Incidence of Venous Thromboembolism in Nursing Home Residents

AbstractObjectiveVenous thromboembolism (VTE) is common in the elderly, but its epidemiology in nursing home residents remains unclear. This study estimated rates of VTE recorded on nursing home admission and incidence during residence.DesignRetrospective analysis of AnalytiCare long term care (LTC) database for the period January 2007 to June 2009.Setting181 nursing homes in 19 US states.ParticipantsEligible residents had 1 or more admission Minimum Data Set (MDS) 2.0 assessment(s) over the study period. All VTE cases were extracted if MDS indicated deep vein thrombosis or pulmonary embolism. The number of admissions and days at risk were estimated from a random sample (n = 1350) of all residents.MeasurementsThe earliest admission was identified as the admission index date. VTE cases were classified as either “On Admission” (VTE coded on admission index date) or “During Residence” (coded afterward). Residents were followed from admission index date until censoring.ResultsA total of 2144 VTE admission cases (3.7% of all admissions) were identified. A further 757 cases of VTE occurring during residence were identified, yielding an incidence of 3.68 cases of VTE per 100 person-years of postadmission residence. VTE admission rates were highest for residents younger than 50 years (4.8%, confidence interval [CI]: 3.9%–5.9%) and 50 to 64 years (5.1%, CI: 4.6%–5.7%) but similar for those aged 65 to 74 (3.6%, CI: 3.3%–4.0%), 75 to 84 (3.6%, CI: 3.3%–3.9%), and 85 years or older (3.1%, CI: 2.9%–3.4%). The incidence of VTE during residence was similar among these age strata.ConclusionApproximately 1 in 25 nursing home admissions had a VTE diagnosis. VTE incidence during residence was higher than reported in earlier nursing home studies. These incidence rates merit further investigation because diagnostic improvements may be driving greater recognition of VTE in LTC

Patient Experience-of-Care Is Associated With Adherence/Persistence to Cardiometabolic Disease Medications in an Ambulatory Setting

Background: We aimed to investigate associations between patient ratings of experience-of-care and medication adherence or persistence to cardiometabolic disease (CMD) medications in an ambulatory care setting. Methods: This retrospective study was conducted using electronic health records and administrative data from an ambulatory care network in Northern California. We included managed-care beneficiaries (≥ 18 years) with a prescription for a CMD medication between 2010 and 2014. CMD medications included antihyperglycemic, antihyperlipidemic and antihypertensive agents. Within each class, we chose the first medication prescribed within 14 days of an office encounter that was associated with a completed Press-Ganey patient-experience survey. Primary outcome measures were adherence (proportion of days covered ≥ 0.80) and persistence (no gap in pharmacy fills \u3e 1.5× of a day’s supply). The main predictor variables were experience-of-care domains, which comprised health care providers’ (a) explanation about problems or conditions; (b) effort to include patients in treatment decisions; (c) information about medications; and (d) information about follow-up care. Experience-of-care was rated on a scale of 1 (very poor) to 5 (very good). Multivariable logistic regression models were fitted to assess associations between adherence or persistence (yes/no) and ratings for each experience-of-care domain (dichotomized as 5 vs \u3c 5), with statistical adjustment for important patient, prescription and provider characteristics. Odds ratios (ORs) were generated. Results: Eligibility criteria were met by 5,045 patients. The majority of patients were ≥ 65 years old (61.8%); median of CMD medications was 2. Patients receiving antihyperglycemic medications had higher odds of adherence when they had better experience-of-care with “inclusion in treatment decisions” (OR: 1.64) and “information about follow-up care” (OR: 1.60). Patients receiving antihyperlipidemic medications had higher odds of persistence when they had better experiences-of-care within each domain (range of ORs: 1.38–1.57). Patients receiving antihypertensive medications had higher odds of persistence when they had better experiences-of-care with “inclusion in treatment decisions” (OR: 1.52) and “information about medications” (OR: 1.55). Conclusion: In an ambulatory care setting, better experience-of-care with a health care provider in making shared treatment decisions was consistently a positive predictor of adherence/persistence. The relationship between other domains of experience-of-care and adherence/persistence differed by therapeutic class. Improving adherence or persistence to CMD medications through better patient experiences with their health care providers will likely require tailored approaches

Assessing barriers to access and equity for COVID-19 vaccination in the US

Abstract Background Historical vaccination coverage in economically disadvantaged, ethnic minority, non-affluent white and agricultural populations in the US has lagged coverage in more affluent urban and suburban white populations due to a variety of social and economic factors. In the current COVID-19 pandemic, sociocultural and economic challenges continue to present significant obstacles to achieving equitable uptake of COVID-19 vaccines. The goal of this study was to qualitatively assess perceptions of key US healthcare stakeholders of the most significant barriers to COVID-19 vaccine access and equity to better characterize their expected impact on US communities. Methods After conducting a targeted literature review (TLR), we hypothesized 20 high-impact barriers which included structural and logistical barriers, capturing systemic challenges to vaccine accessibility, and attitudinal and informational barriers, affecting patient willingness to pursue vaccination. We developed a qualitative discussion guide, which included both open-ended and closed-ended questions, and interview stimulus material to conduct one-on-one in-depth interviews to assess the expected prevalence, severity, and persistence of these 20 high-impact barriers, which were hypothesized based on TLR. As a part of this qualitative study, we conducted one-on-one in-depth interviews with a diverse set of 15 US healthcare stakeholders who were involved in the COVID-19 vaccine rollout in states with relatively disparate vaccination rates by ethnicity. These stakeholders were selected to reflect an array of roles in the COVID-19 vaccine rollout, including infectious disease specialists, pharmacists, community advocacy representatives, and partners of local governments involved in the COVID-19 vaccine rollout and community education. Results Respondents identified limited vaccination sites in rural settings and technology-related barriers as the most prevalent and severe structural and logistical barriers in US communities. Respondents assessed COVID-19 vaccine safety concerns and politically motivated skepticism to be the most prevalent and severe attitudinal and informational barriers. Respondents cited proliferation of mobile vaccination clinics and local community messaging to endorse vaccines as the most effective solutions to these top structural and attitudinal barriers. Respondents expected politically motivated skepticism to be the most significant and persistent barrier to broader vaccine uptake in the US. Conclusions Our study suggests that attitudinal barriers, particularly politically motivated skepticism, are likely to remain the most persistent challenges to widespread vaccination against COVID-19 in the US