Opioid Prescribing and Outcomes in Patients With Sickle Cell Disease Post-2016 CDC Guideline

Importance

Although the intention of the 2016 US Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain was not to limit pain treatment for patients with sickle cell disease (SCD), clinicians and patients have recognized the possibility that the guideline may have altered outcomes for this population. However, the outcomes of the 2016 guideline for this patient population are unknown.

Objective

To examine changes in opioid prescribing patterns and health outcomes among patients with SCD before and after the release of the 2016 CDC guideline.

Design, Setting, and Participants

This retrospective cohort study conducted interrupted time series analysis of claims data from the Merative MarketScan Commercial Database from January 1, 2011, to December 31, 2019. In this population-based study in the US, individuals with SCD who were at least 1 year of age, had no cancer diagnosis, and had pharmacy coverage for the month of measurement were included. The data were analyzed from January 2021 to November 2023.

Exposure

The CDC Guideline for Prescribing Opioids for Chronic Pain released in March 2016.

Main Outcomes and Measures

The main variables measured in this study included the practice of opioid prescribing among patients with SCD (ie, rate of opioid prescriptions dispensed, mean number of days supplied, mean total morphine milligram equivalents [MME] per patient, and mean daily MME per opioid prescription) and pain-related health outcomes (rates of emergency department visits related to vaso-occlusive crises [VOC] and hospitalizations related to VOC).

Results

The cohort included 14 979 patients with SCD (mean [SD] age, 25.9 [16.9] years; 8520 [56.9%] female). Compared with the preguideline trends, the following changes were observed after the guideline was released: significant decreases in the coefficient for change in slope of the opioid dispensing rate (-0.29 [95% CI, -0.39 to -0.20] prescriptions per 100 person-month; P < .001), the number of days supplied per prescription (-0.05 [95% CI, -0.06 to -0.04] days per prescription-month; P < .001), and opioid dosage (-141.0 [95% CI, -219.5 to -62.5] MME per person-month; P = .001; -10.1 [95% CI, -14.6 to -5.6] MME/prescription-month; P < .001). Conversely, a significant increase in VOC-related hospitalizations occurred after the guideline release (0.16 [95% CI, 0.07-0.25] hospitalizations per 100 person-month; P = .001). These changes were observed to a greater extent among adult patients, but pediatric patients experienced similar changes in several measures, even though the guideline focused exclusively on adult patients.

Conclusions and Relevance

This retrospective cohort study showed that the 2016 CDC guideline may have had unintended negative outcomes on the patient population living with SCD.

Treatment patterns and outcomes among adults with immune thrombocytopenia receiving pharmaceutical second-line therapies: a retrospective cohort study using administrative claims data

OBJECTIVES

To describe and compare real-world treatment patterns and clinical outcomes among individuals with immune thrombocytopenia (ITP) receiving second-line therapies (rituximab, romiplostim, or eltrombopag).

METHODS

A retrospective cohort study was conducted using a large administrative claims database (January 2013-May 2020) among continuously enrolled patients ≥18 years prescribed second-line ITP therapies. The index date was the date of the first claim of the study medications. Treatment patterns and outcomes were measured during the 12-month follow-up period. Inverse probability of treatment weighting (IPTW) was used to balance covariates across treatment groups. Multivariable logistic regression was used to compare treatment patterns and bleeding risk outcomes.

RESULTS

A total of 695 patients were included (rituximab, N = 285; romiplostim, N = 212; eltrombopag, N = 198). After IPTW, all baseline covariates were balanced. Compared to eltrombopag, patients in the rituximab cohort were 57% more likely to receive other ITP therapies (systematic corticosteroids or third-line therapies) during the follow-up period (odds ratio [OR] = 1.571, p = .030). There was no significant difference in the odds of receiving a different second-line therapy or experiencing a bleeding-related episode among three groups (p > .050). Patients in the romiplostim cohort were 69% more likely to receive rescue therapy compared to those in the rituximab cohort (OR = 1.688, p = .025).

CONCLUSION

Patients with ITP receiving rituximab were more likely to need other ITP therapies but did not experience higher risk of bleeding compared to those receiving eltrombopag or romiplostim. Benefits, risks, cost-effectiveness, and patient preference should all be considered in optimizing second-line therapy for ITP.

Pregnancy-related risk factors and receipt of postpartum care among Texas Medicaid pregnant enrollees: Opportunities for pharmacist services

BACKGROUND

The United States (US) experiences the highest rate of maternal mortality of similar countries. Postpartum care (PPC) focused on chronic disease management is potentially lifesaving, especially among pregnancies complicated by risk factors such as diabetes, hypertension, and mental health conditions (MHCs), which are conditions in which pharmacists can have an impact.

OBJECTIVE

To evaluate the prevalence of maternal mortality risk factors and their relationships with receipt of PPC among Texas Medicaid enrollees.

METHODS

A retrospective study included women with a delivery between 3/25/2014-11/1/2019 who were continuously enrolled in Texas Medicaid during the study period from 84 days pre-delivery to 60 days post-delivery. PPC was defined as ≥1 visit associated with postpartum follow-up services. Maternal mortality risk factors (diabetes, hypertension, and MHCs) during and after pregnancy were identified using diagnoses and medication utilization. Age, race/ethnicity, cesarean delivery, and preterm birth served as covariates. Multivariable logistic regression was used to address the study objective.

RESULTS

The sample (N = 617,010) was 26.5±5.7 years, primarily (52.8%) Hispanic, and 33.0% had cesarean deliveries and 9.3% had preterm births. Risk factor prevalence included: diabetes (14.0%), hypertension (14.3%), and MHCs during (6.3%) and after (9.1%) pregnancy. A majority (77.9%) had a PPC visit within 60 days of delivery. The odds of receiving PPC were 1.2 times higher for patients with diabetes (OR = 1.183; 95% CI = 1.161-1.206; P < 0.0001), 1.1 times higher for patients with hypertension (OR = 1.109; 95% CI= 1.089-1.130; P < 0.0001), and 1.1 times higher for patients with MHCs (OR=1.138; 95% CI = 1.108-1.170; P < 0.0001) than patients without, respectively.

CONCLUSION

Over three-quarters of Texas Medicaid pregnant enrollees received PPC within 60 days of delivery and risk factors were prevalent and predictive of receipt of PPC. Pharmacists can have a positive impact on maternal health by addressing hypertension, diabetes, and MHC risk factors.

Reliability and Validity Evidence for an Academic Gender Equity Questionnaire

Objective. The majority of practicing pharmacists and student pharmacists are women. However, instruments to assess perceptions of gender equity within pharmacy academia are not available. The objective of this research was to describe the psychometric analysis of a questionnaire developed to assess gender equity by a Gender Equity Task Force and to report reliability and validity evidence.Methods. A questionnaire with 21 items addressing the teaching, research, service, advancement, mentoring, recruitment, and gender of college leaders was created. The survey was distributed via email in December 2020 to all social and administrative science section members of two professional associations. Rasch analysis was performed to evaluate the reliability and validity evidence for the questionnaire.Results. After reverse coding, all items met parameters for unidimensionality necessary for Rasch analysis. Once adjacent categories were merged to create a 3-point scale, the scale and items met parameters for appropriate functionality. Items were ordered hierarchically in order of difficulty. The modified instrument and scale can be treated as interval level data for future use.Conclusion. This analysis provides reliability and validity evidence supporting use of the gender equity questionnaire in the social and administrative academic pharmacy population if recommended edits such as the 3-point scale are used. Future research on gender equity can benefit from use of a psychometrically sound questionnaire for data collection.

Comparing survival outcomes between neoadjuvant and adjuvant chemotherapy within breast cancer subtypes and stages among older women: a SEER-Medicare analysis

BACKGROUND

This study aimed to compare survival outcomes of neoadjuvant (NAC) and adjuvant chemotherapy (AdC) within each breast cancer subtype and stage among older women.

METHODS

Older (≥ 66 years) women newly diagnosed with stage I-III invasive ductal breast cancer during 2010-2017 and treated with both chemotherapy and surgery within one year were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Analyses were performed within each of six groups, jointly defined based on subtype (hormone receptor [HR]-positive/human epidermal growth factor receptor 2 [HER2]-negative, HER2 + , and triple-negative) and stage (I-II and III). Kaplan-Meier curves and multivariable Cox models were used to compare overall and recurrence-free survival between NAC and AdC, with optimal full matching performed for confounding adjustment.

RESULTS

Among 8,495 included patients, 8,329 (20.6% received NAC) remained after matching. Before multiple testing adjustment, Cox models showed that NAC was associated with a lower hazard for death among stage III HER2 + patients (hazard ratio = 0.347, 95% confidence interval CI 0.161-0.745) but a higher hazard for death among triple-negative patients (stage I-II: hazard ratio = 1.558, 95% CI 1.024-2.370; stage III: hazard ratio = 2.453; 95% CI 1.254-4.797). A higher hazard for death/recurrence was associated with NAC among stage I-II HR + /HER2- patients (hazard ratio = 1.305, 95% CI 1.007-1.693). No significant difference remained after multiple testing adjustment.

CONCLUSIONS

The opposite trends (before multiple testing adjustment) of survival comparisons for advanced HER2 + and triple-negative disease warrant further research. Caution is needed due to study limitations such as cancer stage validity.

Gender inequity: Enough talk, time for action

While gender inequity has been shown to be an ongoing issue in the pharmacy profession, it has moved to the forefront due to increasing numbers of women in pharmacy. Two national organizations, American Pharmacists Association (APhA) and American Association of Colleges of Pharmacy (AACP) convened a joint Gender Equity Task Force to examine this matter among social and administrative sciences pharmacy faculty. The Task Force launched a survey and conducted interviews, as well as held several forums to solicit recommendations. This commentary provides recommendations for pharmacy constituents and stakeholders regarding: training and programming, leadership and mentoring, policy, and expansion. The goal is for organizations and leadership to incorporate recommendations with the goal of closing the gap in gender inequity.

