The document summarizes several clinical trends from internal corporate newsletters, including: 1) Psychotropic polypharmacy among office-based psychiatrists has increased from 1996-2006, with the average number of medications prescribed per visit doubling. This raises concerns about potential drug interactions and unclear benefits. 2) Osteoarthritis accounts for approximately 3 lost work days annually per patient costing employers $469-520 per patient in absenteeism costs, totaling $10 billion annually in the US. 3) A study found chronic kidney disease in 42% of individuals with undiagnosed diabetes and 18% of individuals with prediabetes, indicating the need for earlier CKD screening in pre

1. Samples of articles from an internal corporate newsletter on clinical trends. Some text has
been edited to remove proprietary product information.
Polypharmacy
Office-Based Psychotropic Medication Polypharmacy a Growing Trend Nationally
Our company products can assist customers in using claims data to chart medication use
by class and patient population. Government customers may find this of relevance in
terms of payment integrity. Providers would find this relevant as a patient safey issue if
a patient is receiving prescriptions from more than one provider with poor coordination
amongst them.
Eighty percent of persons reported with depression in 2006 stated that the condition
impaired their ability to work productively. Of the 102 million diagnosed, only 39%
sought treatment. Because of the large number affected and the subsequent effect on
healthcare resources and national businesses, increasing the number of Americans with
depression who receive treatment is an important public health goal and a national
objective of Healthy People 2010.
A study analysis by the Johns Hopkins Bloomberg School of Public Health evaluated
patterns and recent trends in psychotropic polypharmacy among visits to office-based US
psychiatrists between 1996 and 2006.
On average, psychotropic drug prescriptions written per visit increased from 1 in 1996-
1997 to 2 in 2005-2006:
Written per visit 1996-1997 2005-2006
2 medications 42.6% 59.8%
3 medications 16.9% 33.2%
A significant increase in prescribing combinations of 2 or more antidepressants,
antipsychotics, sedative-hypnotics, and antidepressant-antipsychotics was seen between
the two periods. No change was seen in the prescription of mood stabilizer combinations.
This polypharmacy was seen across medical condition:
- 2 antidepressants for major depression
- 2 antipsychotics for schizophrenia
- 2 mood stabilizers
- 2 sedative-hypnotics for anxiety disorders
Because no long term efficacy data is available on these polypharmacy practices,
researchers are cautious that this trend may increase the risk of drug-drug interactions
with unclear clinical benefits shown.

2. SOURCE:
Arch Gen Psychiatry. January 2010
http://www.ncbi.nlm.nih.gov/pubmed/20048220
Clinical Condition - Arthritis
Effect of Osteoarthritis on Absenteeism Costs
[We have] done research for our Employer customers on productivity loss due to
osteoarthritis. Such research can be re-purposed for other customers.
According to the Centers for Disease Control, over 27 million Americans have
osteoarthritis (OA). Disease prevalence, health impact, and economic consequences are
expected to skyrocket over the next decades.
The cost to employers in the form of absenteeism was recently estimated by researchers
at DePuy. OA was shown to account for approximately three lost work days annually at a
cost of $469 for women and $520 for men. Ten billion dollars annually in absenteeism
costs is attributed to osteoarthritis.
SOURCE:
Journal of Occupational and Environmental Medicine. March 2010
http://www.ncbi.nlm.nih.gov/pubmed/20190656
Clinical Condition - Kidney Disease/ESRD
Potential for Early Kidney Disease in Prediabetics Found
Opportunity: Among our products offerings is a tool which can enable Employers and
Payers to identify employees and members with kidney disease risk. Other products can
assist with monitoring this targeted group to improve management of their diabetes with
a secondary goal of lowering their risk of developing kidney disease.
Diabetes is the greatest predictor of kidney disease. Diabetic patients account for the
greater percentage of the CKD burden in the U.S. Because of the direct and indirect costs
of diabetes in CKD, researchers believe there should be broader screening for kidney
disease in patients at risk for diabetes.
The University of California, San Francisco analyzed data of about 8,200 Americans
from the National Health and Nutrition Examination Survey. Based on lab tests, chronic
kidney disease (CKD) was found in:
• 42% of individuals with undiagnosed diabetes

3. • 40% of individuals with diagnosed diabetes
• 18% of individuals with prediabetes
• 11% of individuals without diabetes or prediabetes
Based on this data, approximately 13 million individuals with undiagnosed diabetes or
prediabetes already have signs of kidney damage and/or reduced kidney function. While
the study could not establish whether the CKD came before the diabetes or the other way
around, researchers say that CKD screening should be extended to prediabetics. One
suggests that it is time to consider the concept of pre-CKD, identifying patients at a very
early stage when the disease may still be preventable or reversible.
SOURCE:
Clinical Journal of the American Society of Nephrology. April 2010
http://www.ncbi.nlm.nih.gov/pubmed/20338960
Disease Management
Effectiveness of Using CHD Risk Information
Coronary heart disease (CHD) remains at the top of the list of leading causes of death in
the U.S. and other countries. Behavioral change is one approach to lowering mortality
and morbidity risks.
Researchers at the University of North Carolina Chapel Hill conducted a study to
determine the effect of providing global risk information to at-risk adults.
Repetition of risk information, especially in tandem with repeated counseling led to small
but significant CHD risk reduction.
SOURCE:
Arch Intern Med. 2010
http://www.ncbi.nlm.nih.gov/pubmed/20142567

4. Quality care and measurement
Postsurgical Pneumonia Prevention Program Effective
Pneumonia prevention is a key hospital improvement quality measure.
Pneumonia following surgery is a common occurrence, leading to extended hospital stays
and poorer patient outcomes. A strategy by the Veterans Affairs Palo Alto Health Care
System has been shown to reduce pneumonia in hospital surgical wards.
Implementation of the eight-point intervention strategy which includes cough and deep
breathing exercise, education, twice daily oral hygiene and bed elevation to at least 30
degrees began in 2007. The intervention resulted in an 81% decrease in postsurgical
pneumonia incidence between 2006 and 2008.
Extending the program across VA systems "could help improve patient care and lower
morbidity, mortality and overall healthcare costs."
SOURCE:
Journal of the American College of Surgeons. April 2010
http://www.ncbi.nlm.nih.gov/pubmed/20347742