Burden of Illness among Elderly Individuals with Parkinson\u27s disease

Parkinson\u27s disease (PD) is the second most common neurodegenerative disease affecting an estimated one million individuals in the United States (U.S.) and five million individuals globally. With increasing age, the prevalence of PD also increases. Challenges of PD include high economic burden of formal care, informal caregiving burden, and also management of a chronic illness (e.g. type 2 diabetes mellitus) in the presence of PD. The purpose of this study was to use observational data from real-world settings to provide a comprehensive view of the burden of illness among elderly individuals with PD by assessing the formal economic burden, informal caregiving burden and the state of management of chronic illness with complexity (CIC) in the presence of two debilitating conditions (PD and type 2 diabetes mellitus). This study used a triangulation approach by using three different datasets: (i) National Medicare 5% sample claims database to evaluate the formal economic burden; (ii) the National Alliance for Caregiving (NAC) data to assess the informal caregiver burden; and (iii) the nationwide claims database of Humana Medicare Advantage Part D enrollees to evaluate the state of management of chronic illness with complexity. The specific aims of the three studies were: (1) among elderly Medicare beneficiaries aged 65 or older, estimate excess home healthcare use and expenditures among individuals with PD compared to individuals without PD and analyze predisposing, enabling, need factors, personal health behaviors, and external environment associated with excess home healthcare use and expenditures among individuals with PD; (2) assess the informal caregiver burden and estimate costs associated with informal caregiving burden among caregivers providing care to elderly individuals; and (3) assess process, and intermediate clinical outcomes of diabetes care among individuals with chronic illness with complexity defined as co-occurring PD and diabetes. From the results of the first study, we found that elderly Medicare beneficiaries with PD had significantly higher home healthcare use and expenditures compared to those without PD. The differences in home healthcare use and expenditures among elderly Medicare beneficiaries with and without PD were mainly explained by personal health behaviors such as baseline resource use and need factors such as physical and mental health conditions. In terms of the economic burden of informal caregiving, we did not observe a significant difference in informal caregiving costs between caregivers of elderly individuals with and without PD, despite the costs of informal caregiving for elderly individuals with PD being 1.27 times higher than those without PD. Individuals with CIC were less likely to achieve American Diabetes Association recommended annual HbA1c and lipid testing goals compared to those without CIC (T2DM without PD). However, individuals with CIC achieved glycemic and lipid control outcomes. Thus, these findings taken together underscore the advantage of using an integrated delivery system with better care coordination and providing holistic care approach. As majority of elderly individuals with PD are community-dwelling, novel intervention techniques are needed to be developed to reduce the informal caregiving burden

Healthcare expenditures among community-dwelling adults with thyroid cancer in the United States: A propensity score matched analysis

Objective: This study assessed the excess healthcare expenditures and factors associated with it among community-dwelling adults with thyroid cancer compared to non-cancer controls in the United States. Method: A retrospective, cross-sectional, matched case-control study design was used by pooling multiple years of Medical Expenditure Panel Survey (MEPS) data (2002-2012). The eligible study sample comprised of adults (age >= 18 years), who were alive during the calendar year and reported positive healthcare expenditure. The case group consisted of adults with thyroid cancer only while the control group consisted of adults who did not have any form of cancer. Total and subtypes of mean annual healthcare expenditures comprised the main study outcome. We also calculated the total and subtypes of out-of-pocket (OOP) expenditures as well as OOP as a percentage of household income. Ordinary Least Square (OLS) regressions on log-transformed expenditures were conducted to elucidate the influence of different factors on healthcare expenditures among adults with thyroid cancer. Results: The yearly average total healthcare expenditures among adults with thyroid cancer was significantly higher compared to propensity score matched controls ($9,585 vs.$5,830, p < 0.001). Similar observations were found in terms of inpatient, and outpatient expenditures. Functional status as well as comorbid conditions were significantly associated with excess expenditures. The yearly average total OOP expenditure for adults with thyroid cancer was significantly higher compared to matched controls ($1,425 vs.$974, p < 0.001), with major differences observed in inpatient OOP ($178 vs.$24, p = 0.003), outpatient OOP ($435vs.$256, p < 0.001), and prescription OOP ($554 vs.$423, p < 0.001) expenditures. There was a significant (p < 0.001) difference between the average OOP as a percentage of household income between adults with thyroid cancer (Mean: 7.54%, S.E: 1.52%) and matched controls (Mean: 5.80%, S.E: 0.47%). Conclusions: Our findings suggest that holistic care approach could be helpful to significantly reduce the economic burden in this population. Viable strategies such as limits on OOP costs are required to minimize this high OOP burden among cancer survivors and their families.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Depression Treatment among Adults with Multiple Sclerosis and Depression in Ambulatory Care Settings in the United States

