ResearchPad - health-policy https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Telemedicine Facilitation of Transfer Coordination From Emergency Departments]]> https://www.researchpad.co/article/elastic_article_13006 Interhospital transfers are costly to patients and to the health care system. The use of telemedicine may enable more efficient systems by decreasing transfers or diverting transfers from crowded referral emergency departments (EDs) to alternative appropriate facilities. Our primary objective is to describe the prevalence of telemedicine for transfer coordination among US EDs, the ways in which it is used, and characteristics of EDs that use telemedicine for transfer coordination.MethodsWe used the 2016 National Emergency Department Inventory–USA survey to identify telemedicine-using EDs. We then surveyed all EDs using telemedicine for transfer coordination and a sample of EDs using telemedicine for other clinical applications. We used a multivariable logistic regression model to identify characteristics independently associated with use of telemedicine for transfer coordination.ResultsOf the 5,375 EDs open in 2016, 4,507 responded to National Emergency Department Inventory–USA (84%). Only 146 EDs used telemedicine for transfer coordination; of these, 79 (54%) used telemedicine to assist with clinical care for local admission, 117 (80%) to assist with care before transfer, and 92 (63%) for arranging transfer to a different hospital. Among telemedicine-using EDs, lower ED annual visit volume (odds ratio 5.87, 95% CI 2.79 to 12.36) was independently associated with use of telemedicine for transfer coordination.ConclusionAlthough telemedicine has potential to improve efficiency of regional emergency care systems, it is infrequently used for coordination of transfer between EDs. When used, it is most often to assist with clinical care before transfer. ]]> <![CDATA[Health and long-term care of the elderly with dementia in rural Thailand: a cross-sectional survey through their caregivers]]> https://www.researchpad.co/article/elastic_article_9133 To describe the circumstances of the elderly with dementia and their caregivers’ characteristics in order to examine factors related to activities of daily living (ADL) and household income to propose a long-term care policy for rural areas of Thailand.SettingA cross-sectional study at the household level in three rural regions of Thailand where there were initiatives relating to community care for people with dementia.ParticipantsCaregivers of 140 people with dementia were recruited for the study.Primary and secondary outcome measuresSocioeconomic characteristics including data from assessment of ADL and instrumental ADL and the Thai version of Resource Utilisation in Dementia were collected. Descriptive statistics were used to explain the characteristics of the elderly with dementia and the caregivers while inferential statistics were used to examine the associations between different factors of elderly patients with dementia with their dependency level and household socioeconomic status.ResultsEighty-six per cent of the dementia caregivers were household informal caregivers as half of them also had to work outside the home. Half of the primary caregivers had no support and no minor caregivers. The elderly with dementia with high dependency levels were found to have a significant association with age, dementia severity, chance of hospitalisation and number of hospitalisations. Though most of these rural samples had low household incomes, the patients in the lower-income households had significantly lower dementia severity, but, with the health benefit coverage had significantly higher chances of hospitalisation.ConclusionAs the informal caregivers are the principal human resources for dementia care and services in rural area, policymakers should consider informal care for the Thai elderly with dementia and promote it as the dominant pattern of dementia care in Thailand. ]]> <![CDATA[Prevalence of occupational exposure and its influence on job satisfaction among Chinese healthcare workers: a large-sample, cross-sectional study]]> https://www.researchpad.co/article/N9c79913e-f6c5-418a-8f8e-664736c60c1c This study had three objectives: (1) describe the prevalence of occupational exposure among Chinese medical personnel in detail, (2) verify the partial mediating role of work environment satisfaction in the relationship between occupational exposure and job satisfaction, and (3) examine if stress symptoms moderate the relationship between occupational exposure and job satisfaction.DesignA large cross-sectional online survey was conducted in July 2018 in China.SettingA survey was conducted in 54 cities across 14 provinces of China.ParticipantsA total of 12 784 questionnaires were distributed, and 9924 healthcare workers (HCWs) completed valid questionnaires. The response rate was 77.63%.Outcome measuresA confidential questionnaire