1
|
Peppard W, Sheldon H, Endrizzi S, Walker R, Kirchen G, Schrang A, Nagavally S, Egede L. Racial Equity in Opioid Prescribing: A
Pharmacist‐Led
Multidisciplinary Health System Assessment. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- William Peppard
- Froedtert & the Medical College of Wisconsin, Froedtert Hospital Milwaukee Wisconsin
| | - Holly Sheldon
- Froedtert & the Medical College of Wisconsin, Froedtert Hospital Milwaukee Wisconsin
| | - Sarah Endrizzi
- Froedtert & the Medical College of Wisconsin, Froedtert Hospital Milwaukee Wisconsin
| | | | - Gwynne Kirchen
- Froedtert & the Medical College of Wisconsin, Froedtert Hospital Milwaukee Wisconsin
| | - Alexis Schrang
- Froedtert & the Medical College of Wisconsin, Froedtert Hospital Milwaukee Wisconsin
| | | | | |
Collapse
|
2
|
Wagner JA, Bermudez-Millan A, Berthold SM, Buckley T, Buxton OM, Feinn R, Kuoch T, Kong S, Lim M, Polomoff C, Scully M. Risk factors for drug therapy problems among Cambodian Americans with complex needs: a cross-sectional, observational study. Health Psychol Behav Med 2022; 10:145-159. [PMID: 35087696 PMCID: PMC8788352 DOI: 10.1080/21642850.2021.2021917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Pharmaceutical drug therapy problems (DTPs) are a major public health problem. We examined patient-level risk factors for DTPs among Cambodian Americans. Methods Community health workers (CHWs) verbally administered surveys and completed a detailed medication review form with participants. A doctoral-level pharmacist reviewed the form with the patient and CHW to determine DTP number and type (appropriateness, effectiveness, safety, and adherence). Results Participants (n = 63) averaged 55 years old, 6 years of education, 52% were married, 87% spoke Khmer at home, with modal household income <$20,000 (41%). The percentage of participants with DTPs was: 45% appropriateness, 25% effectiveness, 64% safety, and 30% adherence, averaging 3.7 DTPs per patient. In multiple regressions, patient characteristics uniquely predicted each type of DTP. In a multiple regression controlling for number of medications, being married reduced total DTPs (IRR = 0.70) and being depressed increased total DTPs (IRR = 1.26). Conclusions Vulnerable patients should be prioritized for pharmacist/CHW teams to identify DTPs. Trial registration:ClinicalTrials.gov identifier: NCT02502929.
Collapse
Affiliation(s)
- Julie A. Wagner
- Behavioral Sciences and Community Health, University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | - Angela Bermudez-Millan
- Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | | | - Thomas Buckley
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Orfeu M. Buxton
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Richard Feinn
- Department of Medical Sciences, Quinnipiac University School of Medicine, Hamden, CT, USA
| | | | - Sengly Kong
- Khmer Health Advocates, West Hartford, CT, USA
| | - Mackenzie Lim
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Christina Polomoff
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Mary Scully
- Khmer Health Advocates, West Hartford, CT, USA
| |
Collapse
|
3
|
Sanders M, Bringley K, Thomas M, Boyd M, Farah S, Fiscella K. Promoting MedlinePlus utilization in a federally qualified health center using a multimodal approach. J Med Libr Assoc 2018; 106:361-369. [PMID: 29962914 PMCID: PMC6013131 DOI: 10.5195/jmla.2018.216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 12/01/2017] [Indexed: 11/25/2022] Open
Abstract
Background Most patients want more health information than their clinicians provide during office visits. Written information can complement information that is provided verbally, yet most primary care practices, including federally qualified health centers, have not implemented systematic programs to ensure that patients receive understandable, relevant, and accurate health information at the point of care. MedlinePlus in particular is underutilized. Case Presentation The authors conducted a multimodal intervention to promote the use of MedlinePlus at a federally qualified health center. We provided MedlinePlus training to clinicians and patients through group and one-on-one trainings and multimedia promotion. We administered pre- and post-intervention surveys to patients, clinicians, and nurses to assess changes in the use and recognition of MedlinePlus at the point of care. We used quantitative and qualitative data to understand the impact of the intervention. A National Library of Medicine grant provided resources that supported equipment and staff. Group training improved use of MedlinePlus by clinicians and staff. One-on-one training was most effective for patients, particularly when it was integrated into the work-flow. Conclusions A multimodal approach can promote use of MedlinePlus among community health center patients. However, the process is labor- and resource-intensive and requires careful attention to work flow and leveraging of brief opportunities.
