetration across organizations), and fidelity (documentation of all required clinical values). Comparisons were made using t-tests and chi-square testing., Results: Among 1240 eligible patients, 478 (35.8%) had documentation of any service by a participating pharmacist during a one-year implementation period. Using diabetes as an example, documentation was consistently highest for tobacco status (38.1%), followed by blood pressure (29.7%), and HbA1C (38.1%). CMM recipients on average were older, used more medication, and were more likely to have at least one comorbid condition than non-recipients. 41.8% of patients with vascular disease had documentation of both blood pressure and tobacco status while 24.4% of patients with diabetes had blood pressure, tobacco, and HbA1C documentation., Conclusions: Improving pharmacist access to a patient's medical records could help improve access to CMM services for patients under value-based care models that rely on patient targeting and clinical measurements., (Copyright © 2022 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: Medication synchronization (med-sync) aligns patients' monthly or quarterly chronic medications to a predetermined single pickup date at a community pharmacy. The study objective was to examine med-sync enrollment disparities based on Medicare beneficiaries' predisposing, enabling, and need characteristics., Methods: This was a retrospective cohort study using a Medicare dataset of beneficiaries receiving medications from pharmacies that self-identified as providing med-sync. Medicare beneficiaries who were continuously enrolled in fee-for-service medical and pharmacy benefits during the study period (2014-2016) were included. Study cohorts (med-sync and non-med-sync patients) were defined, and bivariate and multivariable logistic regression analyses were performed. Andersen's Health Services Utilization Model guided our inclusion of predisposing, enabling, and need characteristics to examine for association with med-sync enrollment., Results: A total of 170,180 beneficiaries were included, of which 13,193 comprised the med-sync cohort and 156,987 comprised the non-med-sync cohort. Bivariate logistic regression analysis revealed statistically significant differences (P < 0.05) in cohorts based on age, geographic region, type of residence, number of unique chronic medications, comorbidities, outpatient visits, and inpatient hospitalizations. Beneficiaries had higher odds of being enrolled in med-sync with increasing age (adjusted odds ratio [AOR] 1.003 [95% CI 1.001-1.005]) and if they resided in the Northeast (AOR 1.094 [95% CI 1.018-1.175]), South (AOR 1.109 [95% CI 1.035-1.188]), and West (AOR 1.113 [95% CI 1.020-1.215]) than those in the Midwest. Beneficiaries residing in nonmetro areas had lower odds of enrollment (AOR 0.914 [95% CI 0.863-0.969]) than those in metro areas. Beneficiaries with previous fewer inpatient hospitalizations (AOR 0.945 [95% CI 0.914-0.977]) were more likely to be enrolled, and those with more outpatient visits (AOR 1.003 [95% CI 1.001-1.004]) were more likely to be enrolled. Those taking a higher number of oral chronic medications (AOR 1.005 [95% CI 1.002-1.008]) had greater odds of enrollment in med-sync., Conclusions: Med-sync program expansion opportunities exist to address potential enrollment disparities based on age, geographic region, metropolitan area, and prior health utilization. Further studies are needed to develop and examine strategies among pharmacies to improve med-sync enrollment outreach to these subgroups of patients., (Copyright © 2022 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Comparative effectiveness evaluation of newer P2Y12 inhibitors (prasugrel and ticagrelor) compared with clopidogrel after acute coronary syndrome (ACS) is limited in real-world US populations. The objective of this study was to evaluate cardiovascular events based on ticagrelor, prasugrel, and clopidogrel use in a real-world patient setting. This retrospective cohort study used the IBM MarketScan database (January 1, 2013, to December 31, 2018) to create three propensity score-matched pairs: ticagrelor vs. clopidogrel (N = 21,719), prasugrel vs. clopidogrel (N = 11,513), and prasugrel vs. ticagrelor (N = 11,065). The primary outcome was a composite of myocardial ischemia, unstable angina, stroke, and heart failure hospitalization. These groups were compared in a time-to-event analysis for the primary outcome at 30, 90, and 180 days following P2Y12 inhibitors initiation after percutaneous coronary intervention. Compared with clopidogrel, ticagrelor use suggested a 10% reduction in the primary outcome at 90 days (hazard ratio (HR): 0.90, 95% confidence interval (CI): 0.82-0.99). There were no differences for all other matched pairs or follow-up combinations. In the subgroup analysis of females, the results suggested a risk reduction of 27% for prasugrel at 30 days (HR: 0.73, 95% CI: 0.53-1.00) and 17% for ticagrelor at 90 days (HR: 0.83, 95% CI: 0.70-0.98) when compared with clopidogrel. Among patients treated with bare-metal stents, the results suggested that prasugrel vs. ticagrelor was associated with a 55% and 33% reduced risk for the primary outcome at 30 days and 180 days, respectively. With limited evidence in the United States comparing these drugs, this study helps inform clinicians when choosing P2Y12 inhibitors after ACS., (© 2022 The Authors. Clinical Pharmacology & Therapeutics published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.)

