PROVIDER PERSPECTIVES ON SPECIALTY PRESCRIBING

Prescribing specialty medications is a complex and time-consuming process. Today there is no simple definition for specialty medications, but in general, they are costly and require unique handling. To manage the high costs and high-touch patient care associated with specialty medications, providers must follow specific guidelines for prior authorization and patient enrollment.

Branded specialty medications are projected to surpass half of medicine spending in the U.S. by 2022.1 And specialty medication takes up 94% of commercial medical benefit drug spend, but this spend represents just 15% of all patients.2 Since costs often fall under the patient’s medical benefit— not the pharmacy benefit—the information gap that providers face widens.

In 2018, Surescripts surveyed providers to gain insight on their experience when writing specialty prescriptions. We identified two pain points: a lack of key information in drug selection and the burdensome manual prescribing process. Providers believe that the pain points can be addressed and specialty prescribing improved if they have the right information at the point of care.

The full report from Surescripts can be downloaded below.  

The Link Between Burnout And Physician Hierarchy

When polled, specialists and primary care physicians alike blame the healthcare system for their burnout. Specifically, they call out “too many bureaucratic tasks,” “increasing computerization,” “too many hours” and “lack of pay” as some of the most common causes. 

These factors no doubt contribute, but they fail to explain why some specialties experience far greater rates of exhaustion, depression and dissatisfaction than others. 

The Forbes article can be viewed at this link.  

Contested futures: envisioning “Personalized,” “Stratified,” and “Precision” medicine

In recent years, discourses around “personalized,” “stratified,” and “precision” medicine have proliferated. These concepts broadly refer to the translational potential carried by new data-intensive biomedical research modes. Each describes expectations about the future of medicine and healthcare that dataintensive innovation promises to bring forth. The definitions and uses of the concepts are, however, plural, contested and characterized by diverse ideas about the kinds of futures that are desired and desirable. In this paper, we unpack key disputes around the “personalized,” “stratified,” and “precision” terms, and map the epistemic, political and economic contexts that structure them as well as the different roles attributed to patients and citizens in competing future imaginaries. We show the ethical and value baggage embedded within the promises that are manufactured through terminological choices and argue that the context and future-oriented nature of these choices helps to understanding how data-intensive biomedical innovations are made socially meaningful. Keywords: personalized

The full article can be downloaded below.

Sonja Erikainen & Sarah Chan (2019): Contested futures: envisioning “Personalized,” “Stratified,” and “Precision” medicine, New Genetics and Society, DOI: 10.1080/14636778.2019.1637720

Precision Medicine Goes Microscopic: Engineering the Microbiome to Improve Drug Outcomes

Despite the recognition, nearly a century ago, that the human microbiome plays a clinically relevant role in drug disposition, mechanistic insights, and translational applications are still limited. Here, we highlight the recent re-emergence of ‘‘pharmacomicrobiomics,’’ which seeks to understand how inter-individual variations in the microbiome shape drug efficacy and side effect profiles. Multiple bacterial species, genes, and enzymes have already been implicated in the direct biotransformation of drugs, both from targeted case studies and from systematic computational and experimental analyses. Indirect mechanisms are also at play; for example, microbial interactions with the host immune system can have broad effects on immunomodulatory drugs. Finally, we discuss multiple emerging strategies for the precise manipulation of complex microbial communities to improve treatment outcomes. In the coming years, we anticipate a shift toward a more comprehensive view of precision medicine that encompasses our human and microbial genomes and their combined metabolic activities.

The full article can be downloaded below.  

Provisional Drug Overdose Death Counts

This data visualization presents provisional counts for drug overdose deaths based on a current flow of mortality data in the National Vital Statistics System. Counts for the most recent final annual data are provided for comparison. National provisional counts include deaths occurring within the 50 states and the District of Columbia as of the date specified and may not include all deaths that occurred during a given time period. Provisional counts are often incomplete and causes of death may be pending investigation (see Technical notes) resulting in an underestimate relative to final counts. To address this, methods were developed to adjust provisional counts for reporting delays by generating a set of predicted provisional counts (see Technical notes).

