Percutaneous Coronary Intervention in Patients With a History of Gastrointestinal Bleeding (From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium)

Potent antithrombotic agents are routinely prescribed after percutaneous coronary intervention (PCI) to reduce ischemic complications. However, in patients who are at an increased bleeding risk, this may pose significant risks. We sought to evaluate the association between a history of gastrointestinal bleeding (GIB) and outcomes after PCI. We linked clinical registry data from PCIs performed at 48 Michigan hospitals between 1/2013 and 3/2018 to Medicare claims. We used 1:5 propensity score matching to adjust for patient characteristics. In-hospital outcomes included bleeding, transfusion, stroke or death. Post-discharge outcomes included 90-day all-cause readmission and long-term mortality. Of 30,206 patients, 1.1% had a history of GIB. Patients with a history of GIB were more likely to be older, female, and have more cardiovascular comorbidities. After matching, those with a history of GIB (n = 312) had increased post-procedural transfusions (15.7% vs 8.4%; p \u3c 0.001), bleeding (11.9% vs 5.2%; p \u3c 0.001), and major bleeding (2.8% vs 0.6%; p = 0.004). Ninety-day readmission rates were similar among those with and without a history of GIB (34.3% vs 31.3%; p = 0.318). There was no significant difference in post-discharge survival (1 year: 78% vs 80%; p = 0.217; 5 years: 54% vs 51%; p = 0.189). In conclusion, after adjusting for baseline characteristics, patients with a history of GIB had increased risk of post-PCI in-hospital bleeding complications. However, a history of GIB was not significantly associated with 90-day readmission or long-term survival

Willingness to Stop Proton Pump Inhibitors in Patients with Gastroesophageal Reflux Disease: Results of a Patient Survey

http://deepblue.lib.umich.edu/bitstream/2027.42/175717/2/1-s2.0-S0016508518329974-main.pdfPublished versionDescription of 1-s2.0-S0016508518329974-main.pdf : Published versio

Preliminary development and validation of the Patient‐Physician Relationship Scale for physicians for disorders of gut‐brain interaction

BackgroundAn effective patient‐physician relationship (PPR) is essential to the care of patients with irritable bowel syndrome (IBS). After developing a PPR questionnaire for patients, we sought to develop and validate an IBS‐specific instrument to measure physician expectations of the PPR.MethodsWe conducted focus groups about PPRs among 15 clinicians who treat patients with IBS from community and academic centers. Qualitative analysis was used to generate the Patient‐Physician Relationship Scale ‐PhysicianResultsThe PPRS‐Physician contained 35 questions pertaining to interpersonal and psychosocial features considered desirable or undesirable in a relationship with IBS patients. 1113 physicians (22%) completed the survey. Physicians were predominantly middle‐aged (mean = 55.1 years), male (85.0%), white (74.5%), and practiced primarily within group settings (61.6%), with an average of 25.7% of their patients having IBS. Factor analysis revealed three relevant factors: interfering attributes, positive attributes, and personal connection. The scale ranged from possible 0 to 100 (mean = 83.8; SD = 8.38). Cronbach’s alpha reliability measure of the scale was 0.938, indicating high internal consistency. There was a significant moderate, positive correlation between JSPE and the PPRS (P < 0.001, r = 0.488), establishing concurrent validity.ConclusionsWe describe the development and validation of the first questionnaire to measure physician expectations of the PPR. This instrument can be used clinically, and for future studies on physician communication.The Patient‐Physician Relationship Scale (PPRS) for physicians may be used in research, education, and clinical practice to evaluate physicians’ expectations the patient‐physician relationship with patients with DGBI with respect to interfering attributes, positive attributes, and personal connection.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/166448/1/nmo13976.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/166448/2/nmo13976_am.pd

Su1100 A Systematic Review of Patient-Oriented Educational Interventions to Improve Quality of Pre-Colonoscopy Bowel Preparation

http://deepblue.lib.umich.edu/bitstream/2027.42/175718/2/1-s2.0-S0016508515313718-main.pdfPublished versionDescription of 1-s2.0-S0016508515313718-main.pdf : Published versio