Collapse
Affiliation(s)
- Mechelle Sanders
- Department of Family Medicine Research Programs and Department of Public Health Sciences, University of Rochester, 1381 South Avenue, Rochester, NY 14620
| | - Kate Bringley
- Woodward Health Center, Anthony L. Jordan Health Center, 480 Genesee Street, Rochester, NY 14611
| | - Marie Thomas
- Department of Family Medicine Research Programs, University of Rochester, 1381 South Avenue, Rochester, NY 14620
| | - Michele Boyd
- Department of Family Medicine Research Programs, University of Rochester, 1381 South Avenue, Rochester, NY 14620
| | - Subrina Farah
- Department of Family Medicine Research Programs, University of Rochester, 1381 South Avenue, Rochester, NY 14620
| | - Kevin Fiscella
- Department of Family Medicine Research Programs and Department of Public Health Sciences, University of Rochester, 1381 South Avenue, Rochester, NY 14620
| |
Collapse
|
4
|
Figueroa JF, Zheng J, Orav EJ, Jha AK. Across US Hospitals, Black Patients Report Comparable Or Better Experiences Than White Patients. Health Aff (Millwood) 2016; 35:1391-8. [PMID: 27503962 PMCID: PMC5561548 DOI: 10.1377/hlthaff.2015.1426] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patient-reported experience is a critical part of measuring health care quality. There are limited data on racial differences in patient experience. Using patient-level data for 2009-10 from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), we compared blacks' and whites' responses on measures of overall hospital rating, communication, clinical processes, and hospital environment. In unadjusted results, there were no substantive differences between blacks' and whites' ratings of hospitals. Blacks were less likely to recommend hospitals but reported more positive experiences, compared to whites. Higher educational attainment and self-reported worse health status were associated with more negative evaluations in both races. Additionally, blacks rated minority-serving hospitals worse than other hospitals on all HCAHPS measures. Taken together, there were surprisingly few meaningful differences in patient experience between blacks and whites across US hospitals. Although blacks tend to receive care at worse-performing hospitals, compared to whites, within any given hospital black patients tend to report better experience than whites do.
Collapse
Affiliation(s)
- José F Figueroa
- José F. Figueroa is a physician in the Department of Medicine at Brigham and Women's Hospital, in Boston, Massachusetts
| | - Jie Zheng
- Jie Zheng is a senior statistician at the Harvard T. H. Chan School of Public Health, in Boston
| | - E John Orav
- E. John Orav is an associate professor of biostatistics at the Harvard T. H. Chan School of Public Health
| | - Ashish K Jha
- Ashish K. Jha is a professor of health policy and management at the Harvard T. H. Chan School of Public Health
| |
Collapse
|
5
|
Hussein M, Waters TM, Chang CF, Bailey JE, Brown LM, Solomon DK. Impact of Medicare Part D on Racial Disparities in Adherence to Cardiovascular Medications Among the Elderly. Med Care Res Rev 2015; 73:410-36. [PMID: 26577228 DOI: 10.1177/1077558715615297] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 10/12/2015] [Indexed: 01/13/2023]
Abstract
Medicare Part D improved medication adherence among the elderly, but to date, its effect on disparities in adherence remains unknown. We estimated Part D impact on racial/ethnic disparities in adherence to cardiovascular medications among seniors, using pooled data from the Medical Expenditure Panel Survey (2002-2010) on 14,221 Medicare recipients (65+ years) and 3,456 near-elderly controls (60-64 years). Study sample included White, Black, or Hispanic respondents who used at least one cardiovascular medication. Twelve-month adherence was measured as having an overall proportion of days covered ≥80%. Adherence disparities were defined according to the Institute of Medicine framework. Using difference-in-differences logistic regression, we found Part D to be associated with a 16-percentage-point decrease in the White-Hispanic disparity in overall adherence among seniors, net of the change among controls. Black-White disparities worsened only among men, by 21 percentage points. Increasing access and improving quality of medication use among disadvantaged seniors should remain a policy priority.