Impact of adherence to hydroxyurea on health outcomes among patients with sickle cell disease

Although new pharmaceutical therapy options have recently become available, hydroxyurea is still the most commonly used and affordable treatment option for sickle cell disease (SCD). This study aimed to update the evidence on hydroxyurea adherence and its association with clinical and economic outcomes among individuals with SCD. This retrospective study used Texas Medicaid claims data from 09/2011-08/2016. Individuals were included if they had ≥1 inpatient or ≥2 outpatient SCD diagnoses, had ≥1 hydroxyurea prescription, were 2-63 years of age, and were continuously enrolled in Texas Medicaid between 6 months before and 1 year after the first hydroxyurea prescription fill date (index date). Hydroxyurea adherence (Medication Possession Ratio; MPR), vaso-occlusive crisis (VOC)-related outcomes, healthcare utilization and expenditures (SCD-related and all-cause) during the 1 year following the index date were measured. Bivariate and multivariable analyses were used to address the study objectives. Among 1035 included individuals (age: 18.8 ± 12.5 years, female: 52.1%), 20.9% were adherent to hydroxyurea (defined as MPR≥0.8). After adjustment for demographic and clinical characteristics, compared to being non-adherent, adhering to hydroxyurea was significantly associated with: a lower risk (Odds Ratio [OR] = 0.480, p = .0007) and hazard rate (Hazard Ratio [HR] = 0.748, p = .0005) of a VOC event, fewer VOC events (Incidence Rate Ratio [IRR] = 0.767, p = .0009), fewer VOC-related hospital days (IRR = 0.593, p = .0003), fewer all-cause and SCD-related hospitalizations (IRR = 0.712, p = .0008; IRR = 0.707, p = .0008, respectively) and emergency department visits (IRR = 0.768, p = .0037; IRR = 0.746, p = .0041, respectively), and lower SCD-related total healthcare expenditures (IRR = 0.796, p = .0266). Efforts to increase adherence to hydroxyurea could improve clinical and economic outcomes among individuals with SCD.

Real-world opioid use among patients with migraine enrolled in US commercial insurance and risk factors associated with migraine progression

BACKGROUND: Migraineurs may be categorized as having episodic migraine (EM: < 15 headache days/month) or chronic migraine (CM: ≥ 15 days/month for > 3 months with ≥ 8 days/month having features of migraine). Opioid use has been linked to progression from EM to CM. OBJECTIVE: To describe the utilization of opioid prescriptions among patients with migraine, to determine the association between opioid use and migraine progression, and to explore demographic and clinical risk factors for migraine progression. METHODS: This retrospective cohort study used Optum's deidentified Clinformatics Data Mart Database from January 2015 to December 2018. Adult patients with a migraine diagnosis and continuous health plan enrollment were included. Opioid use was measured by average daily morphine equivalent dose, also known as morphine milligram equivalent (MME). Descriptive statistics were used to summarize the opioid use by patient demographic and clinical characteristics. A Cox proportional hazards model with stepwise selection was used to determine the risk factors of new-onset CM. RESULTS: Overall, 35% of patients with migraine (27,331 of 78,134) received prescription opioids (> 0 MME/day) during the 12-month follow-up period. Higher opioid dosage was found in patients who had CM and comorbidities of interest. Compared with patients with EM, patients with CM were twice as likely to receive at least 20 MME/day (CM 3.8% vs EM 1.9%) and had a higher median opioid day supply (CM 20 vs EM 10) during follow-up. About 7% of patients with CM with at least 1 opioid prescription had at least 50 MME/day in any 90-day period during follow-up. A significant association was found between MME level and the likelihood of new-onset CM. Additional significant risk factors of migraine progression included younger age, female sex, South and West regions, and having a diagnosis of medication overuse headache, depression, back pain, or fibromyalgia (all P < 0.05). CONCLUSIONS: Despite guidelines and the availability of more migraine-specific treatments, opioids are still commonly prescribed to patients with migraines in real-world practice, especially for those with CM. In this study population, a higher risk of new-onset CM was associated with receiving higher opioid doses.

Economic Burden of Chronic Comorbidities Among Community-Dwelling Older Adults With Dementia: A Propensity Score Matched National-Level Study

OBJECTIVE

This study examined the extent to which chronic comorbidities contribute to excess health care expenditures between older adults with dementia and propensity score (PS)-matched nondementia controls.

METHODS

This was a retrospective, cross-sectional, PS-matched case (dementia): control (nondementia) study of older adults (65 y or above) using alternative years data from pooled 2005 to 2015 Medical Expenditure Panel Surveys (MEPS). Chronic comorbidities were identified based on Clinical Classifications System or ICD-9-CM codes. Ordinary least squares regression was utilized to quantify the impact of chronic comorbidities on the excess expenditures with logarithmic transformation. Expenditures were expressed as 2019 US dollars. All analyses accounted for the complex survey design of MEPS.

RESULTS

The mean yearly home health care expenditures were particularly higher among older adults with dementia and co-occurring anemia, eye disorders, hyperlipidemia, and hypertension compared with PS-matched controls. Ordinary least squares regression models revealed that home health care expenditures were 131% higher (β=0.837, P <0.001) among older adults with dementia compared with matched nondementia controls before adjusting for chronic comorbidities. When additionally adjusting for chronic comorbidities, the percentage increase, while still significant ( P <0.001) decreased from 131% to 102%.

CONCLUSIONS

The excess home health care expenditures were partially explained by chronic comorbidities among community-dwelling older adults with dementia.

Neoadjuvant chemotherapy use trends among older women with breast cancer: 2010-2017

PURPOSE

This study assessed chemotherapy use trends before (neoadjuvant chemotherapy [NAC]) or after surgery (adjuvant chemotherapy [AdC]) among older women with breast cancer and examined factors related to NAC receipt.

METHODS

Women (> 65 years) diagnosed with stage I-III breast cancer during 2010-2017 who received NAC or AdC were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. All patients were stratified into six strata based on subtype (hormone receptor-positive/human epidermal growth factor receptor 2-negative [HR + /HER2-], HER2 + , and triple-negative breast cancer [TNBC]) and stage (I-II and III). Cochran-Armitage tests were performed to test temporal trends of NAC use in each stratum. Multivariable logistic regression analyses were performed to identify factors (sociodemographic and clinical) related to NAC use.

RESULTS

Among included older (mean ± standard deviation: 72.3 ± 5.2 years) women (N = 8,495) with stage I-III breast cancer, NAC use increased from 11.7% (2010) to 32.6% (2017). Significant increases in NAC were found in all strata (p < .0001) with more substantial increases in HER2 + disease and TNBC compared to HR + /HER2- disease. Multivariable logistic regressions identified the youngest age category (66-69 years) and later stage as significant (p < 0.05) predictors of NAC receipt in most strata, in addition to diagnosis year.

CONCLUSION

Similar to the overall breast cancer population, NAC use increased among a population of older women. NAC was received by most patients with stage III HER2 + disease or TNBC in more recent years and was more common among younger elderly women and those in stage III.

Patient-Reported Barriers to Adherence Among ACEI/ARB Users from a Motivational Interviewing Telephonic Intervention

PURPOSE

Hypertension is a common comorbidity among type 2 diabetes mellitus (T2DM) patients, which increases the risk of cardiovascular diseases. Despite the proven benefit of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in this population, poor medication adherence is prevalent, resulting in higher complications and mortality rate. Motivational interviewing (MoI) has demonstrated effectiveness in improving medication adherence and identifying barriers. This study aimed to assess and identify patient-reported barriers to adherence to ACEI/ARB from an MoI telephonic intervention conducted by student pharmacist interns.

PATIENTS AND METHODS

This retrospective study was conducted within an MoI intervention customized by past ACEI/ARB adherence trajectories for nonadherent patients with T2DM and hypertension enrolled in a Medicare Advantage Plan. Adherence barriers were extracted from the interviewers' notes by two independent researchers. Descriptive analysis was performed to summarize the overall frequency of barriers as well as across trajectory groups, identified from the initial and follow-up calls.

RESULTS

In total, 247 patients received the initial MoI call from which 41% did not communicate any barrier for ACEI/ARB use despite having low adherence. About 59% of the patients reported at least one barrier during the initial call. The most common barriers included forgetfulness, discontinuation by physicians, side effects, multiple comorbidities, polypharmacy, lack of knowledge about disease/medication, and cost issues. The follow-up calls helped with uncovering at least one new barrier for 28 patients who previously communicated a different issue with their medication during the first call. Additionally, 18 patients with initial denial for having any barrier to adherence reported at least one barrier throughout the follow-up calls.

CONCLUSION

This study summarized patient-reported barriers to ACEI/ARB adherence from an MoI telephonic intervention performed among nonadherent patients. Identifying specific barriers for patients may help to further design tailored interventions that address the barriers and improve adherence.

Impact of a pilot workshop on student pharmacists' confidence and comfort in counseling patients at risk for maternal mortality

BACKGROUND AND PURPOSE

This study examined whether a pilot workshop focused on maternal mortality had an impact on pharmacy students' confidence, comfort, and knowledge regarding preeclampsia, postpartum depression and opioid poisoning.

EDUCATIONAL ACTIVITY AND SETTING

The two-hour workshop included lecture, video, discussion and case studies. P1-P3 student pharmacists completed pre- and post-surveys measuring confidence (N = 5) and comfort (N = 15) using a 5-point Likert type scale (1 = strongly disagree to 5 = strongly agree), as well as knowledge with 12 true/false statements. Data were analyzed using paired t-tests and McNemar's tests, as well as Cronbach's alphas for scale reliability.