was distributed to HCWs. The relationships among and the mechanisms of the variables were explored using descriptive statistical analyses, Pearson’s correlation coefficient and multiple linear regression analysis.ResultsThe most common occupational exposures among HCWs in the past 12 months were psychosocial and organisational hazards (85.93%). Overall, physicians (93.7%) and nurses (89.2%) were the main victims of occupational exposure. Occupational exposure correlated negatively with work environment satisfaction and job satisfaction, and positively with stress symptoms. Moreover, work environment satisfaction fully mediated the relationship between occupational exposure and job satisfaction, and stress symptoms moderated the relationship between occupational exposure and job satisfaction.ConclusionThe incidence of occupational exposure among HCWs is generally high. The high frequency of psychosocial and organisational hazards among physicians and nurses should be taken seriously and dealt with in a timely manner by hospital managers. The negative impact of occupational exposure on job satisfaction must be buffered by measures to reduce stress symptoms and enhance working environment satisfaction, ultimately improving the overall quality of life of HCWs and promoting comprehensive development of the medical team. ]]> <![CDATA[Assessment of Hospital Readmissions From the Emergency Department After Implementation of Medicare’s Hospital Readmissions Reduction Program]]> https://www.researchpad.co/article/Nfb136eae-d0ea-4d18-8e92-7c311f04021c The Medicare Hospital Readmissions Reduction Program (HRRP) is associated with reduced readmission rates, but it is unknown how this decrease occurred.ObjectiveTo examine whether the HRRP was associated with changes in the probability of readmission at emergency department (ED) visits after hospital discharge (ED revisits) overall and depending on whether admission is typically indicated for the patient’s condition at the ED revisit.Design, Setting, and ParticipantsThis retrospective cohort study used hospital and ED discharge data from California, Florida, and New York from January 1, 2010, to December 31, 2014. A difference-in-differences analysis examined change in readmission probability at ED revisits for recently discharged patients; ED revisits with clinical presentations for which admission is typically indicated vs those for which admission is more variable (ie, discretionary) were examined separately. Inclusion criteria were Medicare patients 65 years and older who revisited an ED within 30 days of inpatient discharge. Data were analyzed from December 18, 2018, to September 11, 2019.ExposuresBefore and after HRRP implementation among patients initially hospitalized for targeted vs nontargeted conditions.Main Outcomes and MeasuresThirty-day unplanned hospital readmissions at the ED revisit.ResultsA total of 9 914 068 index hospitalizations were identified in California, Florida, and New York from 2010 to 2014. Of 2 052 096 discharges in 2010, 1 168 126 (56.9%) discharges were women and 566 957 discharges (27.6%) were among patients older than 85 years. Among 1 421 407 patients with an unplanned readmission within 30 days of discharge, 1 266 107 patients (89.1%) were admitted through the ED. A total of 1 906 498 ED revisits were identified. After adjusting for patient demographic and clinical characteristics from the index hospitalization, HRRP implementation was associated with fewer readmissions from the ED, with a difference-in-difference estimate of −0.9 (95% CI, −1.4 to −0.4) percentage points (P < .001), or a 1.4% relative decrease from the 65.8% pre-HRRP readmission rates. Implementation of the HRRP was associated with fewer readmissions at the ED revisit involving clinical presentations for which admission is typically indicated (difference-in-differences estimate, −1.1 [95% CI, −1.6 to −0.6] percentage points; P < .001), or a 1.2% relative decrease from the 93.6% pre-HRRP rate. These results appear to be associated with patients presenting at the ED revisit with congestive heart failure (difference-in-difference estimate, −1.2 [95% CI, −2.0 to −0.4] percentage points; P = .003).Conclusions and RelevanceThese findings suggest that implementation of the HRRP was associated with a lower likelihood of readmission for recently discharged patients presenting to the ED, specifically for congestive heart failure. This highlights the critical role of the ED in readmission reduction under the HRRP and suggests that patient outcomes after HRRP implementation should be further studied. ]]> <![CDATA[Concordance Between Electronic Health Record Data and Medicare Part D Claims Data for Oral Anticancer Drug Use]]> https://www.researchpad.co/article/N1471ba53-b3db-456b-a586-1aa1e4fa1a49 This cross-sectional study determines the concordance between electronic health record and Medicare Part D claims data for the receipt of oral anticancer agents.

