Health Literacy and Medication Adherence Among Patients Treated in a Free Health Clinic: A Pilot Study

Background: A patient’s health literacy is not routinely assessed during visits with a health care provider. Since low health literacy is a risk factor for poor health outcomes, assessing health literacy should be considered as part of the standard medical workup. Objectives: To evaluate the health literacy levels and medication adherence of patients treated by pharmacists in both the general medicine and the chronic care clinics at an urban free health clinic. Methods: Eligible patients from the free health clinic completed the Rapid Estimate of Adult Literacy in Medicine (REALM), a health literacy measurement tool, during their clinic visit in 2011. Medication adherence was self-reported by the patients. Results: A total of 100 patients participated (mean age = 48). The majority of participants were female (56%) and white (55%). Most (64%) of the patients scored at a high school reading level according to REALM. Only 21% of participants read at a seventh- to eighth-grade level. Overall medication adherence rate was 73%. Forgetting to take medication was the most popular reason given for nonadherence. Conclusion: Disease state and adherence were significantly related in patients with HIV/AIDS and hypertension. Patient’s ethnicity was significantly associated with literacy levels (P < .05). Although patients’ literacy levels were not significantly associated with self-reported adherence in this population, availability of a patient’s baseline health literacy level as a part of the medical record may help clinicians to individualize their interaction based on the patient’s health literacy level in order to achieve better health outcomes, including improved medication adherence, especially for underserved populations

Inpatient prescribing patterns of long-acting injectables and their oral or short-acting injectable equivalent formulations

Background: Long-acting injectable (LAI) antipsychotics (APs) each have an oral equivalent formulation, while aripiprazole, olanzapine, and ziprasidone each also have a short-acting injectable (SAI) equivalent formulation. Inpatient prescribing patterns of LAIs and their oral/SAI equivalents are less characterized in populations other than Medicaid, Medicare, and Veterans Affairs populations. Mapping out inpatient prescribing patterns remains an important first step to ensure appropriate use of antipsychotics during this critical juncture of patient care prior to discharge. This study determined inpatient prescribing patterns of first- (FGA) and second-generation antipsychotic (SGA) LAIs and their oral/SAI formulations.Methods: This was a large retrospective study using the Cerner Health Facts® database. Hospital admissions due to schizophrenia, schizoaffective disorder, or bipolar disorder from 2010 to 2016 were identified. AP utilization was defined as the proportion of inpatient stays during which at least 1 AP was administered to the total number of inpatient visits over the observed period. Descriptive analyses were used to determine prescribing patterns for APs. Chi-square tests were used to determine utilization differences across years.Results: 94,989 encounters were identified. Encounters during which oral/SAI of SGA LAIs were administered were most common (n = 38,621, 41%). Encounters during which FGA LAIs or SGA LAIs were administered were the least common (n = 1,047, 1.1%). Prescribing patterns differed across years (p &lt; 0.05) within the SGA LAI subgroup analysis (N = 6,014). Paliperidone palmitate (63%, N = 3,799) and risperidone (31%, N = 1,859) were the most frequently administered. Paliperidone palmitate utilization increased from 30% to 72% (p &lt; 0.001), while risperidone utilization decreased from 70% to 18% (p &lt; 0.001).Conclusions: Compared with their oral or SAI formulations, LAIs were underutilized from 2010 to 2016. Among SGA LAIs, the prescribing patterns of paliperidone palmitate and risperidone changed significantly

Plasma Dynamics

Contains table of contents for Section 2 and reports on three research projects.National Science Foundation Grant ECS 89-02990U.S. Air Force - Office of Scientific Research Grant F49620-93-1-0108U.S. Army - Harry Diamond Laboratories Contract DAAL02-92-K-0037U.S. Department of Energy Grant DE-FG02-91-ER-40648U.S. Navy - Office of Naval Research Grant N00014-90-J-4130National Aeronautics and Space Administration Grant NAGW-2048National Science Foundation Grant ECS 88-22475U.S. Department of Energy Grant DE-FG02-91-ER-54109Magnetic Fusion Science Fellowship Progra

Plasma Dynamics

Contains table of contents for Section 2 and reports on four research projects.National Science Foundation Grant ECS 89-02990U.S. Air Force - Office of Scientific Research Grant AFOSR 89-0082-BU.S. Army - Harry Diamond Laboratories Contract DAAL02-89-K-0084U.S. Department of Energy Contract DE-AC02-90ER40591U.S. Navy - Office of Naval Research Grant N00014-90-J-4130Lawrence Livermore National Laboratory Subcontract B-160456National Science Foundation Grant ECS 88-22475U.S. Department of Energy Contract DE-FG02-91-ER-54109National Aeronautics and Space Administration Grant NAGW-2048U.S.-Israel Binational Science Foundation Grant 87-0057U.S Department of Energy Contract DE-AC02-78-ET-5101

Plasma Dynamics

Contains table of contents for Section 2 and reports on four research projects.National Science Foundation Grant ECS-89-02990U.S. Air Force - Office of Scientific Research Grant AFOSR 89-0082-CU.S. Army - Harry Diamond Laboratories Contract DAAL02-89-K-0084U.S. Army - Harry Diamond Laboratories Contract DAAL02-92-K-0037U.S. Department of Energy Contract DE-AC02-90ER-40591U.S. Navy - Office of Naval Research Grant N00014-90-J-4130Lawrence Livermore National Laboratories Subcontract B-160456National Aeronautics and Space Administration Grant NAGW-2048National Science Foundation Grant ECS-88-22475U.S. Department of Energy Grant DE-FG02-91-ER-5410

Guidelines for Diagnosis and Management of Infective Endocarditis in Adults: A WikiGuidelines Group Consensus Statement.

IMPORTANCE Practice guidelines often provide recommendations in which the strength of the recommendation is dissociated from the quality of the evidence. OBJECTIVE To create a clinical guideline for the diagnosis and management of adult bacterial infective endocarditis (IE) that addresses the gap between the evidence and recommendation strength. EVIDENCE REVIEW This consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In April 2022 a call to new and existing members was released electronically (social media and email) for the next WikiGuidelines topic, and subsequently, topics and questions related to the diagnosis and management of adult bacterial IE were crowdsourced and prioritized by vote. For each topic, PubMed literature searches were conducted including all years and languages. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were crafted discussing the risks and benefits of different approaches. FINDINGS A total of 51 members from 10 countries reviewed 587 articles and submitted information relevant to 4 sections: establishing the diagnosis of IE (9 questions); multidisciplinary IE teams (1 question); prophylaxis (2 questions); and treatment (5 questions). Of 17 unique questions, a clear recommendation could only be provided for 1 question: 3 randomized clinical trials have established that oral transitional therapy is at least as effective as intravenous (IV)-only therapy for the treatment of IE. Clinical reviews were generated for the remaining questions. CONCLUSIONS AND RELEVANCE In this consensus statement that applied the WikiGuideline method for clinical guideline development, oral transitional therapy was at least as effective as IV-only therapy for the treatment of IE. Several randomized clinical trials are underway to inform other areas of practice, and further research is needed