Outcomes data have enabled physicians to have a much more complete overview of the patient's qual... more Outcomes data have enabled physicians to have a much more complete overview of the patient's quality of life and health than their predecessors. One medical center has sought to develop a comprehensive point-of-service outcomes measurement tool for the assessment of patients with asthma. This information may provide a real-time overview on a desktop computer system of the patient's progress. A pilot project involving a therapeutic intervention in patients with asthma was conducted to test the utility of this outcomes tool in a practice setting.
Allergic rhinitis is one of the most common presentations of allergic disorders in the United Sta... more Allergic rhinitis is one of the most common presentations of allergic disorders in the United States, affecting more than 20% of the population. Chronic rhinitis affects patients' quality of life and exacerbates comorbid conditions. Its widespread burden affects society by substantially decreasing worker and scholastic productivity. Allergic rhinitis is typically managed with pharmacotherapy to alleviate symptoms and control comorbid conditions, yet many of these agents carry their own burden due to bothersome and sometimes severe side effects that can compromise patient safety. A new generation of non- or less-sedating antihistamines has recently emerged. These agents offer the promise of enhanced efficacy and tolerability. Of these agents, levocetirizine is the latest antihistamine introduced in the United States. It appears to be safe and effective for the treatment of allergic rhinitis. In addition to covering the above topics, this article reviews the value of levocetirizine for the treatment of allergic rhinitis based on its pharmacologic and pharmacokinetic profile, its efficacy compared with placebo and other new-generation antihistamines, and its safety and tolerability.
Clinical decision-making in allergic rhinoconjunctivitis management involves a significant degree... more Clinical decision-making in allergic rhinoconjunctivitis management involves a significant degree of complexity given the number of pharmaceutical agents; the option for allergen immunotherapy (AIT); and the risk for disease advancement, including the development of asthma as well as new environmental allergic sensitivities. Given the complex array of treatment options that are currently available, there is an opportunity to use a shared decision-making (SDM) approach with associated aids and tools that facilitate the interactive participation of practitioners and patients in the SDM process. This article reviews the general constructs of SDM, the unmet need for SDM aids, the collection of patient preference data for allergic rhinoconjunctivitis, the utility of SDM aids which have been specifically created for AIT, and outlines actionable steps to implement AIT SDM in clinical practice.
Background: Perennial allergic rhinitis (PAR) exerts significant quality-of-life and economic bur... more Background: Perennial allergic rhinitis (PAR) exerts significant quality-of-life and economic burdens on society. Beclomethasone dipropionate (BDP) nasal aerosol is the first nonaqueous, hydrofluoroalkane-propelled intranasal corticosteroid approved for patients in the United States to treat PAR and seasonal allergic rhinitis. Objective: To evaluate real-world effectiveness of BDP nasal aerosol from the patient's perspective by using a postmarketing observational registry. Methods: Patients (N ϭ 824) from 43 U.S. study sites completed monthly patient-reported outcome instruments, including the Rhinitis Control Assessment Test (primary outcome variable),
The Journal of Allergy and Clinical Immunology: In Practice, Sep 1, 2020
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Annals of Allergy Asthma & Immunology, Nov 1, 2018
14≤ age≤ 75 years) with class I, IIa, or IIb MG according to Osserman's classification are enroll... more 14≤ age≤ 75 years) with class I, IIa, or IIb MG according to Osserman's classification are enrolled, and are blindly separated into Chinese herb group and control group. The Chinese herb group is treated with Huangqi formula and control group with placebo, treatment duration is four weeks. Muscle weakness is assessed by Chinese Score for MG (CSMG; rang 12-60; higher scores worse weakness), and QoL is assessed by the SF-36 (rang: 0-100; higher scores better QoL); Both CSMG and SF-36 are evaluated at the enrollment and after four-week treatment. Results: Analysis is based on 248 patients (male 110, 44%; age:46±18 year), of whom 125 patients randomized into the Chinese herb group and 121 finish the treatment; 123 in the control group and 120 finish the study. There is no significant difference in demographic and clinical characteristics between two groups (P> 0.05), and no difference in CSMG (Chinese herb vs control groups: 24.1±5.9 vs 23.3±6.6) and SF-36 (55.7±16.6 vs 57.7±16.5) at the baseline either. After four-week treatment, muscle weakness declined 6.4±5.0 in Chinese herb group and 1.0±3.8 in control group (P= 0.000). However, no significant changes are found in SF-36 scores between the two groups (56.7±16.1 and 57.1±15.9). ConClusions: This study proves that Chinese herb can relieve MG patients' muscle weakness, but it is not enough to improve patients' QoL in four weeks.