Background. There is little information regarding depression treatment patterns among adults with MS and depression in ambulatory settings at national level in the United States (US). Objectives. The objectives of this study were to identify patterns and predictors of depression treatment in ambulatory settings in US among adults with MS and depression. Methods. A cross-sectional study was conducted by pooling multiple years (2005–2011) of National Ambulatory Medical Care Survey and the outpatient department of the National Hospital Ambulatory Medical Care Survey data. The final study sample was comprised of ambulatory visits among adults with MS and depression. Dependent variable of this study was pharmacological treatment for depression with or without psychotherapy. Predictors of depression treatment were determined by conducting multivariable logistic regression. Results. Out of all ambulatory visits involving MS diagnosis, 20.59% also involved a depression diagnosis. Depression treatment was observed in 57.25% of the study population. Fluoxetine was the most prescribed individual antidepressant. Age and total number of chronic diseases were significant predictors of depression treatment. Conclusion. Approximately six out of ten ambulatory visits involving MS and depression recorded some form of depression treatment. Future longitudinal studies should examine health outcomes associated with depression treatment in this population

Contraindicated drug–drug interactions associated with oral antimicrobial agents prescribed in the ambulatory care setting in the United States

Objectives Antimicrobial agents are commonly used in ambulatory care settings. Our objective was to examine national-level patterns of contraindications between oral antibacterial or antifungal agents and patients' other oral medications in the US ambulatory care setting. Methods This cross-sectional study included multiple year pooled data (2003–2011) from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (NHAMCS Outpatient Department). Visits by adults (age ≥18 years) in ambulatory settings in the United States who were prescribed oral antibacterial or antifungal agents were evaluated for potential drug–drug interaction (DDI) contraindications. Findings with relative standard error >30% or unweighted sample size <30 were not reported because these were deemed unreliable estimates. Results From 2003 to 2011, there were 1 235 000 outpatient visits (proportion = 0.52%; 95% confidence interval (CI), 0.29–0.74) in which a patient was prescribed an antimicrobial agent associated with a contraindicated DDI. The most prevalent antimicrobials with contraindicated combination among outpatients were simultaneous use of macrolide-containing products (erythromycin or clarithromycin) with statin medication–containing products (simvastatin or lovastatin) (841 864 visits, proportion = 1.91%; 95% CI, 0.96–2.86). The next most common combination was use of fluoroquinolones with antiarrhythmic agents (amiodarone, sotalol, quinidine or procainamide) (365 622 visits, proportion = 0.19%; 95% CI, 0.06–0.32). Conclusions Providers should be aware of potential contraindicated DDIs when prescribing antibiotics, especially macrolides and fluoroquinolones

Xm(2) Scores for Estimating Total Exposure to Multimodal Strategies Identified by Pharmacists for Managing Pain: Validity Testing and Clinical Relevance

Objective. To assess the validity of an exposure score obtained from the Xm(2) tool for all pharmacological and nonpharmacological strategies used by individuals to manage chronic pain. Methods. Using data from individuals with chronic pain, eXposure multimodal (Xm(2)) scores were calculated by assigning one point for every 100 mg of morphine equivalent used (opioid medications); 25% of the maximum recommended exposure used (nonopioid medications); and any use of another strategy then summed. Content, criterion, construct, and convergent validity were assessed. Results. The sample of 149 individuals used a mean of 12.6 (SD = 4.6) strategies to manage pain and had a mean Xm(2) score of 16.8 (SD = 9.1). Content validity was established by demonstrating that the pain management strategies identified were also reported in the literature. Criterion validity was established by the positive association of exposure scores with the following: interference with work (odds ratio (OR) = 2.23, 95% confidence interval (CI) = 1.14-4.36), daily activities (OR = 2.10, CI = 1.07-4.13), relationships (OR = 1.98, CI = 1.01-3.88), and leisure activities (OR = 2.31, CI = 1.18-4.50); workdays missed (OR = 5.10, CI = 1.92-13.58); emergency department visits (OR = 3.40, CI = 1.17-9.91); hospitalizations (OR = 4.18, CI = 0.86-20.37); and by a negative association with satisfaction (OR = 0.40, CI = 0.18-0.88). Construct validity was established by the positive association of exposure with baseline pain intensity (p < 0.01) and odds of experiencing an adverse event (OR = 2.31, CI = 1.18-4.52). Convergent validity was established through correlations of pain intensity from the Xm(2) score and existing quantitative analgesic questionnaire (QAQ) score. Discussion. Xm(2) scores represent a valid estimate of total exposure to multimodal strategies used and provide clinically relevant information for deciding what strategies to use at what level.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Can Administration of Potentized Homeopathic Remedy, Arsenicum Album, Alter Antinuclear Antibody (ANA) Titer in People Living in High-Risk Arsenic Contaminated Areas? I. A Correlation with Certain Hematological Parameters