In closely monitored randomized controlled trials (RCTs), newer P2Y12 agents (ticagrelor and prasugrel) reduced cardiovascular outcomes compared with clopidogrel following percutaneous coronary intervention (PCI) in acute coronary syndrome. However, these RCTs indicated a higher bleeding risk with these newer agents. This study evaluated the comparative safety of each P2Y12 inhibitor on hospitalizations due to major bleeding in a real-world population. This retrospective, propensity score-matched (PSM) cohort study utilized the IBM MarketScan database over 6 years (2013-2018) to identify incident users of P2Y12 inhibitors with age ≥18 years. The primary safety outcome was hospitalization due to any major bleeding event including gastrointestinal, intracranial, and other serious forms of bleeding. In pairwise comparisons using Cox-proportional hazards models, ticagrelor, prasugrel, and clopidogrel users were compared for the primary safety outcome at 30, 90, and 180 days following the first prescription of P2Y12 inhibitor after PCI. There were 21,719 (ticagrelor vs. clopidogrel), 11,513 (prasugrel vs. clopidogrel), and 11,065 (prasugrel vs. ticagrelor) PSM pairs. Overall, the risk of major bleeding was similar for all P2Y12 inhibitors. Hospitalization for major bleeding was generally lower among ticagrelor users vs. clopidogrel and higher among prasugrel users compared with clopidogrel. Importantly, a 66% higher risk of major bleeding at 90 days is suggested with prasugrel compared with clopidogrel (hazard ratio 1.66; 95% confidence interval, 1.11-2.48). This study indicated a higher short-term bleeding risk with prasugrel compared with clopidogrel, which concurs with the results of RCTs., (© 2022 The Authors. Clinical Pharmacology & Therapeutics published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.)

Grouping by common fate plays an important role in how human observers perceive environmental objects. In this study, the effect of aging upon the ability to utilize common fate was evaluated. Twenty-two younger and older adults (mean ages were 23.4 and 74.7 years, respectively) participated in two experiments. On any given trial, the participants sequentially viewed two apparent motion sequences and were required to indicate which temporal interval contained a coherently moving dotted line embedded in noisy random background motion. In Experiment 1, the number of dots defining the target was varied, while in Experiment 2, the target interpoint spacing was varied. The younger adults outperformed the older adults by 19.4 percent in Experiment 1 and 50.5 percent in Experiment 2. The older and younger adults were similarly affected by variations in the number of target dots and the target interpoint spacing. The individual older participants' object detection accuracies were highly correlated with their individual chronological ages, such that the performance of the younger old participants was much higher than that exhibited by the older old. Increases in age systematically affect the ability of older adults to detect and visually perceive objects defined by common fate., (© 2022. The Author(s).)

