This research, a descriptive qualitative analysis of self-defined serious illness goals, expands the knowledge what goals are important beyond physical-making existing disease-specific guidelines more holistic. Integration care discussions and documentation is standard for quality palliative but not consistently executed into general specialty practice. Over 14 months, lay health-care workers (care guides) provided monthly supportive visits 160 patients with advanced heart failure, cancer,...

Given the lack of real-world data on oral semaglutide use outside clinical trials, purpose this study was to describe dose, prescriber specialty, and change in hemoglobin A1c (HbA1c) after 6 months treatment for patients with type 2 diabetes mellitus (T2DM).This a retrospective among adult T2DM ≥ 1 claim between November 1, 2019`1-June 30, 2020. Patients had continuous health plan enrollment 12 prior (pre-index) following (post-index) date first (index). Dose at initiation specialty...

Abstract Aim To describe the change in glycated haemoglobin (HbA1c) among patients with type 2 diabetes following treatment a 7 or 14 mg maintenance dose of oral semaglutide. Materials and Methods This retrospective, claims‐based study included adult pre‐index HbA1c ≥7%, initiating semaglutide between 1 November 2019 30 June 2020; had continuous health plan enrolment for ≥12 months before (pre‐index) ≥6 (post‐index) date first claim (index). Patients were required to have mg. Pre‐index...

Objective: Previous research indicates that 9-1-1 response to incidents involving children is particularly distressing for emergency medical services (EMS) clinicians. This qualitative study was conducted increase understanding about the difficulties of responding pediatric calls and obtain information how organizations can better support EMS providers in managing potentially difficult calls. Methods: Paramedics technicians from a single U.S. ambulance service were invited participate focus...

The 2018 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends combination long-acting muscarinic antagonists/long-acting beta2-agonists (LAMA + LABA) as preferred maintenance therapy patients with symptomatic chronic obstructive lung disease (COPD) after monotherapy and stepping up to triple (TT; LAMA LABA inhaled corticosteroids [ICS]) in case of further exacerbations. Restrictions on TT recommendations have primarily been driven by higher pneumonia risk associated...

This mixed methods study documents emotional exhaustion experiences among care team members during the development of an innovative approach for caring adults with serious illness. A design was employed to examine depleting work that may produce exhaustion, and energizing aspects increase meaningfulness work, thus reducing exhaustion. The population studied included involved in illness (n = 18). Team were surveyed quarterly over 18-month period using Maslach Burnout Inventory (MBI). MBI...

Studies have shown that workers’ identities matter for a host of individual and organizational outcomes. However, the question how work becomes more complex when considering settings where workers must negotiate multiple – sometimes conflicting identities. Interprofessional healthcare teams are one such setting. Within interprofessional teams, expected to adopt both professional team-based identities, leading confusion conflicts. Using longitudinal qualitative analyses team members’...

Whole person care is appropriate for seriously ill persons. The current framework of palliative domains in the National Consensus Project (NCP) Guidelines Quality Palliative Care offers an opportunity to reassess delivered at home, earlier course illness.This qualitative study was used test applicability a proposed, expanded set domains. results were inform home-based, upstream model supportive serious illness.Quotes relating experience late-life illness derived from transcripts 12...

Quality of life (QOL) is an important consideration for people living with advancing chronic conditions. Palliative care providers speak about how, despite physical decline in late life, many patients report growth and meaning other domains. This mixed methods study uses QOL survey responses to explore domain trajectories interview data how conditions experience distinct domains.The sample includes 156 now-deceased participants who completed the FACIT-Pal quarterly, 40 (10 now-deceased)...

BACKGROUND: More than 5.6 million Americans suffer from dementia, and that number is expected to double by 2060. This comes at a considerable burden the health care system with costs estimated $157-$215 billion in 2010. Depending on dementia type disease progression, approximately 20%-70% of patients experience dementia-related psychosis (DRP), characterized hallucinations and/or delusions resulting worse clinical outcomes greater caregiver compared without DRP. OBJECTIVE: To compare...

The treatment landscape for type 2 diabetes mellitus (T2DM) is complex and constantly evolving, real-world evidence of prescribing patterns limited. objectives this study were to characterize lines therapy (LOTs), calculate the length time spent on each LOT, identify reasons LOT end among patients who initiated oral semaglutide T2DM.

