Jun Wu

Older patients with Alzheimer’s disease and related dementias (ADRD) face high rates of unplanned hospital readmissions, many of which may be avoidab

Obesity affects approximately 40% of U.S. adults and is associated with increased cardiometabolic risk. While lifestyle interventions remain fundamental, pharmacologic therapies such as Semaglutide and tirzepatide have demonstrated significant weight reduction in clinical trials when titrated to maintenance doses. However, real-world adherence to recommended titration schedules remains unclear. This retrospective observational study evaluated adults prescribed Semaglutide (Wegovy^®) or Tirzepatide (Zepbound^®) for weight management between January 2021 and April 2025 through ICUBAcares, a pharmacist-led call center. Primary outcomes included the proportion of patients reaching the recommended maintenance dose and time required to do so. Secondary outcomes examined prescriber specialty patterns and monthly plan costs for non-optimized dosing. Among 739 medication courses, 52.9% of Semaglutide users reached the 2.4 mg dose versus 77.6% of tirzepatide users reaching 15 mg (p < 0.001). Median time to maintenance was significantly shorter for tirzepatide (32 days) than Semaglutide (143 days) (p < 0.001). Endocrinologists had the highest success rate for Tirzepatide (88.2%), while family medicine had the highest volume for both. Non-optimized dosing was associated with higher estimated monthly plan costs. These findings underscore the importance of improving adherence to titration protocols in real-world settings to maximize both clinical and economic outcomes in obesity pharmacotherapy.

Background Managing multiple chronic conditions (MCC) requires complex oversight. A usual source of care (USC) is pivotal in navigating complex care and coordination and enhancing self-management. However, the knowledge about access and quality of USC and associated disparities is limited in US adults with MCC. Objectives To examine access and perceived quality of USC and identify sociodemographic disparities in US adults with MCC. Design This is a cross-sectional study using US Medical Expenditure Panel Survey (MEPS) data. Participants This study used 2019 and 2021 MEPS Household Component data to identify US adults reporting two or more chronic conditions. Main Measures The outcomes included characteristics, accessibility, and perceived quality of USC. Quality of care was measured by asking respondents if their provider asked about treatments given by other providers and involved them in treatment decision-making. Logistic regression was used to identify sociodemographic disparities in access and perceived quality of USC. Person-level weights were applied to statistical analysis to obtain national estimates. Key Results The study sample included 9471 eligible US adults with MCC, of which 91.6% reported having a USC, representing 44.9 million US individuals. Respondents who were older (≥ 65 years), married, non-Hispanic White, insured, or Midwestern were more likely to have a USC. Family physicians accounted for 63.5% of reported USC providers. Nearly 43% of respondents indicated difficulty accessing providers after hours. Over 20% of the respondents reported that their providers did not ask about treatments from other doctors or consistently involve them in treatment decision-making. Younger (< 65 years), married, non-Hispanic White, or more educated respondents were more likely to be asked about treatments from other doctors or consistently involved in treatment decision-making. Conclusion Most US adults with MCC reported having a USC. However, sociodemographic disparities exist in having access to a USC and the quality of care.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer cardiorenal benefits in diabetes management. Since 2020, public awareness of GLP-1 RAs for diabetes, weight loss, and the prevention of cardiovascular disease has led to a surge in their utilization. However, the high cost of GLP-1 RAs and limitations in insurance coverage have been considered significant barriers to access. Current knowledge regarding how GLP-1 RA use affects total health care costs in diabetes care after 2020 in the United States remains limited. Consequently, further research is needed to examine the financial burden of GLP-1 RA use on patients and payers, as well as its overall impact on total health care costs at the national level. To examine GLP-1 RA utilization and association with health care costs among US adults with type 2 diabetes. Using data from the 2021-2022 Medical Expenditure Panel Survey, the study sample included individuals (aged ≥18 years) with a diagnosis of type 2 diabetes. Outcomes included GLP-1 RA use and all-cause and diabetes-related health care costs, including medical and prescription drug costs paid by patients and insurers. Generalized linear regression with a log link and gamma distribution was used to assess the effect of GLP-1 RA use on health care costs, adjusting for sociodemographic and health-related characteristics. Among 3,587 eligible adults with type 2 diabetes, 637 (18.8%) used GLP-1 RAs, representing an estimated 3.66 million US adults-a marked increase compared with pre-2020 estimates of less than 10%. Fewer older adults (aged ≥65 years) used GLP-1 RAs (35.1%) compared with adults aged 45-64 years (50.6%). The average annual per-person cost of GLP-1 RA was $6,947. Although insurance covered more than 95% of GLP-1 RA cost, these medications represented a substantial proportion of diabetes care costs: 63.3% of antidiabetic drug costs and 55.7% of total diabetes-related costs among GLP-1 RA users. After adjustment, GLP-1 RA use was associated with a 219% increase in diabetes-related costs and a 55.3% increase in total all-cause health care costs. GLP-1 RA utilization among US adults with type 2 diabetes has substantially increased, with use in 2021-2022 nearly double that of the period prior to 2020. The higher health care costs associated with taking GLP-1 RAs were largely attributable to high drug costs, of which over 95% were covered by insurance.