An experiment evaluated the ability of 30 younger and older adults to visually judge object size under three conditions: (1) full cue, (2) in the dark, with linear perspective, and (3) in complete darkness. Each observer made repeated judgments for the same square stimuli (the task was to adjust a separation until it matched the perceived size of the squares), enabling an evaluation of precision as well as accuracy. The judgments were just as accurate in the dark with linear perspective condition as in the full cue condition, indicating that linear perspective serves as an important source of optical information to support the perception of object size). In contrast, in complete darkness (where linear perspective information was unavailable), the accuracy of the observers' judgments was poor. Finally, there was no difference in either the accuracy or the precision of the observers' judgments between the two age groups, despite the fact that the older adults were more than 50 years older than the younger adults (mean age of the younger and older adults was 22.3 and 74.1 years, respectively). The ability to visually perceive object size is well maintained with increasing age, unlike a number of other important visual abilities., (© 2022. The Author(s).)

BACKGROUND: Despite the strong efficacy of direct-acting antivirals (DAAs) against the hepatitis C virus, many patients require a second regimen of DAA treatment. However, limited research exists to characterize rates of retreatment across different DAA agents or potential factors that may increase retreatment risk. OBJECTIVE: To characterize patterns and predictors of DAA retreatment among a large, generalizable, commercially insured US population of patients. METHODS: Using the IBM MarketScan Commercial Claims and Encounters data source, this retrospective cohort study examined retreatment patterns among patients receiving DAAs between 2013 and 2019. Descriptive statistics were used to compare patient characteristics predictive of retreatment risk and to examine rates of retreatment in patients initiating different DAA treatments. RESULTS: Among 31,553 DAA users, a total of 1,017 (3.2%) required DAA retreatment. Among the 1,017 patients re-treated, 44 (4.3%) received a third treatment regimen and 2 patients received a fourth treatment regimen. The average total cost for a retreatment regimen was $109,683, with patient out-of-pocket costs totaling $1,287 Patients requiring retreatment had higher rates of hypertension (32.0% vs 26.7%; P < 0.001), diabetes (16.9% vs 11.9%; P < 0.001), coagulopathy (9.9% vs 4.5%; P < 0.001), deficiency anemia (11.1% vs 7.4%; P < 0.001), alcohol abuse (3.3% vs 2.3%; P = 0.038), prior liver transplantation (3.4% vs 2.3%; P = 0.024), and hepatocellular carcinoma (6.1% vs 1.9%; P < 0.001) compared with patients not requiring retreatment. CONCLUSIONS: Although uncommon, some patients receiving DAAs require a second regimen of DAA treatment at substantial cost to both health plans and patients. These patients tend to have more comorbidities and markers of hepatic disease severity. Patients with high retreatment risk may benefit from careful monitoring for occurrences of retreatment.

Objective: To describe patterns and predictors of perinatal prescription stimulant use., Methods: We used MarketScan ® commercial claims data (2013-2018) and a repeated cross-sectional study design to assess perinatal use of prescription stimulants. Clinical/demographic characteristics were compared across cohorts of women who continued versus discontinued stimulant treatment at various stages of pregnancy. Associations were tested for significance using chi-square tests (categorical variables) and independent t -tests (continuous variables)., Results: Out of 612,001 pregnancies, 15,413 involved pre-pregnancy stimulant use. Of these, stimulant treatment was discontinued prior to conception in 6,416 (42%), discontinued during trimester 1 in 5,977 (39%), and continued into later trimesters in 3,020 (19%). Compared with pregnancies involving stimulant discontinuation prior to conception, those that continued into pregnancy occurred in women who were older (29.9 vs. 28.9 years) and had more severe ADHD (3.1 vs. 1.8 ADHD-related billing claims)., Conclusions: There is considerable heterogeneity in the management of ADHD during pregnancy.

