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Behari J, Bradley A, Townsend K, Becich MJ, Cappella N, Chuang CH, Fernandez SA, Ford DE, Kirchner HL, Morgan R, Paranjape A, Silverstein JC, Williams DA, Donahoo WT, Asrani SK, Ntanios F, Ateya M, Hegeman-Dingle R, McLeod E, McTigue K. Limitations of Noninvasive Tests-Based Population-Level Risk Stratification Strategy for Nonalcoholic Fatty Liver Disease. Dig Dis Sci 2024; 69:370-383. [PMID: 38060170 DOI: 10.1007/s10620-023-08186-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are highly prevalent but underdiagnosed. AIMS We used an electronic health record data network to test a population-level risk stratification strategy using noninvasive tests (NITs) of liver fibrosis. METHODS Data were obtained from PCORnet® sites in the East, Midwest, Southwest, and Southeast United States from patients aged [Formula: see text] 18 with or without ICD-10-CM diagnosis codes for NAFLD, NASH, and NASH-cirrhosis between 9/1/2017 and 8/31/2020. Average and standard deviations (SD) for Fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS), and Hepatic Steatosis Index (HSI) were estimated by site for each patient cohort. Sample-wide estimates were calculated as weighted averages across study sites. RESULTS Of 11,875,959 patients, 0.8% and 0.1% were coded with NAFLD and NASH, respectively. NAFLD diagnosis rates in White, Black, and Hispanic patients were 0.93%, 0.50%, and 1.25%, respectively, and for NASH 0.19%, 0.04%, and 0.16%, respectively. Among undiagnosed patients, insufficient EHR data for estimating NITs ranged from 68% (FIB-4) to 76% (NFS). Predicted prevalence of NAFLD by HSI was 60%, with estimated prevalence of advanced fibrosis of 13% by NFS and 7% by FIB-4. Approximately, 15% and 23% of patients were classified in the intermediate range by FIB-4 and NFS, respectively. Among NAFLD-cirrhosis patients, a third had FIB-4 scores in the low or intermediate range. CONCLUSIONS We identified several potential barriers to a population-level NIT-based screening strategy. HSI-based NAFLD screening appears unrealistic. Further research is needed to define merits of NFS- versus FIB-4-based strategies, which may identify different high-risk groups.
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Affiliation(s)
- Jaideep Behari
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Suite 201, Kaufmann Medical Building, 3471 Fifth Ave, Pittsburgh, PA, 15213, USA.
| | - Allison Bradley
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15206, USA
| | - Kevin Townsend
- US Medical Affairs, Pfizer Inc, New York, NY, 10017, USA
| | - Michael J Becich
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15206, USA
| | - Nickie Cappella
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15206, USA
| | - Cynthia H Chuang
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, 17033, USA
| | - Soledad A Fernandez
- Department of Biomedical Informatics, Wexner Medical Center, The Ohio State University, Columbus, OH, 43201, USA
| | - Daniel E Ford
- Department of General Internal Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger Health System, Danville, PA, 17822, USA
| | - Richard Morgan
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15206, USA
| | - Anuradha Paranjape
- Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
| | - Jonathan C Silverstein
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15206, USA
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, 48105, USA
| | - W Troy Donahoo
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, 32608, USA
| | | | - Fady Ntanios
- US Medical Affairs, Pfizer Inc, New York, NY, 10017, USA
| | - Mohammad Ateya
- US Medical Affairs, Pfizer Inc, New York, NY, 10017, USA
| | | | - Euan McLeod
- Pfizer Health Economics and Outcomes Research, Tadworth, UK
| | - Kathleen McTigue
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15260, USA
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Chuang CH, Weisman CS, Liu G, Horvath S, Velott DL, Zheng A, Leslie DL. Impact of the Affordable Care Act on Prescription Contraceptive Use and Costs Among Privately Insured Women, 2006-2020. Womens Health Issues 2024; 34:7-13. [PMID: 37940509 DOI: 10.1016/j.whi.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND In the years immediately following the Affordable Care Act (ACA)'s contraceptive coverage requirement, out-of-pocket costs fell for all Food and Drug Administration-approved contraceptive methods and use of long-acting reversible contraception (LARC) increased. This analysis examines whether these trends have continued through 2020 for privately insured women. METHODS Using 2006-2020 MarketScan data, we examined trends in prescription contraceptive use and out-of-pocket costs among women 13 to 49 years old. Multivariable analyses model the likelihood of contraceptive use and paying $0 post-ACA requirement (vs. pre-ACA requirement) for contraception, controlling for age group, U.S. region, urban versus rural, and cohort year. RESULTS The likelihood of LARC insertion increased post-ACA requirement (adjusted odds ratio [aOR] 1.127, 95% confidence interval [CI] 1.121-1.133), with insertion rates peaking at 3.73% for intrauterine devices (IUDs) and 1.08% for implants in 2019, before declining with the onset of the COVID-19 pandemic in 2020. Although the likelihood of paying $0 for LARC increased after the ACA requirement (IUD: aOR 5.495, 95% CI 5.278-5.716; implant: aOR 7.199, 95% CI 6.992-7.412), the proportion of individuals paying $0 declined to 69% for IUDs and 73% for implants in 2020, after having peaked at 88% in 2014 and 90% in 2016, respectively. For oral contraceptives, both use (aOR 1.028, 95% CI 1.026-1.030) and paying $0 (aOR 20.399, 95% CI 20.301-20.499) increased significantly after the ACA requirement. CONCLUSION With the exception of oral contraceptives, the proportion of individuals paying $0 for all contraceptive methods declined after peaking in 2014 for IUDs, 2016 for the implant, and 2019 for non-LARC methods. Future monitoring is needed to understand the continuing impact of the ACA requirement on prescription contraceptive use and costs.
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Affiliation(s)
- Cynthia H Chuang
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Carol S Weisman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Sarah Horvath
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Diana L Velott
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Amy Zheng
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Nilles EK, Champon X, Mulder H, Shaw KM, Smith M, Lampron ZM, Wozniak G, Chamberlain AM, Carton T, Viera AJ, Ahmad FS, Steinberg BA, Chuang CH, Mctigue KM, McClay JC, Polonsky TS, Maeztu C, Sanders M, Warren N, Singh R, Liu M, VanWormer JJ, Park S, Modrow MF, Rakotz M, Cooper-Dehoff RM, Pletcher MJ, O'Brien EC. Seasonal variation in blood pressure control across US health systems. J Hypertens 2023; 41:751-758. [PMID: 36883471 DOI: 10.1097/hjh.0000000000003396] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE We aimed to characterize seasonal variation in US population-based blood pressure (BP) control and BP-related metrics and evaluate the association between outdoor temperature and BP control variation. METHODS We queried electronic health records (EHRs) from 26 health systems, representing 21 states, to summarize BP metrics by quarters of 12-month periods from January 2017 to March 2020. Patients with at least one ambulatory visit during the measurement period and a hypertension diagnosis during the first 6 months or prior to the measurement period were included. Changes in BP control, BP improvement, medication intensification, average SBP reduction after medication intensification across quarters and association with outdoor temperature were analyzed using weighted generalized linear models with repeated measures. RESULTS Among 1 818 041 people with hypertension, the majority were more than 65 years of age (52.2%), female (52.1%), white non-Hispanic (69.8%) and had stage 1/2 hypertension (64.8%). Overall, BP control and process metrics were highest in quarters 2 and 3, and lowest in quarters 1 and 4. Quarter 2 had the highest percentage of improved BP (31.95 ± 0.90%) and average SBP reduction after medication intensification (16 ± 0.23 mmHg). Quarter 3 had the highest percentage of BP controlled (62.25 ± 2.55%) and lowest with medication intensification (9.73 ± 0.60%). Results were largely consistent in adjusted models. Average temperature was associated with BP control metrics in unadjusted models, but associations were attenuated following adjustment. CONCLUSION In this large, national, EHR-based study, BP control and BP-related process metrics improved during spring/summer months, but outdoor temperature was not associated with performance following adjustment for potential confounders.
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Affiliation(s)
- Ester Kim Nilles
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - XiaoXia Champon
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - Hillary Mulder
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - Kathryn M Shaw
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Myra Smith
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Zachary M Lampron
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | | | - Alanna M Chamberlain
- Department of Quantitative Health Sciences
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Thomas Carton
- Louisiana Public Health Institute, Tulane University, New Orleans, Louisiana
| | - Anthony J Viera
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, North Carolina
| | - Faraz S Ahmad
- Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Kathleen M Mctigue
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Tamar S Polonsky
- Biological Sciences Division, University of Chicago, Chicago, Illinois
| | - Carlos Maeztu
- Department of Health Outcomes and Policy, Clinical and Translational Science Institute, University of Florida, Gainesville, Florida
| | - Margaret Sanders
- Louisiana Public Health Institute, Tulane University, New Orleans, Louisiana
| | | | | | - Mei Liu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Jeffrey J VanWormer
- Marshfield Clinic Research Institute, Center for Clinical Epidemiology and Population Health, Marshfield, Wisconsin
| | - Soo Park
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | | | | | - Rhonda M Cooper-Dehoff
- Department of Pharmacotherapy and Translational Research, Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Emily C O'Brien
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
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Brawley AM, Schaefer EW, Lucarelli E, Ural SH, Chuang CH, Hwang W, Paul IM, Daymont C. Differing prevalence of microcephaly and macrocephaly in male and female fetuses. Front Glob Womens Health 2023; 4:1080175. [PMID: 36911049 PMCID: PMC9998507 DOI: 10.3389/fgwh.2023.1080175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/01/2023] [Indexed: 03/14/2023] Open
Abstract
Objective To compare the proportion of female and male fetuses classified as microcephalic (head circumference [HC] < 3rd percentile) and macrocephalic (>97th percentile) by commonly used sex-neutral growth curves. Methods For fetuses evaluated at a single center, we retrospectively determined the percentile of the first fetal HC measurement between 16 and 0/7 and 21-6/7 weeks using the Hadlock, Intergrowth-21st, and NICHD growth curves. The association between sex and the likelihood of being classified as microcephalic or macrocephalic was evaluated with logistic regression. Results Female fetuses (n = 3,006) were more likely than male fetuses (n = 3,186) to be classified as microcephalic using the Hadlock (0.4% male, 1.4% female; odds ratio female vs. male 3.7, 95% CI [1.9, 7.0], p < 0.001), Intergrowth-21st (0.5% male, 1.6% female; odds ratio female vs. male 3.4, 95% CI [1.9, 6.1], p < 0.001), and NICHD (0.3% male, 1.6% female; odds ratio female vs. male 5.6, 95% CI [2.7, 11.5], p < 0.001) curves. Male fetuses were more likely than female fetuses to be classified as macrocephalic using the Intergrowth-21st (6.0% male, 1.5% female; odds ratio male vs. female 4.3, 95% CI [3.1, 6.0], p < 0.001) and NICHD (4.7% male, 1.0% female; odds ratio male vs. female 5.1, 95% CI [3.4, 7.6], p < 0.001) curves. Very low proportions of fetuses were classified as macrocephalic using the Hadlock curves (0.2% male, < 0.1% female; odds ratio male vs. female 6.6, 95% CI [0.8, 52.6]). Conclusion Female fetuses were more likely to be classified as microcephalic, and male fetuses were more likely to be classified as macrocephalic. Sex-specific fetal head circumference growth curves could improve interpretation of fetal head circumference measurements, potentially decreasing over- and under-diagnosis of microcephaly and macrocephaly based on sex, therefore improving guidance for clinical decisions. Additionally, the overall prevalence of atypical head size varied using three growth curves, with the NICHD and Intergrowth-21st curves fitting our population better than the Hadlock curves. The choice of fetal head circumference growth curves may substantially impact clinical care.
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Affiliation(s)
- Amalia M Brawley
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, United States
| | - Eric W Schaefer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Elizabeth Lucarelli
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, United States
| | - Serdar H Ural
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, United States
| | - Cynthia H Chuang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.,Department of Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Wenke Hwang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Ian M Paul
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.,Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
| | - Carrie Daymont
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.,Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
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Zheng A, Nelson HN, McCall-Hosenfeld JS, Lehman EB, Chuang CH. Recent Intimate Partner Violence and Oral Contraceptive Pill Adherence in a Cohort of Reproductive-Aged Women. J Womens Health (Larchmt) 2022; 31:1703-1709. [PMID: 36126298 PMCID: PMC9805850 DOI: 10.1089/jwh.2021.0622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective: Intimate partner violence (IPV) is an important public health problem that impacts reproductive decision-making. Although previous literature has reported a negative impact on contraceptive adherence overall, this study specifically aims to investigate the association between IPV and oral contraceptive pill (OCP) adherence. Methods: We analyzed baseline survey data from 373 OCP users participating in the MyNewOptions study. Recent IPV was defined as any positive response to HARK, a 4-question tool assessing emotional, sexual, and physical abuse in the past year, or self-report of sexual coercion in the past 6 months. High OCP adherence was defined by self-report of missing ≤1 pill per month, which was then corroborated by pharmacy claims data. Multivariable regression analyses were performed to assess the influence of recent IPV history and patient-level variables on OCP adherence. Results: Just over half of our participants were highly adherent to OCPs (53.6%), and approximately one-quarter reported recent IPV exposure (25.2%). Women with recent IPV were significantly less likely to be OCP adherent than those without IPV (adjusted odds ratio (AOR) 0.54, 95% confidence interval (CI): 0.32-0.92). Protestant religion was also associated with high OCP adherence (AOR 2.41, 95% CI: 1.24-4.65, compared with no religious affiliation), while younger age groups (18-25 and 26-33 years) were less likely to have high OCP adherence compared with the 34-40 age group (AOR 0.45, 95% CI: 0.20-1.00 and AOR 0.40, 95% CI: 0.18-0.91, respectively). Conclusion: Recent IPV exposure is associated with low OCP adherence among women of reproductive age. ClinicalTrials.gov identifier: NCT02100124.