Clinical decision-making in hereditary angioedema (HAE) management involves a high degree of comp... more Clinical decision-making in hereditary angioedema (HAE) management involves a high degree of complexity given the number of therapeutic agents that are available and the risk for significant morbidity and potential mortality attributable to the disease. Given this complexity, there is an opportunity to develop shared decision-making (SDM) aids and/or tools that would facilitate the interactive participation of practitioners and patients in the SDM process. This article reviews the general constructs of SDM, the unmet need for SDM in HAE, and the steps necessary to create a SDM tool specific for HAE, and outlines the challenges that must be navigated to guide the establishment and widespread implementation of SDM in the management of HAE.
Allergy is a significant component in many asthma patients. Omalizumab is a monoclonal anti-immun... more Allergy is a significant component in many asthma patients. Omalizumab is a monoclonal anti-immunoglobulin E antibody for the treatment of allergic asthma. Clinical trials have shown that omalizumab treatment is associated with improved symptom control and reduced inhaled corticosteroid doses, resulting in fewer exacerbations and reduced utilization of resources. Omalizumab therapy may benefit patients who remain uncontrolled or who cannot tolerate standard therapy.
Allergy and asthma proceedings : the official journal of regional and state allergy societies
Costs for managed care organizations to process prior authorizations (PAs) for nonformulary medic... more Costs for managed care organizations to process prior authorizations (PAs) for nonformulary medications have been estimated to be dollars 20-25 per request. Costs for physicians to process these requests have not been studied extensively. A data collection tool was developed and used by physicians and nurses to document time spent on processing PAs. Data were collected over 8 weeks and 117 requests were processed. Nurses averaged 5.6 +/- 6.5 calls per day per nurse and spent an average of 17 minutes per call. Physicians averaged 1.9 +/- 1.2 calls per day averaging 5.8 +/- 5.0 minutes per call. During the study period nurses spent >40 hours on 231 calls and physicians spent >8 hours on 154 calls. Based on the hourly rate of the nurses and physicians, the total cost in this specialty practice was dollars 17.77 per PA. Of the 117 PA requests, 98.7% were approved the first time they were processed. There are substantial costs with processing PAs for nonformulary drugs on the physi...
Asthma is a very common chronic disease characterized by clinically recurrent episodes of wheezin... more Asthma is a very common chronic disease characterized by clinically recurrent episodes of wheezing, dyspnea, chest tightness, and coughing. Both genetic and environmental factors appear to play major roles in the etiology of asthma. The economic and social costs of asthma are varied and far reaching. Patients suffer a significant decline in quality of life, and managed care organizations have become increasingly aware of its impact on health care expenditures. This article explores current treatment therapies for asthma, the challenges of managing asthma effectively, and strategies for improving outcomes in patients with asthma.
The Journal of Allergy and Clinical Immunology: In Practice, 2021
What is already known about this topic? Digital technology provides an opportunity to improve and... more What is already known about this topic? Digital technology provides an opportunity to improve and individualize asthma self-management significantly across a variety of intervention types; however, the impact of different digital intervention characteristics has yet to be assessed.
