Publications by authors named "Inmaculada Hernandez"
Background: Heart failure (HF) readmission rates vary across geographic regions in the United States, yet the impact of external exposome factors, such as contextual-level social determinants of health (SDoH), on adverse HF outcomes is not well understood.
Objective: This study aims to examine the association between external exposome factors and the risk of HF readmission and all-cause mortality using a data-driven approach.
Methods: We conducted a retrospective cohort study using electronic health record (EHR) data from the OneFlorida+ Network, including patients hospitalized for HF (HHF) from 2016 to 2022.
Background: Previous analyses measuring geographic access to community pharmacies (pharmacy access) have relied solely on driving distance or time, without considering other modes of transportation such as walking and public transportation. This omission represents an important limitation, particularly in metropolitan areas where other transportation modes are regularly used, which potentially can lead to the underestimation of inequities in pharmacy access.
Objectives: To investigate whether measuring pharmacy access based on driving underestimates inequities in access, given the fact that not everyone has access to a vehicle.
Since 2021, hospitals have been required to report the prices of common, shoppable services, including drugs, as per the Hospital Price Transparency Rule. In this paper, we used Hospital Price Transparency data aggregated by Turquoise Health to investigate the usability of price transparency data to evaluate variation in reimbursement for provider-administered drugs. We extracted records for 30 procedure codes corresponding to provider-administered drugs reported by at least 1,000 National Provider Identifiers (NPIs) and evaluated variability in rates reported for each procedure code.
View Article and Find Full Text PDFImportance: Community pharmacies are crucial for public health, providing essential services such as medication dispensing, vaccinations, and point-of-care testing. Addressing disparities in pharmacy access, particularly in underserved rural and low-income areas, is critical for health equity.
Objective: To identify areas in the US at risk of becoming pharmacy deserts through the development of a novel pharmacy vulnerability index.
Aims: To characterize trends in the initiation of newer anti-obesity medications (AOMs) and determine factors associated with their use among obese/overweight populations.
Materials And Methods: This study utilized electronic health record data from OneFlorida+ (2015-2024). Adults eligible for AOMs were included, defined as having a body mass index (BMI) ≥30 kg/m or a BMI of 27-29.
Aims: To characterize trends in the initiation of newer anti-obesity medications (AOMs) and determine factors associated with their use among obese/overweight populations.
Materials And Methods: This retrospective study utilized electronic health record data from OneFlorida+ (2015-2024). Adults eligible for AOMs were included, defined as having a BMI ≥30 kg/m² or a BMI of 27-29.
Use of Potentially Nephrotoxic Drugs in Type 2 Diabetes Patients on SGLT2i: A Trajectories Analysis.
Pharmacoepidemiol Drug Saf
February 2025
Purpose: To characterize trajectories of nephrotoxic potential (NxP) drug use among older adults with Type 2 Diabetes (T2D) treated with SGLT2is and identify associated patient characteristics.
Methods: Using 2012-2019 Medicare data, we selected patients with T2D who filled at least one prescription for SGLT2is. Index date was the date of the first SGLT2i prescription filled.
Mortality predictors and definition proposal for complicated coagulase-negative Staphylococcus bacteraemia: a multicentre prospective cohort study.
Clin Microbiol Infect
April 2025
Objectives: The study aimed to explore a definition for complicated coagulase-negative staphylococci bloodstream infections (CoNS BSIs) and to identify predictors for mortality.
Methods: A prospective cohort study was conducted from October 2016 to March 2017 in 26 Spanish hospitals. Complicated CoNS BSI criteria included lack of early catheter removal in catheter-related cases, foreign indwelling implant, persistent bacteraemia, fever ≥72 hours on active therapy, metastatic infection or deep-seated focus, and infective endocarditis.
Fear of missing out: Drug availability in the United States vs Canada.
J Manag Care Spec Pharm
December 2024
Background: Per capita spending on drugs in the United States is double that of Canada. One commonly debated point when comparing the 2 countries is whether this additional spending allows residents of the United States access to valuable therapies not available in Canada.
Objective: To characterize the therapeutic value of prescription drugs used in the United States that are not marketed in Canada.
Article Synopsis
- Drug shortages, worsened by the COVID-19 pandemic, remain a significant public health concern, with both the US and Canada having shared regulatory standards for reporting supply chain issues that could lead to these shortages.
- The study aimed to compare the frequency of drug-related supply chain issues reported in the US and Canada that were linked to actual drug shortages, using a longitudinal analysis of data from 2017 to 2021.
- Results indicated that 49.0% of supply chain issue reports in the US were correlated with drug shortages, whereas only 34.0% were linked to shortages in Canada, highlighting potential differences in the impact of these issues between the two countries.
Background & Aims: Patients with acutely decompensated (AD) cirrhosis are immunocompromised and particularly susceptible to infections. This study investigated the immunomodulatory actions of albumin by which this protein may lower the incidence of infections.
Methods: Blood immunophenotyping was performed in 11 patients with AD cirrhosis and 10 healthy volunteers (HV).
Article Synopsis
- - Viremic non-progressors (VNPs) are a rare group of HIV-1 individuals who maintain normal CD4 T cell counts despite high viral loads, resembling natural hosts of simian immunodeficiency virus, but the reasons for this are not fully understood.