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Affiliation(s)
- Amy Zheng
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Hallie N. Nelson
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer S. McCall-Hosenfeld
- Division of General Internal Medicine and Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Erik B. Lehman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Cynthia H. Chuang
- Division of General Internal Medicine and Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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6
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Patel D, Liu G, Roberts SCM, Leslie DL, Weisman CS, Horvath S, Chuang CH. Association of Provider Specialty With Abortion-Related Morbidity and Adverse Events Among Patients Having Procedural and Medication Abortions. Womens Health Issues 2022; 32:327-333. [PMID: 35437157 DOI: 10.1016/j.whi.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/20/2022] [Accepted: 03/11/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Since abortion was legalized throughout the United States in 1973, states have passed restrictive abortion policies, including permitting only obstetrician-gynecologist physicians (OBGYNs) to provide abortions. We are unaware of any research that directly compares patient safety-related outcomes by physician specialty. In this study, we compared major and any abortion-related morbidity and adverse events in abortion care provided by physicians of other specialties versus OBGYNs. STUDY DESIGN Using the IBM Watson Health MarketScan claims database, we identified privately insured individuals who had an induced abortion between January 1, 2011, and December 31, 2014. The primary outcome was major abortion-related morbidity or adverse events, and the secondary outcome was any abortion-related morbidity or adverse events occurring within 6 weeks of the abortion. RESULTS The study cohort included 34,764 patients who had 35,407 abortions-4,843 (13.7%) abortions provided by physicians of other specialties and 30,564 (86.3%) abortions provided by OBGYNs. Major and any abortion-related morbidity or adverse event occurred in 115 (0.3%) and 1,271 (3.6%) of 35,407 of abortions, respectively. In adjusted analyses, there was no statistically significant difference in major abortion-related morbidity or adverse events comparing physicians of other specialties versus OBGYNs (adjusted odds ratio, 1.02; 95% confidence interval, 0.59-1.75), and no statistically significant difference in any abortion-related morbidity or adverse events comparing physicians of other specialties versus OBGYNs (adjusted odds ratio, 0.91; 95% confidence interval, 0.77-1.09). CONCLUSIONS There were no differences in abortion-related morbidity or adverse events by physician specialty. Our findings do not support state laws limiting abortion care to OBGYN physicians.
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Affiliation(s)
- Dolly Patel
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
| | - Guodong Liu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, California
| | - Douglas L Leslie
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Carol S Weisman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania; Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Sarah Horvath
- Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Cynthia H Chuang
- Division of General Internal Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania; Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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7
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Doan YP, Lehman EB, Chuang CH. Effect of Neighborhood-Level Income on Access to Emergency Contraception. Contraception 2022; 112:120-123. [PMID: 35247367 DOI: 10.1016/j.contraception.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aim to investigate whether availability of over-the-counter EC varies by neighborhood income level, independent vs chain pharmacies, or urban vs rural pharmacies. STUDY DESIGN We conducted a cross-sectional "mystery shopper" telephone survey in July 2019 to ascertain whether sampled pharmacies stocked EC. Pharmacies located in 12 Pennsylvania counties were randomly sampled after stratification by neighborhood income level. RESULTS Of 200 pharmacies sampled, 195 responded. Only 76% had EC available for same day purchase, which did not differ by neighborhood-level income. The odds that chain pharmacies stocked EC were nearly 10 times the odds that independent pharmacies stocked EC, with 96 out of 105 chain pharmacies versus 52 out of 90 independent pharmacies having EC available for same day purchase (91% vs. 58%; OR 9.50, 95% CI 4.03-22.42). The mean number of barriers (stocking over-the-counter EC behind-the-counter, cost >$40, and requiring identification for purchase) was lower among chain vs. independent pharmacies. Pharmacies in low/moderate income areas (64% vs. 44%, p=0.02) and independent pharmacies (94% vs. 32%, p<0.01) were more likely to keep over-the-counter EC behind-the-counter. Independent pharmacies were more likely to require identification for purchase (29% vs. 59%, p < 0.01). CONCLUSION More than a decade after over-the-counter approval, EC is still not uniformly available at pharmacies in Pennsylvania. Barriers including behind-the-counter stocking and identification requirements disproportionally limit access in low-income neighborhoods and independent pharmacies, threatening equitable access to this contraceptive method.
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Affiliation(s)
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State College of Medicine
| | - Cynthia H Chuang
- Division of General Internal Medicine, Pennsylvania State College of Medicine, Hershey, PA
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Smith SM, Desai RA, Walsh MG, Nilles EK, Shaw K, Smith M, Chamberlain AM, Derington CG, Bress AP, Chuang CH, Ford DE, Taylor BW, Chandaka S, Patel LP, McClay J, Priest E, Fuloria J, Doshi K, Ahmad FS, Viera AJ, Faulkner M, O'Brien EC, Pletcher MJ, Cooper-DeHoff RM. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and COVID-19-related outcomes: A patient-level analysis of the PCORnet blood pressure control lab. Am Heart J Plus 2022; 13:100112. [PMID: 35252907 PMCID: PMC8889730 DOI: 10.1016/j.ahjo.2022.100112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/21/2022] [Accepted: 02/11/2022] [Indexed: 12/20/2022]
Abstract
SARS-CoV-2 accesses host cells via angiotensin-converting enzyme-2, which is also affected by commonly used angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), raising concerns that ACEI or ARB exposure may portend differential COVID-19 outcomes. In parallel cohort studies of outpatient and inpatient COVID-19-diagnosed adults with hypertension, we assessed associations between antihypertensive exposure (ACEI/ARB vs. non-ACEI/ARB antihypertensives, as well as between ACEI- vs. ARB) at the time of COVID-19 diagnosis, using electronic health record data from PCORnet health systems. The primary outcomes were all-cause hospitalization or death (outpatient cohort) or all-cause death (inpatient), analyzed via Cox regression weighted by inverse probability of treatment weights. From February 2020 through December 9, 2020, 11,246 patients (3477 person-years) and 2200 patients (777 person-years) were included from 17 health systems in outpatient and inpatient cohorts, respectively. There were 1015 all-cause hospitalization or deaths in the outpatient cohort (incidence, 29.2 events per 100 person-years), with no significant difference by ACEI/ARB use (adjusted HR 1.01; 95% CI 0.88, 1.15). In the inpatient cohort, there were 218 all-cause deaths (incidence, 28.1 per 100 person-years) and ACEI/ARB exposure was associated with reduced death (adjusted HR, 0.76; 95% CI, 0.57, 0.99). ACEI, versus ARB exposure, was associated with higher risk of hospitalization in the outpatient cohort, but no difference in all-cause death in either cohort. There was no evidence of effect modification across pre-specified baseline characteristics. Our results suggest ACEI and ARB exposure have no detrimental effect on hospitalizations and may reduce death among hypertensive patients diagnosed with COVID-19.
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Affiliation(s)
- Steven M Smith
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, United States of America
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States of America
| | - Raj A Desai
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States of America
| | - Marta G Walsh
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, United States of America
| | - Ester Kim Nilles
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Katie Shaw
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Myra Smith
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Alanna M Chamberlain
- Departments of Quantitative Health Sciences and Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Catherine G Derington
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Adam P Bress
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, United States of America
| | | | - Daniel E Ford
- Johns Hopkins University, Baltimore, MD, United States of America
| | - Bradley W Taylor
- Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Sravani Chandaka
- University of Kansas Medical Center, Kansas City, KS, United States of America
| | | | - James McClay
- University of Nebraska, Omaha, NE, United States of America
| | - Elisa Priest
- Baylor Scott & White Health, Dallas, TX, United States of America
| | - Jyotsna Fuloria
- School of Medicine, Louisiana State University, New Orleans, LA, United States of America
| | - Kruti Doshi
- Cook County Health, Chicago, IL, United States of America
| | - Faraz S Ahmad
- Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Anthony J Viera
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, United States of America
| | - Madelaine Faulkner
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Emily C O'Brien
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America
| | - Mark J Pletcher
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, United States of America
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Patel DS, Roberts SCM, Leslie DL, Liu G, Weisman C, Horvath S, Chuang CH. POSTER ABSTRACTS. Contraception 2021. [DOI: 10.1016/j.contraception.2021.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Julian K, Ba DM, Liu G, Leslie DL, Chuang CH. Out-of-Pocket Costs of Insulin and Diabetes-Related Supplies Among Patients With Type 1 Diabetes. Clin Ther 2021; 43:1272-1277. [PMID: 34162482 DOI: 10.1016/j.clinthera.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/05/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
The cost of insulin has increased exponentially since its discovery in the 1920s, but the degree to which this financial burden has been transferred to patients is unknown. The present study is a retrospective analysis using claims data for privately insured patients with type 1 diabetes from 2005 to 2017. We quantify the mean annual out-of-pocket costs for insulin and diabetes-related supplies during the study period. It is imperative for health care professionals to be aware of this cost, and we hope that these findings serve as a call for legislation to cap the rising price of insulin. (Clin Ther. 2021;XX:XXX-XXX) © 2021 Elsevier HS Journals, Inc.
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Affiliation(s)
- Katherine Julian
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
| | - Djibril M Ba
- Department of Public Health Sciences & Center for Applied Studies in Health Economics, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Guodong Liu
- Department of Public Health Sciences & Center for Applied Studies in Health Economics, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Douglas L Leslie
- Department of Public Health Sciences & Center for Applied Studies in Health Economics, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Cynthia H Chuang
- Department of Public Health Sciences & Center for Applied Studies in Health Economics, Pennsylvania State University College of Medicine, Hershey, Pennsylvania; Division of General Internal Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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11
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Forrest CB, Xu H, Thomas LE, Webb LE, Cohen LW, Carey TS, Chuang CH, Daraiseh NM, Kaushal R, McClay JC, Modave F, Nauman E, Todd JV, Wallia A, Bruno C, Hernandez AF, O'Brien EC. Impact of the Early Phase of the COVID-19 Pandemic on US Healthcare Workers: Results from the HERO Registry. J Gen Intern Med 2021; 36:1319-1326. [PMID: 33694071 PMCID: PMC7946335 DOI: 10.1007/s11606-020-06529-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The HERO registry was established to support research on the impact of the COVID-19 pandemic on US healthcare workers. OBJECTIVE Describe the COVID-19 pandemic experiences of and effects on individuals participating in the HERO registry. DESIGN Cross-sectional, self-administered registry enrollment survey conducted from April 10 to July 31, 2020. SETTING Participants worked in hospitals (74.4%), outpatient clinics (7.4%), and other settings (18.2%) located throughout the nation. PARTICIPANTS A total of 14,600 healthcare workers. MAIN MEASURES COVID-19 exposure, viral and antibody testing, diagnosis of COVID-19, job burnout, and physical and emotional distress. KEY RESULTS Mean age was 42.0 years, 76.4% were female, 78.9% were White, 33.2% were nurses, 18.4% were physicians, and 30.3% worked in settings at high risk for COVID-19 exposure (e.g., ICUs, EDs, COVID-19 units). Overall, 43.7% reported a COVID-19 exposure and 91.3% were exposed at work. Just 3.8% in both high- and low-risk settings experienced COVID-19 illness. In regression analyses controlling for demographics, professional role, and work setting, the risk of COVID-19 illness was higher for Black/African-Americans (aOR 2.32, 99% CI 1.45, 3.70, p < 0.01) and Hispanic/Latinos (aOR 2.19, 99% CI 1.55, 3.08, p < 0.01) compared with Whites. Overall, 41% responded that they were experiencing job burnout. Responding about the day before they completed the survey, 53% of participants reported feeling tired a lot of the day, 51% stress, 41% trouble sleeping, 38% worry, 21% sadness, 19% physical pain, and 15% anger. On average, healthcare workers reported experiencing 2.4 of these 7 distress feelings a lot of the day. CONCLUSIONS Healthcare workers are at high risk for COVID-19 exposure, but rates of COVID-19 illness were low. The greater risk of COVID-19 infection among race/ethnicity minorities reported in the general population is also seen in healthcare workers. The HERO registry will continue to monitor changes in healthcare worker well-being during the pandemic. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04342806.
