Cost-Effectiveness Analysis of Efforts to Reduce Risk of Type 2 Diabetes and Cardiovascular Disease in Southwestern Pennsylvania, 2005-2007

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938403/pdf/PCD75A109.pd

Persistent Polypharmacy and Fall Injury Risk: The Health, Aging and Body Composition Study

Background Older adults receive treatment for fall injuries in both inpatient and outpatient settings. The effect of persistent polypharmacy (i.e. using multiple medications over a long period) on fall injuries is understudied, particularly for outpatient injuries. We examined the association between persistent polypharmacy and treated fall injury risk from inpatient and outpatient settings in community-dwelling older adults. Methods The Health, Aging and Body Composition Study included 1764 community-dwelling adults (age 73.6 ± 2.9 years; 52% women; 38% black) with Medicare Fee-For-Service (FFS) claims at or within 6 months after 1998/99 clinic visit. Incident fall injuries (N = 545 in 4.6 ± 2.9 years) were defined as the initial claim with an ICD-9 fall E-code and non-fracture injury, or fracture code with/without a fall code from 1998/99 clinic visit to 12/31/08. Those without fall injury (N = 1219) were followed for 8.1 ± 2.6 years. Stepwise Cox models of fall injury risk with a time-varying variable for persistent polypharmacy (defined as ≥6 prescription medications at the two most recent consecutive clinic visits) were adjusted for demographics, lifestyle characteristics, chronic conditions, and functional ability. Sensitivity analyses explored if persistent polypharmacy both with and without fall risk increasing drugs (FRID) use were similarly associated with fall injury risk. Results Among 1764 participants, 636 (36%) had persistent polypharmacy over the follow-up period, and 1128 (64%) did not. Fall injury incidence was 38 per 1000 person-years. Persistent polypharmacy increased fall injury risk (hazard ratio [HR]: 1.31 [1.06, 1.63]) after adjusting for covariates. Persistent polypharmacy with FRID use was associated with a 48% increase in fall injury risk (95%CI: 1.10, 2.00) vs. those who had non-persistent polypharmacy without FRID use. Risks for persistent polypharmacy without FRID use (HR: 1.22 [0.93, 1.60]) and non-persistent polypharmacy with FRID use (HR: 1.08 [0.77, 1.51]) did not significantly increase compared to non-persistent polypharmacy without FRID use. Conclusions Persistent polypharmacy, particularly combined with FRID use, was associated with increased risk for treated fall injuries from inpatient and outpatient settings. Clinicians may need to consider medication management for FRID and other fall prevention strategies in community-dwelling older adults with persistent polypharmacy to reduce fall injury risk

Hostility Modifies the Association between TV Viewing and Cardiometabolic Risk

Background. It was hypothesized that television viewing is predictive of cardiometabolic risk. Moreover, people with hostile personality type may be more susceptible to TV-induced negative emotions and harmful health habits which increase occurrence of cardiometabolic risk. Purpose. The prospective association of TV viewing on cardiometabolic risk was examined along with whether hostile personality trait was a modifier. Methods. A total of 3,269 Black and White participants in the coronary artery risk development in young adults (CARDIA) study were assessed from age 23 to age 35. A cross-lagged panel model at exam years 5, 10, 15, and 20, covering 15 years, was used to test whether hours of daily TV viewing predicted cardiometabolic risk, controlling confounding variables. Multiple group analysis of additional cross-lagged panel models stratified by high and low levels of hostility was used to evaluate whether the association was modified by the hostile personality trait. Results. The cross-lagged association of TV viewing at years 5 and 15 on clustered cardiometabolic risk score at years 10 and 20 was significant (B=0.058 and 0.051), but not at 10 to 15 years. This association was significant for those with high hostility (B=0.068 for exam years 5 to 10 and 0.057 for exam years 15 to 20) but not low hostility. Conclusion. These findings indicate that TV viewing is positively associated with cardiometabolic risk. Further, they indicate that hostility might be a modifier for the association between TV viewing and cardiometabolic risk

