Joseph Thomas

Objectives: Patient perceptions of their doctors may influence talking to them about urinary incontinence (UI). We estimated prevalence of UI among Medicare beneficiaries and assessed association between beneficiaries’ demographic and clinical characteristics and whether they spoke to their doctor about UI and association between beneficiaries’ perceptions of their doctor and whether they spoke to their doctor about UI. Methods: This study was approved by the Purdue University Institutional Review Board (IRB) and determined exempt, category 4 (protocol number 1907022503, approval on August 5th, 2019). Medicare Current Beneficiary Survey (MCBS) 2016 data were analyzed. Beneficiaries who indicated that they lost urine control 2–3 times a month or above were classified as experiencing UI. An 11-item patient perception of their physician scale was created based on MCBS items. Perceptions were categorized as favorable or unfavorable. SAS version 9.4 for Unix was used for all analyses. PROC LOGISTIC was used to assess multi-variable association between beneficiaries’ perceptions of their doctors and talking to their doctor about UI. Results: Among 7466 persons meeting inclusion criteria, 1856 (24.9%) had UI. The perception of doctor scale scores ranged from 15 to 44, with mean score = 36.57 (standard deviation = 5.29). The scale Cronbach alpha reliability was 0.93. Using sensitivity and receiver operating characteristic analysis, a cutoff of 30 or higher was identified as a favorable perception. Beneficiaries with favorable perceptions of their doctor were more likely to speak to their doctor about experiencing UI than beneficiaries with unfavorable perceptions (odds ratio = 1.55, 95% confidence interval = 1.03 to 2.35, P-value = 0.038). Conclusion: Overall, the more favorable the perception of their physicians, the more likely beneficiaries were to speak to them about their UI.

Purpose: Incremental health care resource utilization and expenditures associated with autosomal dominant polycystic kidney disease (ADPKD) were estimated. Methods: Study data were from a large administrative claims database. Individuals aged 18 years or older enrolled in tracked health plans for 12 months from April 1, 2011 through March 31, 2012, and with an International Classification of Disease, Ninth Revision, Clinical Modification diagnosis code for “polycystic kidney, autosomal dominant” (753.13) or for “polycystic kidney, unspecified type” (753.12) were identified as having ADPKD, and linked one-to-one with individuals without ADPKD based on age and gender. Zero-inflated negative binomial models estimated incremental health care resource utilization and expenditures, adjusting for risk factors. Results: A total of 3,844 individuals with ADPKD who satisfied selection criteria were linked one-to-one with 3,844 individuals without ADPKD. Multivariate, regression models adjusting for risk factors revealed incremental mean (standard error) resource use associated with ADPKD of 0.68 (0.090) hospital days, equal to 68 additional hospital days per 100 ADPKD patients, and 6.9 (0.28) outpatient visits, equal to 690 additional visits per 100 ADPKD patients. Mean (standard error) incremental total expenditures associated with ADPKD were US$8,639 ($470). Mean incremental expenditures were largest for outpatient expenditures at US$4,918 ($198), followed by mean incremental hospital expenditures of US$2,603 ($263), and mean incremental medication expenditures of US$1,589 ($77). Based on sub-group analysis, mean incremental total expenditures were US$2,944 ($417) among ADPKD patients without end-stage renal disease and US$38,962 ($6,181) for those with end-stage renal disease. Conclusion: ADPKD was associated with considerable incremental health care resource utilization and expenditures. Significant illness burden was found even before patients reached end-stage renal disease.

Faculty Discussant: Olayinka Shiyanbola, PhD Article 1: The Association Between Adverse Drug Reaction Incidence and Drug Adherence : A Systematic Approach Huang CY; Villa KR;Dircksen, K; Sabbaghi A; Murawski MMArticle 2: Adherence to Biologic and Conventional Disease Modifying Anti-Rheumatic Drugs in Patients with Rheumatoid Arthritis Pragya Mishra, MS, PhD Candidate; Joseph Thomas III, PhD, ProfessorArticle 3: Cost-Effectiveness of a Theoretical Pharmacist-Led Breast Cancer Adherence Intervention Alemseged Ayele Asfaw, MSc; Brian Talon, PharmD; Scott Wirth PharmD, BCOP; Lisa Sharp PhD; Daniel Touchette PharmD, MAArticle 4: Antidiabetic Drug Adherence among Childless Adults Experiencing Medicaid Coverage Expansion in Wisconsin Nam Hyo Kim, MS; Kevin A. Look, PhD; Marguerite Burns, PhDArticle 5: Exploring the Barriers and Facilitators of Medication Adherence in Patients with Type 2 Diabetes across Different Health Literacy LevelsYen-Ming Huang, MS; Olayinka O. Shiyanbola, PhD BPharmArticle 6: Closing the Medicare Part D Coverage Gap: Impact on Out-Of-Pocket Burden, Drug Utilization, and Access to Care among Beneficiaries and Those with Cancer Joohyun Park, MS; Kevin A. Look, PharmD, PhDArticle 7: Relationship of Travel Distance and Time to Dispensing Pharmacies on Warfarin Control in an Urban Population Connie H. Yan, PharmD; Edith Nutescu, PharmD, MS; Lisa K. Sharp, PhD