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Affiliation(s)
- Christopher B Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Haolin Xu
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Laine E Thomas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Laura E Webb
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Lauren W Cohen
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Timothy S Carey
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cynthia H Chuang
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Nancy M Daraiseh
- Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH, USA
| | - Rainu Kaushal
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | | | - François Modave
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | | | - Amisha Wallia
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine and the Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cortney Bruno
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Emily C O'Brien
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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Phillips TA, Foley KA, Levi BH, Jhaveri P, Chuang CH, Abdulahad D, Lehman E, Fogel BN. The Impact of Medical Scribes on Relative Value Units in a Pediatric Primary Care Practice. Acad Pediatr 2021; 21:542-547. [PMID: 32445825 DOI: 10.1016/j.acap.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Our study assessed the impact of adding medical scribes to an academic pediatric primary practice by measuring the relationship between work relative value units (wRVUs) and use of the medical scribe. METHODS This is a retrospective comparative study on the effect of medical scribes on average wRVUs per patient encounter. wRVUs were abstracted from procedure codes in the billing system. RESULTS Six clinicians performed 2277 patient visits included in the study over 2 different time periods during 2017 and 2018. The first period was without the use of medical scribes and the second period included scribes. Average clinician wRVU production per visit increased by 7.68% (P < .001) with medical scribes over the previous period without them. CONCLUSIONS This study shows that scribes contribute to improving the wRVU per visit in a primary pediatric practice. This finding is consistent with other research showing that scribes help increase volume and improve wRVUs for specialists who perform complex procedures.
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Affiliation(s)
- Troy A Phillips
- Department of Learning and Performance Systems, Penn State University (TA Phillips), State College, Pa.
| | - Kasey A Foley
- Department of Communication Arts and Sciences, Penn State University (KA Foley), State College, Pa
| | - Benjamin H Levi
- Department of Pediatrics, Penn State College of Medicine (BH Levi, P Jhaveri, D Abdulahad, and BN Fogel), Hershey, Pa; Department of Humanities, Penn State College of Medicine (BH Levi), Hershey, Pa
| | - Pooja Jhaveri
- Department of Pediatrics, Penn State College of Medicine (BH Levi, P Jhaveri, D Abdulahad, and BN Fogel), Hershey, Pa; Penn State College of Medicine (P Jhaveri), Hershey, Pa
| | - Cynthia H Chuang
- Department of Medicine, Penn State College of Medicine (CH Chuang), Hershey, Pa; Department of Public Health Sciences, Penn State College of Medicine (CH Chuang and E Lehman), Hershey, Pa
| | - Denise Abdulahad
- Department of Pediatrics, Penn State College of Medicine (BH Levi, P Jhaveri, D Abdulahad, and BN Fogel), Hershey, Pa
| | - Erik Lehman
- Department of Public Health Sciences, Penn State College of Medicine (CH Chuang and E Lehman), Hershey, Pa
| | - Benjamin N Fogel
- Department of Pediatrics, Penn State College of Medicine (BH Levi, P Jhaveri, D Abdulahad, and BN Fogel), Hershey, Pa; Penn State College of Medicine (P Jhaveri), Hershey, Pa
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13
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Gonzalo JD, Chuang CH, Glod SA, McGillen B, Munyon R, Wolpaw DR. General Internists as Change Agents: Opportunities and Barriers to Leadership in Health Systems and Medical Education Transformation. J Gen Intern Med 2020; 35:1865-1869. [PMID: 31898138 PMCID: PMC7280380 DOI: 10.1007/s11606-019-05611-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/21/2019] [Accepted: 12/06/2019] [Indexed: 01/20/2023]
Abstract
Health systems are increasingly engaging in mission development around the quadruple aim of patient experience of care, population health, cost of care, and work-life balance of clinicians. This integrated approach is closely aligned with the education principles and competencies of health systems science (HSS), which includes population health, high-value care, leadership, teamwork, collaboration, and systems thinking. Influenced by health outcomes research, the systems-based practice competency, and the Clinical Learning Environment Review, many medical schools and residency programs are taking on the challenge of comprehensively incorporating these HSS competencies into the education agenda. General internal medicine physicians, inclusive of hospitalists, geriatricians, and palliative and primary care physicians, are at the frontlines of this transformation and uniquely positioned to contribute to and lead health system transformation, role model HSS competencies for trainees, and facilitate the education of a new workforce equipped with HSS skills to accelerate change in healthcare. Although GIM faculty are positioned to be early adopters and leaders in evolving systems of care and education, professional development and changes with academic health systems are required. This Perspective article explores the conceptualization and opportunities to effectively link GIM with healthcare and medical education transformation.
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Affiliation(s)
- Jed D Gonzalo
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA.
| | - Cynthia H Chuang
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Susan A Glod
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Brian McGillen
- Division of Hospital Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Ryan Munyon
- Division of Hospital Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel R Wolpaw
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
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14
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Chuang CH, Weisman CS, Velott DL, Lehman E, Chinchilli VM, Francis EB, Moos MK, Sciamanna CN, Armitage CJ, Legro RS. Reproductive Life Planning and Contraceptive Action Planning for Privately Insured Women: The MyNewOptions Study. Perspect Sex Reprod Health 2019; 51:219-227. [PMID: 31820551 DOI: 10.1363/psrh.12123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 06/13/2019] [Accepted: 08/05/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Although reproductive life planning (RLP) is recommended in federal and clinical guidelines and may help insured women make personalized contraceptive choices, it has not been systematically evaluated for effectiveness. METHODS In 2014, some 984 privately insured women aged 18-40 who were not intending to become pregnant in the next year were randomly assigned to receive RLP, RLP with contraceptive action planning (RLP+) or information only (the control group). Women's contraceptive use, prescription contraceptive use, method adherence, switching to a more effective method, method satisfaction and contraceptive self-efficacy were assessed at six-month intervals during the two-year follow-up period. Differences between groups were identified using binomial logistic regression, linear regression and generalized estimating equation models. RESULTS During the follow-up period, the proportion of women using any contraceptive method increased from 89% to 96%, and the proportion using a long-acting reversible contraceptive or sterilization increased from 8% to 19%. Contraceptive adherence was high (72-76%) in all three groups. In regression models, the sole significant finding was that women in the RLP+ group were more likely than those in the RLP group to use a prescription method (odds ratio, 1.3). No differences were evident between the intervention groups and the control group in overall contraceptive use, contraceptive adherence, switching to a more effective method, method satisfaction or contraceptive self-efficacy. CONCLUSIONS The study does not provide evidence that web-based RLP influences contraceptive behaviors in insured women outside of the clinical setting. Further research is needed to identify strategies to help women of reproductive age identify contraceptive methods that meet their needs and preferences.
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Affiliation(s)
- Cynthia H Chuang
- Department of Medicine and Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Carol S Weisman
- Departments of Public Health Sciences and Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA
| | - Diana L Velott
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Erik Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Erica B Francis
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA
| | - Merry-K Moos
- Department of Health Psychology, University of Manchester, Manchester, UK
| | - Christopher N Sciamanna
- Department of Medicine and Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | | | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA
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15
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Weisman CS, Chuang CH, Snyder AH, Liu G, Leslie DL. ACA’s Contraceptive Coverage Requirement: Measuring Use And Out-Of-Pocket Spending. Health Aff (Millwood) 2019; 38:1537-1541. [DOI: 10.1377/hlthaff.2018.05484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Carol S. Weisman
- Carol S. Weisman is a distinguished professor of public health sciences and obstetrics and gynecology, Penn State College of Medicine, in Hershey, Pennsylvania
| | - Cynthia H. Chuang
- Cynthia H. Chuang is a professor of medicine, public health sciences, and obstetrics and gynecology and chief of the Division of General Internal Medicine, Penn State College of Medicine
| | - Ashley H. Snyder
- Ashley H. Snyder is an assistant professor of medicine, Penn State College of Medicine
| | - Guodong Liu
- Guodong Liu is an associate professor of public health sciences, Penn State College of Medicine
| | - Douglas L. Leslie
- Douglas L. Leslie is a professor of public health sciences and psychiatry and director of the Center for Applied Studies in Health Economics, Penn State College of Medicine
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16
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Affiliation(s)
- Cynthia H Chuang
- From the Division of General Internal Medicine, Department of Medicine (C.H.C.), the Department of Public Health Sciences (C.H.C., C.S.W.), and the Department of Obstetrics and Gynecology (C.H.C., C.S.W.), Penn State College of Medicine, Hershey, PA
| | - Carol S Weisman
- From the Division of General Internal Medicine, Department of Medicine (C.H.C.), the Department of Public Health Sciences (C.H.C., C.S.W.), and the Department of Obstetrics and Gynecology (C.H.C., C.S.W.), Penn State College of Medicine, Hershey, PA
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17
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Snyder AH, Weisman CS, Liu G, Leslie D, Chuang CH. The Impact of the Affordable Care Act on Contraceptive Use and Costs among Privately Insured Women. Womens Health Issues 2018; 28:219-223. [DOI: 10.1016/j.whi.2018.01.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 11/26/2022]
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18
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Nelson HN, Borrero S, Lehman E, Velott DL, Chuang CH. Measuring oral contraceptive adherence using self-report versus pharmacy claims data. Contraception 2017; 96:453-459. [PMID: 28882679 DOI: 10.1016/j.contraception.2017.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 08/08/2017] [Accepted: 08/25/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Proportion of Days Covered (PDC) is a measure of medication adherence that uses prescription claims data to describe the proportion of days that the patient possessed medication. The objective of this study is to compare PDC and self-report as measures of oral contraceptive pills (OCPs) adherence and to identify individual-level predictors of adherence. STUDY DESIGN In a sample of 384 OCP users, self-report was compared with PDC as measures of adherence over the past 3 months. Patient-level variables were examined for associations with adherence using multivariable logistic regression models. RESULTS High adherence, defined as missing ≤1 pill per month, was 76%, 68% and 54% as measured by self-report, PDC and both measures, respectively. Younger women (ages 18-25 and 26-33 years) were significantly less likely to have high adherence on both measures than women in the 34-40 age group [adjusted odds ratio (OR) 0.20, 95% confidence interval (CI) 0.08-0.51 and adjusted OR 0.26, 95% CI 0.11-0.62, respectively). Other predictors of high adherence on both self-report and PDC measures included being in a relationship (adjusted OR 2.30, 95% CI 1.14-4.64, compared with unpartnered women), Protestant religion (adjusted OR 2.08, 95% CI 1.07-4.06, compared with women with no religious affiliation) and higher contraceptive self-efficacy (adjusted OR 1.63, 95% CI 1.03-2.58). CONCLUSION PDC derived from pharmacy claims, or a combination of PDC and self-report measures, may be an alternative to self-report alone for measuring OCP adherence. IMPLICATIONS PDC may be a potential tool for measuring women's adherence to OCPs and should be validated in future studies.
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Affiliation(s)
| | - Sonya Borrero
- Division of General Internal Medicine, University of Pittsburgh; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
| | - Erik Lehman
- Department of Public Health Sciences, Penn State College of Medicine
| | - Diana L Velott
- Department of Public Health Sciences, Penn State College of Medicine
| | - Cynthia H Chuang
- Division of General Internal Medicine, Penn State College of Medicine; Department of Public Health Sciences, Penn State College of Medicine
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19
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Schieffer KM, Chuang CH, Connor J, Pawelczyk JA, Sekhar DL. Association of Iron Deficiency Anemia With Hearing Loss in US Adults. JAMA Otolaryngol Head Neck Surg 2017; 143:350-354. [PMID: 28033450 DOI: 10.1001/jamaoto.2016.3631] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Hearing loss in the US adult population is linked to hospitalization, poorer self-reported health, hypertension, diabetes, and tobacco use. Because iron deficiency anemia (IDA) is a common and easily correctable condition, further understanding of the association between IDA and all types of hearing loss in a population of US adults may help to open new possibilities for early identification and appropriate treatment. Objective To evaluate the association between sensorineural hearing loss (SNHL) and conductive hearing loss and IDA in adults aged 21 to 90 years in the United States. Design, Setting, and Participants The prevalence of IDA and hearing loss (International Classification of Diseases, Ninth Revision codes 389.1 [SNHL], 389.0 [conductive hearing loss], and 389 [combined hearing loss]) was identified in this retrospective cohort study at the Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. Iron deficiency anemia was determined by low hemoglobin and ferritin levels for age and sex in 305 339 adults aged 21 to 90 years. Associations between hearing loss and IDA were evaluated using χ2 testing, and logistic regression was used to model the risk of hearing loss among those with IDA. The study was conducted from January 1, 2011, to October 1, 2015. Main Outcomes and Measures Hearing loss. Results Of 305 339 patients in the study population, 132 551 were men (43.4%); mean (SD) age was 50.1 (18.5) years. There was a 1.6% (n = 4807) prevalence of combined hearing loss and 0.7% (n = 2274) prevalence of IDA. Both SNHL (present in 26 of 2274 individuals [1.1%] with IDA; P = .005) and combined hearing loss (present in 77 [3.4%]; P < .001) were significantly associated with IDA. Logistic regression analysis confirmed increased odds of SNHL (adjusted odds ratio [OR], 1.82; 95% CI, 1.18-2.66) and combined hearing loss (adjusted OR, 2.41; 95% CI, 1.90-3.01) among adults with IDA, after adjusting for sex. Conclusions and Relevance Iron deficiency anemia was associated with SNHL and combined hearing loss in a population of adult patients. Further research is needed to better understand the potential links between IDA and hearing loss and whether screening and treatment of IDA in adults could have clinical implications in patients with hearing loss.