Collapse
Affiliation(s)
- Mustafa Hussein
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Teresa M Waters
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - James E Bailey
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - David K Solomon
- The University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
6
|
Basger BJ, Moles RJ, Chen TF. Application of drug-related problem (DRP) classification systems: a review of the literature. Eur J Clin Pharmacol 2014; 70:799-815. [DOI: 10.1007/s00228-014-1686-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/16/2014] [Indexed: 11/28/2022]
|
7
|
Shah BR, Booth GL, Lipscombe LL, Feig DS, Bhattacharyya OK, Bierman AS. Near equality in quality for medication utilization among older adults with diabetes with universal medication insurance in Ontario, Canada. J Eval Clin Pract 2014; 20:176-83. [PMID: 24304561 DOI: 10.1111/jep.12104] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 12/24/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES To determine whether demographic, community or health status disparities in cardioprotective medication utilization by diabetes patients exist under a universal drug insurance programme, and whether they narrow or widen during periods of increasing drug utilization. METHODS We examined all prescriptions filled by all people with diabetes aged ≥65 years in Ontario, Canada in annual cohorts from 1996 (n = 175 345) to 2010 (n = 504 093). We ascertained whether any disparities in use of three classes of cardioprotective medication (statins, all antihypertensives and renin-angiotensin-aldosterone system inhibitors) existed, and whether disparities changed over time. RESULTS Utilization of all three cardioprotective medication classes increased substantially over time, particularly statins (rate ratio per year: 1.13, 95% confidence interval 1.11-1.15). We found no disparities associated with many of the demographic or community characteristics examined (including sex, income or rural residence). Use of statins was lower in those aged ≥80 compared with younger age groups, although this disparity narrowed during the study. Persistently lower use of antihypertensives by minorities and by recent immigrants may be due to lower quality of care, barriers to access, or other patient or provider factors, which highlights the need for ongoing monitoring for disparities even in populations with universal drug insurance. Differences in medication utilization based on health status characteristics such as previous cardiovascular disease were medically indicated. CONCLUSIONS Although a universal drug insurance programme was reasonably successful in ensuring few disparities in cardioprotective medication use by older patients with diabetes, disparities persisted for some subpopulations, so additional interventions continue to be needed to ensure equitable care.
Collapse
Affiliation(s)
- Baiju R Shah
- University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
8
|
Determinants of CPAP Adherence in Hispanics with Obstructive Sleep Apnea. SLEEP DISORDERS 2014; 2014:878213. [PMID: 24649371 PMCID: PMC3932645 DOI: 10.1155/2014/878213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 12/09/2013] [Accepted: 12/17/2013] [Indexed: 12/02/2022]
Abstract
Purpose. We hypothesized that socioeconomic factors and a language barrier would impact adherence with continuous positive airway pressure (CPAP) among Hispanics with obstructive sleep apnea (OSA). Methods. Patients with OSA who were prescribed CPAP for at least 1 year and completed a questionnaire evaluating demographic data, socioeconomic status, and CPAP knowledge and adherence participated in the study. Results. Seventy-nine patients (26 males; 53 ± 11 yrs; body mass index (BMI) = 45 ± 9 kg/m2) with apnea-hypopnea index (AHI) 33 ± 30 events/hr completed the study. Included were 25 Hispanics, 39 African Americans, and 15 Caucasians, with no difference in age, AHI, CPAP use, or BMI between the groups. While there was a difference in educational level (P = 0.006), income level (P < 0.001), and employment status (P = 0.03) between the groups, these did not influence CPAP adherence. Instead, overall improvement in quality of life and health status and perceived benefit from CPAP influenced adherence, both for the group as a whole (P = 0.03, P = 0.004, and P = 0.001, resp.), as well as in Hispanics (P = 0.02, P = 0.02, P = 0.03, resp.). Conclusion. In Hispanic patients with OSA, perceived benefit with therapy, rather than socioeconomic status or a language barrier, appears to be the most important factor in determining CPAP adherence.
