The influence of year-end bonuses on colorectal cancer screening

The objective of the paper is to estimate the effect of physician bonus eligibility on CRC screening while controlling for patient and primary care physician characteristics. The study is retrospective, using a managed care plan’s claims data on fifty-year-old commercially insured patients in the years 2000 and 2001. The data also include links to enrollment and provider files. Multivariate logistic regression models are used to assess the association between CRC screening receipt and physician bonus eligibility. The results indicate that the probability that a patient received a CRC screening was approximately 3 percentage points higher in the year physicians were eligible for a bonus. There were also significant differences according to the gender of both the patient and physician, income, and race.

Lifetime Interpersonal Polyvictimization: Abuse Typologies and Mental Health Outcomes in a Nationally Representative Sample of Men from the United States

Background Interpersonal polyvictimisation experiences are a specific type of traumatic experience that include physical, sexual or psychological attacks against a person and much research has concentrated on female only or mixed samples. Being a victim of one form of victimisation experience increases the risk of further victimisation experience resulting in polyvictimisation, and elevates the likelihood on negative mental health outcomes. Objectives The current study seeks to establish interpersonal polyvictimisation typologies within a male sub-population of a large epidemiologic sample and establish associated risk of psychopathology across a range of mental health outcomes. Methods Using data from 15,794 adult males, aged over 18 years who completed the NESARC III, a Latent Class Analysis (LCA) of the endorsement of interpersonal victimisation experiences was conducted to establish latent profiles of interpersonal polyvictimisation. Subsequently regression analysis was conducted to establish risk of psychopathology across a series of DSM 5 diagnosed mental health conditions. Findings A three-class solution was deemed optimal in line with published fit statistics. Class 3 was categorised by low/no endorsement and was labelled ‘normative’, Class 2 was categorised by high endorsement of childhood indicators and was labelled ‘childhood’, class 1 showed a moderate endorsement across life-course victimisation indicators and was labelled ‘lifecourse’. Interpersonal polyvictimisation profiles showed increased risk of negative mental health outcomes in adulthood suggesting that distinct typologies of interpersonal polyvictimisation exist within the adult male only population. Conclusions Experiences of interpersonal polyvictimisation are robustly associated with adult psychopathology in males including elevated rates of the likelihood of PTSD, Anxiety and Depression in a dose response fashion. Interventions and support services should therefore be developed and implemented that are targeted to gender specific distinctiveness

Role of Community Pharmacists in Asthma

Asthma is one of the most common chronic conditions affecting the Australian population. Amongst primary healthcare professionals, pharmacists are the most accessible and this places pharmacists in an excellent position to play a role in the management of asthma. Globally, trials of many community pharmacy-based asthma care models have provided evidence that pharmacist delivered interventions can improve clinical, humanistic and economic outcomes for asthma patients. In Australia, a decade of coordinated research efforts, in various aspects of asthma care, has culminated in the implementation trial of the Pharmacy Asthma Management Service (PAMS), a comprehensive disease management model. There has been research investigating asthma medication adherence through data mining, ways in which usual asthma care can be improved. Our research has focused on self-management education, inhaler technique interventions, spirometry trials, interprofessional models of care, and regional trials addressing the particular needs of rural communities. We have determined that inhaler technique education is a necessity and should be repeated if correct technique is to be maintained. We have identified this effectiveness of health promotion and health education, conducted within and outside the confines of the pharmacy, in public for a and settings such as schools, and established that this outreach role is particularly well received and increases the opportunity for people with asthma to engage in their asthma management. Our research has identified that asthma patients have needs which pharmacists delivering specialized models of care, can address. There is a lot of evidence for the effectiveness of asthma care by pharmacists, the future must involve integration of this role into primary care

Development and evaluation of an innovative model of inter-professional education focused on asthma medication use