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<![CDATA[Assessment of Completeness of Hospital Readmission Rates Reported in Medicare Advantage Contracts’ Healthcare Effectiveness Data and Information Set]]> https://www.researchpad.co/article/Nf2980fa8-aa8a-425a-b839-cf07d21eda88

This cross-sectional study evaluates the agreement between readmission rates reported by Medicare Advantage contracts and readmission rates calculated from their encounter data in the Healthcare Effectiveness Data and Information Set (HEDIS).

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<![CDATA[State Regulations Governing Firearms in Early Care and Education Settings in the US]]> https://www.researchpad.co/article/Nab89942a-0b75-4d88-8833-991dda7497ea

This cross-sectional study documents existing US state regulations governing the presence and storage of firearms in early care and education settings and the extent to which these regulations align with national standards.

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<![CDATA[Population-Based Estimates of Health Care Utilization and Expenditures by Adults During the Last 2 Years of Life in Canada’s Single-Payer Health System]]> https://www.researchpad.co/article/N2a6d0a04-e49f-4a68-9e54-c48bb8991024

Key Points

Question

What are the population-level trends in health care utilization and expenditures in the 2 years before death among adults in Ontario, Canada?

Findings

This cohort study found that health care expenditures in the last 2 years of life increased in Ontario from CAD$5.12 billion in 2005 to CAD$7.84 billion in 2015, and the intensity of health care utilization and deaths in hospital varied by resource utilization gradients.

Meaning

In this study, the observed trends demonstrated that costs and hospital-centered care before death are high in Ontario.

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<![CDATA[Factors associated with professional confidence in Japanese public health nurses: A cross‐sectional survey]]> https://www.researchpad.co/article/Ndad67b08-f2bc-4756-9646-a6c4293c5532

Abstract

Objectives

To clarify factors associated with professional confidence in Japanese public health nurses (PHNs) and to examine the relationship between professional confidence and professional competency.

Design

A cross‐sectional study.

Sample

Public health nurses (N = 1,512) working in local government agencies.

Measurements

An anonymous, self‐administered questionnaire with questions on demographic characteristics (sex, age, experience as a PHN, educational background, affiliation, and position) and 34 items on professional confidence developed by the researchers based on a literature review was administered. Factors associated with the professional confidence were extracted through an exploratory factor analysis, and construct validity of the confidence was verified through a confirmatory factor analysis.

Results

In total, 883 responses (response rate, 58.4%) were received; only 467 (30.9%) of them were valid. On the basis of the exploratory factor analysis results, professional confidence included 17 items, with the following four factors: “technical practice,” “effortful learning,” “exploring the evidence,” and “educators in workplace.” The goodness‐of‐fit model in the confirmatory factor analysis proved the construct validity of professional confidence.

Conclusions

Professional confidence was gained by self‐improvement that reflects on public health practice. Professional confidence underpinned the generalist level of professional competency among PHNs.

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<![CDATA[Association of a Lay Health Worker Intervention With Symptom Burden, Survival, Health Care Use, and Total Costs Among Medicare Enrollees With Cancer]]> https://www.researchpad.co/article/Nf8e6f990-a29e-4509-9958-1df2dc167e41

Key Points

Question

Is a lay health worker–led screening and referral intervention associated with patient symptom burden, acute care use, and total costs of care?

Findings

In this multisite quality improvement study of 425 Medicare Advantage enrollees with a diagnosis of cancer who were provided usual cancer care augmented by a lay health worker trained to proactively screen patient symptoms, discuss symptoms with a physician assistant, and refer patients with uncontrolled symptoms to palliative care and behavioral medicine compared with 407 control patients diagnosed and treated in the year prior, patients in the intervention group were associated with significant reductions in symptom burden over time, and patients in the control group were associated with worsening symptoms over time. Patients who received the intervention were associated with fewer inpatient and emergency department visits and lower median total costs, and there were no differences in survival.

Meaning

The findings suggest that a lay health worker–led symptom screening and proactive referral intervention may improve value-based cancer care.

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<![CDATA[Legislative landscape for traditional health practitioners in Southern African development community countries: a scoping review]]> https://www.researchpad.co/article/Nf132c0bc-5a39-4c7c-9bd4-b953efb850da

Background and objectives

Globally, contemporary legislation surrounding traditional health practitioners (THPs) is limited. This is also true for the member states of the Southern African Development Community (SADC). The main aim of this study is to map and review THP-related legislation among SADC countries. In order to limit the scope of the review, the emphasis is on defining THPs in terms of legal documents.

Methods

This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews methods. Two independent reviewers reviewed applicable legal definitions of THPs by searching the Southern African Legal Information Institute (SAFLII) database in April 2018 for legislation and bills. To identify additional legislation applicable in countries not listed on SAFLII and/or further relevant SADC legislation, the search engines, Google and PubMed, were used in August 2018 and results were reviewed by two independent reviewers. Full texts of available policy and legal documents were screened to identify policies and legislation relating to the regulation of THPs. Legislation was deemed relevant if it was a draft of or promulgated legislation relating to THPs.