Aim: To compare health plan-paid costs, exacerbations and pneumonia outcomes for patients with chronic obstructive pulmonary disease (COPD) initiating combination tiotropium olodaterol (TIO + OLO) versus triple therapy (TT: long-acting muscarinic antagonist β 2 agonists inhaled corticosteroid). Patients & methods: COPD TIO OLO or TT between 1 January 2014 30 June 2016 were identified from a managed care Medicare database balanced baseline characteristics using inverse probability of...

Healthcare is experiencing two countervailing pressures: to increase efficiency and be more responsive consumer demands. organizations often create new work arrangements, including “lay healthcare” roles, respond these pressures. Using longitudinal qualitative data, this article analyzes how one set of lay healthcare workers attempted construct a workplace identity, sell their value existing professional workers, navigate the precarious conditions role. The authors find that in roles faced...

Abstract Purpose The purpose of this study was to evaluate patient, prescriber, and dose characteristics changes in glycated hemoglobin (HbA 1c ) for patients prescribed once weekly semaglutide diabetes (OW sema T2D). Methods This a retrospective claims-based using the Optum Research Database. sample included adult who had at least one claim OW T2D between Jan 1, 2018, Dec 31, 2019, were continuously enrolled health plan diagnosis type 2 (T2DM) during pre-index or post-index periods....

Introduction Discordance between real-world prescribing patterns and global treatment guidelines for the of chronic obstructive pulmonary disease (COPD) with inhaled single or dual long-acting bronchodilator maintenance therapy is increasingly being reported in literature, particularly regard to addition corticosteroids (ICS). Patient-related factors, e.g. inhalation technique inspiratory flow, are key control COPD. Treatment discordance patient-related factors can lead high-cost side...

Quality of life (QOL) for patients with serious illness in late is important and policy makers has implications improved care delivery. This mixed-methods evaluation examined the effectiveness a new whole-person approach to care—the LifeCourse—which provides ongoing, across-setting assistance from lay health workers, supported by clinical team. We investigated whether participation LifeCourse improves QOL intervention patients, compared usual controls. was assessed using baseline 6 months...

Background: Medical management of patients with type 2 diabetes mellitus (T2DM) is complex because the chronic nature disease and its associated comorbidities. Injectable once-weekly semaglutide for (OW sema T2D) a glucagon-like peptide–1 receptor agonist approved treatment T2DM. Objectives: To describe patient characteristics HbA1c changes prescribed 1.0 mg maintenance dose OW T2D. Methods: This retrospective study included adult T2DM pre-index glycated hemoglobin (HbA1c) at least 7%,...

Background: Medical management of patients with type 2 diabetes mellitus (T2DM) is complex because the chronic nature disease and its associated comorbidities. Injectable once-weekly semaglutide for (OW sema T2D) a glucagon-like peptide–1 receptor agonist approved treatment T2DM. Objectives: To describe patient characteristics HbA1c changes prescribed 1.0 mg maintenance dose OW T2D. Methods: This retrospective study included adult T2DM pre-index glycated hemoglobin (HbA1c) at least 7%,...

Limited research is available on the real-world experiences of patients with dementia Lewy bodies (DLB). This study evaluated clinical events, healthcare utilization, and costs DLB vs other types psychosis (ODP). Study included commercial Medicare Advantage Part D enrollees aged ≥40 years evidence ODP from 6/01/2015‒5/31/2019. Compared ODP, more had events including anticholinergic effects, neurologic cognitive decline. Patients used resources greater dementia-related office outpatient...

Healthcare systems seek effective ways to support and treat the growing number of individuals living with serious illness. The nature these care episodes challenges delivery attain proficiency in dealing multiplicity chronic conditions populations through understanding attending patients' medical nonmedical aspects health. This article describes LifeCourse, a healthcare approach that provides palliative practices patients illness years prior death.

To characterize patients with Parkinson's disease (PD) who initiated dopamine agonist (DA) monotherapy, describe medication utilization and provider types, estimate adherence discontinuation rates.Retrospective study identified PD in the Optum Research Database included those ≥1 claim for DA or levodopa between 09/01/2012 12/31/2018, ≥2 diagnoses, commercial Medicare Advantage Part D (MAPD) insurance, ≥40 years old, continuous medical pharmacy coverage ≥12 months before after index date. A...