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Affiliation(s)
- Kathleen M Schieffer
- Doctoral student, Division of Colon and Rectal Surgery, Department of Surgery, Pennsylvania State University College of Medicine, Hershey
| | - Cynthia H Chuang
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey
| | - James Connor
- Department of Neurosurgery, Pennsylvania State University College of Medicine, Hershey
| | - James A Pawelczyk
- Department of Kinesiology, Noll Laboratory, Pennsylvania State University, State College
| | - Deepa L Sekhar
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey
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20
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Van Scoy LJ, Scott AM, Reading JM, Chuang CH, Chinchilli VM, Levi BH, Green MJ. From Theory to Practice: Measuring end-of-life communication quality using multiple goals theory. Patient Educ Couns 2017; 100:909-918. [PMID: 28011081 DOI: 10.1016/j.pec.2016.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 11/17/2016] [Accepted: 12/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To describe how multiple goals theory can be used as a reliable and valid measure (i.e., coding scheme) of the quality of conversations about end-of-life issues. METHODS We analyzed conversations from 17 conversations in which 68 participants (mean age=51years) played a game that prompted discussion in response to open-ended questions about end-of-life issues. Conversations (mean duration=91min) were audio-recorded and transcribed. Communication quality was assessed by three coders who assigned numeric scores rating how well individuals accomplished task, relational, and identity goals in the conversation. RESULTS The coding measure, which results in a quantifiable outcome, yielded strong reliability (intra-class correlation range=0.73-0.89 and Cronbach's alpha range=0.69-0.89 for each of the coded domains) and validity (using multilevel nonlinear modeling, we detected significant variability in scores between games for each of the coded domains, all p-values <0.02). CONCLUSIONS Our coding scheme provides a theory-based measure of end-of-life conversation quality that is superior to other methods of measuring communication quality. PRACTICE IMPLICATIONS Our description of the coding method enables researches to adapt and apply this measure to communication interventions in other clinical contexts.
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Affiliation(s)
- L J Van Scoy
- Department of Medicine and Humanities, Penn State Milton S. Hershey Medical Center, United States.
| | - A M Scott
- Department of Communication, University of Kentucky, United States
| | - J M Reading
- Department of Medicine, Penn State Milton S. Hershey Medical Center, United States
| | - C H Chuang
- Department of Medicine and Public Health Sciences, Penn State Milton S. Hershey Medical Center, United States
| | - V M Chinchilli
- Department of Public Health Sciences and Statistics, Penn State Milton S. Hershey Medical Center, United States
| | - B H Levi
- Department of Humanities and Pediatrics, Penn State Milton S. Hershey Medical Center, United States
| | - M J Green
- Department of Medicine and Humanities, Penn State Milton S. Hershey Medical Center, United States
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Sekhar DL, Kunselman AR, Chuang CH, Paul IM. Optimizing hemoglobin thresholds for detection of iron deficiency among reproductive-age women in the United States. Transl Res 2017; 180:68-76. [PMID: 27593097 PMCID: PMC5253089 DOI: 10.1016/j.trsl.2016.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/01/2016] [Accepted: 08/09/2016] [Indexed: 12/18/2022]
Abstract
Iron deficiency (ID) affects 9%-16% of US women with well-documented morbidity in academic performance, mood, and concentration. Current ID screening depends on the detection of low hemoglobin (ie, anemia, <12.0 g/dL). However, anemia is a late-stage indicator of ID. The study hypothesis was that using higher hemoglobin thresholds would optimize ID screening. The objective was to assess the sensitivity and specificity of hemoglobin to detect ID among nonpregnant, reproductive-age women of 12-49 years and to determine if psychometric characteristics varied by age and race. This cross-sectional study used National Health and Nutrition Examination Survey 2003-2010 data. ID was defined as body iron, calculated using ferritin and transferrin receptors. Logistic regression and receiver operating characteristic (ROC) curves were used to model the predictive probability of ID by hemoglobin values. ID prevalence by body iron was 11.5% (n = 6602). Using <12.0 g/dL, hemoglobin had a sensitivity of 42.9% (95% confidence interval [CI] = 39.4%, 46.4%) and specificity of 95.5% (95% CI = 95.0%, 96.0%) for ID. The ROC curve was optimized at the hemoglobin threshold of <12.8 g/dL with the sensitivity and specificity of 71.3% (95% CI = 68.0%, 74.5%) and 79.3% (95% CI = 78.2%, 80.3%), respectively. The probability of ID at this threshold was 13.5% (95% CI = 11.3%, 15.9%). Hemoglobin better predicted ID among older (22-49 years) vs younger (12-21 years) women (c-index 0.87 vs 0.77, P < 0.001). Among nonpregnant, reproductive-age women, current hemoglobin thresholds are insufficient to exclude ID. A threshold of <12.8 g/dL improves the detection of ID.
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Affiliation(s)
- Deepa L Sekhar
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pa.
| | - Allen R Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa
| | - Cynthia H Chuang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa; Department of Medicine, Penn State College of Medicine, Hershey, Pa
| | - Ian M Paul
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pa; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa
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Bhuva K, Kraschnewski JL, Lehman EB, Chuang CH. Does body mass index or weight perception affect contraceptive use? Contraception 2016; 95:59-64. [PMID: 27621045 DOI: 10.1016/j.contraception.2016.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 07/06/2016] [Accepted: 09/04/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Overweight and obese women may avoid contraceptive methods they believe are associated with weight gain. The objective of this study was to examine the role of weight and weight perception on contraceptive use. STUDY DESIGN Using cross-sectional data from the MyNewOptions study, we analyzed contraceptive use among 987 privately insured, sexually active women aged 18-40 years. Contraception was categorized into three groups: (1) long-acting reversible contraceptives (LARCs), (2) non-LARC prescription methods and (3) nonprescription methods/no method. Multinomial logistic regression was used to model the effect of body mass index category and weight perception on contraceptive use while controlling for pregnancy intentions, sexual behavior and sociodemographic characteristics. RESULTS Eighty-three (8.4%) women were using LARCs, 490 (49.6%) women were using non-LARC prescription methods and 414 (42.0%) were using nonprescription methods or no method. In the adjusted multinomial model, overweight [adjusted odds ratio (aOR) 3.84, 95% confidence interval (CI) 1.85-7.98) and obese women (aOR 2.82, 95% CI 1.18-6.72) were significantly more likely to use LARCs compared to normal-weight women. There were greater adjusted odds of overweight and obese women using nonprescription methods/no method compared with non-LARC prescription methods, but this finding did not reach statistical significance. Weight perception was not associated with contraceptive use. CONCLUSION In this study sample, overweight and obese women were more likely to use LARCs than normal-weight women. It will be important to further understand how weight influences women and providers' views on contraception in order to better assist women with individualized, patient-centered contraceptive decision making. IMPLICATIONS Overweight and obese women may be reluctant to use contraceptive methods they believe are associated with weight gain (i.e., pills, shot), but how that affects contraceptive use is unclear. Compared with normal-weight women, overweight and obese women in this study were more likely to use LARCs than non-LARC prescription methods.
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Affiliation(s)
- Kalpesh Bhuva
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA 17033, USA
| | - Jennifer L Kraschnewski
- Division of General Internal Medicine, Department of Medicine, Penn State College of Medicine, Hershey, PA 17033, USA; Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA 17033, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA 17033, USA
| | - Cynthia H Chuang
- Division of General Internal Medicine, Department of Medicine, Penn State College of Medicine, Hershey, PA 17033, USA; Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA 17033, USA.
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Lauring JR, Lehman EB, Deimling TA, Legro RS, Chuang CH. Combined hormonal contraception use in reproductive-age women with contraindications to estrogen use. Am J Obstet Gynecol 2016; 215:330.e1-7. [PMID: 27059507 DOI: 10.1016/j.ajog.2016.03.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention's US Medical Eligibility Criteria for Contraceptive Use recommends that combined hormonal contraceptives (ie, birth control pills, contraceptive patch, vaginal ring) should be avoided in women with specific medical conditions because of the increased risk of cardiovascular events associated with estrogen use. Whether women with category 3 (theoretical or proven risk usually outweigh the advantages) or category 4 (unacceptable health risk) contraindications are appropriately avoiding estrogen-containing combined hormonal contraceptives is unknown. OBJECTIVE We describe the prevalence of combined hormonal contraceptive use among a sample of reproductive-age women with medical contraindications to estrogen use. Our hypothesis was that women with categories 3 and 4 contraindications would use estrogen-containing contraception less often than women without medical contraindications. We also explored whether inappropriate estrogen-containing contraceptive use is related to contraceptive provider characteristics. STUDY DESIGN Data are from the baseline survey of the MyNewOptions study, which included privately insured women residing in Pennsylvania aged 18-40 years, who were sexually active and not intending pregnancy in the next year. Women were surveyed about their medical conditions, contraceptive use, and characteristics of their contraceptive provider. Women were considered to have a contraindication to combined hormonal contraceptives if they reported a category 3 or category 4 contraindication: hypertension, smokers older than age 35 years, a history of venous thromboembolism, diabetes with complications, coronary artery disease, systemic lupus erythematosus with antiphospholipid antibodies, breast cancer, or migraine headaches with aura. χ(2) tests for general association were used to compare combined hormonal contraceptives use, contraceptive health provider characteristics, and sociodemographic data in women with and without contraindications to estrogen use. RESULTS The MyNewOptions baseline study sample included 987 adult women who were mostly young (46% were 18-25 years), white (94%), employed (70%), and married or cohabiting (54%). Thirteen percent (n = 130) of the sample had a medical contraindication to estrogen-containing contraceptive use: migraine with aura (81%) was the most common contraindication, followed by smokers older than age 35 years (7%), hypertension (11%), history of venous thromboembolism (4%), and diabetes with complications (2%). High use of combined hormonal contraceptives was reported among the women with medical contraindications to estrogen at 39% (n = 51). This was not statistically different from women without a medical contraindication (47%, P = .1). Among the 130 women with a contraindication, whether they did or did not use an estrogen-containing contraceptive did not vary by education level, income, or weight category. With respect to their contraceptive prescribers, there were no differences in prescriber specialty, provider type, or clinic type comparing women using and not using an estrogen-containing contraceptive. CONCLUSION Among this study sample of reproductive-age women, there was a high rate of combined hormonal contraceptive use in women with a medical contraindication to estrogen use. These women may be at an increased risk for cardiovascular events. Processes need to be improved to ensure that women with medical contraindications to estrogen-containing contraception are being offered the safest and most effective methods, including long-acting reversible contraceptives, such as intrauterine devices and the contraceptive implant.
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Affiliation(s)
- Julianne R Lauring
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA.
| | - Erik B Lehman
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Timothy A Deimling
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Richard S Legro
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Cynthia H Chuang
- Division of General Internal Medicine, Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Van Scoy LJ, Green MJ, Reading JM, Scott AM, Chuang CH, Levi BH. Can Playing an End-of-Life Conversation Game Motivate People to Engage in Advance Care Planning? Am J Hosp Palliat Care 2016; 34:754-761. [PMID: 27406696 DOI: 10.1177/1049909116656353] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) involves several behaviors that individuals undertake to prepare for future medical care should they lose decision-making capacity. The goal of this study was to assess whether playing a conversation game could motivate participants to engage in ACP. METHODS Sixty-eight English-speaking, adult volunteers (n = 17 games) from communities around Hershey, Pennsylvania, and Lexington, Kentucky, played a conversation card game about end-of-life issues. Readiness to engage in 4 ACP behaviors was measured by a validated questionnaire (based on the transtheoretical model) immediately before and 3 months postgame and a semistructured phone interview. These behaviors were (1) completing a living will; (2) completing a health-care proxy; (3) discussing end-of-life wishes with loved ones; and (4) discussing quality versus quantity of life with loved ones. RESULTS Participants' (n = 68) mean age was 51.3 years (standard deviation = 0.7, range: 22-88); 94% of the participants were caucasian and 67% were female. Seventy-eight percent of the participants engaged in ACP behaviors within 3 months of playing the game (eg, updating documents, discussing end-of-life issues). Furthermore, 73% of the participants progressed in stage of change (ie, readiness) to perform at least 1 of the 4 behaviors. Scores on measures of decisional balance and processes of change increased significantly by 3 months postintervention. CONCLUSION This pilot study found that individuals who played a conversation game had high rates of performing ACP behaviors within 3 months. These findings suggest that using a game format may be a useful way to motivate people to perform important ACP behaviors.
