Essays on Physician Incentives and Pharmaceutical Outcomes in Asthmatic Children.

It is believed that health plans, reimbursement mechanisms and financial incentives led to health outcomes for health care utilization and medication adherence from pediatric populations. However, there is little empirical evidence about the effect of health plans, reimbursement mechanisms and financial incentives on asthmatic pediatric population. The first study examined how sociological factors including financial incentives influenced whether asthmatic children received a controller medication, a reliever medication or both. The 2007 National Ambulatory Medical Care Survey was used for this analysis. Compared with physicians who received lower financial incentives, physicians who received medium (39%, p<0.05) or higher (42%, p<0.01) financial incentives from payers were more likely to prescribe controller medication than reliever medication for children with asthma. The second study examined associations between the type of health plan (fee for service vs. capitated) and utilization-based outcomes in asthmatic Medicaid children. Subjects were 6435 Medicaid enrolled asthmatic children who newly started asthma pharmacotherapy and were followed 12 months before and 12 month after the index anti-asthmatic medication. Patient in capitated plans were associated with 77% more hospitalizations and 34% increased incidence rates of emergency department visits, but 42% fewer outpatient visits compared to those in FFS plans (all p<0.05). The third study examined the impact of the type of health plan (public vs. private) on health outcomes in pediatric asthmatic enrollees. Subjects were 11,027 asthmatic children (6,435 in Medicaid and 4,592 in a commercial HMO) who newly started asthma pharmacotherapy and were followed 12 months before after the index anti-asthmatic medication fill. Patients in Medicaid plans were also associated with 20% more inpatient hospitalizations and 50% increased odds of emergency department visits, but had 42% fewer outpatient visits compared to those in private plan (all p<0.05). In sum, the results of this study provide an insight to clinicians, policymakers and health service researchers in evaluating policies related to insurance coverage of essential medications in indigent children with asthma. This, in turn, could help understand important factors that impact health care financing, design strategies to improve asthma related care, and improve health outcomes for needy and poor children in the United States.Ph.D.Social & Administrative SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/91588/1/jochang_1.pd

Sociodemographic Risk Factors of Diabetes and Hypertension Prevalence in Republic of Korea

This study examined the relationships between SES and diabetes and hypertension for Korean adults using the Korean National Health and Nutritional Examination Survey. To handle the four dummy dependent variables: Diabetes and Hypertension, Diabetes alone, Hypertension alone, and Diabetes or Hypertension, four different logistic models were conducted. The descriptive statistics showed a considerable amount of comorbidity between the combined dependent variable of diabetes and hypertension. To gauge more realistic measures of SES, education and income were combined together as four dummy categories. The SES factor indeed had significant impacts on diabetes and hypertension. Socioeconomically disadvantaged groups demonstrated to have increased likelihood of having these diseases. However, we could not find the strong compensating effect between education and income; the higher level of education but lower income variable was only significant in having both diseases, and the higher income but lower level of education variable was only significant in having hypertension alone and either one of the diseases. Only the highest SES one, the one with a higher level of education and a higher income, was significantly lowering the likelihood of having these diseases in all models. Therefore, public policy and intervention programs should focus on individuals matching these socioeconomic characteristics

Quetiapine Misuse and Abuse: Is It an Atypical Paradigm of Drug Seeking Behavior?