FINDINGS

The majority of participants (N = 27) were 18-25 years (85.2%), female (74.1%) and Asian (51.9%). Overall confidence and comfort increased significantly (p < .001) from pre- to post-intervention regarding: 1) preeclampsia (2.5 ± 0.9 to 4.5 ± 0.5); 2) postpartum depression (3.3 ± 0.8 to 4.5 ± 0.5); 3) opioids (3.5 ± 0.9 to 4.7 ± 0.5); 4) maternal mortality risk factors (2.1 ± 0.7 to 4.5 ± 0.5); and 5) pharmacist services related to maternal mortality prevention (2.0 ± 0.7 to 4.5 ± 0.5). Knowledge significantly (p < .05) improved on the majority (83.3%) of items. Scale reliabilities were ≥ 0.8.

SUMMARY

Incorporating maternal mortality training in colleges/schools of pharmacy curricula may have a positive impact on pharmacists' counseling and screening of patients at risk for maternal mortality in practice.

Healthcare Fraud Data Mining Methods: A Look Back and Look Ahead

Healthcare fraud is an expensive, white-collar crime in the United States, and it is not a victimless crime. Costs associated with fraud are passed on to the population in the form of increased premiums or serious harm to beneficiaries. There is an intense need for digital healthcare fraud detection systems to evolve in combating this societal threat. Due to the complex, heterogenic data systems and varied health models across the US, implementing digital advancements in healthcare is difficult. The end goal of healthcare fraud detection is to provide leads to the investigators that can then be inspected more closely with the possibility of recoupments, recoveries, or referrals to the appropriate authorities or agencies. In this article, healthcare fraud detection systems and methods found in the literature are described and summarized. A tabulated list of peer-reviewed articles in this research domain listing the main objectives, conclusions, and data characteristics is provided. The potential gaps identified in the implementation of such systems to real-world healthcare data will be discussed. The authors propose several research topics to fill these gaps for future researchers in this domain.

Age-related healthcare services utilization for the management of sickle cell disease among treated Texas Medicaid patients

Objectives

To determine if there are age-related differences in sickle cell disease (SCD)-related healthcare utilization and to describe temporal healthcare utilization following an emergency department (ED) visit or hospitalization in treated SCD patient population.

Methods

Texas Medicaid prescription and medical claims from 1 September 2011 to 31 August 2016 were used. Patients aged 2–63 years with at least one inpatient or outpatient SCD medical claim and receiving one or more SCD-related medications (hydroxyurea, opioid or non-opioid analgesics) were included. The primary outcomes were utilization of SCD-related ED, inpatient and outpatient visits, all-cause prescription medications and type of SCD-related service at index and subsequent healthcare services. Age group was the primary independent variable.

Key findings

Overall (N = 2339), healthcare service utilization was relatively higher among age groups 2–12, 18–25 and 26–40. Proportions of patients having ≥1 ED and ≥1 inpatient visits, respectively, were significantly higher among age groups 2–12 (33.2%; 23.0%), 18–25 (29.3%; 25.1%) and 26–40 (32.3%; 22.4%) as compared with age group 13–17 (21.3%; 12.9%). The number of outpatient visits was highest among children aged 2–12 (4.5 ± 7.6, P &lt; 0.0001), while mean number of all-cause medications was the highest for older adults aged 41–63 (22.4 ± 16.3; P &lt; 0.0001). After an index ED visit (N = 598), outpatient visits were the most prevalent healthcare services. After an index hospitalization (N = 203), a subsequent hospitalization was the most prevalent healthcare service.

Conclusions

Texas Medicaid SCD patients receiving treatment have a high use of healthcare services, especially among children and young adults who are transitioning from childhood to adulthood. Age-specific interventions should be developed to promote optimal care transitions among young adults.

Age-related prescription medication utilization for the -management of sickle cell disease among Texas Medicaid patients

INTRODUCTION

Sickle cell disease (SCD) is associated with recurrent complications and healthcare burden. Although SCD management guidelines differ based on age groups, little is known regarding actual utilization of preventative (hydroxyurea) and palliative therapies (opioid and nonopioid analgesics) to manage complications. This study assessed whether there were agerelated differences in SCD index therapy type and SCD-related medication utilization.

DESIGN AND PATIENTS

Texas Medicaid prescription claims from September 1, 2011 to August 31, 2016 were retrospectively analyzed for SCD patients aged 2-63 years who received one or more SCD-related medications (hydroxyurea, opioid, or nonopioid analgesics).

OUTCOME MEASURES

The primary outcomes were SCD index drug type and medication utilization: hydroxyurea adherence, and days' supply of opioid, and nonopioid analgesics. Chi-square, analysis of variance, and Kruskal-Wallis tests were used.

RESULTS

Index therapy percentages for included patients (N = 2,339) were the following: opioids (45.7 percent), nonopioids (36.6 percent), dual therapy-opioids and nonopioids (11.2 percent), and hydroxyurea (6.5 percent), and they differed by age-groups (χ² = 243.0, p < 0.0001). Hydroxyurea as index therapy was higher among children (2-12:9.1 percent) compared to adults (26-40:3.7 percent; 41-63:2.9 percent). Opioids as index therapy were higher among adults (18-25:48.0 percent; 26-40:54.9 percent; 41-63:65.2 percent) compared to children (2-12:36.6 percent). Mean hydroxyurea adherence was higher (p < 0.0001) for younger ages, and opioid days' supply was higher for older ages.

CONCLUSIONS

Texas Medicaid SCD patients had low hydroxyurea utilization and adherence across all age groups. Interventions to increase the use of hydroxyurea and newer preventative therapies could result in better management of SCD-related complications and reduce the frequency of pain crises, which may reduce the need for opioid use.

Off-label antipsychotic use patterns among Texas Medicaid adults 2013-2016

Aim: To describe trends in off-label antipsychotic use among Texas Medicaid adults and examine whether demographic and clinical characteristics were associated with off-label use. Methods: Three diagnostic groups (i.e. no diagnosis, on label and off-label) were created based on mental health disorder diagnoses and related antipsychotic prescriptions. Results: During 2013-2016, the prevalence of off-label antipsychotic use decreased from 22.5% to 17.4% and the proportions of no mental health diagnosis remained stable (7.3-9.4%). Patients aged ≥25 years and second-generation antipsychotic users had significantly lower odds of receiving antipsychotics off-label or with no diagnosis. Conclusion: Compared with previous Medicaid database studies, the proportions of off-label antipsychotic use and antipsychotic use with no concurrent psychiatric diagnosis were notably lower.

Perceptions among Muslims regarding fasting, medication use and provider engagement during Ramadan in the United States

BACKGROUND

Muslims with chronic diseases tend to fast during Ramadan, although Islam allows them not to fast. Therefore, understanding their perceptions and how they manage their health, especially as a minority population, is very important.

OBJECTIVE

To examine Muslims' (1) perceptions of fasting exemptions, (2) medication usage behaviour, (3) perceptions of relationships with healthcare providers and (4) factors impacting health management during Ramadan.

METHOD

This was a qualitative study employing four focus groups (two groups of women and two groups of men). Adult Muslims (aged 18 years or more) with chronic diseases were invited to participate. Participants were asked open-ended questions about their fasting ability, medication usage behaviours, healthcare access and collaboration with providers during Ramadan. Trained researchers conducted the focus groups interviews in both English and Arabic. Each focus group was recorded, and three investigators independently transcribed the data and extracted themes and categories. Coding terminology issues were resolved through discussion.

RESULTS

Twenty-five Muslims with chronic diseases (e.g., diabetes, hypertension, renal failure and anaemia) participated. The most prominent themes/subthemes were as follows: (1) fasting exemption (e.g., uncontrolled medical conditions), (2) fasting nonexemption (e.g., controlled medical conditions), (3) nonoral medication use during Ramadan, (4) healthcare provider involvement during Ramadan, and (5) factors impacting health management during Ramadan.

CONCLUSION

Muslim patients perceive fasting as an important religious practice, so they tend to self-modify their medication-taking behaviours. Educating pharmacists and other healthcare providers about Muslim culture, especially their strong desire to fast, may lead to Muslims better managing their medications and viewing pharmacists and other healthcare providers as knowledgeable healthcare providers.

Efavirenz versus Protease Inhibitors in Patients with HIV: A Systematic Review and Meta-Analysis

Efavirenz- and protease inhibitor (PI)-based regimens remain viable options across the globe. We conducted a meta-analysis to compare the effectiveness of efavirenz-based regimens relative to PI-based regimens. EMBASE, PubMed, Cochrane, and clinicaltrials.gov were searched for randomized controlled trials conducted between 1987 and 2018 comparing efavirenz- with PI-based regimens. This was followed by title, abstract, and full-text screens. The quality of selected studies was assessed using the Cochrane risk of bias tool. Meta-analysis of the odds of virological suppression was conducted using the robust variance estimation approach. Fifteen studies met the inclusion criteria and totaled 6712 patients (efavirenz arm = 3339; PI arm = 3373), of which 1610 (24.0%) were females. Follow-up ranged from 24 to 144 weeks. Mean/median age ranged from 33 to 44 years. Mean/median baseline CD4 count ranged from 32 to 557 cells/mL while mean/median baseline viral load ranged from log10 4.5 to log10 5.5 copies/mL. Meta-analysis showed that patients receiving efavirenz-based regimens had 37% higher odds of virological suppression compared to PI-based regimens (odds ratio = 1.37, 95% confidence interval = 1.06-1.77, p = 0.02). The Egger test suggested the presence of publication bias (B = 0.927, t = 2.214, p = 0.033). The main threat to the quality of evidence was attrition bias. Regarding virological suppression, efavirenzbased regimens were more effective than PI-based regimens and, therefore, might be ideal for the management of treatment naïve patients with HIV in settings where NNRTIs and PIs are used.