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Affiliation(s)
- Lauren J Van Scoy
- 1 Department of Medicine and Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Michael J Green
- 1 Department of Medicine and Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jean M Reading
- 2 Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Allison M Scott
- 3 Department of Communication, University of Kentucky, Lexington, KY, USA
| | - Cynthia H Chuang
- 4 Department of Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Benjamin H Levi
- 5 Department of Pediatrics and Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
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25
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Phelan AL, Kunselman AR, Chuang CH, Raja-Khan NT, Legro RS. Exclusion of Women of Childbearing Potential in Clinical Trials of Type 2 Diabetes Medications: A Review of Protocol-Based Barriers to Enrollment. Diabetes Care 2016; 39:1004-9. [PMID: 27208329 PMCID: PMC4878221 DOI: 10.2337/dc15-2723] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/21/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Women of childbearing potential are often excluded from participating in clinical trials owing to concerns about adverse fetal effects of treatment. This study aims to determine the prevalence of fertility-related exclusion criteria in clinical trials of type 2 diabetes medications and to determine whether these criteria are commensurate with drug risk. RESEARCH DESIGN AND METHODS ClinicalTrials.gov was queried for trials of type 2 diabetes medications that were phase 2 or 3, were based in the U.S., and enrolled participants 18-40 years old. Six hundred eighty-eight trials met criteria. Information collected about each trial included enrollment, trial length, exclusion and inclusion criteria, trial sponsor, and pregnancy category of drug(s) administered. RESULTS Most studies (59%) included one or more fertility-related exclusion criteria, most often excluding current pregnancy (55%) and breast-feeding (44%). Trials of medications with increased fetal risk were not more restrictive: trials of category C drugs (evidence of fetal risks in animals) were less likely to exclude pregnancy compared with trials of category B drugs (no known human or animal fetal risks) (45.6% vs. 69.8%, odds ratio [OR] 0.37 [95% CI 0.20, 0.65], P = 0.0005) or to require contraceptive use (29.9% vs. 57.1%, OR 0.32 [95% CI 0.18, 0.56], P = 0.001). CONCLUSIONS In clinical trials of type 2 diabetes medications, exclusion criteria affecting women of childbearing potential are often disproportionate to risk to the participant and fetus. These criteria have the potential to impede young women's access to clinical trials and may hinder the acquisition of clinical knowledge critical for improving the care of women with diabetes.
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Affiliation(s)
- Alannah L Phelan
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA
| | - Allen R Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Cynthia H Chuang
- Department of Medicine, Penn State College of Medicine, Hershey, PA
| | | | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
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Chuang CH, Mitchell JL, Velott DL, Legro RS, Lehman EB, Confer L, Weisman CS. Women's Awareness of Their Contraceptive Benefits Under the Patient Protection and Affordable Care Act. Am J Public Health 2015; 105 Suppl 5:S713-5. [PMID: 26447910 DOI: 10.2105/ajph.2015.302829] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Patient Protection and Affordable Care Act mandates that there be no out-of-pocket cost for Food and Drug Administration-approved contraceptive methods. Among 987 privately insured reproductive aged Pennsylvania women, fewer than 5% were aware that their insurance covered tubal sterilization, and only 11% were aware that they had full coverage for an intrauterine device. For the Affordable Care Act contraceptive coverage mandate to affect effective contraception use and reduce unintended pregnancies, public awareness of the expanded benefits is essential.
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Affiliation(s)
- Cynthia H Chuang
- Cynthia H. Chuang is with the Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA. Julie L. Mitchell is with the Department of Medicine, Penn State College of Medicine. Diana L. Velott, Erik B. Lehman, Lindsay Confer, and Carol S. Weisman are with the Department of Public Health Sciences, Penn State College of Medicine. Richard S. Legro is with the Department of Obstetrics and Gynecology, Penn State College of Medicine
| | - Julie L Mitchell
- Cynthia H. Chuang is with the Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA. Julie L. Mitchell is with the Department of Medicine, Penn State College of Medicine. Diana L. Velott, Erik B. Lehman, Lindsay Confer, and Carol S. Weisman are with the Department of Public Health Sciences, Penn State College of Medicine. Richard S. Legro is with the Department of Obstetrics and Gynecology, Penn State College of Medicine
| | - Diana L Velott
- Cynthia H. Chuang is with the Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA. Julie L. Mitchell is with the Department of Medicine, Penn State College of Medicine. Diana L. Velott, Erik B. Lehman, Lindsay Confer, and Carol S. Weisman are with the Department of Public Health Sciences, Penn State College of Medicine. Richard S. Legro is with the Department of Obstetrics and Gynecology, Penn State College of Medicine
| | - Richard S Legro
- Cynthia H. Chuang is with the Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA. Julie L. Mitchell is with the Department of Medicine, Penn State College of Medicine. Diana L. Velott, Erik B. Lehman, Lindsay Confer, and Carol S. Weisman are with the Department of Public Health Sciences, Penn State College of Medicine. Richard S. Legro is with the Department of Obstetrics and Gynecology, Penn State College of Medicine
| | - Erik B Lehman
- Cynthia H. Chuang is with the Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA. Julie L. Mitchell is with the Department of Medicine, Penn State College of Medicine. Diana L. Velott, Erik B. Lehman, Lindsay Confer, and Carol S. Weisman are with the Department of Public Health Sciences, Penn State College of Medicine. Richard S. Legro is with the Department of Obstetrics and Gynecology, Penn State College of Medicine
| | - Lindsay Confer
- Cynthia H. Chuang is with the Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA. Julie L. Mitchell is with the Department of Medicine, Penn State College of Medicine. Diana L. Velott, Erik B. Lehman, Lindsay Confer, and Carol S. Weisman are with the Department of Public Health Sciences, Penn State College of Medicine. Richard S. Legro is with the Department of Obstetrics and Gynecology, Penn State College of Medicine
| | - Carol S Weisman
- Cynthia H. Chuang is with the Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA. Julie L. Mitchell is with the Department of Medicine, Penn State College of Medicine. Diana L. Velott, Erik B. Lehman, Lindsay Confer, and Carol S. Weisman are with the Department of Public Health Sciences, Penn State College of Medicine. Richard S. Legro is with the Department of Obstetrics and Gynecology, Penn State College of Medicine
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Chuang CH, Velott DL, Weisman CS, Sciamanna CN, Legro RS, Chinchilli VM, Moos MK, Francis EB, Confer LN, Lehman EB, Armitage CJ. Reducing Unintended Pregnancies Through Web-Based Reproductive Life Planning and Contraceptive Action Planning among Privately Insured Women: Study Protocol for the MyNewOptions Randomized, Controlled Trial. Womens Health Issues 2015; 25:641-8. [PMID: 26307564 DOI: 10.1016/j.whi.2015.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/18/2015] [Accepted: 06/29/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Affordable Care Act mandates that most women of reproductive age with private health insurance have full contraceptive coverage with no out-of-pocket costs, creating an actionable time for women to evaluate their contraceptive choices without cost considerations. The MyNewOptions study is a three-arm, randomized, controlled trial testing web-based interventions aimed at assisting privately insured women with making contraceptive choices that are consistent with their reproductive goals. METHODS Privately insured women between the ages of 18 and 40 not intending pregnancy were randomly assigned to one of three groups: 1) a reproductive life planning (RLP) intervention, 2) a reproductive life planning enriched with contraceptive action planning (RLP+) intervention, or 3) an information only control group. Both the RLP and RLP+ guide women to identify their individualized reproductive goals and contraceptive method requirements. The RLP+ additionally includes a contraceptive action planning component, which uses if-then scenarios that allow the user to problem solve situations that make it difficult to be adherent to their contraceptive method. All three groups have access to a reproductive options library containing information about their contraceptive coverage and the attributes of alternative contraceptive methods. Women completed a baseline survey with follow-up surveys every 6 months for 2 years concurrent with intervention boosters. Study outcomes include contraceptive use and adherence. ClinicalTrials.gov identifier: NCT02100124. DISCUSSION Results from the MyNewOptions study will demonstrate whether web-based reproductive life planning, with or without contraceptive action planning, helps insured women make patient-centered contraceptive choices compared with an information-only control condition.
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Affiliation(s)
- Cynthia H Chuang
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Diana L Velott
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Carol S Weisman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Christopher N Sciamanna
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Merry-K Moos
- Center for Maternal & Infant Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erica B Francis
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Lindsay N Confer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Erik B Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Psychological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Weisman CS, Lehman EB, Legro RS, Velott DL, Chuang CH. How do pregnancy intentions affect contraceptive choices when cost is not a factor? A study of privately insured women. Contraception 2015; 92:501-7. [PMID: 26002807 DOI: 10.1016/j.contraception.2015.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/11/2015] [Accepted: 05/13/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to test the hypothesis that among privately insured women who have contraceptive coverage without cost-sharing, using prescription contraception is predicted primarily by pregnancy intentions. STUDY DESIGN Participants are 987 women ages 18-40 who wish to avoid pregnancy for at least the next 12 months and are enrolled in Highmark Health plans in Pennsylvania. Data are from the baseline survey of MyNewOptions, an ongoing randomized controlled trial testing an intervention to help insured women make optimum contraceptive choices. Primary type of contraception used [categorized as long-acting reversible contraception (LARCs), other prescription methods, nonprescription methods or no method] is modeled using multinomial logistic regression, with predictors representing the timing and strength of pregnancy intentions, pregnancy history, pregnancy risk exposure and sociodemographics. RESULTS LARCs were used by 8.4% of the sample; other prescription methods (primarily oral contraceptives), 49.6%; nonprescription methods (primarily condoms), 30.4%; and no method, 11.5%. Pregnancy intentions predicted use of LARCs and other prescription methods compared with no method. The most consistent predictors of using all categories of contraception were pregnancy risk exposure measures (partnership type and frequency of sexual intercourse). CONCLUSIONS In the absence of cost-sharing for contraception, women's choice of prescription contraception was a function primarily of pregnancy risk exposure rather than pregnancy intentions. IMPLICATIONS This study is among the first to examine privately insured women's contraception choices in the context of contraceptive coverage without cost-sharing; it shows that use of prescription contraception is predicted by pregnancy risk exposure and pregnancy intentions.
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Affiliation(s)
- Carol S Weisman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, USA.
| | - Erik B Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Richard S Legro
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, USA
| | - Diana L Velott
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Cynthia H Chuang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
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Chuang CH, Stengel MR, Hwang SW, Velott D, Kjerulff KH, Kraschnewski JL. Behaviours of overweight and obese women during pregnancy who achieve and exceed recommended gestational weight gain. Obes Res Clin Pract 2014; 8:e577-83. [PMID: 25434913 PMCID: PMC4251492 DOI: 10.1016/j.orcp.2013.12.254] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 12/18/2013] [Accepted: 12/20/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Excessive gestational weight gain (GWG) is associated with increased risk of pregnancy-related complications, postpartum weight retention, and long-term obesity. Little is known about the behavioural habits of pregnant women who achieve and exceed recommended GWG. METHOD In 2011, qualitative interviews were conducted in Pennsylvania with postpartum women who were overweight or obese prior to pregnancy to ascertain their behaviours and attitudes regarding dietary habits, physical activity, and self-monitoring during pregnancy. Thematic analysis identified the habits of women who achieved and exceeded recommended GWG guidelines. RESULTS Of the 29 women interviewed, 11 had appropriate GWG and 18 had excessive GWG. Women achieving appropriate GWG reported modest increases in caloric intake if at all, with deliberate meal and snack planning, while women with excessive GWG described "eating-for-two." Nearly all women with excessive GWG reported exercising less during pregnancy (or remaining sedentary), while women with appropriate GWG largely increased or maintained pre-pregnancy physical activity levels. About half of the sample reported self-monitoring weight gain during pregnancy, but women achieving recommended GWG tied their weight monitoring with GWG goals consistent with recommended guidelines. CONCLUSIONS Women who achieved appropriate GWG reported deliberate dietary habits and physical activity planning, with appropriate GWG goals during pregnancy. Women exceeding recommended GWG described "eating-for-two," were sedentary, and either had no goals for GWG or intended to gain more weight than recommended.
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Affiliation(s)
- Cynthia H Chuang
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA 17033, United States; Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, United States.
| | | | | | - Diana Velott
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, United States
| | - Kristen H Kjerulff
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, United States; Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, PA 17033, United States
| | - Jennifer L Kraschnewski
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA 17033, United States; Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, United States
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McCall-Hosenfeld JS, Weisman CS, Perry AN, Hillemeier MM, Chuang CH. "I Just Keep My Antennae Out": How Rural Primary Care Physicians Respond to Intimate Partner Violence. J Interpers Violence 2014; 29:2670-2694. [PMID: 24424251 PMCID: PMC4121375 DOI: 10.1177/0886260513517299] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Women in rural communities who are exposed to intimate partner violence (IPV) have fewer resources when seeking help due to limited health services, poverty, and social isolation. Rural primary care physicians may be key sources of care for IPV victims. The objective of this study was to assess the opinions and practices of primary care physicians caring for rural women with regard to IPV identification, the scope and severity of IPV as a health problem, how primary care providers respond to IPV in their practices, and barriers to optimized IPV care in their communities. Semistructured interviews were conducted with 19 internists, family practitioners, and obstetrician-gynecologists in rural central Pennsylvania. Interview transcripts were analyzed for major themes. Most physicians did not practice routine screening for IPV due to competing time demands, lack of training, limited access to referral services as well as low confidence in their effectiveness, and concern that inquiry would harm the patient-doctor relationship. IPV was considered when patients presented with symptoms of mood, anxiety, or somatic disorders. Responses to IPV included validation, danger assessment, safety planning, referral, and follow-up planning. Perceived barriers to rural women seeking help for IPV included traditional gender roles, lower education, economic dependence on the partner, low self-esteem, and patient reluctance to discuss IPV. To overcome barriers, physicians created a "safe sanctuary" to discuss IPV and suggested improved public health education and referral services. Interventions to improve IPV-related care in rural communities should address barriers at multiple levels, including both physicians' and patients' comfort with discussing IPV. Provider training, community education, and improved access to referral services are key areas in which IPV-related care should be improved in rural communities. Our data support routine screening to better identify IPV and a more pro-active stance toward screening and counseling.