- - A study using single-cell and multiomics methods examined 16 VNPs and 29 HIV+ progressors, revealing genetic factors like CCR5Δ32 heterozygosity and lower CCR5 expression, alongside reduced intestinal disruption and immune responses in VNPs.
- - The research highlights various traits contributing to the immune stability in VNPs, indicating important insights for potential HIV treatment strategies in the future.
Drugs anticipated to be selected for the Medicare Drug Price Negotiation Program in 2025.
J Manag Care Spec Pharm
November 2024
Background: The Centers for Medicare and Medicaid Services (CMS) recently announced the Maximum Fair Price for the first 10 Medicare Part D drugs selected for price negotiation. By February 2025, CMS should announce the list of Part D drugs to be negotiated with implementation of the negotiated prices in 2027.
Objective: To identify up to 15 Medicare Part D single-source drugs anticipated to be selected by CMS for price negotiation in 2025.
Background: Antihypertensive medication use patterns have likely been influenced by changing costs and accessibility over the past 3 decades. This study examines the relationships between patent exclusivity loss, medication costs, and national health policies on antihypertensive medication use.
Methods: Using 1996 to 2021 Medical Expenditure Panel Survey data of US adults with hypertension taking at least 1 antihypertensive medication, we conducted a cross-sectional analysis.
Article Synopsis
- By September 2024, the Centers for Medicare and Medicaid Services (CMS) will disclose the Maximum Fair Prices for the first 10 drugs involved in price negotiation, using various pricing benchmarks and effectiveness data.
- The study analyzed net prices and therapeutic alternatives to estimate initial price offers, considering regulatory guidelines and available clinical effectiveness data.
- Initial price offers will likely be influenced by statutory price ceilings and net prices, with generics prompting potential discounts, while some drugs may need stronger negotiation strategies due to similar pricing among alternatives.
The Cost of Inflammatory Bowel Disease Care: How to Make it Sustainable.
Clin Gastroenterol Hepatol
February 2025
Article Synopsis
- - The rising rates of inflammatory bowel diseases (IBDs) like Crohn's and ulcerative colitis are leading to significant healthcare costs ranging from $9,000 to $12,000 per year in wealthy areas, but this doesn't fully capture factors like disease severity and regional healthcare differences.
- - Indirect costs from lost productivity due to IBD are substantial yet often underestimated, and challenges such as access disparities and lack of standardized care guidelines complicate efforts to manage costs effectively.
- - To make IBD care sustainable, strategies like using biologic therapies early, increasing access to biosimilars, and implementing multidisciplinary care teams with a focus on technology and patient feedback are essential for improving outcomes and reducing financial burdens.
COVID-19 Diagnosis, Oral Anticoagulation, and Stroke Risk in Patients with Atrial Fibrillation.
Am J Cardiovasc Drugs
September 2024
Article Synopsis
- - The study examined the relationship between COVID-19 infection, oral anticoagulation (OAC) use, and stroke risk in patients with atrial fibrillation (AF) using a large database of patient records.
- - Results showed that while OAC use reduced the overall risk of stroke, COVID-19 infection significantly increased stroke risk, especially for patients hospitalized with the virus.
- - Importantly, the increased stroke risk from COVID-19 was similar for patients whether or not they were on OAC, indicating that OAC use did not alter the risk associated with COVID-19.
Article Synopsis
- Sacubitril/valsartan (ARNi) improves heart failure outcomes, but adherence patterns in real-world settings are not well understood.
- The study analyzed adherence trajectories of HF patients on ARNi between 2015 and 2018, identifying five distinct adherence patterns, with over half of patients not consistently adhering to treatment.
- Factors such as living in socioeconomically disadvantaged areas and being Black were linked to lower adherence, while prescriptions from cardiologists increased adherence likelihood.
Introduction: Bumetanide, a loop diuretic, was identified as a candidate drug for repurposing for Alzheimer's disease (AD) based on its effects on transcriptomic apolipoprotein E signatures. Cross-sectional analyses of electronic health records suggest that bumetanide is associated with decreased prevalence of AD; however, temporality between bumetanide exposure and AD development has not been established.
Methods: We evaluated Medicare claims data using Cox proportional hazards regression to evaluate the association between time-dependent use of bumetanide and time to first AD diagnosis while controlling for patient characteristics.
Cheaper is not always better: Drug shortages in the United States and a value-based solution to alleviate them.
J Manag Care Spec Pharm
July 2024
Drug shortages threaten patients' access to medications and are associated with adverse health outcomes and increased costs. Drug shortages disproportionately occur among generic drugs of limited profitability, most notably drugs administered by injection. In this perspective, we discuss how reimbursement and purchasing practices that were meant to create an efficient marketplace for generics have generated strong price pressure that threatens profitability in certain markets.
View Article and Find Full Text PDFPrice benchmarks of drugs selected for Medicare price negotiation and their therapeutic alternatives.
J Manag Care Spec Pharm
August 2024
Background: The Centers for Medicare and Medicaid Services (CMS) are currently negotiating prices with pharmaceutical manufacturers for the first 10 Part D drugs selected for Medicare drug price negotiation. Non-publicly available data, including the net prices of selected drugs and their therapeutic alternatives, will play a central role in the determination of the maximum fair prices (MFPs).
Objective: To estimate price benchmarks involved in the derivation of the starting point of the CMS initial price offer for the 10 drugs selected for Medicare price negotiation.