If You Build It, Will They Come? The Kaiser Permanente Model Of Online Health Care

2009 ◽  
Vol 28 (2) ◽  
pp. 334-344 ◽  
Author(s):  
Anna-Lisa Silvestre ◽  
Valerie M. Sue ◽  
Jill Y. Allen
Keyword(s):  
Health Care ◽  
Kaiser Permanente

Abstract P50: Early Nonadherence to Antihypertensive Medications

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Emily B Schroeder ◽  
Jennifer L Ellis ◽  
Nikki M Carroll ◽  
Elizabeth A Bayliss ◽  
Marsha A Raebel
Keyword(s):  
Health Care ◽  
Medication Adherence ◽  
Antihypertensive Medication ◽  
Multivariate Model ◽  
Care Plan ◽  
Office Visits ◽  
Antihypertensive Medications ◽  
Kaiser Permanente ◽  
Pharmacy Claims ◽  
C Statistic

Background: Medication adherence is extremely important in the treatment of hypertension. Most medication adherence metrics are based on refill rates from pharmacy claims databases and require at least two drug dispensings for the calculations. Little is known about individuals who demonstrate early non-adherence to antihypertensive medications, either by never filling a prescription (primary non-adherence) or by filling a prescription only once (early non-persistence). Methods: We conducted a retrospective cohort study of 6,393 Kaiser Permanente Colorado enrollees with hypertension who received a first prescription for an antihypertensive medication between January 1, 2007 and June 30, 2008. We linked prescription orders to medication dispensings and then classified patients into primary non-adherent, early non-persistent, or ongoing dispensings groups. Multivariate logistic modeling was performed to investigate potential predictors of primary non-adherence compared to ongoing dispensings. Results: Five percent (331 of 6,393) of patients were primarily non-adherent, 26% (1,672 of 6,393) demonstrated early non-persistence, and 69% (4,390 of 6,393) received ongoing dispensings. In a multivariate model, the following characteristics were associated with a higher likelihood of exhibiting primary non-adherence compared to receiving ongoing dispensings: Hispanic (OR 1.74, 95% CI 1.20-2.52) or other racial/ethnic minority (1.48, 1.13-1.95), an enrollment period less than 10 years (1.28,1.00-1.62), more than four comorbidities compared to no comorbidities (1.76, 1.02-3.02), and fewer than five health care contacts in the six months after the medication was prescribed (1.31, 1.02-1.67). The copayment amount for office visits or medications was not associated with primary non-adherence. The c-statistic for the model containing demographic characteristics, comorbidities, and health care plan information was 0.63. Conclusions: A substantial number of individuals newly prescribed an antihypertensive medication exhibited early non-adherence. Our multivariate model had limited discrimination, indicating that further research is needed to better characterize these individuals and explore barriers to early adherence.

scholarly journals Endoscopy by Nonphysicians

2007 ◽  
Vol 21 (1) ◽  
pp. 17-18 ◽  
Author(s):  
Elaine R Gossman
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
The United States ◽  
Current Status ◽  
Care Providers ◽  
Kaiser Permanente ◽  
Efficient System ◽  
Effective Manner

In 1945, Henry J Kaiser organized a group of physicians to provide health care for shipyard workers and their families. His foundation, Kaiser Permanente (USA), has developed into a prepaid health plan facility serving 8.4 million members in nine states and in Washington, DC, within the United States. It aspires to provide high quality, affordable, integrated health care within an organized, efficient system. A focus on preventive care in a cost-effective manner is a high priority. The Kaiser Permanente northwest region (covering northwest Oregon and southwest Washington) serves nearly one-half of a million members. Our region has utilized nurse practitioners (NPs) and physician assistants (PAs) (allied health care providers) in a variety of capacities for many years. The present paper reviews the background and current status of their role in endoscopy.

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