Background:Telehealth use increased during the coronavirus disease 2019 (COVID-19) pandemic to pr... more Background:Telehealth use increased during the coronavirus disease 2019 (COVID-19) pandemic to provide patient care while deferring to social distancing recommendations.Objective:Health-care provider and patient surveys were conducted to assess the impact of COVID-19 on the use and perception of telehealth visits for atopic and respiratory diseases.Methods:Health-care provider (N = 200) and patient (N = 200) surveys were conducted in the United States between September and October, 2020, and January, 2021. The participants were required to have used telehealth before or after March 1, 2020, the cutoff date selected to represent the start of the COVID-19 pandemic.Results:Before the pandemic, 40% of the health-care provider participants were conducting telehealth visits, which increased to 100% after the pandemic started. The average time spent per telehealth visit with patients increased from 13 to 16 minutes. A higher percentage of family medicine physicians/pediatricians had access to most monitoring tools than allergy/dermatology specialists both before the pandemic and after the pandemic started. Practice expenses reportedly increased after the pandemic started for 42% of participants. Before the pandemic, 27% of the patient participants used telehealth, which increased to 94% after the pandemic started. Ratings of “good” or “excellent” for the overall telehealth experience by the health-care provider participants improved from 44% before to 60% after the pandemic started, and by the patient participants improved from 77% to 88%. The willingness by the health-care provider participants to recommend telehealth to colleagues improved from 73% before to 83% after the pandemic started. The willingness by the patient participants to use telehealth again dropped slightly, from 94% to 89%.Conclusion:Telehealth visits for atopic and respiratory diseases increased during the COVID-19 pandemic. Telehealth experiences were overall positive, particularly for the patients.
Background: Most U.S. patient and health care provider surveys with regard to nasal allergy treat... more Background: Most U.S. patient and health care provider surveys with regard to nasal allergy treatments were conducted before sublingual immunotherapy (SLIT)-tablets and allergy immunotherapy (AIT) shared decision-making tools were available. Objective: Patient and health care provider surveys with regard to current perceptions of nasal allergy burden, symptoms, and treatments were conducted to compare with previous surveys and provide insight into the use of SLIT-tablets and AIT shared decision-making tools. Methods: From November-December 2019, adults (N = 510) diagnosed with nasal allergies and health care providers (N = 304) who treated nasal allergies in the United States completed surveys with regard to nasal allergy management. Results: Of the patient respondents, 42% reported that their symptoms were only somewhat controlled and 48% had avoided activities because of their nasal allergies. In all, 38% were using only over-the-counter (OTC) medications for treatment, and 42%, 7...
A systemwide outcomes management plan is in the process of implementation at Dean Medical Center.... more A systemwide outcomes management plan is in the process of implementation at Dean Medical Center. Plans for data collection include a core data set of patient satisfaction, basic health, and functional and risk status along with specific clinical and clinically related functional status reported by patients and providers.
Introduction: Little is known about how patients with asthma and eczema perceive their medical ca... more Introduction: Little is known about how patients with asthma and eczema perceive their medical care and burden of disease. A survey was conducted to evaluate the perceptions among the general patient population with
Poor adherence to asthma medication and inadequate communication are critical problems in asthma ... more Poor adherence to asthma medication and inadequate communication are critical problems in asthma care in older adults. They contribute to morbidity and mortality through poor asthma control, frequent asthma exacerbations, acute care visits, and oral corticosteroid usage in this particularly vulnerable population. The objective of this chapter is to discuss evidence-based, time-efficient strategies that can be adopted by healthcare professionals (HCPs) to increase patient adherence and promote optimal asthma outcomes. Authors will use asthma management guidelines in older patients and other key publications to enhance discussion. Findings include that establishing patient-centered, collaborative care in older asthmatic adults facilitates effective patient–provider communication that likely will improve adherence, thus leading to improved asthma outcomes. One critical strategy is shared decision-making (SDM), in which the older adult patient and the HCP share relevant information, dis...