Collapse
|
9
|
Peron EP, Marcum ZA, Boyce R, Hanlon JT, Handler SM. Year in review: medication mishaps in the elderly. ACTA ACUST UNITED AC 2012; 9:1-10. [PMID: 21459304 DOI: 10.1016/j.amjopharm.2011.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This paper reviews articles from 2010 that examined medication mishaps (ie, medication errors and adverse drug events [ADEs]) in the elderly. METHODS The MEDLINE and EMBASE databases were searched for English-language articles published in 2010 using a combination of search terms including medication errors, medication adherence, medication compliance, suboptimal prescribing, monitoring, adverse drug events, adverse drug withdrawal events, therapeutic failures, and aged. A manual search of the reference lists of the identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional publications. Five studies of note were selected for annotation and critique. From the literature search, this paper also generated a selected bibliography of manuscripts published in 2010 (excluding those previously published in the American Journal of Geriatric Pharmacotherapy or by one of the authors) that address various types of medication errors and ADEs in the elderly. RESULTS Three studies focused on types of medication errors. One study examined underuse (due to prescribing) as a type of medication error. This before-and-after study from the Netherlands reported that those who received comprehensive geriatric assessments had a reduction in the rate of undertreatment of chronic conditions by over one third (from 32.9% to 22.3%, P < 0.05). A second study focused on reducing medication errors due to the prescribing of potentially inappropriate medications. This quasi-experimental study found that a computerized provider order entry clinical decision support system decreased the number of potentially inappropriate medications ordered for patients ≥ 65 years of age who were hospitalized (11.56 before to 9.94 orders per day after, P < 0.001). The third medication error study was a cross-sectional phone survey of managed-care elders, which found that more blacks than whites had low antihypertensive medication adherence as per a self-reported measure (18.4% vs 12.3%, respectively; P < 0.001). Moreover, blacks used more complementary and alternative medicine (CAM) than whites for the treatment of hypertension (30.5% vs 24.7%, respectively; P = 0.005). In multivariable analyses stratified by race, blacks who used CAM were more likely than those who did not to have low antihypertensive medication adherence (prevalence rate ratio = 1.56; 95% CI, 1.14-2.15; P = 0.006). The remaining two studies addressed some form of medication-related adverse patient events. A case-control study of Medicare Advantage patients revealed for the first time that the use of skeletal muscle relaxants was associated significantly with an increased fracture risk (adjusted odds ratio = 1.40; 95% CI, 1.15-1.72; P < 0.001). This increased risk was even more pronounced with the concomitant use of benzodiazepines. Finally, a randomized controlled trial across 16 centers in France used a 1-week educational intervention about high-risk medications and ADEs directed at rehabilitation health care teams. Results indicated that the rate of ADEs in the intervention group was lower than that in the usual care group (22% vs 36%, respectively, P = 0.004). CONCLUSION Information from these studies may advance health professionals' understanding of medication errors and ADEs and may help guide research and clinical practices in years to come.
Collapse
Affiliation(s)
- Emily P Peron
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
| | | | | | | | | |
Collapse
|
10
|
Pepper JK, Carpenter DM, DeVellis RF. Does adherence-related support from physicians and partners predict medication adherence for vasculitis patients? J Behav Med 2012; 35:115-23. [PMID: 22350097 DOI: 10.1007/s10865-012-9405-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 02/01/2012] [Indexed: 10/28/2022]
Abstract
Few studies have explored mediators between medication-related support and medication adherence for individuals with rare, systemic autoimmune conditions. Using the Information-Motivation-Behavioral Skills model, we tested whether depressive symptomatology and medication adherence self-efficacy mediated the relationship between adherence support and changes in medication adherence among vasculitis patients, and whether support from physicians and partners differentially affected medication adherence. Vasculitis patients (n = 172) completed baseline and follow-up questionnaires about their medication adherence and perceived adherence support. Bootstrapped mediation analyses tested the effects of physician and partner support on changes in medication adherence. Adherence self-efficacy mediated the relationship between physician support and changes in medication adherence (B = 0.05, SE = 0.03, 95% CI 0.01, 0.13). Neither self-efficacy nor depressive symptomatology mediated the effects of partner support. Although physicians spend little time with patients, they can increase patients' confidence about taking medications correctly and potentially improve health outcomes by bolstering medication adherence.
Collapse
Affiliation(s)
- Jessica K Pepper
- Department of Health Behavior and Health Education, UNC Gillings School of Global Public Health, CB#7440, Chapel Hill, NC 27599, USA.