Results

Four of 14 Southern African countries have legislation relating to THPs. Three countries, namely South Africa, Namibia and Zimbabwe, have acknowledged the roles and importance of THPs in healthcare delivery by creating a council to register and formalise practices, although they have not operationalised nor registered and defined THPs. In contrast, Tanzania has established a definition couched in terms that acknowledge the context-specific and situational knowledge of THPs, while also outlining methods and the importance of local recognition. Tanzanian legislation; thus, provides a definition of THP that specifically operationalises THPs, whereas legislation in South Africa, Namibia and Zimbabwe allocates the power to a council to decide or recognise who a THP is; this council can prescribe procedures to be followed for the registration of a THP.

Conclusions

This review highlights the differences and similarities between the various policies and legislation pertaining to THPs in SADC countries. Legislation regarding THPs is available in four of the 14 SADC countries. While South Africa, Tanzania, Namibia and Zimbabwe have legislation that provides guidance as to THP recognition, registration and practices, THPs continue to be loosely defined in most of these countries. Not having an exact definition for THPs may hamper the promotion and inclusion of THPs in national health systems, but it may also be something that is unavoidable given the tensions between lived practices and rigid legalistic frameworks.

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<![CDATA[Differences in reimbursement listing of anticancer therapies in China: an observational study]]> https://www.researchpad.co/article/N50f56119-91e5-478a-96a7-3705d790b06e

Objective

Access to highly priced anticancer medications usually requires insurance coverage. A first step towards coverage of such medications is their inclusion in reimbursement lists. We assessed listing for reimbursement in China between 2009 and 2018 of anticancer medications on the WHO’s Essential Medicines List.

Setting and study design

Using publicly available data, we assessed which anticancer medications listed in the 20th WHO Model List of Essential Medicines (EML) were included in China’s National Reimbursement Drug List (NRDL). For five targeted anticancer medications on the WHO EML, we also assessed inclusion in the 31 Chinese Provincial Reimbursement Drug Lists (PRDLs). Logistic regression was used to test whether inclusion of targeted anticancer medications was associated with provincial economic levels.

Primary outcome measures

Inclusion of five targeted anticancer medications in the NRDL and PRDLs before and after 2017.

Results

The 2017 NRDL included all anticancer medications on the WHO EML (except for one not approved in China at the time), and by 2018, all 31 PRDLs listed the targeted anticancer medications except for nilotinib; four provinces had covered all five targeted medications before the 2017 NRDL coverage mandate. Provincial economic level and regional incidence of specific cancers seemed unrelated to the inclusion of five targeted anticancer medications in PRDLs.

Conclusion

Our findings suggest that by including medications in the national and provincial reimbursement lists, China has taken an important first step in promoting access to targeted anticancer medications. Further research is needed to determine whether inclusion in PRDLs improved the availability, appropriate use and affordability of highly priced targeted anticancer medications in China.

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<![CDATA[The urban-rural disparity in the prevalence and risk factors of hypertension among the elderly in China—a cross-sectional study]]> https://www.researchpad.co/article/Nbfff3a2f-ac2c-40de-8f4d-0b2b6a7afbb0

Introduction

This study aimed to assess the prevalence of hypertension and to explore the disparities of its risk factors among urban and rural elderly.

Method

Data of hypertensive patients were collected from the China Health and Retirement Longitudinal Study (CHARLS) 2015. Stratified sample households were selected from 450 villages or communities of 150 counties from 28 provinces. Multivariable logistic regression was performed to analyze the factors correlated with hypertension.

Results

Prevalence of HBP was 47.6% (95% CI [45.2%–50.1%]) in total and it was close between urban and rural population (48.6% vs 47.2%). Factors associated with HBP were different between urban and rural areas. In urban areas, hypertension was significantly associated with literacy and diabetes in both genders, high BMI level and smoke quitters in males, and physical activity and dyslipidemia in females. In rural areas, hypertension was significantly associated with older age, higher BMI level in both males and females, and dyslipidemia in males.

Conclusions

The prevalence are about the same among urban and rural residents, but their risk factors vary from each other. Disparity in the risk factors between urban and rural population should be taken into consideration for further intervention.

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<![CDATA[Lessons learnt from the implementation of new care models in the NHS: a qualitative study of the North East Vanguards programme]]> https://www.researchpad.co/article/N717e02a4-6d97-46d9-a9aa-fa6dcc380709

Objective

To examine lessons learnt from the implementation of five Vanguard initiatives in the North East of England.