Recent case reports in medical literatures suggest that more and more second-generation atypical antipsychotics (AAs) have been prescribed for off-label use; quetiapine (Brand name: Seroquel®) showed increase in its trend for off-label use. Little is known about the reasons behind this trend, although historical sedative and hypnotic prescription patterns suggest that despite relatively superior safety profiles of quetiapine (especially for movement disorders), it may be used for treating substance abuse disorder. In addition, recent studies have shown a strong potential for misuse and abuse (MUA) of quetiapine beyond Food and Drug Administration-approved indications. This includes drug-seeking behaviors, such as feigning symptoms, motivated by quetiapine and use of quetiapine in conjunction with alcohol. Quetiapine appears to be the most documented AA with street values bartered illicitly on the street. A recent report from the Drug Abuse Warning Network has shown a high prevalence of quetiapine-related emergency department visits involving MUA. Several other case studies have found that quetiapine causes seeking behaviors observed in substance use disorder. In fact, the majority of quetiapine MUA involved patients diagnosed with substance use disorder. In the absence of a definitive mechanism of action of quetiapine\u27s reinforcing properties, it is imperative to gather robust evidence to support or refute increasing off-label use of AAs

Does state budget pressure matter for uncompensated care spending in hospitals? Findings from Texas and California

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91348/1/hpm2106.pd

Is patients’ rurality associated with in-hospital sepsis death in US hospitals?

BackgroundThe focus of this study was to explore the association of patients’ rurality and other patient and hospital-related factors with in-hospital sepsis mortality to identify possible health disparities across United States hospitals.MethodsThe National Inpatient Sample was used to identify nationwide sepsis patients (n = 1,977,537, weighted n = 9,887,682) from 2016 to 2019. We used multivariate survey logistic regression models to identify predictors for how patients’ rurality is associated with in-hospital death.FindingsDuring the study periods, in-hospital death rates among sepsis inpatients continuously decreased (11.3% in 2016 to 9.9% in 2019) for all rurality levels. Rao-Schott Chi-Square tests demonstrated that certain patient and hospital factors had varied in-hospital death rates. Multivariate survey logistic regressions suggested that rural areas, minorities, females, older adults, low-income, and uninsured patients have higher odds of in-hospital mortality. Further, specific census divisions like New England, Middle Atlantic, and East North Central had greater in-hospital sepsis death odds.ConclusionRurality was associated with increased in-hospital sepsis death across multiple patient populations and locations. Further, rurality in New England, Middle Atlantic, and East North Central locations is exceptionally high odds. In addition, minority races in rural areas also have an increased odds of in-hospital death. Therefore, rural healthcare requires a more significant influx of resources and should also include assessing patient-related factors

Review of the four item Morisky Medication Adherence Scale (MMAS-4) and eight item Morisky Medication Adherence Scale (MMAS-8)

Erratum Redacted by authors in order to address a question regarding the use of a measure.    Type: Original Researc

Examining the Impact of a Pharmacists Postpartum Counseling Service; Evidence from a University Hospital

Purpose: To describe a pharmacist's counseling service pertaining to methods of contraception on the postpartum unit of a university hospital and to evaluate the number of postpartum patients who desire information on contraception with the demographics of age, public or private insurance, and whether the patient was English or Spanish-speaking. Methods: Retrospective cohort data analysis of postpartum women who received the option of counseling by a pharmacist or pharmacy intern at a university hospital over a year and 7 month period. There were 2,048 cases included for this study. The total number of patients who wanted information as well as pharmacist preparation time and counseling time were also noted. Results: Patients who were interested in a hormonal contraception method were 3 times more likely to desire counseling compared with patients who declined information (p<0.05). Also, patients who wanted an implantable form of contraception were 8 times more likely to desire information compared with patients who declined counseling (p<0.05). Patients in the age range of 18-25, 26-30, and 31-45 years were less likely (56%, 64%, & 65%) to want counseling compared with the age range of 12-17 years (all p<0.05). Lastly, patients who spoke Spanish were 3 times more likely to have been counseled compared with non-Spanish speaking patients. The number of postpartum patients counseled on different contraception methods was 1,546 versus 699 patients who declined counseling. Total pharmacist preparation time totaled 160.95 hours, while total patient counseling time totaled 204.55 hours. Conclusion: Overall, postpartum women who chose to be counseled by a pharmacist were considering either a hormonal or implantable method of contraception, were younger than the age of 17 and were Spanish speaking. The average amount of pharmacist preparation time spent was 4.3 minutes per patient and actual counseling time on average was 5.5 minutes per patient.   Type: Original Researc

