Generic discount drug programs (GDDPs, which charge nominal fees to fill prescriptions) have grown over time and their initial lower use by racial/ethnic minorities has evaporated.
GDDPS can reduce medication costs and help patients get their drug therapy. However, the initial use of GDDPs was low in 2007 at 3.6 percent of patients receiving any prescription drugs, especially among minorities.
The authors used data from the Medical Expenditure Panel Survey for their research letter to examine the use of GDDPs as the program matured since being introduced in 2006 at Walmart and now provided by other retailers.
Of the 13,486 adults who in 2010 had at least one prescription, 3,208 of them were GDDP users for a weighted rate of 23.1 percent. Use of the GDDP was more likely among elderly, sicker and uninsured groups, as well as by people living in rural areas and central regions of the United States. However, the rate of GDDP use was not significantly different across educational level, income and racial/ethnic groups.
“The lower use of GDDPs among racial/ethnic minorities observed when the program was deployed no longer existed when the program matured.”
The study appears in JAMA Internal Medicine.
Postpericardiotomy syndrome (the episode of symptoms of pericarditis, including chest pain), postoperative atrial fibrillation (AF), and postoperative pericardial/pleural effusions (excess fluid around the heart and lungs) are all complications that can arise post-cardiac surgery. These complications affect more than one third of patients and, as a result, may be responsible for increased morbidity, extended hospital stay, lead to hospital readmissions and often a need for invasive treatments.
In one trial, according to the paper, use of colchicine assisted in the prevention of the above complications.
Colchicine is derived from the meadow saffron or autumn crocus plant.
Colchicine is a highly toxic plant hormone that is utilized medically in the treatment of gout. Colchicine is derived from the meadow saffron or autumn crocus plant, which is plentiful in meadows in Europe and has become naturalized in parts of North America. It is produced in tablets, granules, and ampoules of sterile solution.
The objective of the study was to determine the effectiveness and safety of using oral colchicine to reduce complications after cardiac surgery.
Dr. Massimo Imazio, of Maria Vittoria Hospital, Torino, Italy, and colleagues randomly assigned 360 cardiac surgery patients, enrolled in 11 centers in Italy, to two groups. The patients received either placebo or colchicine starting between 48 and 72 hours before surgery, and continued for 1 month after surgery. Centers were encouraged to use continuous electrocardiographic (ECG) monitoring for at least 5 days after surgery.
Patients received follow-up involving physical examination, blood chemistry, ECG, echocardiography aimed at identification and assessment of pericardial effusion, and thoracic ultrasound at 1 day, 3 days, day of discharge after surgery, weekly during the rehabilitation phase, then at 1 month and 3 months. At least one chest X-ray was performed during the hospital stay and then as clinically indicated.
Use of colchicine ‘significantly reduced incidence of postpericardiotomy syndrome’
The main outcomes of the study are as follows:
- Postpericardiotomy occurred in 35 of 180 patients (19.4%)
- Postoperative AF occurred in 61 of 180 patients (33.9%)
- Postoperative pericardial/pleural effusions occurred in 103 of 180 patients (57.2%)
- Adverse event rates occurred in 36 of 180 patients (20.0%).
- Postpericardiotomy occurred in 53 of 180 patients (29.4%)
- Postoperative AF occurred in 75 of 180 patients (41.7%)
- Postoperative pericardial/pleural effusions occurred in 106 of 180 patients (58.9%)
- Adverse event rates occurred in 21 of 180 patients (11.7%).
The authors write:
“In this multicenter trial, perioperative administration of colchicine significantly reduced the incidence of postpericardiotomy syndrome after cardiac surgery but did not reduce the risk of postoperative AF and postoperative pericardial/pleural effusions by intention-to-treat analysis.”
They add, “About 20% of all patients enrolled in the trial discontinued study drug; this relatively high rate may have affected the overall efficacy of the drug, especially for postoperative AF prevention.”
The study, released early online to coincide with its presentation at the European Society of Cardiology Congress, highlights that adverse event rates occurred primarily due to increased incidence of gastrointestinal intolerance, 14.4% in the colchicine group and 6.7% in the placebo group. No serious adverse events were observed.
“The high rate of adverse effects is a reason for concern and suggests that colchicine should be considered only in well-selected patients,” the researchers conclude.
Medical News Today reported in March how changes in the organized cell membrane network of heart muscle lead to heart failure. Colchicine has the beneficial side effect of lowering the risk of heart attack in patients taking it.
Written by Hannah Nichols
Copyright: Medical News Today