Medication Therapy Management for Texas MediCAID Patients With Asthma and Chronic Obstructive Pulmonary Disease-A Pilot Study

BACKGROUND

Pharmacists can play an important role in providing medication therapy management (MTM) services, which focus on appropriate medication use. This pilot study aimed to describe pharmacists' MTM service provision, results/outcomes of pharmacists' recommendations and resolution/acceptance rate among patients with high-risk asthma and/or chronic obstructive pulmonary disease (COPD).

METHODS

This was a prospective descriptive study of MTM services provided by community pharmacists to Texas Medicaid patients (5-63 years) with "high risk" asthma or COPD. Patients received in-person and telephone consultations that included medication review, asthma control test assessment, and education on adherence and proper medication/device use. Data extracted from MTM software was used to describe: reasons for MTM services, type of pharmacists' interventions, outcomes of pharmacists' recommendations and acceptance rate.

RESULTS

Twenty-eight pharmacists provided 139 MTM interventions with 63 patients (2.2 interventions per patient). The most frequent intervention reason was complex drug therapy (53.2%), underuse of medication (8.6%), need for drug therapy (8.6%), new or changed prescription therapy (6.5%), and administration technique (5.0%). The resolution rate was 77.7%. Patient and prescriber, respectively, refused recommendation in 12% and 6% of the interventions. Outcomes included comprehensive medication review (46.7%), improved adherence (6.5%), therapeutic success (6.5%), improved administration technique (5.0%), and initiation of new therapy (5.0%).

CONCLUSION

Through the provision of MTM, pharmacists were able to identify and intervene with medication-related problems. These interventions are instrumental in helping patients better manage their asthma/COPD. The high resolution rate was encouraging. Larger scale studies are needed to assess clinical and economic outcomes.

Prevalence of and Factors Associated with Gabapentinoid Use and Misuse Among Texas Medicaid Recipients

BACKGROUND AND OBJECTIVES

Gabapentin and pregabalin have been considered relatively safe opioid-sparing adjuncts for pain management. However, rising prescribing trends, presence of gabapentinoids in opioid-related overdoses, and the growing body of evidence regarding gabapentinoid misuse and abuse, have caused gabapentinoids to emerge as a drug class of public health concern. This study aimed to assess the prevalence of, and factors associated with gabapentinoid use and misuse.

METHODS

This retrospective study of Texas Medicaid data from 1/1/2012 to 30/8/2016 included patients aged 18-63 years at index date, with ≥ 1 gabapentinoid prescription, and continuously enrolled 6 months pre-index and 12 months post-index. Gabapentinoid misuse was defined as ≥ 3 claims exceeding daily doses of 3600 mg for gabapentin and 600 mg for pregabalin. Age, gender, concurrent opioid use, neuropathic pain diagnoses and gabapentinoid type were independent variables. Descriptive and inferential statistics were used.

RESULTS

Of included subjects (N = 39,000), 0.2% (N = 81) met study criteria for gabapentinoid misuse. Overall, the majority (76.4%) of gabapentinoid users were aged 41-63 years with a mean ± SD age of 48.2 ± 10.7 years. Those patients meeting the study criteria for gabapentinoid misuse were significantly younger (45.1 ± 11.0 vs 48.2 ± 10.7, p = 0.0084). Majority of the study sample was female (68.1%). However, a significantly higher proportion of males met the study criteria for gabapentinoid misuse compared to females (0.3% vs 0.2%, p = 0.0079). Approximately one-half (51.9%) of the study sample had neuropathic pain, and gabapentinoid misuse was significantly higher in neuropathic pain patients compared to those without neuropathic pain (0.3% vs 0.1%, p = 0.0078). Over three-quarters (77.4%) of patients were using gabapentin; however, gabapentinoid misuse was significantly higher among pregabalin users (0.4% vs 0.2%, p = 0.0003). Approximately 20% (17.3%) of gabapentinoid users had ≥ 90 days of concurrent opioid use. However, there was no significant difference in gabapentinoid misuse among patients with concurrent opioid use compared to patients without (0.3% vs 0.2%, p = 0.1440). Factors significantly associated with misuse included: male sex (odds ratio [OR] 0.486; 95% confidence interval [CI] 0.313-0.756; p = 0.0013); neuropathic pain (OR 2.065; 95% CI 1.289-3.308; p = 0.0026); and pregabalin versus gabapentin use (OR 2.337, 95% CI 1.492-3.661; p = 0.0002). Concurrent opioid use was not significantly associated with gabapentinoid misuse (OR 1.542, 95% CI 0.920-2.586; p = 0.1006).

CONCLUSION

Prevalence of gabapentinoid misuse was low (0.2%) among Texas Medicaid recipients. Younger age, male gender, neuropathic pain diagnosis and pregabalin use were significantly associated with higher levels of gabapentinoid misuse.

Use of a claims-based algorithm to estimate disease severity in the multiple sclerosis Medicare population

BACKGROUND/OBJECTIVE

To compare algorithm determined disease severity, risk of multiple sclerosis (MS) relapse, and MS-related hospitalization between the age-eligible and disability-eligible MS Medicare populations.

METHODS

Using the Humana claims dataset (2013 - 2015), patients were divided into Medicare age-eligible and disability-eligible groups. A previously developed algorithm, which used MS symptoms and healthcare utilization to categorize MS disease severity into three groups (low, moderate, high) at baseline was employed. Flexible parametric and Cox proportional hazard models were used to estimate the risk for MS relapses and MS-related hospitalizations among the MS disease severity groups and the two eligibility cohorts in the follow-up period.

RESULTS

Of the overall sample (N = 6,559), the majority (N = 4,813, 73.4%) were disability-eligible and in the low disease severity group (N = 4,468, 68.1%). In 10 of 16 disease severity algorithm predictors, the prevalence of these predictors was significantly (p<0.001) higher in the disability-eligible group compared to the age-eligible group. Survival analyses revealed that the disability-eligible group had a significantly higher risk for follow-up MS relapses and follow-up MS-related hospitalizations (HR = 1.79 [CI 1.54 - 2.08] and HR = 1.38 [CI 1.11-1.72], respectively) compared to those in the age-eligible group. When both eligibility and disease severity were considered in the model increases in hazard ratios corresponded generally to increases in disease severity. However, the type of Medicare eligibility does not appear to have a clear pattern across MS disease severity groups for either MS relapse or hospitalizations, CONCLUSION: The disability-eligible Medicare population had a significantly higher prevalence of MS comorbidities and higher MS severity scores at baseline. In addition, they had a higher risk for MS-related relapses and MS-related hospitalizations in the follow-up period. It is important to account for disability status when assessing disease severity and healthcare utilization.

Assessment of basal insulin adherence using 2 methodologies among Texas Medicaid enrollees with type 2 diabetes

BACKGROUND: Basal insulin is often recommended as the initial therapy for patients with type 2 diabetes who require insulin treatment. Adequate adherence is critical to diabetes management, yet suboptimal insulin adherence has been reported. Second-generation long-acting (SGLA) insulin has higher dosing flexibility and lower hypoglycemia risk and may improve adherence. However, little is known regarding adherence to SGLA insulin and how adherence to SGLA insulin compares with intermediate-acting neutral protamine Hagedorn (NPH) and first-generation long-acting (FGLA) insulin. Measurement of insulin adherence is challenging because of the inaccuracies of recorded days supply of insulin, and traditional medication possession ratio (MPR) may be negatively affected. Adjusted MPR (aMPR) has been developed in an effort to address this issue. OBJECTIVE: To examine the unadjusted and adjusted associations between basal insulin type and adherence to basal insulin using MPR and aMPR. METHODS: This retrospective database study used Texas Medicaid prescription claims from January 1, 2014, through June 30, 2017. The index date was the date of the first basal insulin prescription without the same prescription 6 months before (pre-index), and all patients were followed for 12 months (post-index). Patients aged 18-63 years with ≥ 1 pre-index prescription of an oral hypoglycemia agent (OHA) or a glucagon-like peptide-1 receptor agonist (GLP-1 RA), without any post-index prescription of premixed insulin or a basal insulin different from index insulin, and with continuous enrollment throughout the pre- and post-index periods, were included. The dependent variable was basal insulin adherence over 12 months, measured using MPR and aMPR. Unadjusted and adjusted adherence comparisons were conducted by basal (background) insulin type (NPH, FGLA, and SGLA). Covariates included age, gender, baseline use of basal insulins and comorbid medications, total number of medications, OHA adherence, post-index number of OHAs, and use of bolus insulins and GLP-1 RAs. Analysis of variance, chi-square tests, and multiple logistic regression analyses were performed. RESULTS: Of the 5,034 patients included, NPH, FGLA, and SGLA insulin users accounted for 3.7%, 89.8%, and 6.5%, respectively. The overall mean (SD) age was 50.9 (9.9) years, and 65.9% were female. In the unadjusted bivariate analyses, SGLA insulin users had significantly higher adherence, using either MPR (SGLA 0.68 [0.25] vs. FGLA 0.59 [0.27] vs. NPH 0.55 [0.27]; P < 0.0001) or aMPR (0.83 [0.23] vs. 0.78 [0.26] vs. 0.73 [0.28]; P = 0.0001). After controlling for covariates, insulin type was not significantly associated with the likelihood of being adherent (MPR or aMPR ≥ 0.8) using either measure. CONCLUSIONS: Adherence to SGLA insulin was not different from adherence to other basal insulins after controlling for patient characteristics. Yet, MPR and aMPR have limitations and warrant further confirmation of the study findings. Before new adherence measures for insulin therapy are developed, MPR and aMPR should be used with caution. DISCLOSURES: No specific funding was received for this manuscript. The authors report no potential conflicts of interest. Part of the data from this study was presented as posters at the American Pharmacists Association 2020 Annual Meeting & Exposition, March 20-23, 2020, in National Harbor, MD, and at the International Society for Pharmacoeconomics and Outcomes Research 2020 Conference, May 16-20, 2020, in Orlando, FL.