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Affiliation(s)
| | - Carol S Weisman
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Amanda N Perry
- Pennsylvania State University College of Agricultural Sciences, State College, PA, USA
| | - Marianne M Hillemeier
- Pennsylvania State University College of Health and Human Development, State College, PA
| | - Cynthia H Chuang
- Pennsylvania State University College of Medicine, Hershey, PA, USA
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MaCauley MJ, Showalter JW, Beck MJ, Chuang CH. The effect of a provider-enhanced clinical decision support tool for guiding venous thromboembolism pharmacoprophylaxis in low-risk patients. Hosp Pract (1995) 2014; 40:7-12. [PMID: 23086089 DOI: 10.3810/hp.2012.08.984] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Computer-based tools to assess venous thromboembolism (VTE) risk have been shown to increase VTE pharmacoprophylaxis rates and decrease VTE incidence in high-risk hospitalized patients. However, VTE risk may be underestimated using computer-based tools alone. We tested the effect of a provider-enhanced clinical decision support (CDS) tool on VTE pharmacoprophylaxis and VTE incidence in patients who would have been deemed "low risk" using a computer-based risk-assessment tool alone. METHODS The study sample was adult patients hospitalized during a 13-month period who were determined to be at low risk for VTE with a computer-based risk-assessment tool. The provider-enhanced CDS tool was implemented 4 months into the study period and required providers to stratify patients as being at high, moderate, or low risk for VTE. We compared rates of VTE pharmacoprophylaxis and VTE incidence before and after implementation of the provider-enhanced CDS tool. RESULTS There were 1322 patients in the 4-month pre-implementation period and 3347 patients in the 9-month post-implementation period who were determined to be at low risk for VTE based on a computer-based risk-assessment tool. Using the provider-enhanced CDS tool, providers stratified 31% of these computer-assigned low-risk patients as being at moderate risk for VTE and 7% as being at high risk for VTE. The rate of VTE pharmacoprophylaxis increased from 27% to 34% (P < 0.01). The venous thromboprophylaxis rate decreased from 0.98% to 0.42% after implementation of the provider-enhanced CDS tool (P < 0.02). CONCLUSION Patients identified as being at low risk for VTE solely by computer-based algorithms may include patients whom providers determine to be at risk for VTE. Provider-enhanced CDS tools may outperform computer-based VTE risk-stratification algorithms.
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Kraschnewski JL, Chuang CH. "Eating for two": excessive gestational weight gain and the need to change social norms. Womens Health Issues 2014; 24:e257-9. [PMID: 24794540 DOI: 10.1016/j.whi.2014.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 03/11/2014] [Accepted: 03/13/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Jennifer L Kraschnewski
- Departments of Medicine and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Cynthia H Chuang
- Departments of Medicine and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Amin W, Tsui FR, Borromeo C, Chuang CH, Espino JU, Ford D, Hwang W, Kapoor W, Lehmann H, Martich GD, Morton S, Paranjape A, Shirey W, Sorensen A, Becich MJ, Hess R. PaTH: towards a learning health system in the Mid-Atlantic region. J Am Med Inform Assoc 2014; 21:633-6. [PMID: 24821745 PMCID: PMC4078296 DOI: 10.1136/amiajnl-2014-002759] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 03/19/2014] [Accepted: 03/25/2014] [Indexed: 12/02/2022] Open
Abstract
The PaTH (University of Pittsburgh/UPMC, Penn State College of Medicine, Temple University Hospital, and Johns Hopkins University) clinical data research network initiative is a collaborative effort among four academic health centers in the Mid-Atlantic region. PaTH will provide robust infrastructure to conduct research, explore clinical outcomes, link with biospecimens, and improve methods for sharing and analyzing data across our diverse populations. Our disease foci are idiopathic pulmonary fibrosis, atrial fibrillation, and obesity. The four network sites have extensive experience in using data from electronic health records and have devised robust methods for patient outreach and recruitment. The network will adopt best practices by using the open-source data-sharing tool, Informatics for Integrating Biology and the Bedside (i2b2), at each site to enhance data sharing using centrally defined common data elements, and will use the Shared Health Research Information Network (SHRINE) for distributed queries across the network.
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Affiliation(s)
- Waqas Amin
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Fuchiang Rich Tsui
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Charles Borromeo
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Cynthia H Chuang
- Department of Medicine and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jeremy U Espino
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Daniel Ford
- Department of Medicine, Division of Health Science Informatics, John Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Wenke Hwang
- Department of Public Health Sciences, Division of Health Services Research, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Wishwa Kapoor
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Harold Lehmann
- Department of Medicine, Division of Health Science Informatics, John Hopkins School of Medicine, Baltimore, Maryland, USA
| | - G Daniel Martich
- Department of Critical Care Medicine, UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sally Morton
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anuradha Paranjape
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - William Shirey
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Aaron Sorensen
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael J Becich
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rachel Hess
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Gonzalo JD, Wolpaw DR, Lehman E, Chuang CH. Patient-centered interprofessional collaborative care: factors associated with bedside interprofessional rounds. J Gen Intern Med 2014; 29:1040-7. [PMID: 24615186 PMCID: PMC4061365 DOI: 10.1007/s11606-014-2817-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/12/2014] [Accepted: 02/07/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Medical care delivered in hospital-based medicine units requires interprofessional collaborative care (IPCC) to improve quality. However, models such as bedside interprofessional rounds, or encounters that include the team of physician and nurse providers discussing medical care at the patient's bedside, are not well studied. OBJECTIVE To examine the incidence of and time spent in bedside interprofessional rounds on internal medicine teaching services in one academic medical center. DESIGN AND PARTICIPANTS Observational descriptive study of internal medicine faculty serving as inpatient medicine attending physicians. Participants completed a daily electronic survey following team rounding sessions to assess rounding characteristics (November 2012-June 2013); variables such as resident level-of-training, attending physician years' of experience, house staff call day and clinic schedule were obtained from administrative data. Descriptive, Kruskal-Wallis, and multivariable logistic regression statistics were used to evaluate the study objectives. MAIN MEASURES Primary outcomes were: (1) incidence of bedside interprofessional rounds, (2) time spent with patients during bedside interprofessional rounding encounters, and, (3) factors associated with increased occurrence of and time spent with patients during bedside interprofessional rounds. Covariates included resident level-of-training, attending physician years' of experience, census size, and call day. KEY RESULTS Of 549 rounding sessions, 412 surveys were collected (75 % response) from 25 attending physicians. Bedside interprofessional rounds occurred with 64 % of patients (median 8.0 min/encounter), differing by unit (intermediate care 81 %, general medicine 63 %, non-medicine 57 %, p < 0.001). Factors independently associated with increased occurrence of bedside interprofessional rounds were senior resident (OR 2.67, CI 1.75-4.06, PGY-3/PGY-4 vs. PGY-2), weekdays (OR 1.74, CI 1.13-2.69), team census size ≤ 11 (OR 2.36, CI 1.37-4.06), and attending physicians with ≤ 4 years' experience (OR 2.15, CI 1.31-3.55). Factors independently associated with increased time spent during encounters were attending physicians with ≤ 4 years (OR 2.38, CI 1.44-3.95), 5-15 years of experience (OR 1.82, CI 1.10-3.02), and weekdays (OR 1.71, CI 1.10-2.65). CONCLUSIONS These findings highlight factors associated with increasing or decreasing occurrence and time spent in bedside interprofessional collaborative care delivery. Systematic changes to census size caps, resident scheduling, and attending physician education and staffing may be required to increase the occurrence of interprofessional collaborative care.
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Affiliation(s)
- Jed D Gonzalo
- Department of Medicine, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA,
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Sciamanna CN, Patel VA, Kraschnewski JL, Rovniak LS, Messina DA, Stuckey HL, Curry WJ, Chuang CH, Sherwood LL, Hess SL. A strength training program for primary care patients, central Pennsylvania, 2012. Prev Chronic Dis 2014; 11:E107. [PMID: 24967829 PMCID: PMC4075490 DOI: 10.5888/pcd11.130403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Primary care providers can recommend strength training programs to use "Exercise as Medicine," yet few studies have examined the interest of primary care patients in these programs. METHODS We conducted a cross-sectional survey of primary care patients in central Pennsylvania. Interest in participating in free group-based strength training and weight control programs was assessed, in addition to patient demographics, medical history, and quality of life. RESULTS Among 414 patients, most (61.0%) were aged 54 or older, and 64.0% were female. More patients were interested in a strength training program (55.3%) than in a weight control program (45.4%). Nearly three-quarters (72.8%) of those reporting 10 or more days of poor physical health were interested in a strength training program compared with 49.5% of those reporting no days of poor physical health. After adjusting for potential confounders, those reporting poorer physical health had 2.7 greater odds (95% confidence interval, 1.4-5.1) of being interested in a strength training program compared with those reporting better physical health. Patients with hypertension, diabetes, or high cholesterol were not more interested in a strength training program than those without these conditions. CONCLUSION Primary care practices may consider offering or referring patients to community-based strength training programs. This study observed high levels of interest in these widely available programs. Practices may also consider screening and referring those with poorer physical health, as they may be the most interested and have the most to gain from participating.
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Affiliation(s)
- Christopher N Sciamanna
- Penn State Hershey Medical Center, Division of General Internal Medicine, H034, 500 University Dr, Hershey, PA 17033. E-mail:
| | - Vijay A Patel
- Penn State Hershey Medical Center, Hershey, Pennsylvania
| | | | - Liza S Rovniak
- Penn State Hershey Medical Center, Hershey, Pennsylvania
| | | | | | | | | | | | - Stacy L Hess
- Penn State Hershey Medical Center, Hershey, Pennsylvania
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Kraschnewski JL, Chuang CH, Poole ES, Peyton T, Blubaugh I, Pauli J, Feher A, Reddy M. Paging "Dr. Google": does technology fill the gap created by the prenatal care visit structure? Qualitative focus group study with pregnant women. J Med Internet Res 2014; 16:e147. [PMID: 24892583 PMCID: PMC4060145 DOI: 10.2196/jmir.3385] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/07/2014] [Accepted: 05/19/2014] [Indexed: 01/28/2023] Open
Abstract
Background The prenatal care visit structure has changed little over the past century despite the rapid evolution of technology including Internet and mobile phones. Little is known about how pregnant women engage with technologies and the interface between these tools and medical care, especially for women of lower socioeconomic status. Objective We sought to understand how women use technology during pregnancy through a qualitative study with women enrolled in the Women, Infants, and Children (WIC) program. Methods We recruited pregnant women ages 18 and older who owned a smartphone, at a WIC clinic in central Pennsylvania. The focus group guide included questions about women’s current pregnancy, their sources of information, and whether they used technology for pregnancy-related information. Sessions were audiotaped and transcribed. Three members of the research team independently analyzed each transcript, using a thematic analysis approach. Themes related to the topics discussed were identified, for which there was full agreement. Results Four focus groups were conducted with a total of 17 women. Three major themes emerged as follows. First, the prenatal visit structure is not patient-centered, with the first visit perceived as occurring too late and with too few visits early in pregnancy when women have the most questions for their prenatal care providers. Unfortunately, the educational materials women received during prenatal care were viewed as unhelpful. Second, women turn to technology (eg, Google, smartphone applications) to fill their knowledge gaps. Turning to technology was viewed to be a generational approach. Finally, women reported that technology, although frequently used, has limitations. Conclusions The results of this qualitative research suggest that the current prenatal care visit structure is not patient-centered in that it does not allow women to seek advice when they want it most. A generational shift seems to have occurred, resulting in pregnant women in our study turning to the Internet and smartphones to fill this gap, which requires significant skills to navigate for useful information. Future steps may include developing interventions to help health care providers assist patients early in pregnancy to seek the information they want and to become better consumers of Internet-based pregnancy resources.
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Oluyemi AO, Welch AR, Yoo LJ, Lehman EB, McGarrity TJ, Chuang CH. Colorectal cancer screening in high-risk groups is increasing, although current smokers fall behind. Cancer 2014; 120:2106-13. [PMID: 24737546 DOI: 10.1002/cncr.28707] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 02/25/2014] [Accepted: 03/17/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is limited information about colorectal cancer (CRC) screening trends in high-risk groups, including the black, obese, diabetic, and smoking populations. For this study, the authors evaluated national CRC screening trends in these high-risk groups to provide insights into whether screening resources are being appropriately used. METHODS This was a nationally representative, population-based study using the Behavioral Risk Factor Surveillance System from the Centers for Disease Control. Data analysis was performed using bivariate analyses with weighted logistic regression. RESULTS In the general population, CRC screening increased significantly from 59% to 65% during the years 2006 to 2010. The screening prevalence in non-Hispanic blacks was 58% in 2006 and 65% in 2010. Among obese individuals, the prevalence of up-to-date CRC screening increased significantly from 59% in 2006 to 66% in 2010. Screening prevalence in individuals with diabetes was 63% in 2006 and 69% in 2010. The CRC screening prevalence in current smokers was 45% in 2006 and 50% in 2010. The odds of CRC screening in the non-Hispanic black population, the obese population, and the diabetic population were higher than in non-Hispanic whites, normal weight individuals, and the population without diabetes, respectively. Current smokers had significantly lower odds of CRC screening than never-smokers in the years studied (2006: odds ratio [OR], 0.71; 95% confidence interval [CI], 0.66-0.76; 2008: OR, 0.67; 95% CI, 0.63-0.71; 2010: OR, 0.69; 95% CI, 0.66-0.73). CONCLUSIONS The prevalence of CRC screening in high-risk groups is trending upward. Despite this, current smokers have significantly lower odds of CRC screening compared with the general population.
