Michael Nichol

University of Southern California, Health Policy and Management, Faculty Member

Followers

95,885

Following

Co-authors

Public Views

Chunbo Shao

Johns Hopkins University

Mehmet Akif KILIC

Sağlık Bilimleri Üniversitesi

Mamas Theodorou

Open University of Cyprus

Balasubramanian Thiagarajan

Dr MGR Educational and Research Institute University

Cemal Cingi

Eskisehir Osmangazi University, Turkey

Kenneth Pakenham

The University of Queensland, Australia

win-myint oo

AIMST University

Georgina A Phillips

University of Melbourne

Gonca Sennaroglu

Hacettepe University

Angela Martinez

University of California, Los Angeles

Interests

Uploads

Papers by Michael Nichol

Real-World Dispensing of Buprenorphine in California during Prepandemic and Pandemic Periods

Healthcare, Jan 17, 2024

Introduction: The opioid overdose crisis in the United States has become a significant national e... more Introduction: The opioid overdose crisis in the United States has become a significant national emergency. Buprenorphine, a primary medication for individuals coping with opioid use disorder (OUD), presents promising pharmacokinetic properties for use in primary care settings, and is often delivered as a take-home therapy. The COVID-19 pandemic exacerbated the scarcity of access to buprenorphine, leading to dire consequences for those with OUD. Most existing studies, primarily focused on the immediate aftermath of the COVID-19 outbreak, highlight the challenges in accessing medications for opioid use disorder (MOUDs), particularly buprenorphine. However, these studies only cover a relatively short timeframe. Methods: To bridge this research gap, in our study, we utilized 33 months of California's prescription drug monitoring program (PDMP) data to provide insights into real-world buprenorphine dispensing trends since the onset of the pandemic from 2018 to 2021, focusing on outcomes such as patient counts, prescription volumes, prescriber involvement, days' supply, and dosage. Statistical analysis employed interrupted time series analysis to measure changes in trends before and during the pandemic. Results: We found no significant impact on patient counts or prescription volumes during the pandemic, although it impeded the upward trajectory of prescriber numbers that was evident prior to the onset of the pandemic. An immediate increase in days' supply per prescription was observed post-pandemic. Conclusion: Our findings differ in comparison to previous data regarding the raw monthly count of patients and prescriptions. The analysis encompassed uninsured patients, offering a comprehensive perspective on buprenorphine prescribing in California. Our study's insights contribute to understanding the impact of COVID-19 on buprenorphine access, emphasizing the need for policy adjustments.

Download

What quantifies good primary care in the United States? A review of algorithms and metrics using real-world data

BMC Primary Care, Jun 24, 2023

Primary care physicians (PCPs) play an indispensable role in providing comprehensive care and ref... more Primary care physicians (PCPs) play an indispensable role in providing comprehensive care and referring patients for specialty care and other medical services. As the COVID-19 outbreak disrupts patient access to care, understanding the quality of primary care is critical at this unprecedented moment to support patients with complex medical needs in the primary care setting and inform policymakers to redesign our primary care system. The traditional way of collecting information from patient surveys is time-consuming and costly, and novel data collection and analysis methods are needed. In this review paper, we describe the existing algorithms and metrics that use the real-world data to qualify and quantify primary care, including the identification of an individual's likely PCP (identification of plurality provider and major provider), assessment of process quality (for example, appropriate-care-model composite measures), and continuity and regularity of care index (including the interval index, variance index and relative variance index), and highlight the strength and limitation of real world data from electronic health records (EHRs) and claims data in determining the quality of PCP care. The EHR audits facilitate assessing the quality of the workflow process and clinical appropriateness of primary care practices. With extensive and diverse records, administrative claims data can provide reliable information as it assesses primary care quality through coded information from different providers or networks. The use of EHRs and administrative claims data may be a cost-effective analytic strategy for evaluating the quality of primary care.