| | | | | |
Collapse
|
11
|
Choudhry NK, Saya UY, Shrank WH, Greenberg JO, Melia C, Bilodeau A, Kadehjian EK, Dolan ML, Dudley JC, Kachalia A. Cost-related medication underuse: prevalence among hospitalized managed care patients. J Hosp Med 2012; 7:104-9. [PMID: 21972200 DOI: 10.1002/jhm.948] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 04/27/2011] [Accepted: 05/02/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND The affordability of prescription medications continues to be a major public health issue in the United States. Estimates of cost-related medication underuse come largely from surveys of ambulatory patients. Hospitalized patients may be vulnerable to cost-related underuse and its consequences, but have been subject to little investigation. OBJECTIVE To determine impact of medication costs in a cohort of hospitalized managed care beneficiaries. METHODS We surveyed consecutive patients admitted to medical services at an academic medical center. Questions about cost-related underuse were based on validated measures; predictors were assessed with multivariable models. Participants were asked about strategies to improve medication affordability, and were contacted after discharge to determine if they had filled newly prescribed medications. RESULTS One-hundred thirty (41%) of 316 potentially eligible patients participated; 93 (75%) of these completed postdischarge surveys. Thirty patients (23%) reported cost-related underuse in the year prior to admission. In adjusted analyses, patients of black race were 3.39 times (95% confidence interval [CI], 1.05 to 11.02) more likely to report cost-related underuse than non-Hispanic white patients. Virtually all respondents (n = 123; 95%) endorsed at least 1 strategy to make medications more affordable. Few (16%) patients, prescribed medications at discharge, knew how much they would pay at the pharmacy. Almost none had spoken to their inpatient (4%) or outpatient (2%) providers about the cost of newly prescribed drugs. CONCLUSIONS Cost-related underuse is common among hospitalized patients. Individuals of black race appear to be particularly at risk. Strategies should be developed to address this issue around the time of hospital discharge.
Collapse
Affiliation(s)
- Niteesh K Choudhry
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Askari M, Wierenga PC, Eslami S, Medlock S, De Rooij SE, Abu-Hanna A. Studies pertaining to the ACOVE quality criteria: a systematic review. Int J Qual Health Care 2011; 24:80-7. [PMID: 22140194 DOI: 10.1093/intqhc/mzr071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To identify and uniformly describe studies employing the Assessing Care Of Vulnerable Elders (ACOVE) quality indicators within a comprehensive thematic model that reflects how the indicators were used. DATA SOURCES A systematic search of MEDLINE, EMBASE and CINAHL was conducted. STUDY SELECTION English-language studies meeting our criteria published prior to January 2010. Data extraction Included studies were analyzed and described by two independent researchers. RESULTS OF DATA SYNTHESIS A total of 41 articles met our selection criteria. Studies were classified into the themes 'Application of indicators' (32 studies) and ' ANALYSIS and development of indicators' (13 studies). 'Application' studies included assessing quality of care, influencing behavior of health professionals and examining the association of quality of care with other factors. 'Analysis and development' included studies developing new indicator sets, and those adapting and validating the original quality indicators to new settings. CONCLUSIONS The indicators were used in a wide range of applications with two main foci: the assessment of quality of care for elderly patients, and investigating the feasibility of similar indicators and their adaptation to new settings. Very few of the studies published to date have addressed the goal of care improvement. We foresee an important role for application of indicators that proactively help health-care professionals to deliver the right care at the right time, for example by resorting to decision support systems.
Collapse
Affiliation(s)
- Marjan Askari
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
13
|
Butrick M, Roter D, Kaphingst K, Erby LH, Haywood C, Beach MC, Levy HP. Patient reactions to personalized medicine vignettes: an experimental design. Genet Med 2011; 13:421-8. [PMID: 21270639 PMCID: PMC3240937 DOI: 10.1097/gim.0b013e3182056133] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Translational investigation on personalized medicine is in its infancy. Exploratory studies reveal attitudinal barriers to "race-based medicine" and cautious optimism regarding genetically personalized medicine. This study describes patient responses to hypothetical conventional, race-based, or genetically personalized medicine prescriptions. METHODS Three hundred eighty-seven participants (mean age = 47 years; 46% white) recruited from a Baltimore outpatient center were randomized to this vignette-based experimental study. They were asked to imagine a doctor diagnosing a condition and prescribing them one of three medications. The outcomes are emotional response to vignette, belief in vignette medication efficacy, experience of respect, trust in the vignette physician, and adherence intention. RESULTS Race-based medicine vignettes were appraised more negatively than conventional vignettes across the board (Cohen's d = -0.51-0.57-0.64, P < 0.001). Participants rated genetically personalized comparably with conventional medicine (-0.14-0.15-0.17, P = 0.47), with the exception of reduced adherence intention to genetically personalized medicine (Cohen's d = -0.38-0.41-0.44, P = 0.009). This relative reluctance to take genetically personalized medicine was pronounced for racial minorities (Cohen's d = -0.38-0.31-0.25, P = 0.02) and was related to trust in the vignette physician (change in R = 0.23, P < 0.001). CONCLUSIONS This study demonstrates a relative reluctance to embrace personalized medicine technology, especially among racial minorities, and highlights enhancement of adherence through improved doctor- patient relationships.
Collapse
Affiliation(s)
- Morgan Butrick
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21202, USA.
| | | | | | | | | | | | | |
Collapse
|