BACKGROUND: Inter-professional learning has been promoted as the solution to many clinical management issues. One such issue is the correct use of asthma inhaler devices. Up to 80% of people with asthma use their inhaler device incorrectly. The implications of this are poor asthma control and quality of life. Correct inhaler technique can be taught, however these educational instructions need to be repeated if correct technique is to be maintained. It is important to maximise the opportunities to deliver this education in primary care. In light of this, it is important to explore how health care providers, in particular pharmacists and general medical practitioners, can work together in delivering inhaler technique education to patients, over time. Therefore, there is a need to develop and evaluate effective inter-professional education, which will address the need to educate patients in the correct use of their inhalers as well as equip health care professionals with skills to engage in collaborative relationships with each other. METHODS: This mixed methods study involves the development and evaluation of three modules of continuing education, Model 1, Model 2 and Model 3. A fourth group, Model 4, acting as a control. Model 1 consists of face-to-face continuing professional education on asthma inhaler technique, aimed at pharmacists, general medical practitioners and their practice nurses. Model 2 is an electronic online continuing education module based on Model 1 principles. Model 3 is also based on asthma inhaler technique education but employs a learning intervention targeting health care professional relationships and is based on sociocultural theory. This study took the form of a parallel group, repeated measure design. Following the completion of continuing professional education, health care professionals recruited people with asthma and followed them up for 6 months. During this period, inhaler device technique training was delivered and data on patient inhaler technique, clinical and humanistic outcomes were collected. Outcomes related to professional collaborative relationships were also measured. DISCUSSION: Challenges presented included the requirement of significant financial resources for development of study materials and limited availability of validated tools to measure health care professional collaboration over time

DNA copy number, including telomeres and mitochondria, assayed using next-generation sequencing

<p>Abstract</p> <p>Background</p> <p>DNA copy number variations occur within populations and aberrations can cause disease. We sought to develop an improved lab-automatable, cost-efficient, accurate platform to profile DNA copy number.</p> <p>Results</p> <p>We developed a sequencing-based assay of nuclear, mitochondrial, and telomeric DNA copy number that draws on the unbiased nature of next-generation sequencing and incorporates techniques developed for RNA expression profiling. To demonstrate this platform, we assayed UMC-11 cells using 5 million 33 nt reads and found tremendous copy number variation, including regions of single and homogeneous deletions and amplifications to 29 copies; 5 times more mitochondria and 4 times less telomeric sequence than a pool of non-diseased, blood-derived DNA; and that UMC-11 was derived from a male individual.</p> <p>Conclusion</p> <p>The described assay outputs absolute copy number, outputs an error estimate (p-value), and is more accurate than array-based platforms at high copy number. The platform enables profiling of mitochondrial levels and telomeric length. The assay is lab-automatable and has a genomic resolution and cost that are tunable based on the number of sequence reads.</p

Interpersonal polyvictimization and mental health in males

A consistent conclusion within the extant literature is that victimization and in particular polyvictimization leads to adverse mental health outcomes. A large body of literature exists as it pertains to the association between victimisation and mental health in studies utilising samples of childhood victims, female only victims, and samples of male and female victims; less research exists as it relates to males victims of interpersonal violence. The aim of the current study was therefore to identify profiles of interpersonal victimizations in an exclusively male sample and to assess their differential impact on a number of adverse mental health outcomes. Using data from 14,477 adult males from Wave 2 of the NESARC, we identified interpersonal victimization profiles via Latent Class Analysis. Multinomial Logistic Regression was subsequently utilized to establish risk across mental health disorders. A 4-class solution was optimal. Victimisation profiles showed elevated odds ratios for the presence of mental health disorders; suggesting that multiple life-course victimisation typologies exists, and that victimization is strongly associated with psychopathology. Several additional notable findings are discussed

An integrated general practice and pharmacy-based intervention to promote the use of appropriate preventive medications among individuals at high cardiovascular disease risk: protocol for a cluster randomized controlled trial

Background: Cardiovascular diseases (CVD) are responsible for significant morbidity, premature mortality, and economic burden. Despite established evidence that supports the use of preventive medications among patients at high CVD risk, treatment gaps remain. Building on prior evidence and a theoretical framework, a complex intervention has been designed to address these gaps among high-risk, under-treated patients in the Australian primary care setting. This intervention comprises a general practice quality improvement tool incorporating clinical decision support and audit/feedback capabilities; availability of a range of CVD polypills (fixed-dose combinations of two blood pressure lowering agents, a statin ± aspirin) for prescription when appropriate; and access to a pharmacy-based program to support long-term medication adherence and lifestyle modification. Methods: Following a systematic development process, the intervention will be evaluated in a pragmatic cluster randomized controlled trial including 70 general practices for a median period of 18 months. The 35 general practices in the intervention group will work with a nominated partner pharmacy, whereas those in the control group will provide usual care without access to the intervention tools. The primary outcome is the proportion of patients at high CVD risk who were inadequately treated at baseline who achieve target blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels at the study end. The outcomes will be analyzed using data from electronic medical records, utilizing a validated extraction tool. Detailed process and economic evaluations will also be performed. Discussion: The study intends to establish evidence about an intervention that combines technological innovation with team collaboration between patients, pharmacists, and general practitioners (GPs) for CVD prevention. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN1261600023342

Lack of asthma and rhinitis control in general practitioner-managed patients prescribed fixed-dose combination therapy in Australia

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