The association between hydroxyurea adherence and opioid utilization among Texas Medicaid enrollees with sickle cell disease

BACKGROUND: Individuals with sickle cell disease (SCD) suffer from recurrent catastrophic pain crises that are often managed by opioid analgesics. Being adherent to hydroxyurea has been associated with decreased health care resource use for pain; however, evidence of its association with opioid use is limited. OBJECTIVE: To determine if adherence to hydroxyurea is associated with opioid use among patients with SCD. METHODS: This retrospective study used Texas Medicaid data from September 1, 2011, to August 31, 2016 (study period). The index date was the date of hydroxyurea initiation. Patients who were aged 2-63 years at the index date, had ≥ 1 inpatient or ≥ 2 outpatient SCD diagnoses during the study period, had ≥ 1 hydroxyurea prescription during the identification period (September 1, 2011-August 31, 2015), had no diagnosis of other indications for hydroxyurea during the study period, and were continuously enrolled for at least 12 months after the index date were included. Hydroxyurea adherence was measured using medication possession ratio (MPR). The study outcomes (measured 1-year post-index) were (a) opioid use; (b) number of opioid prescriptions; (c) strong opioid use (morphine, hydromorphone, fentanyl, and methadone); (d) number of strong opioid prescriptions; (e) high-dose opioid use (≥ 50 mg morphine milligram equivalent [MME]); and (f) days supply for opioid prescriptions. Covariates included demographic (age and gender) and clinical (vaso-occlusive crisis [VOC], avascular necrosis, iron overload, acute chest syndrome, and blood transfusion) characteristics. Descriptive, bivariate (chi-square and Wilcoxon-Mann-Whitney tests), multiple logistic regression, and negative binomial regression analyses were performed. RESULTS: 1,146 patients (18.3 [12.3] years) met the inclusion criteria. Of these, 19.6% were adherent to hydroxyurea (defined as MPR ≥ 80%) and mean (SD) MPR was 48.3% (29.7%). In the 1 year following hydroxyurea initiation, 923 (80.5%) patients had ≥ 1 opioid prescription with 7.6 (9.4) opioid prescriptions per patient, while 259 (22.6%) patients had ≥ 1 strong opioid prescription with 1.5 (4.4) strong opioid prescriptions per patient. Average (SD) opioid dose was 41.7 (74.3) mg MME, and 27.1% had high daily MME doses (≥ 50 mg MME). Average (SD) opioid days supply was 83.1 (112.2) days. After adjusting for covariates, compared with being nonadherent, being adherent to hydroxyurea was associated with a 50.5% decreased risk of having strong opioids (OR = 0.495, 95% CI = 0.278-0.879, P = 0.0165). Additionally, SCD-related complications (VOC, avascular necrosis, and iron overload) and older age were significant factors associated with opioid use and higher MME. Post hoc analyses showed that being adherent to hydroxyurea was significantly associated with lower probabilities of experiencing SCD-related complications. CONCLUSIONS: Results showed that patients with SCD are moderately adherent to hydroxyurea. Being adherent to hydroxyurea was found to be associated with a lower risk of receiving a prescription for strong opioids. Findings suggest that close monitoring and interventions to improve adherence may help mitigate strong opioid use among these patients. DISCLOSURES: This research did not receive any specific funding. Barner and Kang report grants from Novartis Pharmaceuticals, unrelated to this work. A part of this study was presented as a poster at the American Pharmacists Association (APhA) 2019 Annual Meeting and Exposition (March 22-25, 2019, Seattle, WA) and received the 2019 APhA-APRS Presentation Award in the APhA-APRS Contributed Research Paper, Graduate Student/Fellow/Postdoctoral Scholar category.

Association Between Vaso-Occlusive Crises and Opioid Prescriptions Among Patients with Sickle Cell Disease: A Retrospective Claims-Based Study

Background/Objectives: Among sickle cell disease (SCD) patients, vaso-occlusive crises (VOCs) are recurrent and unpredictable attacks of acute pain. These pain crises are often treated with analgesics, including opioids, which have been associated with misuse and overdose. The aim of this study was to examine the association between VOC events and opioid use and assess the association between opioid prescriptions and health care resource utilization among SCD patients. Methods: This was a retrospective cohort study using Texas Medicaid medical and prescription claims between September 2011 and August 2016. The index date was the first SCD diagnosis. Patients (2-63 years) with at least one inpatient or two outpatient SCD diagnoses, who were continuously enrolled during 12 months postindex, were included in the study. The primary outcome was number of opioid prescriptions, while the independent variable was number of VOC events. Covariates included age, gender, nonopioid medication use, nonstudy SCD-related medication (penicillin and folic acid) use, evidence of blood transfusions, number of SCD-related complications, number of SCD-related comorbid conditions, and Charlson Comorbidity Index score. Negative binomial regression analysis was used to address study objectives. Results: Of 3368 included patients, 1978 (58.7%) had at least one opioid prescription with a mean of 4.2 (SD=7.2). Overall, 2071 (61.5%) had at least one VOC event with an average of 2.9 (SD=4.4). The results from the negative binomial regression showed that for every increase in VOC events, the number of opioid prescriptions increased by 9.5% (Incidence rate ratio=1.095, 95% CI: 1.078-1.111; P ≤ 0.0001). Other significant covariates associated with higher opioid use included age (13 and older compared to 2-12) and increase in the number of nonopioid pain medications, nonstudy SCD-related medications, and SCD-related complications. Conclusions: The majority of SCD patients had at least one VOC event and were prescribed opioids during the 12-month study period. We found that each VOC event was associated with a 9.5% increase in the use of opioids. SCD guidelines recommend opioids for the treatment of VOC-related pain. Payers and providers should be aware of opioid use in this population, consider appropriate VOC prevention measures, and provide SCD patients with access to appropriate pain management.

Association between Vaso-occlusive Crises and Opioid Prescriptions among Patients with Sickle Cell Disease: A Retrospective Claims-based Study

BACKGROUND/OBJECTIVES

Among sickle cell disease (SCD) patients, vaso-occlusive crises (VOCs) are recurrent and unpredictable attacks of acute pain. These pain crises are often treated with analgesics, including opioids, which have been associated with misuse and overdose. The aim of this study was to examine the association between VOC events and opioid use and assess the association between opioid prescriptions and health care resource utilization among SCD patients.

METHODS

This was a retrospective cohort study using Texas Medicaid medical and prescription claims between September 2011 and August 2016. The index date was the first SCD diagnosis. Patients (2-63 years) with at least one inpatient or two outpatient SCD diagnoses, who were continuously enrolled during 12 months postindex, were included in the study. The primary outcome was number of opioid prescriptions, while the independent variable was number of VOC events. Covariates included age, gender, nonopioid medication use, nonstudy SCD-related medication (penicillin and folic acid) use, evidence of blood transfusions, number of SCD-related complications, number of SCD-related comorbid conditions, and Charlson Comorbidity Index score. Negative binomial regression analysis was used to address study objectives.

RESULTS

Of 3368 included patients, 1978 (58.7%) had at least one opioid prescription with a mean of 4.2 (SD=7.2). Overall, 2071 (61.5%) had at least one VOC event with an average of 2.9 (SD=4.4). The results from the negative binomial regression showed that for every increase in VOC events, the number of opioid prescriptions increased by 9.5% (Incidence rate ratio=1.095, 95% CI: 1.078-1.111; P ≤ 0.0001). Other significant covariates associated with higher opioid use included age (13 and older compared to 2-12) and increase in the number of nonopioid pain medications, nonstudy SCD-related medications, and SCD-related complications.

CONCLUSIONS

The majority of SCD patients had at least one VOC event and were prescribed opioids during the 12-month study period. We found that each VOC event was associated with a 9.5% increase in the use of opioids. SCD guidelines recommend opioids for the treatment of VOC-related pain. Payers and providers should be aware of opioid use in this population, consider appropriate VOC prevention measures, and provide SCD patients with access to appropriate pain management.

Priority community engagement strategies for cardiovascular health: A checklist for community pharmacists

OBJECTIVE

The objective of this study was to identify essential strategies for use by community pharmacists seeking to establish community partnerships to prevent and manage cardiovascular disease (CVD) in their local communities.

METHODS

A multistep process was used to develop and refine the Community-Clinical Linkages for Cardiovascular Health (CCL-CVD) checklist. First, the authors reviewed the extant literature related to community pharmacists' community engagement and identified evidence-based recommendations for community pharmacists from the Centers for Disease Control and Prevention's guidance documents and linkage framework. Next, the authors developed a 9-item checklist of community engagement strategies for use by practicing community pharmacists with an interest in health promotion and partnership development. The authors then surveyed 15 content experts from across the United States and asked them to evaluate each of the 9 checklist items on a 3-point scale: (1) essential; (2) useful, but not essential; or (3) not necessary. On the basis of the survey results, the authors calculated a content validity ratio (CVR) for each of the 9 strategies and performed a content analysis of the qualitative responses provided by the content experts.

RESULTS

Eleven content experts completed the survey for a response rate of 73%. The CVR for 3 strategies from the initial CCL-CVD checklist reached statistical significance, and these 3 strategies were considered essential strategies for community pharmacists to use when working to develop community partnerships to improve CVD. The following strategies were considered essential: (1) gathering data to support the need for pharmacists' services, (2) identifying preferred communication strategies, and (3) creating mechanisms for documentation and establishing an evaluation plan. An additional strategy-develop goals and objectives for the partnership-neared statistical significance and was included as a second-tier strategy.

CONCLUSION

The multistep process resulted in a practical, 2-tiered checklist for use by community pharmacists who are interested in community engagement and developing sustainable CCLs to improve CVD health.