Review of the four item Morisky Medication Adherence Scale (MMAS-4) and eight item Morisky Medication Adherence Scale (MMAS-8)

Erratum Redacted by authors in order to address a question regarding the use of a measure.&nbsp; &nbsp; Type:&nbsp;Original Researc

The impact of market conditions on RN staffing in hospitals: Using resource dependence theory and information uncertainty perspective

© 2020 Shin et al. Purpose: Due to a limited number of studies with generalizable findings on the relationships between market conditions and RN staffing levels in hospitals, this study examined such relationships employing a longitudinal design with a representative national sample. Materials and Methods: We used longitudinal panel datasets from 2006 to 2010, drawn from various datasets including the American Hospital Association Annual Survey Database and the Area Health Resource File. A random-effects linear regression model was used to measure the influence of market conditions on RN staffing levels. Results: The results of this study showed that market conditions were significantly associated with RN staffing levels in hospitals. First, an increase in per capita income and being located in urban rather than rural areas were associated with a greater number of RNs per 1,000 inpatient days and a higher ratio of RNs to LPNs and nursing aides. In addition, an increase in the number of physician specialists was associated with an increase in the number of RNs per 1,000 inpatient days. Second, an increase in Medicare HMO penetration in the environment was related to an increase in the RNs to LPNs and nursing aides ratio. Lastly, an increase in market competition was associated with an increase in the number RNs per 1,000 inpatient days and the ratio of RNs to LPNs and nursing aides. Conclusion: The findings of this study suggest that staffing decision makers in hospitals should consider how to best align their RN staffing levels with their operating environment. In addition, health policy makers may improve the levels the RN supply in communities that needs more RNs by modulating external environmental forces (eg, specialist resources) that influence RN staffing levels in hospitals

Factors associated with physician prescribing behavior of dipeptidyl peptidase-4 inhibitors for type 2 diabetes in the US outpatient population

Objective: Although the use of dipeptidyl peptidase-4 (DPP-4) inhibitors has been increasing after their first approval in 2006, little is known about their prescribing pattern. Therefore, the objective of this study is to evaluate the prescribing pattern of the DPP-4 inhibitors for the treatment of type 2 diabetes mellitus (T2DM) and examine sociological factors associated with physician prescribing behavior in the U.S. outpatient setting. Methods: This cross-sectional study was conducted utilizing data from the 2006-2010 National Ambulatory Medical Care Survey (NAMCS) and employed the Eisenberg model that explains physician decision making in the context of sociologic influences. For independent variables, the following characteristics were determined based on the Eisenberg model: patient characteristics, physician characteristics, the physician-health care system interaction, and the physician-patient relationship. The dependent variable was the use of DPP-4 inhibitors. Multivariate logistic regressions were used for analyses. Results: The estimated population size was 535,158,796 patients during five years, and 3.85% of them were prescribed DPP-4 inhibitors. Among the patient characteristic-related factors, the odds of the use of DPP-4 inhibitors was 73% lower in patients with Medicaid compared to patients with private insurance (OR = 0.27; 95% CI, 0.08-0.88; p = .030). For the physician characteristic-related factor, the odds of prescribing DPP-4 inhibitors for primary care physicians are about 86% higher than the odds for non-primary care physicians (OR = 1.86; 95% CI, 1.17-2.95; p = .008). In addition, physicians in private offices were 3.01 times more likely to prescribe DPP-4 inhibitors than physicians in the health maintenance organizations (HMO) (OR = 3.01; 95% CI, 1.03-8.78; p = .043). Conclusions: Patient characteristics, physician characteristics, and the physician’s relationship with the health care system were associated with an increased use of DPP-4 inhibitors. However, the physician’s relationship with the patient was not associated with an increased use of DPP-4 inhibitors