Purpose Results of a survey assessing the extent and scope of collaborative drug therapy management (CDTM) in U.S. hospitals are presented. Methods A survey questionnaire was mailed to a national random sample of hospital pharmacies. Pharmacy directors provided data on CDTM activities; their views on support for CDTM, the financial and strategic impact of CDTM, and the effect of state regulations on CDTM practice were assessed using summative Likert-type scales. Logistic regression was performed to assess associations of respondent demographics and hospital characteristics with CDTM use. Results The usable response rate was 30.2%. Pharmacists were reported to be engaged in CDTM in 66% of respondents’ hospitals, a significantly (p < 0.0001) greater proportion than reported in a comparable 2003 survey. The most prevalent CDTM activities were ordering laboratory and related tests (58.7% of hospitals), adjusting drug strength (57.9%), and changing the frequency of administration (53.8%). The most commonly reported diseases or treatment areas for CDTM use were anticoagulation (52.4% of hospitals), infectious diseases (44.8%), and parenteral nutrition (32.6%). Conclusion From 2003 to 2013, the prevalence of CDTM use in surveyed U.S. hospitals increased significantly, from about 50% to 66%. The 3 most common specific CDTM activities in 2003—ordering test results, adjusting drug strength, and changing frequency of administration—were still the most common in 2013 but were allowed at higher percentages of hospitals.

And associations between patient centeredness and illness representations were assessed among persons with diabetes. A mail survey of diabetic patients visiting a multispecialty physician network serving urban and suburban populations in a large midwestern city was conducted. The Patient Assessment of Chronic Illness Care-5A questionnaire was used to assess perceived chronic care quality and patient centeredness. The Brief Illness Perception Questionnaire was used to assess illness representations. Of 500 mailed surveys, 89 completed surveys were returned. The sample consisted mostly of retirees (61%), Whites (81%), and women (60%). Higher perceived chronic care quality was associated with better disease understanding of diabetes (0.24, p = .05). Patients reporting higher patient centeredness (or lower patient-centeredness scores) indicated better disease understanding (−0.26, p = .04) and those reporting higher patient centeredness (or lower patient-centeredness scores) perceived less impact of illness (0.29, p = .02). Chronic care quality as defined in the Chronic Care Model and consistency of chronic care with patient expectations (patient centeredness) was associated with illness representations favorable for good self-care management....

Pulmonary arterial hypertension (PAH) is a progressive and life-threatening disease. Understanding of PAH prevalence remains limited, but PAH has been reported as a frequent complication in connective tissue diseases. This study estimated prevalence of PAH in patients with connective tissue diseases and prevalence of idiopathic PAH using a systematic review of the literature. We searched PubMed through May 19, 2012 for all studies on prevalence of PAH in patients with connective tissue diseases or prevalence of idiopathic PAH. To be included, studies had to be in English, have humans as subjects, and determine prevalence within a time interval of up to 2 years. Studies only investigating pediatric patients were excluded. Pooled prevalence estimates were calculated. Twenty studies were identified in the review. Seventeen of the 20 studies reported prevalence of PAH in connective tissue diseases and three reported prevalence of idiopathic PAH. The pooled prevalence estimate of idiopathic PAH was 12 cases per million population (95 % CI 5 cases per million to 22 cases per million) with estimates ranging from 5.9 cases per million population to 25 cases per million population. The pooled prevalence estimate of PAH in patients with connective tissue diseases was 13 % (95 % CI, 9.18 % to 18.16 %) with reported estimates ranging from 2.8 % to 32 %. Prevalence of PAH in patients with connective tissue diseases was substantially higher than that of idiopathic PAH based on pooled prevalence estimates. Comparisons of PAH prevalence in persons with connective tissue disease and idiopathic PAH using a large observational study would be helpful in better assessing relative prevalence.

Objectives: Association between wellness coaching and changes in health-related quality of life over 1 year and 2 years was assessed. Methods: Difference-in-differences analysis of covariance assessed association between coaching and change in 8-item short-form health survey (SF-8) summary scores. Ordered logistic models assessed coaching and change in SF-8 individual domain scores. This was a case–control study. Results: Participants in at least one coaching program were more likely to have increases in social functioning after 1 year and less likely to have increases in role physical after 2 years. Participants in nutrition coaching had more positive change in mental component summary scores after 1 year. Participants in stress management had more negative change in mental component summary scores after 1 year and after 2 years and had more negative change in physical component summary scores after 2 years. Conclusions: Findings were mixed regarding association between coaching and change in health-related quality of life.