Patient experience with clinical pharmacist services in Travis County Federally Qualified Health Centers

Background

Positive patient experiences with care have been linked to improved health outcomes. Patient experience surveys can provide feedback about the level of patient-centered care provided by clinical pharmacists and information about how to improve services.

Objectives

Study objectives are: 1) To describe patient experience with clinical pharmacist services in a federally qualified health center (FQHC). 2) To determine if demographic or health-related factors were associated with patient experience.

Methods

This cross-sectional survey included adult patients who were English or Spanish speaking, and completed a clinical pharmacist visit in March or April 2018. Patient experience was evaluated, on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), with 10 items using four domains: pharmacist-patient interaction information provision, support for self-care, and involvement in decision making. In addition, one item was used to rate the overall experience. Demographic and health-related variables were also collected. Eligible patients completed the survey after their clinical pharmacist visit. Descriptive and inferential statistics, as well as Cronbach's alpha for scale reliability, were employed.

Results

Respondents (N=99) were 55.4 (SD=12.1) years and 53.1% were women. Overall, patients rated their experiences very high with the 10-item scale score of 4.8 (SD=0.4) out of 5 points and the overall experience rating of 4.9 (SD=0.4) out of 5 points. With the exception of race, there were no differences between patient experience and demographic and health-related variables. African Americans had significantly (p=0.0466) higher patient experience scores compared to Hispanics.

Conclusions

Patients receiving care in a FQHC highly rated their experience with clinical pharmacists. This indicates that clinical pharmacists provided a high level of patient-centered care to a diverse group.

Impact of a depression counseling intervention on student pharmacists' confidence and comfortability: A pilot study

INTRODUCTION

The objective of this study was to assess the impact of a mental health educational intervention on pharmacy students' confidence and comfortability when engaging in depression counseling.

METHODS

Third-year pharmacy students completed two 15-item rating scales addressing confidence and comfortability about depression. The intervention was 2.5 hours long and included a depression overview, consumer educator presentation, motivational interviewing, and case studies. Surveys were administered at baseline, immediately after the intervention, and three months post intervention. Data were analyzed using paired t-tests and repeated measures analyses.

RESULTS

Of the 23 students who participated in the intervention, 12 (52.2%) completed the three-month follow-up. Confidence increased significantly (p < 0.05) from 3.5 ± 0.5 to 4.1 ± 0.4 immediately post intervention and was sustained at three months post (3.9 ± 0.5). Similarly, comfortability increased significantly (p < 0.05) from 3.6 ± 0.4 to 4.1 ± 0.5 immediately post and was sustained at three months post (4.1 ± 0.6). Cronbach's alphas ranged from 0.90 to 0.96.

CONCLUSION

Pharmacy students' depression counseling confidence and comfortability improved and was sustained after a 2.5-hour intervention with motivational interviewing, consumer education, and case studies.

Willingness to Seek Help for Depression in Young African American Adults: Study Protocol

Background

In the United States, among those living with mental illness, 81% of African American (AA) young adults do not seek treatment compared with 66% of their white counterparts. Although the literature has identified unique culturally related factors that impact help seeking among AAs, limited information exists regarding the development and evaluation of interventions that incorporate these unique factors.

Objective

This study aims to describe a study protocol designed to develop a culturally relevant, theory-based, psychoeducational intervention for AA young adults; to determine if exposure to the intervention impacts AA young adults’ willingness to seek help; and to determine whether cultural factors and stigma add to the prediction of willingness to seek help.

Methods

The Theory of Planned Behavior (TPB) and Barrera and Castro’s framework for cultural adaptation of interventions were used as guiding frameworks. In stage 1 (information gathering), a literature review and three focus groups were conducted to identify salient cultural beliefs. Using stage 1 results, the intervention was designed in stage 2 (preliminary adaptation design), and in stage 3 (preliminary adaptation tests), the intervention was tested using pretest, posttest, and 3-month follow-up surveys. An experimental, mixed methods, prospective one-group intervention design was employed, and the primary outcomes were participants’ willingness and intention to seek help for depression and actual help-seeking behavior.

Results

This study was funded in May 2016 and approved by the University of Texas at Austin institutional review board. Data were collected from November 2016 to March 2016. Of the 103 students who signed up to participate in the study, 70 (67.9%) completed the pre- and posttest surveys. The findings are expected to be submitted for publication in 2020.

Conclusions

The findings from this research are expected to improve clinical practice by providing empirical evidence as to whether a culturally relevant psychoeducational intervention is useful for improving help seeking among young AAs. It will also inform future research and intervention development involving the TPB and willingness to seek help by identifying the important factors related to willingness to seek help. Advancing this field of research may facilitate improvements in help-seeking behavior among AA young people and reduce the associated mental health disparities that apparently manifest early on.

International Registered Report Identifier (IRRID)

DERR1-10.2196/16267

Group-Based Trajectory Modeling to Identify Patterns of Adherence and Its Predictors Among Older Adults on Angiotensin-Converting Enzyme Inhibitors (ACEIs)/Angiotensin Receptor Blockers (ARBs)

PURPOSE

Commonly prescribed medications among patients with comorbid diabetes mellitus and hypertension include ARBs and ACEIs. However, these medications are associated with suboptimal adherence leading to inadequately controlled blood pressure. Unlike traditional single estimates of proportion of days covered (PDC), group-based trajectory modeling (GBTM) can graphically display the dynamic nature of adherence. The objective of this study was to evaluate adherence using GBTMs among patients prescribed ACEI/ARBs and identify predictors associated with each adherence trajectory.

PATIENTS AND METHODS

Patients with an ACEI/ARBs prescription were identified between July 2017 and December 2017 using a Medicare Advantage dataset. PDC was used to measure monthly patient adherence during the one-year follow-up period. The monthly PDC was added to a logistic group-based trajectory model to provide distinct patterns of adherence. Further, a multinomial logistic regression was conducted to determine predictors of each identified adherence trajectory. Predictors included various socio-demographic and clinical patient characteristics.

RESULTS

A total of 22,774 patients were included in the analysis and categorized into 4 distinct adherence trajectories: rapid decline (12.6%); adherent (58.5%); gaps in adherence (12.2%), and gradual decline (16.6%). Significant predictors associated with all lower adherence trajectories included 90 days refill, >2 number of other medications, ≥1 hospitalizations, and prevalent users. Significant predictors associated with the rapid decline trajectory included male sex, comorbidities, and increased CMS risk score. Further, significant predictors associated with the gaps in adherence trajectory included increasing age, and comorbidities. Lastly, significant predictors associated with the gradual decline trajectory included increasing age, no health plan subsidy, comorbidities, and increasing CMS risk score.

CONCLUSION

Identifying various patient characteristics associated with non-adherent trajectories can guide the development of tailored interventions to enhance adherence to ACEI/ARBs.

Examination of Barriers to Medication Adherence, Asthma Management, and Control Among Community Pharmacy Patients With Asthma

OBJECTIVE

To describe the prevalence of common barriers to asthma medication adherence and examine associations between patient-reported asthma controller adherence and asthma control, therapy adherence barriers, and asthma management characteristics.

METHODS

Previously developed asthma-specific tool was pilot tested on a convenience sample of adult patients with persistent asthma. The following data were collected via patient survey: demographic characteristics and comorbidities, adherence, asthma control, and asthma management characteristics. Descriptive and inferential statistics were used to address the study objective.

RESULTS

The patients (N = 93) were 45.4 (17.2) years of age, and 66.7% were female. The majority had poor (68.8%) adherence, with 61.3% of patients having controlled asthma. There was no significant association between adherence and asthma control. The mean number of barriers for good and poor adherence groups differed significantly: 2.0 ± 1.1 and 5.4 ± 2.4, respectively (P < .0001). Having an asthma action plan (AAP) was the only asthma management characteristic significantly related to adherence. The majority of patients with poor adherence did not have an AAP (76.6%), whereas 81.5% of patients with good adherence did have an AAP (P < 0.0001).

CONCLUSIONS

The use of this survey tool confirmed presence of asthma-specific barriers, thus using this specialized approach may lead to more effective, targeted counseling in community pharmacy settings.

An Investigation of Health Management Perceptions and Wellness Behaviors in African American Males in Central Texas

Little is known regarding interventions that incorporate health management perceptions among African American (AA) men, to reduce the risk for developing various medical conditions. Using the Theory of Planned Behavior (TPB), the study objective was to better understand health-care perceptions of AA men by assessing participants' attitudes, subjective norms (SNs), and perceived behavioral control (PBC) regarding health management. AA adult males in Texas were recruited to participate in one of four qualitative focus groups. The TPB was used to assess participants' attitudes (advantages/disadvantages), SNs (approvers/disapprovers), and PBC (enablers/barriers) regarding health management. All four sessions were audiotaped, transcribed, and independently analyzed by researchers to identify major themes. Participants ( n = 23) were 45.2 ± 16.2 years of age (range 24-74). Regarding attitudes toward health management, participants viewed increased longevity and avoiding future health problems as advantages; however, increased cost, lack of confidence in health care, and social pressures were disadvantages. Regarding SNs, parents and children were positive influencers, while spouses and coworkers were both positive and negative influencers. For PBC, a support system and health awareness were identified as enablers, while medical mistrust, fear, and culture were barriers. The results convey that health management behaviors in AA males are multifaceted. Health-care providers should seek to understand these factors, discuss these issues with AA males, and integrate treatment strategies that are culturally informed and patient centered. Findings from this study may be used to develop targeted interventions that improve health outcomes for AA males.

The impact of a required course on third year pharmacy students' perceived abilities and intentions in providing medication therapy management

BACKGROUND AND PURPOSE

To examine the impact of a Medication Therapy Management (MTM) course on third-year pharmacy students' (P3s) perceived abilities and intentions to provide MTM services before and after the course.