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Affiliation(s)
- Aminat O Oluyemi
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Tinloy J, Chuang CH, Zhu J, Pauli J, Kraschnewski JL, Kjerulff KH. Exercise during pregnancy and risk of late preterm birth, cesarean delivery, and hospitalizations. Womens Health Issues 2014; 24:e99-e104. [PMID: 24439953 DOI: 10.1016/j.whi.2013.11.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 11/08/2013] [Accepted: 11/08/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Federal physical activity guidelines recommend at least 150 minutes of moderate-intensity exercise per week during pregnancy. We studied whether regular exercise during pregnancy is associated with preterm birth, cesarean delivery, and hospitalization during pregnancy. METHODS Self-reported weekly exercise was ascertained in 3,006 women during the third trimester of pregnancy. Using multivariable logistic regression, we report the relationship between regular exercise (≥150 min/wk) and late preterm birth, cesarean delivery, and hospitalization during pregnancy, controlling for age, race, marital status, education, poverty status, prepregnancy body mass index weight category, gestational weight gain, and prepregnancy diabetes or hypertension. RESULTS Nearly one third of women reported meeting current federal physical activity recommendations during pregnancy. Five percent had late preterm birth, 29% had cesarean deliveries, and 20% reported hospitalization during pregnancy. In multivariable analysis, regular exercise during pregnancy was not associated with late preterm birth or hospitalization during pregnancy. Physical activity of 150 or more minutes per week was associated with reduced odds of cesarean delivery compared with less than 60 minutes per week, but the finding was not significant (adjusted odds ratio, 0.86; 95% confidence interval, 0.69-1.07). CONCLUSION In the First Baby Study, physical activity was not associated with late preterm birth or hospitalizations, and may be associated with decreased odds of cesarean delivery.
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Affiliation(s)
- Jennifer Tinloy
- Department of Medicine, MidState Medical Center, Meriden, Connecticut
| | - Cynthia H Chuang
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jaimey Pauli
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, Pennsylvania
| | - Jennifer L Kraschnewski
- Division of General Internal Medicine, H034, Penn State College of Medicine, Hershey, Pennsylvania
| | - Kristen H Kjerulff
- Departments of Public Health Sciences & Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
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Colon-Gonzalez MC, McCall-Hosenfeld JS, Weisman CS, Hillemeier MM, Perry AN, Chuang CH. "Someone's got to do it" - Primary care providers (PCPs) describe caring for rural women with mental health problems. Ment Health Fam Med 2013; 10:191-202. [PMID: 25632302 PMCID: PMC4306261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Little is known about how primary care providers (PCPs) approach mental health care for low-income rural women. We developed a qualitative research study to explore the attitudes and practices of PCPs regarding the care of mood and anxiety disorders in rural women. METHOD We conducted semi-structured interviews with 19 family physicians, internists, and obstetrician-gynecologists (OBGYNs) in office-based practices in rural central Pennsylvania. Using thematic analysis, investigators developed a coding scheme. Questions focused on 1) screening and diagnosis of mental health conditions, 2) barriers to treatment among rural women, 3) management of mental illnesses in rural women, and 4) ideas to improve care for this population. RESULTS PCP responses reflected these themes: 1) PCPs identify mental illnesses through several mechanisms including routine screening, indicator-based assessment, and self-identification by the patient; 2) Rural culture and social ecology are significant barriers to women in need of mental healthcare; 3) Mental healthcare resource limitations in rural communities lead PCPs to seek creative solutions to care for rural women with mental illnesses; 4) To improve mental healthcare in rural communities, both social norms and resource limitations must be addressed. CONCLUSION Our findings can inform future interventions to improve women's mental healthcare in rural communities. Ideas include promoting generalist education in mental healthcare, and expanding access to consultative networks. In addition, community programs to reduce the stigma of mental illnesses in rural communities may promote healthcare seeking and receptiveness to treatment.
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Affiliation(s)
- Maria C Colon-Gonzalez
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI,
| | | | - Carol S Weisman
- Public Health Sciences and Obstetrics and Gynecology, The Pennsylvania State University College of Medicine, Hershey, PA,
| | - Marianne M Hillemeier
- Health Policy and Administration and Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,
| | - Amanda N Perry
- Department of Agricultural Economics, Sociology, and Education DCollege of Agricultural Sciences, The Pennsylvania State University, State College, PA;
| | - Cynthia H Chuang
- Medicine and Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA,
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Rosenwasser LA, McCall-Hosenfeld JS, Weisman CS, Hillemeier MM, Perry AN, Chuang CH. Barriers to colorectal cancer screening among women in rural central Pennsylvania: primary care physicians' perspective. Rural Remote Health 2013; 13:2504. [PMID: 24099635 PMCID: PMC4050077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) is the third leading cause of death among women in the USA. Rural populations have lower rates of CRC screening than their urban counterparts, and rural women have lower screening rates compared with rural men. The purpose of this qualitative study was to identify (1) beliefs of primary care physicians (PCPs) about CRC screening in rural communities, (2) factors that may cause gender disparities in CRC screening in rural areas, and (3) solutions to overcome those barriers. METHODS Semi-structured interviews were conducted with 17 PCPs practicing in rural central Pennsylvania. PCPs were asked about their CRC screening practices for women, availability of CRC screening services, reminder systems for CRC screening, and barriers to screening specific to their rural communities and to gender. Thematic analysis was used to identify major themes. RESULTS All 17 PCPs endorsed the importance of CRC screening, but believed that there are barriers to CRC screening specific to women and to rural location. All PCPs identified colonoscopy as their screening method of choice, and generally reported that access to colonoscopy services in their rural areas was not a significant barrier. Barriers to CRC screening for women in rural communities were related to (1) PCPs' CRC screening practices, (2) gender-specific barriers to CRC screening, (3) patient-related barriers, (4) community-related barriers, and (5) physician practice-related barriers. Physicians overwhelmingly identified patient education as necessary for improving CRC screening in their rural communities, but believed that education would have to come from a source outside the rural primary care office due to lack of resources, personnel, and time. CONCLUSION Overall, the PCPs in this study were motivated to identify ways to improve their ability to engage more eligible patients in CRC screening. These findings suggest several interventions to potentially improve CRC screening for women in rural areas, including encouraging use of other effective CRC screening modalities (eg fecal occult blood testing) when colonoscopy is not possible, systems-based reminders that leverage electronic resources and are not visit-dependent, and public health education campaigns aimed specifically at women in rural communities.
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Affiliation(s)
| | - Jennifer S. McCall-Hosenfeld
- Assistant Professor of Medicine and Public Health Sciences; Penn State College of Medicine; 600 Centerview Drive, A210; Hershey, PA 17033;
| | - Carol S. Weisman
- Distinguished Professor of Public Health Sciences and Obstetrics and Gynecology; Penn State College of Medicine; 600 Centerview Drive, A210; Hershey, PA 17033;
| | - Marianne M. Hillemeier
- Professor of Health Policy and Administration and Public Health Sciences; Penn State College of Medicine; 600 Centerview Drive, A210; Hershey, PA 17033;
| | - Amanda N. Perry
- Education Program Associate; Penn State College of Medicine; 600 Centerview Drive, A210; Hershey, PA 17033;
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McCall-Hosenfeld JS, Chuang CH, Weisman CS. Prospective association of intimate partner violence with receipt of clinical preventive services in women of reproductive age. Womens Health Issues 2013; 23:e109-16. [PMID: 23481691 DOI: 10.1016/j.whi.2012.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 10/12/2012] [Accepted: 12/18/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Women who experience intimate partner violence (IPV) have a greater risk for adverse health outcomes, suggesting the importance of preventive services in this group. Little prior research has explored how IPV exposure impacts receipt of relevant preventive services. We assess the prospective association of IPV exposure with receiving specific preventive services. METHODS Women in the Central Pennsylvania Women's Health Study's longitudinal cohort study (conducted 2004-2007; n = 1,420) identified past-year exposure to IPV at baseline and receipt of IPV-relevant preventive services (counseling for safety and violence concerns, tests for sexually transmitted infections [STIs], counseling for STIs, Pap testing, counseling for smoking/tobacco use, alcohol/drug use, and birth control) at 2-year follow-up. Multiple logistic regression analysis assessed the impact of IPV on service receipt, controlling for relevant covariates. FINDINGS Women exposed to IPV had greater odds of receiving safety and violence counseling (adjusted odds ratio [AOR], 2.40; 95% confidence interval [CI], 1.25-4.61), and tests for STIs (AOR, 2.46; 95% CI, 1.41-4.28) compared with women who had not been exposed to IPV. Independent of other predictors, including IPV, women who saw an obstetrician-gynecologist were more likely to receive Pap tests, STI/HIV testing and counseling, and birth control counseling, compared with women who had not seen an obstetrician-gynecologist. CONCLUSION Overall rates of preventive service receipt for all women in the sample were low. Women exposed to IPV were more likely to receive safety and violence counseling and STI testing, and seeing an obstetrician-gynecologist increased the odds of receiving several preventive services.
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Affiliation(s)
- Jennifer S McCall-Hosenfeld
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, USA.
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Kraschnewski JL, Chuang CH, Downs DS, Weisman CS, McCamant EL, Baptiste-Roberts K, Zhu J, Kjerulff KH. Association of prenatal physical activity and gestational weight gain: results from the first baby study. Womens Health Issues 2013; 23:e233-8. [PMID: 23816153 PMCID: PMC3742311 DOI: 10.1016/j.whi.2013.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 02/22/2013] [Accepted: 04/30/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND In response to increasing rates of excessive gestational weight gain (GWG) and evidence of postpartum weight retention and long-term overweight and obesity, the Institute of Medicine (IOM) revised their guidelines for GWG in 2009. Prenatal physical activity is recommended, although its role in preventing excessive GWG is unclear. We sought to understand the association between prenatal physical activity and GWG in a longitudinal cohort. METHODS During a baseline survey at 34 weeks, women (n = 3,006) reported their height, prepregnancy weight, and physical activity during pregnancy. GWG was self-reported at 1-month postpartum. Multivariable logistic regression adjusting for age, race/ethnicity, education, poverty status, marital status, gestational age at the time of delivery, and smoking was used to model the association between adequate physical activity during pregnancy and exceeding the IOM recommendations for GWG. FINDINGS Overweight women were most likely to exceed the IOM recommendations for GWG (78.7%), followed by obese women and normal weight women (65.0% and 42.4%, respectively). The majority of women participated in some physical activity during pregnancy, with 41.2% engaging in 60 to 149 minutes and 32.1% engaging in at least 150 minutes of physical activity per week. In adjusted analysis, meeting the physical activity guidelines was associated with a 29% (confidence interval, 0.57-0.88) lower odds of exceeding the IOM recommendations for GWG compared with inactive women. CONCLUSIONS Findings of high rates of excessive GWG, especially among women with overweight and obesity, are concerning given the associated health burdens. The association of guideline-concordant physical activity with appropriate GWG suggests this is an important target for future interventions.
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Affiliation(s)
- Jennifer L. Kraschnewski
- Assistant Professor of Medicine and Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, H034, Hershey, PA 17033, Phone: 717-531-8161, Fax: 717-531-7726,
| | - Cynthia H. Chuang
- Assistant Professor of Medicine and Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, H034, Hershey, PA 17033, Phone: 717-531-8161, Fax: 717-531-7726,
| | - Danielle Symons Downs
- Associate Professor of Kinesiology and Obstetrics and Gynecology, 268Q Recreation Building, The Pennsylvania State University, University Park, PA 16802, Phone: 814-863-0456, Fax: 814-865-1275,
| | - Carol S. Weisman
- Associate Dean for Faculty Affairs, Distinguished Professor of Public Health Sciences and Obstetrics and Gynecology, Penn State College of Medicine, 600 Centerview Drive, A210, Hershey, PA 17033, Phone: 717-531-6690, Fax: 717-531-5779,
| | - Eric L. McCamant
- Resident 1, Medicine Resident, Penn State College of Medicine, 500 University Drive, H034, Hershey, PA 17033, Phone: 717-531-8161, Fax: 717-531-7726,
| | - Kesha Baptiste-Roberts
- Assistant Professor of Nursing, Penn State College of Medicine, 600 Centerview Drive, A110, Hershey, PA 17033, Phone: 717-531-4211, Fax: 717-531-5339,
| | - Junjia Zhu
- Assistant Professor, Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, 600 Centerview Drive, A210, Hershey, PA 17033, Phone: 717-531-1509, Fax: 717-531-5779,
| | - Kristen H. Kjerulff
- Professor of Public Health Sciences and Obstretics and Gynecology, Penn State College of Medicine, 600 Centerview Drive, A210, Hershey, PA 17033, Phone: 717-531-7178, Fax: 717-531-5779,
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Abstract
BACKGROUND Postpartum depression is a mental disorder that occurs after birth and has negative consequences for the mother, infant, and family. The objective of this secondary analysis was to examine whether pregnancy intention was associated with postpartum depression among first-time mothers. METHODS The First Baby Study is a prospective cohort study of women aged 18-35 having a first singleton birth in Pennsylvania. Baseline data were collected during the third trimester. Postpartum depressive symptoms were measured at 1-month postpartum using the Edinburgh Postnatal Depression Scale. Logistic regression was performed to examine the association between unintended pregnancy and postpartum depression, controlling for prepregnancy anxiety/depression and sociodemographic data. RESULTS Of 2972 first-time mothers, 83.4% were white, 70.7% were married, and 56.9% were college educated. Nine hundred fifty-two women (32.0%) reported their pregnancy was unintended and 151 (5.1%) met the threshold for postpartum depression. The prevalence of postpartum depression was higher in women with unintended pregnancies compared to women with intended pregnancies (6.7% vs. 4.3%, p<0.01). However, after controlling for confounders, unintended pregnancy was no longer associated with postpartum depression (adjusted OR 1.41; 95% CI 0.91-2.18). Variables independently associated with postpartum depression included prepregnancy anxiety/depression, Asian race, and Hispanic ethnicity. CONCLUSION Pregnancy intention was not independently associated with postpartum depression among first time mothers in Pennsylvania.