Background Multiple chronic conditions (MCC) require complex patient-centered approaches with effective provider-patient communication. Objective To describe trends in patient perceptions of provider-patient communication during non-emergency care and identify associated racial disparities in US older adults with MCC. Design, Setting, Participants Observational study using pooled US Medical Expenditure Panel Survey (2013–2019) data included adults > 65 with two or more chronic conditions. Main Measures Provider-patient communication was measured by four indicators (how often their doctor explained things clearly, listened carefully, showed respect, and spent enough time with them). The primary outcomes were the annual rates of reporting “always” for the communication indicators. Cochran-Armitage trend tests examined the trends of reporting “always” and associated racial disparities. Multivariable logistic regression identified racial and other factors associated with respondents choosing “always” for one or more categories for provider-patient communication, defined as positive communication. Results Among 9758 older adults with MCC, declining trends for positive communication were shown across all provider-patient communication categories during 2013 to 2019 (ppp<0.001). Older adults from Hispanic or Non-Hispanic Black racial backgrounds were 28 to 51% more likely to report “always” for the four indicators of provider-patient communication than non-Hispanic Whites after adjusting for respondents’ characteristics. Conclusion The rates of “always” reporting positive communication with providers significantly declined from 2013 to 2019 in older adults with MCC, particularly in non-Hispanic Whites. Hispanics and non-Hispanic Blacks were more likely to report positive communication with providers than other races.

Objective: The purpose of this study is to examine the association between delivery of healthcare provider’s advice about lifestyle management and lifestyle behavioural change in pre-diabetes management in adults who were overweight or obese.Design: This cross-sectional study included adults with body mass index (BMI) ≥25 kg/m² and reporting pre-diabetes in USA. Outcomes included the prevalence of receiving provider’s advice on lifestyle management and patterns of practicing lifestyle change. The association between delivery of provider’s advice and lifestyle-related behavioural change in pre-diabetes management was examined.Setting: US Continuous National Health and Nutrition Examination Survey (2013–2018).Participants: A total of 1039 adults with BMI ≥25 kg/m² reported pre-diabetes.Results: Of eligible adults with pre-diabetes, 76.8% received provider’s advice about lifestyle change. The advice group showed higher proportions of ongoing lifestyle change than no advice group, including weight reduction/control (80.1% vs 70.9%, p=0.018), exercise (70.9% vs 60.9%, p=0.013) and diet modifications (83.8% vs 61.8%, p<0.001). After adjustment, those receiving provider’s advice were more likely to increase exercise (OR 1.63, 95% CI 1.12 to 2.38) and modify diet (OR 3.0, 95% CI 1.82 to 4.96).Conclusion: Over 75% of US adults who were overweight or obese and reported pre-diabetes received healthcare provider’s advice about reducing the risk of diabetes through lifestyle change. Provider’s advice increased the likelihood of lifestyle-related behavioural change to exercise and diet.

Background and objectives: Heat shock protein 90 (Hsp90) is a molecular chaperone that plays an essential role in tumor growth. Numerous Hsp90 inhibitors have been discovered and tested in preclinical and clinical trials. Recently, several preclinical studies have demonstrated that Hsp90 inhibitors could modulate pain sensitization. However, no studies have evaluated the impact of Hsp90 inhibitors on pain in the patients. This study aims to summarize the pain events reported in clinical trials assessing Hsp90 inhibitors and to determine the effect of Hsp90 inhibitors on pain in patients. Materials and Methods: We searched PubMed, EBSCOhost, and clinicaltrials.gov for Hsp90 inhibitor clinical trials. The pain-related adverse events were summarized. Meta-analysis was performed using the data reported in randomized controlled trials. Results: We identified 90 clinical trials that reported pain as an adverse effect, including 5 randomized controlled trials. The most common types of pain reported in all trials included headache, abdominal pain, and back pain. The meta-analysis showed that Hsp90 inhibitors increased the risk of abdominal pain significantly and appeared to increase the risk for back pain. Conclusions: In conclusion, Hsp90 inhibitor treatment could potentially increase the risk of pain. However, the meta-analysis demonstrated only moderate evidence for the connection between Hsp90 inhibitor and pain.

The aim was to evaluate the risk of cardiovascular-specific hospitalizations with different types of antihypertensive triple combination therapy among patients enrolled in a Medicare Advantage Plan (MAP).

Background: Cancer increases the risk of developing one or more chronic conditions, yet little research describes the associations between health care costs, utilization patterns, and chronic conditions in adults with cancer. The objective of this study was to examine the treated prevalence of chronic conditions and the association between chronic conditions and health care expenses in US adults with cancer. Methods: This retrospective observational study used US Medical Expenditure Panel Survey (MEPS) Household Component (2010–2015) data sampling adults diagnosed with cancer and one or more of 18 select chronic conditions. The measures used were treated prevalence of chronic conditions, and total and chronic condition-specific health expenses (per-person, per-year). Generalized linear models assessed chronic condition-specific expenses in adults with cancer vs. without cancer and the association of chronic conditions on total health expenses in adults with cancer, respectively, by controlling for demographic and health characteristics. Accounting for the complex survey design in MEPS, all data analyses and statistical procedures applied longitudinal weights for national estimates. Results: Among 3657 eligible adults with cancer, 83.9% (n = 3040; representing 16 million US individuals per-year) had at least one chronic condition, and 29.7% reported four or more conditions. Among those with cancer, hypertension (59.7%), hyperlipidemia (53.6%), arthritis (25.6%), diabetes (22.2%), and coronary artery disease (18.2%) were the five most prevalent chronic conditions. Chronic conditions accounted for 30% of total health expenses. Total health expenses were $6388 higher for those with chronic conditions vs. those without (p < 0.001). Health expenses associated with chronic conditions increased by 34% in adults with cancer vs. those without cancer after adjustment. Conclusions: In US adults with cancer, the treated prevalence of common chronic conditions was high and health expenses associated with chronic conditions were higher than those without cancer. A holistic treatment plan is needed to improve cost outcomes.