Background Pulmonary hypertension (PH) is a devastating potential complication of pulmonary embolism, a manifestation of venous thromboembolism (VTE). The incidence of and risk factors for PH in those with prior VTE are poorly characterized. Methods and Results International Classification of Diseases ( ICD ) codes from inpatient and outpatient medical claims from MarketScan administrative databases for years 2011 to 2018 were used to identify cases of VTE, comorbidities before the VTE event, and PH occurring subsequent to the VTE event. Cumulative incidence and hazard ratios (HR), and their 95% CI, were calculated. The 170 021 VTE cases included in the analysis were on average (±SD) 57.5±15.8 years old and 50.5% were female. A total of 5943 PH cases accrued over an average follow-up of 1.94 years. Two years after incident VTE, the cumulative incidence (95% CI) of PH was 3.5% (3.4%-3.7%) overall. It was higher among older individuals, among women (3.9% [3.8%-4.1%]) than men (3.2% [3.0%-3.3%]), and among patients presenting with pulmonary embolism (6.2% [6.0%-6.5%]) than those presenting with deep vein thrombosis only (1.1% [1.0%-1.2%]). Adjusting for age and sex, risk of PH was higher among patients with VTE with underlying comorbidities. Using the Charlson comorbidity index, there was a dose-response relationship, whereby greater scores were associated with increased PH risk (score ≥5 versus 0: HR, (2.50 [2.30-2.71])). When evaluating individual comorbidities, the strongest associations were observed with concomitant heart failure (HR, 2.17 [2.04-2.31]), chronic pulmonary disease (2.01 [1.90-2.14]), and alcohol abuse (1.66 [1.29-2.13]). Conclusions In this large, real-world population of insured people with VTE, 3.5% developed PH in the 2 years following their initial VTE event. Risk was higher among women, with increasing age, and in those with additional comorbidities at the time of the VTE event. These data provide insights into the burden of PH and risk factors for PH among patients with VTE.

United States clinical practice guidelines for metastatic colorectal cancer recommend use of medications impacted by genetic variants but do not recommend testing. We analyzed real-world treatment using a cancer registry and claims dataset to explore pharmacogenomic (PGx) medication treatment patterns and characterize exposure. In a cohort of 6957 patients, most (86.9%) were exposed to at least one chemotherapy medication with PGx guidelines. In a cohort of 2223 patients with retail pharmacy claims available, most (79.2%) were treated with at least one non-chemotherapy (79.2%) medication with PGx guidelines. PGx-associated chemotherapy exposure was associated with age, race/ethnicity, educational attainment, and rurality. PGx-associated non-chemotherapy exposure was associated with medication use and comorbidities. The potential impact of PGx testing is large and policies aimed at increasing PGx testing at diagnosis may impact treatment decisions for patients with metastatic colorectal cancer as most patients are exposed to medications with pharmacogenomics implications during treatment., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

The ability to visually perceive distances in depth was evaluated in two experiments. In both experiments, the observers were required to bisect a distance interval oriented in depth (8 m total extent in Experiment 1 and 7 m in Experiment 2). The purpose of Experiment 1 was to examine the effects of environmental context (indoors in the dark, indoors in the light, and outdoors) and monocular versus binocular viewing. The purpose of Experiment 2 was to manipulate linear perspective to determine its importance for perceiving depth interval magnitudes. In the outdoor environment, the observers' bisection judgments indicated perceptual compression of farther distances similar to that obtained in many previous studies. In contrast, the observers' judgments in the indoor lighted environment were consistent with the perceptual expansion of farther distances. There was also a beneficial effect of binocular viewing upon the precision of the observers' repeated judgments, but the size of this effect was large only within the dark environment. Finally, linear perspective was found to significantly modulate the observers' bisection judgments such that they became accurate only when perspective was available., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Eighteen younger and older adults (mean ages were 20.4 and 72.8 years, respectively) participated in a tactile speed matching task. On any given trial, the participants felt the surfaces of rotating standard and test wheels with their index fingertip and were required to adjust the test wheel until its speed appeared to match that of the standard wheel. Three different standard speeds were utilized (30, 50, and 70 cm/s). The results indicated that while the accuracy of the participants' judgments was similar for younger and older adults, the precision (i.e., reliability across repeated trials) of the older participants' judgments deteriorated significantly relative to that exhibited by the younger adults. While adverse effects of age were obtained with regards to both the precision of tactile speed judgments and the participants' tactile acuity, there was nevertheless no significant correlation between the older adults' tactile acuities and the precision of their tactile speed judgments., (© 2022. The Author(s).)