Outcomes data have enabled physicians to have a much more complete overview of the patient's qual... more Outcomes data have enabled physicians to have a much more complete overview of the patient's quality of life and health than their predecessors. One medical center has sought to develop a comprehensive point-of-service outcomes measurement tool for the assessment of patients with asthma. This information may provide a real-time overview on a desktop computer system of the patient's progress. A pilot project involving a therapeutic intervention in patients with asthma was conducted to test the utility of this outcomes tool in a practice setting.
Allergic rhinitis is one of the most common presentations of allergic disorders in the United Sta... more Allergic rhinitis is one of the most common presentations of allergic disorders in the United States, affecting more than 20% of the population. Chronic rhinitis affects patients' quality of life and exacerbates comorbid conditions. Its widespread burden affects society by substantially decreasing worker and scholastic productivity. Allergic rhinitis is typically managed with pharmacotherapy to alleviate symptoms and control comorbid conditions, yet many of these agents carry their own burden due to bothersome and sometimes severe side effects that can compromise patient safety. A new generation of non- or less-sedating antihistamines has recently emerged. These agents offer the promise of enhanced efficacy and tolerability. Of these agents, levocetirizine is the latest antihistamine introduced in the United States. It appears to be safe and effective for the treatment of allergic rhinitis. In addition to covering the above topics, this article reviews the value of levocetirizine for the treatment of allergic rhinitis based on its pharmacologic and pharmacokinetic profile, its efficacy compared with placebo and other new-generation antihistamines, and its safety and tolerability.
Clinical decision-making in allergic rhinoconjunctivitis management involves a significant degree... more Clinical decision-making in allergic rhinoconjunctivitis management involves a significant degree of complexity given the number of pharmaceutical agents; the option for allergen immunotherapy (AIT); and the risk for disease advancement, including the development of asthma as well as new environmental allergic sensitivities. Given the complex array of treatment options that are currently available, there is an opportunity to use a shared decision-making (SDM) approach with associated aids and tools that facilitate the interactive participation of practitioners and patients in the SDM process. This article reviews the general constructs of SDM, the unmet need for SDM aids, the collection of patient preference data for allergic rhinoconjunctivitis, the utility of SDM aids which have been specifically created for AIT, and outlines actionable steps to implement AIT SDM in clinical practice.
Background: Perennial allergic rhinitis (PAR) exerts significant quality-of-life and economic bur... more Background: Perennial allergic rhinitis (PAR) exerts significant quality-of-life and economic burdens on society. Beclomethasone dipropionate (BDP) nasal aerosol is the first nonaqueous, hydrofluoroalkane-propelled intranasal corticosteroid approved for patients in the United States to treat PAR and seasonal allergic rhinitis. Objective: To evaluate real-world effectiveness of BDP nasal aerosol from the patient's perspective by using a postmarketing observational registry. Methods: Patients (N ϭ 824) from 43 U.S. study sites completed monthly patient-reported outcome instruments, including the Rhinitis Control Assessment Test (primary outcome variable),
The Journal of Allergy and Clinical Immunology: In Practice, Sep 1, 2020
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Annals of Allergy Asthma & Immunology, Nov 1, 2018
14≤ age≤ 75 years) with class I, IIa, or IIb MG according to Osserman's classification are enroll... more 14≤ age≤ 75 years) with class I, IIa, or IIb MG according to Osserman's classification are enrolled, and are blindly separated into Chinese herb group and control group. The Chinese herb group is treated with Huangqi formula and control group with placebo, treatment duration is four weeks. Muscle weakness is assessed by Chinese Score for MG (CSMG; rang 12-60; higher scores worse weakness), and QoL is assessed by the SF-36 (rang: 0-100; higher scores better QoL); Both CSMG and SF-36 are evaluated at the enrollment and after four-week treatment. Results: Analysis is based on 248 patients (male 110, 44%; age:46±18 year), of whom 125 patients randomized into the Chinese herb group and 121 finish the treatment; 123 in the control group and 120 finish the study. There is no significant difference in demographic and clinical characteristics between two groups (P> 0.05), and no difference in CSMG (Chinese herb vs control groups: 24.1±5.9 vs 23.3±6.6) and SF-36 (55.7±16.6 vs 57.7±16.5) at the baseline either. After four-week treatment, muscle weakness declined 6.4±5.0 in Chinese herb group and 1.0±3.8 in control group (P= 0.000). However, no significant changes are found in SF-36 scores between the two groups (56.7±16.1 and 57.1±15.9). ConClusions: This study proves that Chinese herb can relieve MG patients' muscle weakness, but it is not enough to improve patients' QoL in four weeks.