Design

Data collection comprised semistructured interviews with key informants at each site.

Setting

The study took place across six local authority areas in the North East of England and within six clinical commissioning groups responsible for the delivery of each Vanguard’s aims and objectives.

Participants

Sixty-six interviewees with participants from five Vanguard initiatives in the North East of England, including senior clinicians, project leads and directors, commissioners, and healthcare managers.

Results

While the context for each Vanguard is separate and distinct, there also exists a set of common issues which have a regional dimension. Participants felt that the national programme helped to raise the profile of local change initiatives and also contributed to the wider understanding of regional service integration issues. At the same time our findings demonstrate that all five sites experienced, and were subject to, unrealistic pressure placed on them to deliver outcomes. Of particular concern among all sites was the sheer scale and pace of change occurring at the same time as the National Health Service was being tasked with making significant, if unrealistic, efficiency savings.

Conclusions

It is too early to conclude with any confidence that a successful outcome for the new care models programme will be forthcoming. While early indications show some encouraging signs of promise, the overall context in which the complex and ambitious changes are being implemented remains both fragile and fluid.

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<![CDATA[Methodological quality of public health guideline recommendations on vitamin D and calcium : a systematic review protocol]]> https://www.researchpad.co/article/Nec241bef-bafb-4cba-8cf0-3e563565d112

Introduction

Current recommendations for vitamin D and calcium in dietary guidelines and bone health guidelines vary significantly among countries and professional organisations. It is unknown whether the methods used to develop these recommendations followed a rigourous process and how the differences in methods used may affect the recommended intakes of vitamin D and calcium. The objectives of this study are (1) collate and compare recommendations for vitamin D and calcium across guidelines, (2) appraise methodological quality of the guideline recommendations and (3) identify methodological factors that may affect the recommended intakes for vitamin D and calcium. This study will make a significant contribution to enhancing the methodological rigour in public health guidelines for vitamin D and calcium recommendations.

Methods and analyses

We will conduct a systematic review to evaluate vitamin D and calcium recommendations for osteoporosis prevention in generally healthy middle-aged and older adults. Methodological assessment will be performed for each guideline against those outlined in the 2014 WHO handbook for guideline development. A systematic search strategy will be applied to locate food-based dietary guidelines and bone health guidelines indexed in various electronic databases, guideline repositories and grey literature from 1 January 2009 to 28 February 2019. Descriptive statistics will be used to summarise the data on intake recommendation and on proportion of guidelines consistent with the WHO criteria. Logistic regression, if feasible, will be used to assess the relationships between the methodological factors and the recommendation intakes.

Ethics and dissemination

Ethics approval is not required as we will only extract published data or information from the published guidelines. Results of this review will be disseminated through conference presentations and peer-reviewed publications.

PROSPERO registration number

CRD42019126452

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<![CDATA[Quality of patient, family, caregiver and public engagement in decision-making in healthcare systems: a scoping review protocol]]> https://www.researchpad.co/article/Nd086d5d8-2071-418c-b11d-6d3e8979fb49

Introduction

To advance person- and family-centred healthcare, government initiatives have supported the engagement of patients and family caregivers in decision-making in healthcare systems. There is, however, no consensus on how to define success for such initiatives. This scoping review aims to identify the key elements for defining the quality of patient and family caregiver engagement in decision-making across the engagement domains (individual, community/organisation, system) of British Columbia’s healthcare system. We will use those elements to develop a conceptual evaluation framework.

Methods and analysis

This scoping review follows Arskey and O’Malley’s methodology. (1) The research question was identified through team discussions. (2) Articles for data source will be identified using a librarian-informed search strategy for seven bibliographic databases as well as grey literature sources. (3) Selected articles will be relevant to the evaluation of patient and family caregiver engagement in healthcare systems. (4) Two researchers will independently extract data into predefined and emerging categories. (5) The researchers will reconcile and organise the identified elements. The research team’s collective perspective will then refine the elements, and select, interpret and summarise the results. (6) Persons from key stakeholder groups will be consulted to refine the emergent conceptual framework.

Ethics and dissemination

We will seek ethics approval for the stakeholder consultation. This study follows an integrated knowledge translation approach. The results will inform evaluation of the Patients as Partners Initiative of the British Columbia Ministry of Health, and will be disseminated as a scientific article, a research brief, and presentations at conferences and stakeholder meetings.