The provisional data presented in this visualization include: (a) the reported and predicted provisional counts of deaths due to drug overdose occurring nationally and in each jurisdiction; (b) a U.S. map of the percentage changes in provisional drug overdose deaths for the current 12 month-ending period compared with the 12-month period ending in the same month of the previous year, by jurisdiction; and (c) the reported and predicted provisional counts of drug overdose deaths involving specific drugs or drug classes occurring nationally and in selected jurisdictions. The reported and predicted provisional counts represent the numbers of deaths due to drug overdose occurring in the 12-month periods ending in the month indicated. These counts include all seasons of the year and are insensitive to variations by seasonality. Deaths are reported by the jurisdiction in which the death occurred.

Several data quality metrics, including the percent completeness in overall death reporting, percentage of deaths with cause of death pending further investigation, and the percentage of drug overdose deaths with specific drugs or drug classes reported are included to aid in interpretation of provisional data as these measures are related to the accuracy of provisional counts (see Technical notes). Reporting of the specific drugs and drug classes involved in drug overdose deaths varies by jurisdiction, and comparisons of death rates involving specific drugs across selected jurisdictions should not be made (see Technical notes). Provisional data presented in this visualization will be updated on a monthly basis as additional records are received.

The full CDC release can be viewed at this link.  

Meet The Startup Revolutionizing The Language Of Biology

In 2018, Synthace penned a white paper mapping their vision and the surrounding industry of Computer-Aided Biology. With their focus on the physical equipment and experiment execution and design side, they are well aware of how they slot into a wider collection of solutions that allows for a full physical-digital biological platform.

The "universal language" that Synthace's platform Antha provides sets the company apart in terms of industry vision. Since 2005, over $2 billion has been invested into the Computer-Aided Biology ecosystem, but over 75% of that investment has been into companies focusing on a more "closed-loop" business model that doesn’t allow for interoperability across the whole "biology stack."

The full Forbes article can be viewed at this link.  

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

Our findings affirm that preventable patient harm is a serious problem across medical care settings. Priority areas are the mitigation of major sources of preventable patient harm (such as drug incidents) and greater focus on advanced medical specialties. It is equally imperative to build evidence across specialties such as primary care and psychiatry, vulnerable patient groups, and developing countries. Improving the assessment and reporting standards of preventability in future studies is critical for reducing patient harm in medical care settings.

The full article can be downloaded below.  

By Targeting Each Patient's Unique Tumor, Precision Medicine Is Crushing Once-Untreatable Cancers. But Only a Fraction of Patients Currently Benefit. Can Medicine Close the Gap?

The days when cancer patients received one-size-fits-all regimens of chemotherapy and radiation may soon be a thing of the past. Instead, doctors are taking a far more nuanced view of what drugs and treatments will work on which patients and on what different kinds of cancers. The idea of this so-called precision medicine, or personalized medicine, is that ultimately doctors will use genetic tests—of both the patient and the cancer tumor—to determine the exact drugs or treatments that have the best chance of working.

The full Newsweek article can be viewed at this link.  

Replacing an EHR comes with many challenges and costs

The vast majority of healthcare provider organizations use electronic health records and physician practice management systems to manage the care they give to patients.

Over time, functionality in the EHR and PPM systems can’t keep up with emerging demands, often compelling an organization to initiate a search for new systems. Often idyllically viewed as an easy answer to emerging challenges, switching systems often offers a gauntlet of challenges.

As healthcare organizations rethink their original—or even second or third—system choices, they often take on new—and sometimes, unexpected—problems and costs.

The full Health Data Management article can be viewed at this link.  

Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids

In this survey study of Michigan primary care clinics, 79 clinics contacted (40.7%) stated that their practitioners would not accept new patients receiving opioid therapy for pain. There was no difference based on insurance type.

The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could lead to unintended consequences, such as conversion to illicit substances or poor management of other mental and physical comorbidities.

The full article can be downloaded below.