Download

Su1204 Predictors of Recurrence of Acute Diverticulitis in an Incident Diverticulitis Cohort

Gastroenterology, May 1, 2012

>70 years) than in younger patients (< 40 years old). (12.1% in younger patients vs. 38.3% in eld... more >70 years) than in younger patients (< 40 years old). (12.1% in younger patients vs. 38.3% in elderly patients, P< 0.05). Out of the 1,179 patients with diverticulitis, 169 (14.3%) developed an abscess, for which surgical treatments such as the drainage method or a colonic resection were required. Hospitalization and mortality rate for patients with diverticulitis with an abscess was significantly higher than those without. Risk factors for developing acute diverticulitis with abscess were left-sided diverticulitis, age > 50 years, days spent diagnosing more than 3 days, and men. (Table ). Conclusions: Diverticulitis is more common among the middle aged. However, abscesses developed more often in left-sided diverticulitis in elderly men. It is also important to make a quick diagnosis of diverticulitis to prevent its complication. Table . Risk factors for developing acute diverticulitis with abscess NOTE. CI, confidence interval

Download

PMD20 Cost-Effectiveness Analysis of a New Index for Prostate Cancer Detection

Value in Health, May 1, 2011

Download

Depression and anxiety in persons with Von Willebrand disease

Haemophilia

ObjectiveWe assessed sociodemographic and clinical characteristics associated with depression and... more ObjectiveWe assessed sociodemographic and clinical characteristics associated with depression and anxiety in individuals with Von Willebrand disease (VWD) aged ≥12 years.MethodsThe study collected data on patients’ sociodemographic, joint problems and health‐related quality of life (HRQoL) using EQ‐5D‐3L, 8‐item patient health questionnaire for depression and 7‐item Generalized Anxiety Disorder Questionnaire from participants in seven geographically diverse US haemophilia treatment centres.ResultsAnalyses included 77 participants. The rates of depression and anxiety were 63.6% and 58.3%, respectively. Persons with low VWF displayed higher rates of depression (86.7%) or anxiety (69.2%) compared to those with VWD (58.1%, p = .04 for depression, and 55.9%, p = .38 for anxiety). Logistic regression analyses demonstrated that having joint problems (odds ratio [OR] = 6.3, confidence interval [CI] = 2.0–20.1) was the most important variable associated with depression, followed by being sin...

Impact of Hemophilia a Inhibitor on Joint Health and Health-Related Quality of Life from the Hemophilia Utilization Group Studies Part VIII in the U.S

Blood, 2020

Introduction: Persons with hemophilia A (PwHA) and Factor VIII inhibitors experience significant ... more Introduction: Persons with hemophilia A (PwHA) and Factor VIII inhibitors experience significant economic burden associated with high treatment costs and compromised physical and psychosocial health. Few studies have compared burden of illness for PwHA with active inhibitors to those with tolerized or no inhibitor. We describe clinical and treatment outcomes, and health-related quality of life (HRQoL) in PwHA with and without inhibitors using the Hemophilia Utilization Group Studies Part VIII (HUGS VIII) baseline cross-sectional data. Methods: HUGS VIII prospectively examines the cost and burden of hemophilia care, including HRQoL, arthropathy, and psychosocial impact in PwHA aged ≥2 years. The study enrolled PwHA with inhibitors and without inhibitor at a 1:2 ratio. Participants were classified to three groups: 1) active inhibitor (FVIII≥1.0 Bethesda Units within six months of data extraction), 2) presumably tolerized inhibitor (history of immune tolerance induction, ITI, and using...

Download

The Kaiser Permanente/USC Patient Consultation Study: Change in use and cost of health care services

American Journal of Health-System Pharmacy, 1998

The impacts of three alternative models of pharmacist consultation on the use and cost of health ... more The impacts of three alternative models of pharmacist consultation on the use and cost of health care services were studied. Two studies were conducted concurrently in an HMO over two years. In one, 6000 patients were randomly assigned to one of three consultation models; in the other, the three models were implemented in six geographic regions of California (4600 patients). The models were (1) consultation about new or changed prescriptions as mandated by state law (state model), (2) consultation focused on selected high-risk ambulatory care patients (Kaiser Permanente [KP] model), and (3) a control model. The patients were surveyed three times about their health status and satisfaction, and computerized data on health care use and cost were collected. The effect of the consultation models on the use and cost of health care services was examined across five risk groups that were based on drug-use profiles. An additional 37,750 patients (10% of the patients residing in the areawide study sites) were included in a supplemental analysis of the use and cost of health care services. There was no indication in the random-assignment study that pharmacist consultations affected either drug costs or the cost of office visits. Similar results were found in the areawide study, with the exception that the KP model was associated with lower drug costs than the control model. In the 10% sample, the KP model appeared to be associated with lower office visit costs but higher drug costs. Both models were associated with a lower likelihood of a hospital admission and with lower total health care costs for some high-risk patients compared with the control model. Counseling patients about their medications may be unlikely to reduce medication costs or the cost of office visits but may reduce the likelihood of hospital admissions and the overall costs of health care services; a combination of counseling patients at high risk for drug-related problems and counseling all patients about any new or changed prescription should be considered.