The preventive services use self-efficacy (PRESS) scale in older women: development and psychometric properties

Background\ud Preventive services offered to older Americans are currently under-utilized despite considerable evidence regarding their health and economic benefits. Individuals with low self-efficacy in accessing these services need to be identified and provided self-efficacy enhancing interventions. Scales measuring self-efficacy in the management of chronic diseases exist, but do not cover the broad spectrum of preventive services and behaviors that can improve the health of older adults, particularly older women who are vulnerable to poorer health and lesser utilization of preventive services. This study aimed to evaluate the psychometric properties of a new preventive services use self-efficacy scale, by measuring its internal consistency reliability, assessing internal construct validity by exploring factor structure, and examining differences in self-efficacy scores according to participant characteristics.\ud \ud Methods\ud The Preventive Services Use Self-Efficacy (PRESS) Scale was developed by an expert panel at the University of Pittsburgh Center for Aging and Population Health - Prevention Research Center. It was administered to 242 women participating in an ongoing trial and the data were analyzed to assess its psychometric properties. An exploratory factor analysis with a principal axis factoring approach and orthogonal varimax rotation was used to explore the underlying structure of the items in the scale. The internal consistency of the subscales was assessed using Cronbach’s alpha coefficient.\ud \ud Results\ud The exploratory factor analysis defined five self-efficacy factors (self-efficacy for exercise, communication with physicians, self-management of chronic disease, obtaining screening tests, and getting vaccinations regularly) formed by 16 items from the scale. The internal consistency of the subscales ranged from .81 to .94. Participants who accessed a preventive service had higher self-efficacy scores in the corresponding sub-scale than those who did not.\ud \ud Conclusions\ud The 16-item PRESS scale demonstrates preliminary validity and reliability in measuring self-efficacy in the use of preventive services among older women. It can potentially be used to evaluate the impact of interventions designed to improve self-efficacy in the use of preventive services in community-dwelling older women

Should we screen for type 2 diabetes among asymptomatic individuals? : yes

RCTs of whether screening asymptomatic individuals for undiagnosed diabetes results in reduced mortality or has other benefits have been suggestive, but inconclusive. In this issue of Diabetologia, two additional controlled studies (DOIs: 10.1007/s00125-017-4323-2 and 10.1007/s00125-017-4299-y) that investigated whether screening for type 2 diabetes in asymptomatic individuals is associated with a reduction in mortality are presented. Treating diabetes early, and identifying and treating impaired glucose tolerance, are of benefit, and economic modelling indicates such screening is cost-effective. Now that such screening is already underway in many countries, new data, along with the existing evidence, suggests opportunistic screening is the best way forward. More research is needed, however, on how best to screen and how to improve risk-factor control once dysglycaemia is detected

Specialist and Generalist Care for Type 1 Diabetes Mellitus: Differential Impact on Processes and Outcomes

The incidence of diabetes mellitus (both type 1 and type 2) is growing to epidemic proportions, with an expected combined worldwide prevalence of 220 million by the year 2010. A subsequent increase in the incidence of diabetes complications is likely to follow if present trends continue, placing an increased burden on already troubled healthcare systems. While there are many identified biologic mechanisms for the development of diabetes complications, there has been little exploration of healthcare provider issues and their contribution to these outcomes. One area of research with few data is the influence of diabetes specialty care on outcomes in type 1 diabetic patients. Evidence demonstrates that both process delivery and outcomes are better in individuals with type1 diabetes who are cared for by diabetes specialists compared with generalists. For example, those receiving care from diabetes specialists were more likely to receive diabetes education, to be treated with intensive insulin therapy (>2 injections/day), and to receive an eye examination compared with those receiving generalist care. Additionally, lower rates of proliferative retinopathy were observed in those receiving specialist care. Recent evidence also demonstrates that there are lower incidences of neuropathy, overt nephropathy, and coronary artery disease in those patients who spend a higher proportion of the duration of their diabetes in specialist care. Based on these observations, it is recommended that attempts be made to replicate the favorable characteristics of specialty care in the primary care setting. Healthcare systems should ensure the availability of access to diabetes specialists, as well as ancillary healthcare professionals including diabetes educators, with increased emphasis placed on coordinated care.Diabetes-mellitus, General-practice