Objectives: Coordination of medication prescribing is important in the care of patients with multiple chronic conditions (MCC) given the involvement of multiple providers and multiple medications used to manage MCC. The objective of this study was to identify physician and practice factors associated with physicians' coordination of prescribing for complex patients with MCC., Methods: Our cross-sectional study used a 33-item anonymous, online survey to assess physicians' coordination practices while prescribing for patients with MCC. We sampled primary care physicians (PCPs), psychiatrists, and oncologists across the United States. Coordination of medication prescribing was measured on a 7-point Likert-type scale. χ2, Fisher exact test, and binomial logistic regression, adjusted for factors and covariates, were used to determine differences in coordination of prescribing. Average marginal effects were calculated for factors., Results: A total of 50 PCPs, 50 psychiatrists, and 50 oncologists participated. Most psychiatrists (56%) and oncologists (52%) reported frequently coordinating prescribing with other physicians, whereas less than half of the PCPs (42%) reported frequently coordinating prescribing. Female physicians were 25% points more likely to report coordinating prescribing than male physicians (P = 0.0186), and physicians not using electronic medical records were 30% points more likely to report coordinating prescribing than physicians using electronic medical records (P = 0.0230). Four additional factors were associated with lower likelihood of coordinating prescribing., Conclusions: Physician and practice factors may influence differences in coordination of medication prescribing, despite physician specialty. These factors can provide a foundation for developing interventions to improve coordination of prescribing practices for MCC., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: As a result of COVID-19, numerous adaptations were made to health care delivery, including comprehensive medication management (CMM) delivered in community pharmacies., Objective: Identify and describe the adaptations that have been made to the delivery of CMM among community pharmacies due to COVID-19., Methods: Community pharmacies participating in a CMM implementation and research initiative had regular coaching calls throughout COVID-19 and completed a survey of changes that occurred as a result of COVID-19. Coaching notes and survey results were summarized and mapped to the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to systematically capture changes that occurred., Results: A number of reactive adaptations were made to CMM delivery as a result of COVID-19, including increased virtual or remote delivery of CMM, delaying CMM visits to allow pharmacies to provide care directly related to the pandemic including COVID-19 testing and vaccines, wearing personal protective equipment (PPE) in visits, new ways of obtaining clinical patient information, and shifting CMM staffing models., Conclusion: Adaptations that occurred to CMM during COVID-19 allowed pharmacists to continue to serve their patients and meet public health needs., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Background: We conducted a mediation analysis of the provider team's role in changes to chronic condition medication adherence among cancer survivors., Methods: We used a retrospective, longitudinal cohort design following Medicare beneficiaries from 18-months before through 24-months following cancer diagnosis. We included beneficiaries aged ≥66 years newly diagnosed with breast, colorectal, lung or prostate cancer and using medication for non-insulin anti-diabetics, statins, and/or anti-hypertensives and similar individuals without cancer from Surveillance, Epidemiology, and End Results-Medicare data, 2008-2014. Chronic condition medication adherence was defined as a proportion of days covered ≥ 80%. Provider team structure was measured using two factors capturing the number of providers seen and the historical amount of patient sharing among providers. Linear regressions relying on within-survivor variation were run separately for each cancer site, chronic condition, and follow-up period., Results: The number of providers and patient sharing among providers increased after cancer diagnosis relative to the non-cancer control group. Changes in provider team complexity explained only small changes in medication adherence. Provider team effects were statistically insignificant in 13 of 17 analytic samples with significant changes in adherence. Statistically significant provider team effects were small in magnitude (<0.5 percentage points)., Conclusions: Increased complexity in the provider team associated with cancer diagnosis did not lead to meaningful reductions in medication adherence. Interventions aimed at improving chronic condition medication adherence should be targeted based on the type of cancer and chronic condition and focus on other provider, systemic, or patient factors., Competing Interests: Dr. Lund’s spouse is a full-time, paid employee of GlaxoSmithKline who also holds stock in the amount of approximately $42,000. Dr. Lund also receives unrelated grant funding paid to her institution from AbbVie. Drs. Reeder-Hayes and Wheeler receive unrelated grant funding paid to their institution from Pfizer. Dr. Farley received unrelated grant funding paid to his institution from Astra Zeneca. All other co-authors have no potential conflicts of interest to report. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The SEER-Medicare data is owned by the SEER registry Principal Investigators and the Centers for Medicare and Medicaid Services. Although personal identifiers for all patient and medical care providers have been removed from the SEER-Medicare data, there remains the remote risk of re-identification (given the large amount of data available). Data can be accessed, subject to approval and data use agreement, from the Healthcare Delivery Research Program at the National Cancer Institute. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Introduction: As care teams adopt team-based models of care, it is important to examine the reach of interdisciplinary services, such as pharmacists providing comprehensive medication management (CMM). This study examined the reach of pharmacist-delivered CMM in the first 10 months of a population health-focused primary care transformation (PCT)., Methods: Using electronic health record data, descriptive statistics (counts and percentages, as well as means and standard deviations) were quantified to summarize the patients who received CMM in two PCT pilot clinics pre- and post-PCT., Results: Patients who had at least one CMM visit increased from 554 during the pre-PCT window to 880 during the post-PCT window. However, when adjusted for the increased pharmacist full-time equivalents (FTE) included as part of the PCT, 462 and 330 patients/FTE were seen in the pre- vs post-PCT periods, respectively. When calculating the percentage of patients who received CMM, this increased from 2.3% of all primary care patients seen in the two pilot clinics before the PCT began to 4.4% after the PCT was implemented. Most patient demographics remained largely the same between the pre- and post-PCT periods. However, CMM patients seen in the post-PCT period had more medication therapy problems across all medication therapy problem categories compared to patients in the pre-PCT period. Additionally, patients receiving CMM had significantly more conditions and medications and higher hospitalizations and emergency department use compared to the general clinic population., Conclusions: Reach is an important implementation outcome to determine the representativeness of individuals participating in a given service. This study illustrates that pharmacists providing CMM see complex patients with a high propensity for medication therapy problems. However, opportunities exist to improve the reach of CMM and, in turn, enhance team-based care., Competing Interests: Conflict of interest The authors have no conflicts of interest to disclose.

Objective: To examine whether the length of participation in a patient-centered medical home (PCMH), an evidence-based practice, leads to higher quality care for Medicaid enrollees with multiple co-morbid chronic conditions and major depressive disorder (MDD)., Data Sources: This analysis uses a unique data source that links North Carolina Medicaid claims and enrollment data with other administrative data including electronic records of state-funded mental health services, a state psychiatric hospital utilization database, and electronic records from a five-county behavioral health carve-out program., Study Design: This retrospective cohort study uses generalized estimating equations (GEEs) on person-year-level observations to examine the association between the duration of PCMH participation and measures of guideline-concordant care, including the receipt of minimally adequate care for MDD, defined as 6 months of antidepressant use or eight psychotherapy visits each year., Data Collection/extraction Methods: Adults with two or more chronic conditions reflected in administrative data, including MDD., Principal Findings: We found a 1.7 percentage point increase in the likelihood of receiving guideline-concordant care at 4 months of PCMH participation, as compared to newly enrolled individuals with a single month of participation (p < 0.05). This effect increased with each additional month of PCMH participation; 12 months of participation was associated with a 19.1 percentage point increase in the likelihood of receiving guideline-concordant care over a single month of participation (p < 0.01)., Conclusions: The PCMH model is associated with higher quality of care for patients with multiple chronic conditions and MDD over time, and these benefits increase the longer a patient is enrolled. Providers and policy makers should consider the positive effect of increased contact with PCMHs when designing and evaluating initiatives to improve care for this population., (© 2021 Health Research and Educational Trust.)