Is pharmacy’s vision of the future too narrow?

American Journal of Health-System Pharmacy, 1995

Real-world study of low-density lipoprotein cholesterol levels and cardiovascular outcomes in Chinese: A retrospective cohort study in post-percutaneous coronary intervention acute coronary syndrome patients

International journal of cardiology, Jan 15, 2017

This study aimed to assess the effect of low-density lipoprotein cholesterol (LDL-C) goal attainm... more This study aimed to assess the effect of low-density lipoprotein cholesterol (LDL-C) goal attainments (of <2.6mmol/L and <1.8mmol/L) on first major adverse cardiovascular events (MACEs) for acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI). A retrospective cohort study was conducted using case reviews of post-PCI ACS patients at an acute public hospital in Hong Kong between January 2009 and August 2015. Patients were followed from the date of PCI procedure until the first documented MACE (including all-cause death, myocardial infarction, heart failure, documented unstable angina, revascularization, and stroke) or to the end of the first year. Kaplan-Meier estimates were used to evaluate the impact of LDL-C goal attainments prior to the event on event-free time. A total of 1684 patients were identified (79.0% males). At one-year endpoint, 658 (39.1%) attained the LDL-C goal of <1.8mmol/L, 727 (43.2%) had the LDL-C level between 1.8...

Download

Young adults with hemophilia in the U.S.: demographics, comorbidities, and health status

American journal of hematology, 2015

Improvements in hemophilia care over the last several decades might lead to expectations of a nea... more Improvements in hemophilia care over the last several decades might lead to expectations of a near-normal quality of life for young adults with hemophilia. However, few published reports specifically examine health status indicators in this population. To remedy this knowledge gap, we examined the impact of hemophilia on physical and social functioning and quality of life among a national US cohort of 141 young men with hemophilia aged 18-34 years of age who received care at 10 geographically diverse, federally funded hemophilia treatment centers in 11 states between 2005 and 2013 and enrolled in the Hemophilia Utilization Group Studies. Indicators studied included educational achievement, employment status, insurance, health-related quality of life, and prevalence of the following comorbidities: pain, range of motion limitation, overweight/obesity, and viral status. The cohort was analyzed to compare those aged 18-24 to those aged 25-34 years. When compared to the general US adult ...

Medicare Part D and the challenge of a dynamic marketplace

Managed care interface, 2006

Eligibility, utilization, and costs in a California Medicaid lupus population

Arthritis Care & Research, 2004

ObjectiveTo investigate whether ethnicity was associated with differences in Medicaid eligibility... more ObjectiveTo investigate whether ethnicity was associated with differences in Medicaid eligibility, health care utilization, and direct medical costs in a systemic lupus erythematosus (SLE) population.MethodsA retrospective analysis of California Medicaid claims data was conducted on patients with SLE. Patient eligibility and month‐by‐month utilization and costs were computed and compared across ethnic groups. Descriptive statistics are presented. A mixed regression model on patient‐level data was used to verify the trends of the aggregate data, controlling for covariates. A survival regression model on time to ineligibility was used to show eligibility patterns adjusted for covariates.ResultsHispanic patients were less likely to have a lengthy eligibility period as compared with other cohorts (∼50% versus 70% eligible at month 36, respectively). As treatment progressed, Hispanics generated lower total costs than other cohorts. Results for inpatient frequency, prescription costs, and...

PCV109 Therapy Interruptions in Patients Switched from Branded to Other Generic Statins

Value in Health, 2009

patients undergoing CPR and by those left untreated through spent opportunity costs. This serves ... more patients undergoing CPR and by those left untreated through spent opportunity costs. This serves as a reminder that the technological imperative -because existing technology means that something can be done, then this action ought to be done -must be thoughtfully considered by those undertaking health technology assessments.

Download

PMH6 Economic Outcomes of Antidepressant Use in A Managed Care Organization

Value in Health, 1998

Download

Public Members on Occupational Licensing Boards: Effects on Legislative Regulatory Reforms

Southern Economic Journal, 1989

Those concerned with the effects of occupational regulation have long argued the need for greater... more

Adalimumab for Rheumatoid Arthritis

Disease Management & Health Outcomes, 2004

Third-party payors and national health systems require evidence that new medications for rheumato... more Third-party payors and national health systems require evidence that new medications for rheumatoid arthritis are cost effective. To determine cost effectiveness, one must consider the cost of a given therapy versus the long-term cost of the disease, with and without therapy. The direct and indirect costs of rheumatoid arthritis over the course of the disease, including the considerable costs related