Clinical decision-making in hereditary angioedema (HAE) management involves a high degree of comp... more Clinical decision-making in hereditary angioedema (HAE) management involves a high degree of complexity given the number of therapeutic agents that are available and the risk for significant morbidity and potential mortality attributable to the disease. Given this complexity, there is an opportunity to develop shared decision-making (SDM) aids and/or tools that would facilitate the interactive participation of practitioners and patients in the SDM process. This article reviews the general constructs of SDM, the unmet need for SDM in HAE, and the steps necessary to create a SDM tool specific for HAE, and outlines the challenges that must be navigated to guide the establishment and widespread implementation of SDM in the management of HAE.
Allergy is a significant component in many asthma patients. Omalizumab is a monoclonal anti-immun... more Allergy is a significant component in many asthma patients. Omalizumab is a monoclonal anti-immunoglobulin E antibody for the treatment of allergic asthma. Clinical trials have shown that omalizumab treatment is associated with improved symptom control and reduced inhaled corticosteroid doses, resulting in fewer exacerbations and reduced utilization of resources. Omalizumab therapy may benefit patients who remain uncontrolled or who cannot tolerate standard therapy.
Allergy and asthma proceedings : the official journal of regional and state allergy societies
Costs for managed care organizations to process prior authorizations (PAs) for nonformulary medic... more Costs for managed care organizations to process prior authorizations (PAs) for nonformulary medications have been estimated to be dollars 20-25 per request. Costs for physicians to process these requests have not been studied extensively. A data collection tool was developed and used by physicians and nurses to document time spent on processing PAs. Data were collected over 8 weeks and 117 requests were processed. Nurses averaged 5.6 +/- 6.5 calls per day per nurse and spent an average of 17 minutes per call. Physicians averaged 1.9 +/- 1.2 calls per day averaging 5.8 +/- 5.0 minutes per call. During the study period nurses spent >40 hours on 231 calls and physicians spent >8 hours on 154 calls. Based on the hourly rate of the nurses and physicians, the total cost in this specialty practice was dollars 17.77 per PA. Of the 117 PA requests, 98.7% were approved the first time they were processed. There are substantial costs with processing PAs for nonformulary drugs on the physi...
Asthma is a very common chronic disease characterized by clinically recurrent episodes of wheezin... more Asthma is a very common chronic disease characterized by clinically recurrent episodes of wheezing, dyspnea, chest tightness, and coughing. Both genetic and environmental factors appear to play major roles in the etiology of asthma. The economic and social costs of asthma are varied and far reaching. Patients suffer a significant decline in quality of life, and managed care organizations have become increasingly aware of its impact on health care expenditures. This article explores current treatment therapies for asthma, the challenges of managing asthma effectively, and strategies for improving outcomes in patients with asthma.
The Journal of Allergy and Clinical Immunology: In Practice, 2021
What is already known about this topic? Digital technology provides an opportunity to improve and... more What is already known about this topic? Digital technology provides an opportunity to improve and individualize asthma self-management significantly across a variety of intervention types; however, the impact of different digital intervention characteristics has yet to be assessed.