EDUCATIONAL ACTIVITY AND SETTING

An anonymous 48-item self-administered survey was administered to P3s before and after the MTM course. Forty-six items using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) measured abilities in MTM provision using the following seven subdomains: general MTM ability (GA), medication therapy review (MTR), medication-related problems identification/recommendations (MRPIR), disease measurement/monitoring (DM), communication (CO), follow-up/referral (FR), and billing/documentation (BD). Two items assessed intent to provide MTM in practice. Descriptive statistics, Cronbach's alphas, and paired t-tests were used.

FINDINGS

All enrolled P3s (n = 110) completed both surveys. Subdomain Cronbach's alphas ranged from 0.70-0.97. Paired t-test showed no significant difference in intention to provide MTM before and after the course; however, the results revealed a significant increase in perceived abilities (before vs. after, respectively) regarding MTR (3.2 ± 0.6;4.2 ± 0.4; p < 0.0001), MRPIR (3.3 ± 0.6;4.2 ± 0.4; p < 0.0001), DM (4.2  ±  0.6;4.5  ±  0.5; p = 0.0004), CO (3.9 ± 0.5; 4.3 ± 0.4; p < 0.0001), FR (3.7±0.8;4.2±0.6; p = 0.0002), and BD (2.4±0.9;3.9±0.8; p < 0.0001).

DISCUSSION AND SUMMARY

A required MTM course with both didactic and experiential components were instrumental in improving P3s' perceived abilities to provide MTM services. Additional research is needed to understand why students' intention to provide MTM did not change pre- to post-course completion.

Associations Between Treatment Satisfaction, Medication Beliefs, and Adherence to Disease-Modifying Therapies in Patients with Multiple Sclerosis

Background

Adherence to disease-modifying therapy (DMT) remains problematic for many patients with multiple sclerosis (MS). An improved understanding of factors affecting DMT adherence may inform effective interventions. This study examined associations between treatment satisfaction, medication beliefs, and DMT adherence.

Methods

A survey was mailed in 2016 to 600 adult patients with relapsing-remitting MS taking an injectable or oral DMT. Patients were sampled from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. The survey measured self-reported DMT adherence (doses taken divided by doses prescribed during previous 2-week period-adherence ≥0.80), DMT satisfaction using the Treatment Satisfaction Questionnaire for Medication version II, medication beliefs using the Beliefs About Medicines Questionnaire, and demographic and clinical covariates. Relationships between variables were examined using multivariate logistic regression.

Results

Final analyses included 489 usable surveys. Mean ± SD participant age was 60.5 ± 8.3 years. Most respondents were white (93.8%), female (86.6%), taking an injectable DMT (66.9%), and adherent to DMT (92.8%). Significant predictors of DMT adherence were age (odds ratio [OR], 1.086; 95% CI, 1.020-1.158; P = .011), type of DMT (oral vs. injectable; OR, 23.350; 95% CI, 2.254-241.892; P = .008), and DMT experience (naive vs. experienced; OR, 2.831; 95% CI, 1.018-7.878; P = .046).

Conclusions

In patients with MS sampled from a patient registry, treatment satisfaction and medication beliefs were not significantly associated with DMT adherence. Based on significant predictors, younger patients, patients taking injectable DMTs, and patients with previous experience with another DMT(s) are at higher risk for nonadherence. Future research is warranted to assess relationships between variables in more diverse MS populations.

Patterns of antiepileptic drug use in patients with potential refractory epilepsy in Texas Medicaid

OBJECTIVES

Antiepileptic drug (AED) monotherapy is usually effective in 60% of the patients with epilepsy while the remaining patients have refractory epilepsy. This study compared treatment patterns (adherence, persistence, addition, and switching) associated with refractory and nonrefractory epilepsy.

METHODS

Texas Medicaid claims from 09/01/07-12/31/13 were analyzed, and patients eligible for the study 1) were between 18 and 62 years of age, 2) had a prescription claim for an AED during the identification period (03/01/08-12/31/11) with no prior baseline AED use (6-month), and 3) had evidence of epilepsy diagnosis within 6 months of AED use. Based on AED use in the identification period, patients were categorized into "refractory" (≥3AEDs) and "nonrefractory" (<3AEDs) cohorts. The index date was the date of the first AED claim. Patients in both cohorts were matched 1:1 using propensity scoring and compared for adherence (proportion of days covered (PDC) ≥80% vs. <80%), persistence, addition (yes/no), and switching (yes/no) using multivariate conditional regression models. Conditional logistic regression and Cox proportional hazard models were used to address the study objectives.

RESULTS

Of the 10,599 eligible patients, 2798 (26.5%) patients in the refractory cohort were matched to patients in the nonrefractory cohort. Patients in the refractory cohort had significantly higher (p < 0.005) mean (±Standard deviation (SD)) adherence (88.6% (±19.1%) vs. 77.0% ± (25.8%)) and persistence (328.0 (±87.3) days vs. 294.9 ± (113.4) days) as compared with patients in the nonrefractory cohort. Compared with patients with nonrefractory epilepsy, patients with refractory epilepsy were 3.6 times (odds ratio (OR) = 3.553; 95% confidence interval (CI) = 3.060-4.125; p < 0.0001) more likely to adhere to AEDs and had a 34.7% (hazard ratio (HR) = 0.653; 95% CI = 0.608-0.702; p < 0.0001) lower hazard rate of discontinuation of AEDs. Also, patients with refractory epilepsy were 3.7 times (OR = 3.723; 95% CI = 2.902-4.776; p < 0.0001) more likely to add an alternative AED and 3.6 times (OR = 3.591; 95% CI = 3.010-4.284; p < 0.0001) more likely to switch to an alternative AED.

CONCLUSION

Patients with refractory epilepsy were significantly more likely to adhere and persist to AED regimen and were significantly more likely to add and switch to an alternative AED than patients with nonrefractory epilepsy.

Impact and Feasibility of Implementing a Systematic Approach for Medication Therapy Management in the Community Pharmacy Setting: A Pilot Study

Objective:

To determine how implementing a systematic medication therapy management (MTM) process impacted MTM completion rates.

Methods:

This process improvement pilot included 4 grocery store-based community pharmacy sites. Site staff were trained on a systematic process to integrate OutcomesMTM opportunities into pharmacy workflow. Technicians prepared MTM paperwork, including a standardized comprehensive medication review (CMR) worksheet, which pharmacists used to deliver the service at the counsel window. The primary outcome was the change in CMR completion rate from pre- to post implementation, with each site serving as its own control. Secondary outcomes were change in targeted intervention program (TIP) completion rate and survey results assessing barriers and feasibility.

Results:

The mean CMR completion rate improved from 2.7% ± 5.4% to 23.2% ± 7.7% ( P < .10). The mean TIP completion rate improved from 3.4% ± 4.2% to 24.9% ± 19.2% ( P < 0.10) pre- to post-implementation. Survey results indicated that pharmacists were satisfied with this; the most significant barriers were time spent contacting prescribers, documentation, and claim submission.

Conclusion:

Implementing this systematic approach to providing MTM into the pharmacy workflow may lead to an improvement in CMR completion rate. However, the sample size is small, and the results and process may not be generalizable to other sites.

Do Long-Acting Injectable Antipsychotics Prevent or Delay Hospital Readmission?

INTRODUCTION

Long-acting injectable (LAI) antipsychotics were developed as a way to decrease pill burden and simplify medication regimens by allowing less frequent administration to assist with medication adherence.

METHODS

The purpose of this study was to determine whether LAI antipsychotics prevent or delay hospital readmission in patients with a known history of medication non-adherence. The study is a retrospective evaluation of 240 men and women 18-65 years of age diagnosed with bipolar disorder, schizophrenia, or schizoaffective disorder discharged from an inpatient state hospital over a 2 year period of time on a LAI antipsychotic (fluphenazine LAI, haloperidol LAI, risperidone LAI or paliperidone LAI) or oral antipsychotic. Patients on LAIs were matched to patients on an equivalent oral dose, psychiatric diagnosis, number of prior hospital admissions, and length of stay.

RESULTS

Those who received a LAI (N = 120) had a significantly longer survival time (mean 278.0 days) without readmission compared to those who did not (N = 120; mean 243.6 days). There was no statistically significant difference in the frequency of one-year readmission between those who did receive a LAI (43.1%) and those who did not (56.9%). Those who received a LAI with administration frequency of a month or longer had a significantly longer survival time without readmission (mean 307.9 days) when compared to those with a shorter administration frequency (mean 245.0 days).

CONCLUSION

This study revealed the use of LAI antipsychotics in those with a history of medication non-adherence, particularly those with longer administration frequency, have potentially promising outcomes.

Fetal fibronectin testing and pregnancy outcomes among Texas Medicaid patients at risk for preterm birth

OBJECTIVES

Fetal fibronectin (fFN) testing between the 24th and 34th weeks of pregnancy in patients with symptomatic preterm labor (PTL) helps assess the risk of spontaneous preterm birth (sPTB), yet the extent of its use is unknown. We assessed use of fFN testing among Texas Medicaid enrollees with symptomatic PTL and evaluated time to infant delivery and healthcare utilization/costs.

STUDY DESIGN

Retrospective cohort study using medical and pharmacy claims for Texas Medicaid enrollees.

METHODS

We identified pregnant women triaged through the emergency department (ED) and hospital labor-and-delivery units with symptomatic PTL between January 1, 2012, and May 31, 2015. Patients with fFN testing prior to delivery were propensity score matched 1:1 to patients without fFN testing. Primary outcomes included time to delivery from initial PTL encounter and all-cause maternal healthcare utilization and costs.