Cost‐effectiveness of Prostate Health Index for prostate cancer detection

BJU International, 2011

Study Type – Diagnostic (cost effectiveness)Level of Evidence 2bWhat's known on the subject? ... more Study Type – Diagnostic (cost effectiveness)Level of Evidence 2bWhat's known on the subject? and What does the study add?The Beckman Coulter prostate health index (phi) was developed as a combination of serum prostate specific antigen (PSA), free PSA and a PSA precursor form [−2]proPSA to calculate the probability of prostate cancer and was used as an aid in distinguishing prostate cancer from benign prostatic conditions for men with PSA test 2–10 ng/mL and non‐suspicious digital rectal examination. Phi has been shown to improve diagnostic accuracy in prostate cancer detection compared with total and free PSA. An earlier 1‐year budget impact analysis revealed it to be a complementary approach to current prostate cancer screening strategies.The current study evaluated the cost‐effectiveness of early prostate cancer detection with phi in combination with a PSA test compared with a PSA test alone from the US societal perspective. The model with over 25 annual screening cycles for m...

Download

Medication Adherence and Associated Hemoglobin A1cin Type 2 Diabetes

Annals of Pharmacotherapy, 2004

BACKGROUND:Tight blood glucose control has been correlated with a reduction in diabetes complicat... more BACKGROUND:Tight blood glucose control has been correlated with a reduction in diabetes complications. Adherence to antidiabetic medications is crucial to achieving blood glucose control.OBJECTIVE:To assess the relationship between good glucose control [glycosylated hemoglobin (HbA1c) levels] and adherence to prescribed treatment in patients on a stable medication regimen for type 2 diabetes.METHODS:The Morisky survey, a 4–item questionnaire that predicts patient medication-taking behavior, was used to assess adherence in 301 patients. The relationship of HbA1cto Morisky score was evaluated, controlling for other variables related to patient demographics and clinical characteristics. Data were analyzed using a general linear model on log (HbA1c).RESULTS:Unadjusted mean HbA1cvalues (capped at 14.0%) for patients with Morisky scores of 0 or 1, 2, 3, and 4 were 8.92%, 8.67%, 7.74%, and 7.60%, respectively. Of all patients, 13.0%, 14.0%, 24.3%, and 48.8% had scores of 0 or 1, 2, 3, and ...

Medication Use in Residential Care Facilities for the Elderly

Annals of Pharmacotherapy, 1999

OBJECTIVE: To describe medication use by residents of residential care facilities for the elderly... more OBJECTIVE: To describe medication use by residents of residential care facilities for the elderly (RCFEs). DESIGN: A cross-sectional survey of medication use. SETTING: Licensed, private RCFEs recruited from a roster of all licensed RCFEs in the Los Angeles area. SUBJECTS: Residents who were ≥60 years of age and whose medications were centrally stored in the facility. MEASURES: Age, gender, race, health insurance coverage, dietary restrictions, ambulation status, medical diagnoses, and medication profile. RESULTS: A total of 818 residents were surveyed. Residents were primarily white women who were >80 years. The average number of medications per resident was five; 94% of the sample took at least one medication. Cardiovascular drugs, central nervous system drugs, analgesics, diuretics, and potassium supplements were most commonly used. Use of multiple drugs within a therapeutic class was also common, with means ranging from 1.46 to 1.81 per resident for the most commonly prescribe...

A Critical Evaluation of the Methodology of the Literature on Medication Compliance

Annals of Pharmacotherapy, 1999

OBJECTIVE:To develop a simple evaluation tool to assess methodologic rigor of the literature on p... more OBJECTIVE:To develop a simple evaluation tool to assess methodologic rigor of the literature on patient compliance with medications, and to apply the tool to a sample of the literature.METHODS:A computerized search of the MEDLINE database (January 1980–December 1996) was performed. All English-language articles on compliance with medications were identified, using the MeSH terms patient-compliance and drug-therapy. A 10% sample was then randomly selected for review. Methodologic rigor was assessed on eight standards: study design, specification of patient sample, power analysis, specification of disease, specification of therapeutic regimen, duration of follow-up, definition of compliance, and compliance measurement. The raw scores of the eight standards were then combined in three summary scores, standardized from 0 to 100: study design, disease-related features, and compliance issues.RESULTS:Seventy-two articles from 719 identified were reviewed. The majority of the research artic...

Michael Nichol

Related Authors

Uploads

Papers by Michael Nichol

Log In