Integrated Diabetes Care: A Multidisciplinary Approach

Integrating care across disciplines and organisations around the needs of the person with diabetes has been proposed as an approach that could improve care while reducing cost- but has it and can it? Integrated Diabetes Care- A Multidisciplinary Approach collates evidence of worldwide approaches to both horizontal integration (across disciplines) and vertical integration (across organizations) in diabetes care and describe what was done, what worked and what appeared to be the barriers to achieving the goals of the programmes. Evidence is sought from groups who have developed different approaches to integrating diabetes care in different health systems (eg insurance vs tax payer funded, single vs multiple organization, published vs unpublished). A final chapter brings the evidence together for a final discussion about what seems to work and what does not

Diabetes integrated care : are we there yet?

We commence this chapter with a fundamental dichotomy – is diabetes integrated care an entity to be developed in itself (i.e., a front line diabetes approach) or should it be simply a product of a system carefully crafted by the health system masters (i.e., waiting for the wider system to become “integrated”)? We then describe the components of diabetes integrated care systems reported to date, and compare how and whether different diabetes integrated care approaches dealt with them. The validity of the methods for evaluation is crucial of course, so we make a few comments on how the different projects have been assessed. We fi nalise by trying to build up to suggested foundations for functioning and sustainable diabetes integrated care

0611 Incidence And Prevalence Of Narcolepsy In A U.S. Healthcare Claims Database, 2008–2010

Introduction: Studies worldwide have reported prevalence estimates (approximately 20–55/100,000 persons, some specific countries much lower or greater) for narcolepsy. However, epidemiology studies have been limited in the United States, using various methods and data sources, and are subject to biases (e.g. non-response and selection biases). Fewer studies have reported incidence (rate of newly occurring cases) of narcolepsy, with wide ranging estimates and sample sizes. Methods: We used Truven Health MarketScan Commercial Dissertation Database (THMCDD) to estimate incidence and prevalence of narcolepsy (ICD-9-CM = 347.0, 347.00, 347.01, 347.1, 347.10, 347.11) by age groups and gender in those patients continuously enrolled for years 2008–2010. THMCDD encompasses approximately 100 private-sector health insurers covering over 18 million people. Prevalence was estimated by dividing the number of patients with a narcolepsy diagnosis during 2008–2010 by the number of period enrollees. Incident cases were determined by presence of Multiple Sleep Latency Test (MSLT) within 180 days of the first recorded narcolepsy diagnosis. Results: During the period, there were 8,444,517 continuously enrolled patients and 6,703 with a diagnosis of narcolepsy (overall prevalence estimate - 79.4/100,000). Prevalence (per 100,000) by age group and gender was: 0–10 years (male:6.1, female:5.0), 11–20 years (male:50.5, female:61.8), 21–30 years (male:97.7, female:154.9), 31–40 years (male:95.0, female:132.0), 41–50 (male:76.7, female:112.1), and 51–65 years (male:75.4, female:93.7). Overall incidence was 9.9/100,000 persons per year. Incidence (per 100,000 per year) by age group and gender was: 0–10 years (male:0.6, female:0.4), 11–20 years (male:8.8, female:11.0), 21–30 years (male:14.4, female:22.1), 31–40 years (male:11.1, female:17.9), 41–50 (male:8.5, female:13.9), and 51–65 years (male:6.5, female:10.7). Conclusion: Prevalence and incidence of narcolepsy was greater for females, compared to males, and highest in persons 21–30 years of age. Results from this large U.S. healthcare claims database study suggest that the prevalence and incidence of narcolepsy may have been previously underestimated in U.S. based studies. Support (If Any): None