In this study 28 younger and older observers discriminated the global shapes of objects that were defined by differences in texture. The judged stimulus patterns were 3-point micropattern textures. On any given trial, a texture-defined shape (either a vertically- or horizontally-oriented rectangle) was presented; the observers' task was to discriminate between the two rectangles. The task difficulty was manipulated by varying the deviation from colinearity of each of the individual 3-point texture elements between figure and background (the larger the difference in deviation between figure and ground, the higher the discrimination performance). The results revealed a substantial effect of age. In order for the older observers to reliably discriminate the shape of the target rectangle (with a d' value of 1.5), they needed differences from colinearity that were 54.4 percent larger than those required for the younger observers. While older adults can utilize differences in texture to perceive global shape, their ability is nevertheless significantly impaired., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Several healthcare organizations across Minnesota have developed formal pharmacogenomic (PGx) clinical programs to increase drug safety and effectiveness. Healthcare professional and student education is strong and there are multiple opportunities in the state for learners to gain workforce skills and develop advanced competency in PGx. Implementation planning is occurring at several organizations and others have incorporated structured utilization of PGx into routine workflows. Laboratory-based and translational PGx research in Minnesota has driven important discoveries in several therapeutic areas. This article reviews the state of PGx activities in Minnesota including educational programs, research, national consortia involvement, technology, clinical implementation and utilization and reimbursement, and outlines the challenges and opportunities in equitable implementation of these advances.

Patients with comorbid mental health and chronic conditions often receive care from both psychiatrists and primary care physicians (PCPs). The introduction of multiple providers into the care process introduces opportunities for disruptions in care continuity. The purpose of this study was to explore psychiatrists' and PCPs' comfort prescribing, along with their comfort having other physician specialties prescribe medications for cardiometabolic, psychiatric, and neurological/behavioral conditions. This cross-sectional study utilized an online, validated, pilot-tested, anonymous survey to examine prescribing practices of psychiatrists and PCPs. Eligible participants included physicians with medical degrees, U.S. prescribing authority, and active patient care for ≥2 days/week. Outcomes of interest were physicians' self-comfort and cross-specialty comfort (other specialists prescribing mutual patients' medications) prescribing cardiometabolic, psychiatric, and neurological/behavioral medications. Comfort prescribing was measured using 7-point Likert scales. Discrepancies in comfort were analyzed using student's, one-sample, and paired t-tests. Multiple linear regressions examined associations between physician practice characteristics and physicians' comfort-level prescribing cardiometabolic and psychiatric medication categories. Among 50 psychiatrists and 50 PCPs, psychiatrists reported significantly lower self-comfort prescribing cardiometabolic medications (mean ± SD = 2.99 ± 1.63 vs. 6.77 ± 0.39, p < 0.001), but significantly higher self-comfort prescribing psychiatric medications (mean ± SD = 6.79 ± 0.41 vs. 6.00 ± 0.88, p < 0.001) and neurological/behavioral medications (mean ± SD = 6.48 ± 0.74 vs. 5.56 ± 1.68, p < 0.001) than PCPs. After adjusting for covariates, physician specialty was strongly associated with self-comfort prescribing cardiometabolic and psychiatric medication categories (both p < 0.001). Differences between self-comfort and cross-specialty comfort were identified. Because comfort prescribing medications differed by physician type, incorporating psychiatrists through collaborative methods with PCPs could potentially ensure comfort among physicians when initiating medications.