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<![CDATA[Applying a whole systems lens to the general practice crisis: cross-sectional survey looking at usage of community pharmacy services in England by patients with long-term respiratory conditions]]> https://www.researchpad.co/article/Neb08778c-f544-4197-8701-478c1e658fdb

Objective

UK policy initiatives aiming to extend community pharmacy services to moderate patient demands and to reduce general practitioners’ (GPs) workload have had limited success. This study used marketing theory to identify factors that could influence patients to make better use of community pharmacies within the primary care pathway.

Design

Cross-sectional postal survey design applying the ‘7Ps marketing mix’ (‘product’, ‘price’, ‘place’, ‘promotion’, ‘people’, ‘process’ and ‘physical evidence’).

Setting

Greater Manchester, England.

Participants

Patients with asthma or chronic obstructive pulmonary disease registered at two GP practices.

Primary outcome

Patient preference for community pharmacy services.

Results

The response rate was 29% (289/1003). Most respondents preferred to use GP practices for invasive/diagnostic services (product) while preferring using community pharmacy for medicines supply and minor ailments (place). Stronger preference for using GP practices over community pharmacy was significantly associated with gender (male>female), age group (≥65 years) and healthcare services previously accessed at the pharmacy. Respondents perceived they would be more likely to use community pharmacy services if pharmacists offered them enough time to discuss any concerns (73.3%) (price), if community pharmacies had private/clean consultation rooms (70%–73%) (physical evidence) and if pharmacy staff had strong interpersonal skills (68%–70%) (people). Respondents were divided on likelihood of using community pharmacy services if pharmacists could access their whole medical record but wanted pharmacists to add information about their visit (59.6%) (process). Respondents would be encouraged to use community pharmacy for healthcare services if they were offered services by pharmacy staff or recommended/referred to services by their GP (44%) (promotion).

Conclusions

Using the 7Ps marketing mix highlighted that community pharmacies having staff with strong interpersonal skills, good quality consultation rooms and integrated information systems could positively influence patients to use community pharmacies for management of long-term conditions. There are opportunities for community pharmacies to alleviate GP workload, but a whole system approach will be necessary.

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<![CDATA[Racial Disparities in Patient Characteristics and Survival After Acute Myocardial Infarction]]> https://www.researchpad.co/article/5c50f634d5eed0c48462c01d

Key Points

Question

Does race serve as a surrogate for socioeconomic and clinical factors, and, after adjusting for those factors, do long-term mortality rates differ between black patients and white patients following acute myocardial infarction?

Findings

In this cohort study of 6402 patients from 2 acute myocardial infarction registries, self-identified black patients and white patients differed in several clinical and socioeconomic characteristics. The higher the prevalence of characteristics associated with being a black patient, the higher the 5-year mortality rate, but no differences were observed between black patients and white patients with similar characteristics.

Meaning

A greater prevalence of characteristics associated with black race, but not race itself, was associated with higher mortality risk after acute myocardial infarction.

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<![CDATA[Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers]]> https://www.researchpad.co/article/5c50f5cad5eed0c48462b7e1

Key Points

Question

Among US insurers, what are the coverage and utilization management policies for nonpharmacologic treatments for chronic, noncancer low back pain?

Findings

In this cross-sectional study of 45 Medicaid, commercial, and Medicare Advantage plans, most plans covered at least physical and occupational therapy and chiropractic care for chronic noncancer pain, but there was little evidence of coverage of acupuncture and psychological interventions. Utilization management strategies such as visit limits and prior authorization were common, but criteria varied widely across the plans examined.

Meaning

The lack of consistent coverage and utilization management policies underscores the need for best practices to improve comprehensive, multimodal coverage of treatments for chronic, noncancer low back pain.

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<![CDATA[Exposure-Response Association Between Concurrent Opioid and Benzodiazepine Use and Risk of Opioid-Related Overdose in Medicare Part D Beneficiaries]]> https://www.researchpad.co/article/5c50f590d5eed0c48462b288

Key Points

Question

How does the risk of overdose change with the number of days with concurrent opioid and benzodiazepine use?

Findings

In this cohort study of US Medicare data, the overdose risk associated with concurrent benzodiazepine use changed over time. Concurrent benzodiazepine use was associated with a 5-fold increase in the risk of opioid-related overdose during the initial 90 days and an increase of 1.87 times on days 91 to 180.

Meaning

Policy interventions should focus on preventing concurrent opioid and benzodiazepine use in the first place instead of reducing the length of concurrent use. Patients using both medications should be closely monitored, particularly during the first days of concurrent use.

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