RESULTS

A total of 29,553 women met the criteria for analysis, of whom 14% had a record of receiving fFN testing. Each matched cohort included 4098 patients. Compared with those who did not, patients who underwent fFN testing had significantly more clinical risk factors (mean [SD]: 1.7 [1.1] vs 1.1 [1.0]; P <.0001) and were less likely to deliver during the initial hospital stay (odds ratio [OR], 0.539; 95% CI, 0.489-0.594), deliver ≤3 days following the hospital/ED encounter (OR, 0.499; 95% CI, 0.452-0.551); and receive their first PTL diagnosis during the initial hospital/ED encounter (OR, 0.598; 95% CI, 0.539-0.665). Patients who had an fFN test, compared with those who did not, had 17.5% higher total costs (P <.0001) during the 5 months prior to delivery, but had gestation lengths 9.4 days longer (24.6 vs 15.2 days) than those without testing.

CONCLUSIONS

Frequency of fFN testing was low in Texas Medicaid enrollees with symptomatic PTL. Patients with fFN testing had longer gestation periods and were less likely to deliver within ≤3 days of a hospital/ED encounter for PTL. These results support the role of fFN in screening for risk for sPTB among women with symptomatic PTL.

Pharmacists' perceptions regarding the impact of hydrocodone rescheduling on prescription volume, workflow management, and patient outcomes

OBJECTIVES

To determine (1) pharmacists' perceptions of how rescheduling of hydrocodone combination products (HCPs) from Drug Enforcement Agency (DEA) Schedule III to DEA Schedule II has influenced prescription volume and revenue, pharmacy workflow management, and patient outcomes; and (2) whether perceptions differed between pharmacists who support versus those who oppose HCP rescheduling.

DESIGN

A cross-sectional mail survey.

SETTING

Texas community pharmacies from October to December 2015.

PARTICIPANTS

One thousand randomly selected, registered Texas community pharmacists drawn from the Texas State Board of Pharmacy registry.

MAIN OUTCOME MEASURES

Pharmacists' perceptions, measured on a 5-point Likert scale of HCP rescheduling and its impact on prescription volume and revenue, workflow management, and patient outcomes. Measures were developed specifically for this study.

RESULTS

The response rate was 17% (n = 164). The majority of pharmacists (70.4%) supported HCP rescheduling. More than 80% of respondents perceived that the volume of 2 alternative pain medications-tramadol (DEA Schedule IV) and acetaminophen with codeine (DEA Schedule III) prescriptions dispensed-either "increased" or "significantly increased" (82.0% and 85.8%, respectively) following rescheduling. Overall, pharmacists who opposed rescheduling were significantly more likely to report negative perceptions regarding revenue (P = 0.0142), inventory management (P = 0.0024), and drug shortages (P = 0.0005) than those who supported rescheduling. However, pharmacists who supported rescheduling had more positive perceptions about electronic prescribing (P <0.0115), patient safety (P <0.001), drug abuse (P <0.0001), and legitimate use (P <0.0001).

CONCLUSION

Results showed that legislative efforts, such as rescheduling HCPs, influenced pharmacists' perceptions of practice and patient outcomes. Currently, little is known regarding the impact of HCP rescheduling on pharmacy practice. As new laws are passed to address the opioid epidemic in America, more research will be needed to determine whether legislation is an effective means for managing appropriate access to HCPs and other narcotic analgesics.

The relationship between patient-related factors and medication adherence among Nigerian patients taking highly active anti-retroviral therapy

BACKGROUND

Through several initiatives, there are increasingly more people who have access to anti-retroviral therapy. Adherence to therapy is, however, necessary for successful management of disease.

OBJECTIVES

The objectives of this study were to describe adherence rates and determine what patient-related factors are related to adherence to anti-retroviral therapy among adult patients in an HIV clinic located in Lagos, Nigeria.

METHODS

Adherence was measured using the two-week self-recall method. Barriers, satisfaction with therapy, and socio-demographic and clinical variables served as independent variables. Data were collected via self-administered surveys.

RESULTS

Most of the patients (79.5%) reported 100% adherence. The significant (p<0.05) barriers to adherence were forgetfulness, running out of medication, alcohol use, and medication side effects. For every unit increase in the number of barriers, patients were 60.8% less likely to be 100% adherent (p <0.05, odds ratio, OR = 0.392, 95% CI = 0.295-0.523).

CONCLUSION

Interventions should target helping patients cope with forgetfulness, specifically employing strategies to overcome busyness in schedules, being away from home, and tiredness.

Evaluating the Impact of an Anti-stigma Intervention on Pharmacy Students' Willingness to Counsel People Living with Mental Illness

Third-year pharmacy students (n = 88) participated in an anti-stigma intervention program consisting of presentations, videos, discussion and active-learning exercises. Willingness to counsel (WTC) people with mental illness (MI) was evaluated using immediate pre and post-tests comparing diabetes, depression and schizophrenia. At pre-test, WTC diabetes was highest (higher = increased WTC) while schizophrenia was the lowest. There were no statistically significant differences between pre/post-test WTC for diabetes and depression, while schizophrenia WTC increased significantly (p < 0.05). At post-test, diabetes WTC was significantly higher than depression and schizophrenia (p < 0.0001). Regression results for WTC depression showed that comfortability and gender were significant (p < 0.05) predictors. Regression results for WTC schizophrenia showed that comfortability was a significant (p < 0.05) predictor. As highly accessible healthcare providers, pharmacists have the potential to positively impact healthcare, but this depends on WTC. Colleges of pharmacy may consider instituting policies that support experiential education involving counseling people living with MI, as this may increase comfortability.

Knowledge of Prostate Cancer and Screening Among Young Multiethnic Black Men

The purpose of this study was to assess the knowledge of prostate cancer and screening and its associated factors in young Black men aged 18 to 40 years. This was a cross-sectional study conducted in a convenience sample of 267 young Black men in Austin, Texas. Knowledge about prostate cancer and screening was operationalized through 14 items, including 12 items from the Knowledge about Prostate Cancer Screening Questionnaire (PC knowledge), and two items assessing dietary knowledge and prostate cancer screening controversy. PC knowledge scores were regressed on age, cues to action, health screening experience, and demographic/personal factors. Most participants were African American men of American origin (65.3%) and were college freshmen (18.9%). PC knowledge scores were low, with mean correct responses of 28.5%, mean knowledge score of 5.25 ± 3.81 (possible score range of 0 to 14, with higher scores indicating higher PC knowledge) and a median score of 5.00. On average, 47% of the respondents replied “Don’t Know” to the questions. Overall, PC knowledge scores were low among these young Black men, especially in domains related to risk factors, screening age guidelines, limitations, and diet. It is thus important that these men be educated more on these important domains of prostate cancer and screening so that the decision to screen or not will be an informed one. Health screening experience, residence area, major field of study, and academic classification were significant predictors of knowledge.

Evaluation of an inpatient psychiatric hospital physician education program and adherence to American Diabetes Association practice recommendations

OBJECTIVE

This study evaluated adherence to American Diabetes Association (ADA) recommendations for diabetes monitoring following an educational intervention for physicians in an inpatient psychiatric hospital.

METHODS

This retrospective chart review was conducted in an inpatient psychiatric institution from July 1, 2010-January 15, 2011. A total of 120 subjects (60 subjects each in the pre- and post-intervention groups) meeting the inclusion criteria served as the study sample. Included subjects were admitted and discharged from an inpatient psychiatric institution within 90 days prior to (pre-intervention) and following (post-intervention) the physician education program. The medical staff was presented an educational program intervention, consisting of a 30 minute overview of the ADA 2010 Standards of Care recommendations and distribution of laminated treatment reminders. Electronic grouped order sets for patients with diabetes were also created and implemented.

RESULTS

The primary outcome was change (pre-intervention to post-intervention) in frequency of hemoglobin A1c documentation on admission following the intervention. Secondary outcomes included the change in frequency of documentation of fasting plasma glucose, serum creatinine, urine creatinine/microalbumin ratio (UMA), fasting lipid profile (FLP), and change in days on sliding scale insulin. Regarding change in frequency of documentation of A1c values on admission, chi-square analysis revealed a significant increase from pre-intervention to post-intervention period of 30% (n = 18) to 61.7% (n = 37), respectively (p = 0.0005). Documentation of FLP also significantly increased [73.3% vs. 91.7% (p = 0.0082)]. There were no significant differences in the documentation of fasting plasma glucose, serum creatinine, and UMA or days treated with sliding scale insulin.

CONCLUSION

The physician education program was successful in increasing the assessment of A1c values and lipid profiles for patients with diabetes mellitus in a psychiatric institution.

Determinants of Prostate Cancer Screening Intentions of Young Black Men Aged 18 to 40 Years

INTRODUCTION

Black men are more likely to be diagnosed with prostate cancer, with higher stage and higher grade at presentation. Evidence suggests that for education in health promotion behaviors (such as screenings) in early adult years, young Black men can be better equipped to make informed decisions in later years.

OBJECTIVE

Using the theory of reasoned action (TRA), we assessed the intention of young Black men to screen for prostate cancer when it is recommended and determined its correlates.

METHODS

This was a cross-sectional study of 267 Black men aged 18 to 40 years. A 47-item questionnaire collected information on demographics/personal factors, attitudes toward prostate cancer screening, social influence, comfortability with prostate examinations, cues to action, health screening experiences, knowledge of prostate cancer and screening, and intention. Descriptive statistics were calculated for all variables and hierarchical logistic regression was employed to determine significant predictors of prostate cancer screening intentions.

RESULTS

The regression model accounted for 46% of the variance in intention (p < 0.01), with excellent perception of health, having private or public health insurance, longer regular source of care, positive attitude, positive social influence, positive cues to action, and higher knowledge levels being significant predictors of intentions.

CONCLUSION

This study provides support for the use of TRA in predicting prostate cancer screening intentions among young Black men when it is recommended by a physician. Findings may inform the development of empirical-based interventions to educate and inform at-risk young Black men about the pros and cons of prostate cancer screening so that they can make informed decision on screening when recommended later in life.