P&T Digest: Pain Management

Randall P. Brewer, MD, Chief Medical Editor

Chronic pain is a significant public health issue in the United States and an important concern for MCOs. Untreated or undertreated pain can evolve from a symptom to a chronic condition in its own right, one that has serious comorbid, economic, and quality-of-life consequences. As scientific understanding of the mechanisms involved in chronic pain increases, so too does the opportunity to manage affected patients in a cost-effective manner.

This peer-reviewed digest discusses the clinical and economic implications of chronic and acute pain, current guidelines for treatment, therapeutic approaches to care, and patient-management strategies. It also discusses legal and clinical considerations of opioid and nonopioid therapies for adult and geriatric populations. In consolidating the state of the art about this increasingly important subspecialty of medical care, this is a valuable tool for physicians and other clinicians, managed care clinical executives, and P&T committee members.

Highlights:

• Addressing Pain Management Challenges in Managed Care
• Conceptualizing Pain and Improving Pain Diagnosis and Assessment
• Prevalence and Economic Implications of Chronic Pain the United States
• Guidelines for Pain Management
• Balancing Patient Needs and Provider Responsibilities in the Use of Opioids
• Delivery Systems: Advantages and Disadvantages
• Benefits of Pain Management in the Elderly
• The Value of Multidisciplinary Care

P&T Digest: Asthma

Michael A. Kaliner, MD, Chief Medical Editor

Asthma is one of the most common illnesses in the United States and a major driver of health care utilization costs. It also can be a challenge to manage. Disease severity, as defined by guidelines, does not necessarily correlate with patients� self-reported symptoms, meaning that vigilance is imperative to reducing poor outcomes.

This peer-reviewed digest of current and evolving guidelines for treatment, existing and emerging therapeutic approaches to treatment of depression, and strategies for managing patients and their conditions, is a valuable tool for physicians and other clinicians, managed care clinical executives, and P&T committee members. Its chapters discuss asthma as a disease syndrome, unmet medical needs, its burdens on society, and what can be done to alleviate those burdens.

Highlights:

• Controlling Asthma: A Persistent Liability
• Prevalence and Economic Implications
• Addressing Unmet Needs in Asthma Care
• Treatment Guidelines: Current Recommendations, Future Goals
• Drug Treatment for Long-Term Control of Asthma
• New Developments in Asthma Therapy
• Adherence With Asthma Therapy
• Disease Management Considerations in Asthma
• HEDIS Requirements and Considerations With Asthma

P&T Digest: Depression

David V. Sheehan, MD, MBA, Chief Medical Editor

Depression is one of the most common illnesses in the United States and a major driver of health care utilization costs. Failure to diagnose and treat this condition can lead to poor yet avoidable medical and financial outcomes. The primary goals and challenges of treating depression involve accurate diagnosis of this highly comorbid condition and improving patient compliance with therapy.

This peer-reviewed publication is a digest of up-to-date guidelines for treatment, therapeutic approaches to treatment of depression, pharmacoeconomic considerations in treatment, and a discussion of comorbid conditions. It is a valuable tool for primary care physicians, mental health practitioners, pharmacists, and P&T committee members.

Highlights:

• Depression: Underdiagnosed, Undertreated, Underappreciated
• Prevalence and Economic Effects of Depression
• Clinical Practice Guidelines for Treating Depression in Primary Care
• An Overview of SSRI and SNRI Therapies for Depression
• Pharmacoeconomic Evaluation of Antidepressant Therapies
• Adherence With Antidepressant Medication
• A Review of HEDIS Measures and Performance for Mental Disorders
• Overview and Treatment of Social Anxiety Disorder

P&T Digest: Dry Eye Syndrome

John D. Sheppard, MD, Chief Medical Editor

The understanding of keratoconjunctivitis sicca (KCS), also known as Chronic Dry Eye Disease or Dry Eye Syndrome, has changed dramatically in recent years. Until the late 1990s, KCS was thought to have been due to aqueous insufficiency. Today, KCS is understood to be a multifactorial disease that also involves inflammation of the ocular surface and lacrimal gland, neurotrophic deficiency, and meibomian dysfunction. Delay in treatment may cause disease of the ocular surface. The American Academy of Ophthalmology, in November 2003, released guidelines for treatment that recognizes these contributing factors to the epidemiology of KCS and provides evidence-based guidelines for treatment. This collection of review articles places the etiology of KCS, the AAO recommendations, and the most recent advances in treatment in perspective for practitioners, MCOs, and physicians and pharmacists who serve on pharmacy and therapeutic committees.

Highlights:

• Dry Eye Moves Beyond Palliative Therapy
• Dry Eye: Prevalence, Utilization, and Economic Implications
• Inflammation: A Unifying Theory for the Origin of Dry Eye Syndrome
• Guidelines for the Treatment of Chronic Dry Eye Disease
• Medications for Dry Eye Syndrome: A Drug-Therapy Review
• Considerations in the Pharmacoeconomics of Dry Eye
• Issues in the Use of Preservative-Free Topicals

P&T Digest: Hypertension

Marvin Moser, MD, Chief Medical Editor

Hypertension, a major driver of health care resource utilization and expenditures, is a serious public health threat — and by extension, a threat to the health of populations for which MCOs bear responsibility. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recognizes several contributing factors to the epidemiology of hypertension and provides evidence-based guidelines for treatment. This collection of review articles by nationally recognized hypertension experts places JNC-7 recommendations in perspective for practitioners, MCOs, and physicians and pharmacists who serve on pharmacy and therapeutic committees.

Highlights:

• Hypertension: Prevalence and Economic Implications
• Management of Hypertension in Light of the New National Guidelines
• Outcomes Trials Underlying the JNC-7 Guidelines
• Progression of Uncontrolled Hypertension and Implications for Managing Its Sequelae
• Hypertension: a Review of Therapeutic Options
• Fixed Low-Dose Combination Therapy: Current Recommendations
• Measuring Hypertension Control: NCQA and Beyond
• Compliance – and Improving It – in Hypertension

P&T Digest: Glaucoma

Sharad S. Mansukani, MD, Chief Medical Editor

As the American population ages, the prevalence of glaucoma rises, thus consuming greater medical and financial resources. For the first time, MCOs are attempting to understand ophthalmologic diseases, their interest driven by the market appearance of several new pharmaceutical products to treat glaucoma. The efficacy of these products has created demand and, in turn, a need for appropriate criteria for their utilization. This digest of existing literature and best practices gives physicians and pharmacists on pharmacy and therapeutics committees up-to-date information about the most efficacious and cost-effective medical treatments available in a centralized format virtually unavailable elsewhere.

Highlights:

• Introduction: Glaucoma Arrives on Managed Care’s Doorstep
• Prevalence, Utilization, and Economic Implications
• Clinical Guidelines for the Treatment of Glaucoma
• Glaucoma Medications: A Drug Therapy Review
• Considerations in the Pharmacoeconomics of Glaucoma
• Current Formulary Status of Glaucoma Agents
• Constructing Disease Management Programs for Glaucoma
• Improving Adherence to Drug Treatment Regimens