Background:Telehealth use increased during the coronavirus disease 2019 (COVID-19) pandemic to pr... more Background:Telehealth use increased during the coronavirus disease 2019 (COVID-19) pandemic to provide patient care while deferring to social distancing recommendations.Objective:Health-care provider and patient surveys were conducted to assess the impact of COVID-19 on the use and perception of telehealth visits for atopic and respiratory diseases.Methods:Health-care provider (N = 200) and patient (N = 200) surveys were conducted in the United States between September and October, 2020, and January, 2021. The participants were required to have used telehealth before or after March 1, 2020, the cutoff date selected to represent the start of the COVID-19 pandemic.Results:Before the pandemic, 40% of the health-care provider participants were conducting telehealth visits, which increased to 100% after the pandemic started. The average time spent per telehealth visit with patients increased from 13 to 16 minutes. A higher percentage of family medicine physicians/pediatricians had access to most monitoring tools than allergy/dermatology specialists both before the pandemic and after the pandemic started. Practice expenses reportedly increased after the pandemic started for 42% of participants. Before the pandemic, 27% of the patient participants used telehealth, which increased to 94% after the pandemic started. Ratings of “good” or “excellent” for the overall telehealth experience by the health-care provider participants improved from 44% before to 60% after the pandemic started, and by the patient participants improved from 77% to 88%. The willingness by the health-care provider participants to recommend telehealth to colleagues improved from 73% before to 83% after the pandemic started. The willingness by the patient participants to use telehealth again dropped slightly, from 94% to 89%.Conclusion:Telehealth visits for atopic and respiratory diseases increased during the COVID-19 pandemic. Telehealth experiences were overall positive, particularly for the patients.
Background: Most U.S. patient and health care provider surveys with regard to nasal allergy treat... more Background: Most U.S. patient and health care provider surveys with regard to nasal allergy treatments were conducted before sublingual immunotherapy (SLIT)-tablets and allergy immunotherapy (AIT) shared decision-making tools were available. Objective: Patient and health care provider surveys with regard to current perceptions of nasal allergy burden, symptoms, and treatments were conducted to compare with previous surveys and provide insight into the use of SLIT-tablets and AIT shared decision-making tools. Methods: From November-December 2019, adults (N = 510) diagnosed with nasal allergies and health care providers (N = 304) who treated nasal allergies in the United States completed surveys with regard to nasal allergy management. Results: Of the patient respondents, 42% reported that their symptoms were only somewhat controlled and 48% had avoided activities because of their nasal allergies. In all, 38% were using only over-the-counter (OTC) medications for treatment, and 42%, 7...
A systemwide outcomes management plan is in the process of implementation at Dean Medical Center.... more A systemwide outcomes management plan is in the process of implementation at Dean Medical Center. Plans for data collection include a core data set of patient satisfaction, basic health, and functional and risk status along with specific clinical and clinically related functional status reported by patients and providers.
Introduction: Little is known about how patients with asthma and eczema perceive their medical ca... more Introduction: Little is known about how patients with asthma and eczema perceive their medical care and burden of disease. A survey was conducted to evaluate the perceptions among the general patient population with
Poor adherence to asthma medication and inadequate communication are critical problems in asthma ... more Poor adherence to asthma medication and inadequate communication are critical problems in asthma care in older adults. They contribute to morbidity and mortality through poor asthma control, frequent asthma exacerbations, acute care visits, and oral corticosteroid usage in this particularly vulnerable population. The objective of this chapter is to discuss evidence-based, time-efficient strategies that can be adopted by healthcare professionals (HCPs) to increase patient adherence and promote optimal asthma outcomes. Authors will use asthma management guidelines in older patients and other key publications to enhance discussion. Findings include that establishing patient-centered, collaborative care in older asthmatic adults facilitates effective patient–provider communication that likely will improve adherence, thus leading to improved asthma outcomes. One critical strategy is shared decision-making (SDM), in which the older adult patient and the HCP share relevant information, dis...
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Papers by Don Bukstein