To examine whether elevated antinuclear antibody (ANA) titers reported in random human population of arsenic contaminated villages can be reverted to the normal range by administration of a potentized homeopathic drug, Arsenicum album, randomly selected volunteers in two arsenic contaminated villages and one arsenic-free village in West Bengal (India) were periodically tested for their ANA titer as well as various blood parameters in two types of experiments: ‘placebo-controlled double blind’ experiment for shorter duration and ‘uncontrolled verum fed experiment’ for longer duration. Positive modulation of ANA titer was observed along with changes in certain relevant hematological parameters, namely total count of red blood cells and white blood cells, packed cell volume, hemoglobin content, erythrocyte sedimentation rate and blood sugar level, mostly within 2 months of drug administration. Thus, Arsenicum album appears to have great potential for ameliorating arsenic induced elevated ANA titer and other hematological toxicities

Can Homeopathic Arsenic Remedy Combat Arsenic Poisoning in Humans Exposed to Groundwater Arsenic Contamination?: A Preliminary Report on First Human Trial

Groundwater arsenic (As) has affected millions of people globally distributed over 20 countries. In parts of West Bengal (India) and Bangladesh alone, over 100 million people are at risk, but supply of As-free water is grossly inadequate. Attempts to remove As by using orthodox medicines have mostly been unsuccessful. A potentized homeopathic remedy, Arsenicum Album-30, was administered to a group of As affected people and thereafter the As contents in their urine and blood were periodically determined. The activities of various toxicity marker enzymes and compounds in the blood, namely aspartate amino transferase, alanine amino transferase, acid phosphatase, alkaline phosphatase, lipid peroxidation and reduced glutathione, were also periodically monitored up to 3 months. The results are highly encouraging and suggest that the drug can alleviate As poisoning in humans

Diabetes care among elderly medicare beneficiaries with Parkinson's disease and diabetes

BACKGROUND: Elderly individuals with type 2 diabetes mellitus (T2DM) suffer from several comorbidities, which affect their health outcomes, as well as process of care. This study assessed process and intermediate clinical outcomes of diabetes care among elderly individuals with T2DM and co-occurring Parkinson's disease(PD). METHODS: This study used a retrospective cohort design with propensity score matching using Humana Medicare Advantage Part D claims database (2007-2011) and included elderly (age ≥ 65 years) Medicare beneficiaries with T2DM (identified by ICD-9-CM code of 250.x0 or 250.x2). PD was identified using ICD-9-CM code of 332.xx. After propensity score matching there were 2,703 individuals with T2DM and PD and 8,109 with T2DM and no PD. The three processes of care measures used in this study included: (i) HbA1c test; (ii) Lipid test; (iii) and Nephropathy screening. Intermediate clinical outcomes consisted of glycemic and lipid control. RESULTS: Multivariable conditional logistic regressions revealed that elderly individuals with T2DM and PD were 12 % (AOR: 0.88, 95 %CI: 0.79-0.97) and 18 % (AOR: 0.82, 95 %CI: 0.72-0.94) less likely to meet the annual American Diabetes Association (ADA) recommended HbA1c and lipid testing goals respectively compared to individuals with T2DM and no PD. Multinomial conditional logistic regressions showed that elderly individuals with T2DM and PD were more likely to have HbA1c and lipid (HbA1c < 8 %; LDL-C <100 mg/dl; HDL-C ≥ 50 mg/dl; triglyceride <150 mg/dl; and total cholesterol <200 mg/dl) control. CONCLUSIONS: Among elderly individuals with T2DM, those with PD were less likely to achieve ADA recommended annual HbA1c and lipid testing compared to those without PD. However, PD individuals were more likely to achieve intermediate glycemic and lipid control.This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at [email protected]

Patterns and predictors of depression treatment among adults with chronic kidney disease and depression in ambulatory care settings in the United States

One in five adults with chronic kidney disease (CKD) in the United States (US) suffers from depression. Comorbid depression in adults with CKD is associated with higher morbidity and mortality. This study used US national survey data to examine patterns and predictors of depression treatment among adults with non-dialysis-dependent CKD in the US. A retrospective, cross-sectional study was conducted using 2014-2015 National Ambulatory Medical Care Survey (NAMCS) data. The final study sample consisted of visits by 9.02 million adults (unweighted n = 262; age ≥ 18 years) with CKD and depression in the US. Depression treatment was defined as antidepressant use with or without psychotherapy. To identify predictors of depression treatment, multivariable logistic regression analysis was conducted adjusting for predisposing, enabling, and need factors. Approximately half of adults with CKD and depression received depression treatment. Primary care was the main setting of treatment, and the most commonly prescribed antidepressant class was selective serotonin reuptake inhibitors. Adults being seen for treatment of a chronic problem were 3.2 times more likely to receive depression treatment (OR 3.20; 95% CI 1.38-7.21). In addition, there was a 9% higher likelihood of receiving depression treatment for each unit increase in total number of medications (OR 1.09; 95% CI 1.01-1.19). Finally, adults receiving care in the South were 63% less likely to receive depression treatment (OR 0.37; 95% CI 0.15-0.89). Depression treatment was recorded in approximately half of US ambulatory care visits involving adults with CKD and depression from 2014 to 2015. Further research is warranted to determine how to appropriately manage treatment of depression in adults with CKD.12 month embargo; published online: 4 December 2018This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]