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Affiliation(s)
- Shahed Abbasi
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA
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Kjerulff KH, Velott DL, Zhu J, Chuang CH, Hillemeier MM, Paul IM, Repke JT. Mode of first delivery and women's intentions for subsequent childbearing: findings from the First Baby Study. Paediatr Perinat Epidemiol 2013; 27:62-71. [PMID: 23215713 PMCID: PMC3671865 DOI: 10.1111/ppe.12014] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND More than a dozen studies have reported a reduced rate of childbearing after caesarean delivery (CD). It has been hypothesised that this is because women who deliver by CD are less likely to intend to have subsequent children than women who deliver vaginally - either before childbirth or as a consequence of CD. Little research has addressed either of these hypotheses. METHODS As part of an ongoing prospective study, we interviewed 3006 women in their third trimester and 1 month after first childbirth to assess subsequent childbearing intentions. RESULTS Women who delivered by CD were similar to those who delivered vaginally in intent to have at least one additional child, both before childbirth (90.1% vaginal, 89.9% CD; P = 0.97) and after (87.8% vaginal, 87.1% CD; P = 0.87); however, women who had CD were less likely to intend two or more additional children, both before childbirth (34.7% vaginal, 29.2% CD; P = 0.03) and after (32.2% vaginal, 26.1% CD; P = 0.01). Among women who intended to have at least one additional child before childbirth, 5.0% reported intending to have no additional children 1 month after delivery (5.1% vaginal, 4.6% CD; P = 0.52). CONCLUSIONS Women whose first delivery is by CD are less likely to intend a relatively large family of three or more children than those who deliver vaginally, but delivery by CD does not decrease women's intentions to have at least one more child any more than does vaginal delivery, at least in the short term.
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Affiliation(s)
- Kristen H. Kjerulff
- Department of Public Health Sciences, Penn State University, Hershey, PA 17033, USA,Department of Obstetrics and Gynecology, Penn State University, Hershey, PA 17033, USA
| | - Diana L. Velott
- Department of Public Health Sciences, Penn State University, Hershey, PA 17033, USA
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State University, Hershey, PA 17033, USA
| | - Cynthia H. Chuang
- Department of Public Health Sciences, Penn State University, Hershey, PA 17033, USA,Department of Medicine, Penn State University, Hershey, PA 17033, USA
| | - Marianne M. Hillemeier
- Department of Public Health Sciences, Penn State University, Hershey, PA 17033, USA,Department of Health Policy and Administration, Penn State University, Hershey, PA 17033, USA
| | - Ian M. Paul
- Department of Public Health Sciences, Penn State University, Hershey, PA 17033, USA,Department of Pediatrics College of Medicine, Penn State University, Hershey, PA 17033, USA
| | - John T. Repke
- Department of Obstetrics and Gynecology, Penn State University, Hershey, PA 17033, USA
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Chuang CH, Hwang SW, McCall-Hosenfeld JS, Rosenwasser L, Hillemeier MM, Weisman CS. Primary care physicians' perceptions of barriers to preventive reproductive health care in rural communities. Perspect Sex Reprod Health 2012; 44:78-83. [PMID: 22681422 PMCID: PMC3706998 DOI: 10.1363/4407812] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
CONTEXT Women residing in rural areas are less likely than urban women to receive preventive reproductive health care, but reasons for this disparity remain largely unexplored. METHODS In 2010, semistructured interviews were conducted with 19 rural primary care physicians in central Pennsylvania regarding their experiences in two domains of preventive reproductive health-contraceptive care and preconception care. Major themes were identified using a modified grounded theory approach. RESULTS Physicians perceived that they had a greater role in providing contraceptive care than did nonrural physicians and that contraceptives were widely accessible to patients in their communities; however, the scope of contraceptive services they provided varied widely. Participants were aware of the importance of optimal health prior to pregnancy, but most did not routinely initiate preconception counseling. Physicians perceived rural community norms of unintended pregnancies, large families, and indifference toward career and educational goals for young women as the biggest barriers to both contraceptive and preconception care, as these attitudes resulted in a lack of patient interest in family planning. Lack of time and resources were identified as additional barriers to providing preconception care. CONCLUSIONS Rural women's low use of contraceptive and preconception care services may reflect that preventive reproductive health care is not a priority in rural communities, rather than that it is inaccessible. Efforts to motivate rural women to engage in reproductive life planning, including more proactive counseling by providers, merit examination as ways to improve use of services.
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Affiliation(s)
- Cynthia H Chuang
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA.
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Chuang CH, Cattoi AL, McCall-Hosenfeld JS, Camacho F, Dyer AM, Weisman CS. Longitudinal association of intimate partner violence and depressive symptoms. Ment Health Fam Med 2012; 9:107-14. [PMID: 23730335 PMCID: PMC3513703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Purpose The association between intimate partner violence (IPV) and depression has been well established in cross-sectional research, but how IPV is associated with depressive symptoms over time has not been well studied. Methods Using the Central Pennsylvania Women's Health Study, a population-based longitudinal survey of women aged 18-45 (N = 1,420), we performed a two-step logistic regression analysis. In step 1, the association of recent IPV exposure at baseline with depressive symptoms 2 years later was analysed adjusting for relevant covariates; in step 2, we additionally included positive coping strategies (social support, physical activity) and negative coping strategies (binge drinking/drug use, smoking) in the model. Results Baseline IPV was reported by 4.6 percent of the sample and was independently associated with depressive symptoms 2 years later (adjusted or 1.88, 95% confidence interval [CI] 1.02-3.45). The strongest predictor was depressive symptoms at baseline, which was associated with a fivefold increase in the likelihood of depressive symptoms at 2-year follow-up. Other predictors of future depressive symptoms were IPV at follow-up, older age, lower educational attainment, and lower household income. When we controlled for potential coping strategies in the model (step 2), the relationship between recent IPV and follow-up depressive symptoms was attenuated (adjusted OR 1.50, 95% CI 0.80-2.80). Conclusions Exposure to IPV increases the likelihood of depressive symptoms occurring two years later. Greater social support and binge drinking/drug use attenuates this association, suggesting that interventions focusing on coping mechanisms may serve to reduce the impact of IPV on future depression.
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Affiliation(s)
- Cynthia H Chuang
- Associate Professor of Medicine and Public Health Sciences, Division of General Internal Medicine, Penn State College of Medicine, Hershey, USA
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McCall-Hosenfeld JS, Weisman CS, Camacho F, Hillemeier MM, Chuang CH. Multilevel analysis of the determinants of receipt of clinical preventive services among reproductive-age women. Womens Health Issues 2012; 22:e243-51. [PMID: 22269668 PMCID: PMC3345071 DOI: 10.1016/j.whi.2011.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 08/24/2011] [Accepted: 11/22/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND We investigated the impact of individual- and county-level contextual variables on women's receipt of a comprehensive panel of preventive services in a region that includes both urban and rural communities. METHODS Outcome variables were a screening and vaccination index (a count of Papanicolaou test, blood pressure check, lipid panel, sexually transmitted infections [STI] or HIV test, and influenza vaccination received in the past 2 years) and a preventivecounseling index (a count of topics discussed in the past 2 years: Smoking and tobacco, alcohol or drugs, violence and safety, pregnancy planning or contraception, diet/nutrition, and STIs). Contextual covariates from the Area Resource File (2004-2005) were appended to prospective survey data from the Central Pennsylvania Women's Health Study. Individual-level variables included predisposing, enabling, and need-based measures. Contextual variables included community characteristics and healthcare resources, including a measure of primary care physician (PCP) density specifically designed for this study of women's preventive care. Multilevel analyses were performed. RESULTS We found low overall use of preventive services. In multilevel models, individual-level factors predicted receipt of both screening and vaccinations and counseling services; significant predictors differed for each index. One contextual variable (PCP density) predicted receipt of screenings and vaccinations. CONCLUSIONS Women's receipt of preventive services was determined primarily by individual-level variables. Different variables predicted receipt of screening and vaccination versus counseling services. A contextual measure, PCP density, predicted receipt of preventive screenings and vaccinations. Individual variability in women's receipt of counseling services is largely explained by psychosocial factors and seeing an obstetrician-gynecologist.
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Chuang CH, Martenis ME, Parisi SM, Delano RE, Sobota M, Nothnagle M, Schwarz EB. Contraception and abortion coverage: What do primary care physicians think? Contraception 2012; 86:153-6. [PMID: 22240175 DOI: 10.1016/j.contraception.2011.11.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 11/22/2011] [Accepted: 11/29/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Insurance coverage for family planning services has been a highly controversial element of the US health care reform debate. Whether primary care providers (PCPs) support public and private health insurance coverage for family planning services is unknown. STUDY DESIGN PCPs in three states were surveyed regarding their opinions on health plan coverage and tax dollar use for contraception and abortion services. RESULTS Almost all PCPs supported health plan coverage for contraception (96%) and use of tax dollars to cover contraception for low-income women (94%). A smaller majority supported health plan coverage for abortions (61%) and use of tax dollars to cover abortions for low-income women (63%). In adjusted models, support of health plan coverage for abortions was associated with female gender and internal medicine specialty, and support of using tax dollars for abortions for low-income women was associated with older age and internal medicine specialty. CONCLUSION The majority of PCPs support health insurance coverage of contraception and abortion, as well as tax dollar subsidization of contraception and abortion services for low-income women.
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Affiliation(s)
- Cynthia H Chuang
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA 17033, USA.
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Parisi SM, Zikovich S, Chuang CH, Sobota M, Nothnagle M, Schwarz EB. Primary care physicians' perceptions of rates of unintended pregnancy. Contraception 2011; 86:48-54. [PMID: 22176791 DOI: 10.1016/j.contraception.2011.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 11/02/2011] [Accepted: 11/04/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary care physicians (PCPs) treat many women of reproductive age who need contraceptive and preconception counseling. STUDY DESIGN To evaluate perceptions of rates of unintended pregnancy, we distributed an online survey in 2009 to 550 PCPs trained in General Internal Medicine or Family Medicine practicing in Western Pennsylvania, Central Pennsylvania, Rhode Island or Oregon. RESULTS Surveys were completed by 172 PCPs (31%). The majority (54%) of respondents underestimated the prevalence of unintended pregnancy in the United States [on average, by 23±8 (mean±SD) percentage points], and 81% underestimated the risk of pregnancy among women using no contraception [on average, by 35±20 (mean±SD) percentage points]. PCPs also frequently underestimated contraceptive failure rates with typical use: 85% underestimated the failure rate for oral contraceptive pills, 62% for condoms and 16% for contraceptive injections. PCPs more often overestimated the failure rate of intrauterine devices (17%) than other prescription methods. In adjusted models, male PCPs were significantly more likely to underestimate the rate of unintended pregnancy in the United States than female PCPs [adjusted odds ratio (95% confidence interval): 2.17 (1.01-4.66)]. CONCLUSIONS Many PCPs have inaccurate perceptions of rates of unintended pregnancy, both with and without use of contraception, which may influence the frequency and the content of the contraceptive counseling they provide.
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Affiliation(s)
- Sara M Parisi
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
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50
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Chen KR, Chu WH, Fang HC, Liu CP, Huang CH, Chui HC, Chuang CH, Lo YL, Lin CY, Hwung HH, Fuh AYG. Beyond-limit light focusing in the intermediate zone. Opt Lett 2011; 36:4497-4499. [PMID: 22139221 DOI: 10.1364/ol.36.004497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We experimentally verify that a new nanolens of a designed plasmonic aperture can focus visible light to a single line with its width smaller than the limit of half the wavelength in the intermediate zone. The experimental measurement indicates that while the near field plays a role to increase the spot size in the near zone, it is negligible at the beyond-limit focused region; i.e., the focused light is dominated by the radiative fields. The image taken by the optical microscope shows that the fields focused have propagated to the far zone. Besides being of academic interest, the nanolens capable in achieving a lower diffraction limit in the intermediate zone is important for application possibilities.
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Affiliation(s)
- K R Chen
- Department of Physics, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan.
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